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Nicholson argues he should survive to implement Mid Staffs recommendations

NHS Commissioning Board chief executive Sir David Nicholson believes he should survive any criticism levelled at him by the forthcoming report into care failings at Mid Staffordshire Foundation Trust.

In an exclusive HSJ interview he also said he hoped to hold his new position for “the next few years”. He added: “I can see a whole load of things that I need to do.”

Sir David was chief executive of Shropshire and Staffordshire Strategic Health Authority during 2005 and 2006. He appeared in front of the inquiry for two days. The inquiry’s counsel Tom Kark said Sir David’s insistence that the care failings at Mid Staffordshire were not indicative of a “systemic” issue was a “dangerous attitude”. His declared reliance on the regulatory system to spot poor performance across the NHS was described as “naive” by Mr Kark.

Julie Bailey, who founded the campaign group Cure the NHS after being appalled by the care she witnessed her mother and others receive at Stafford Hospital, told The Daily Telegraph on Monday that: “Sir David needs to stand down immediately if he has got any conscience – he has stood by and watched hundreds of people die.”

Robert Francis’ report into Mid Staffordshire is due to be submitted to the Department of Health this month and is likely to be published in mid-February.

Sir David, who also holds the position of NHS chief executive until the end of March, told HSJ: “I haven’t seen the Francis report, I haven’t seen a leak or anything of the nature.” However, asked if he was considering his position, Sir David said “nothing I’ve seen” to date would made him feel it was under threat.

Mr Francis was required to send letters to anyone criticised in the inquiry. The board chief executive stated he been required to sign an undertaking not to discuss any letters “he may or may not” have received from the inquiry.

Sir David said: “Other people will decide [whether I keep my job], but from my perspective I can see a whole load of things that I need to do.”

He revealed that, “If I ever did think about” resigning it was in the wake of the publication of the initial private inquiry into Mid Staffordshire, also conducted by Mr Francis. Sir David spent a weekend reading the “patient stories” included in the report, something he described as a “completely salutary” experience.

However, he added: “Francis will challenge us around the culture of the NHS, he will challenge us around patient voice, he’ll challenge us about basic quality – I think I’ve got a big contribution to make to make all of those things better because of the experience and understanding I have.”

Sir David also dismissed a persistent rumour that he had taken out an injunction challenging the inquiry’s criticisms of his actions. He said: “I absolutely never would and have never made any kind of threat of doing it.”

The commissioning board and NHS chief made a detailed case for his role in improving patient quality in the past and future.

He said: “When I applied for the job of chief executive of the NHS [in 2006] it was in a particular set of circumstances. My pitch for the job was that NHS leadership had lost its focus, the purpose of why we were there. We got so excited about the technical changes that were going on that we missed out what we were trying do – which is to improve services for patients.”

Sir David claimed the work he led in the subsequent years, such as setting up the national quality board, lead to a “point in 2010 when the NHS was delivering all things it said it would deliver, we had a £1.5bn surplus, we had the best patient satisfaction we’d ever had and public confidence was at an all-time high”. Despite this he claimed all “still wasn’t right” with the NHS.

Two issues remained unresolved. The first was the need to deliver £20bn worth of efficiencies by 2015. “It seemed to me that I was in the best place to see that through to the conclusion”, he said. The other issues he said was the need “to give patients more clout - that is the unfinished business for me”.

He continued: “As chief executive of the NHS a lot of my legitimacy comes from the fact that I am accountable to an elected politician. In the new world the legitimacy of the commissioning board comes from the legislation. But that in itself will never shift anything.

“It struck me right from the beginning that the commissioning board’s legitimacy needs to come from its connection with patients and the public. That’s why we structured the commissioning board around the five domains of the outcomes framework and created the patients and information directorate. The commissioning board should know more about what patients were thinking and feeling.”

Visit www.hsj.co.uk over the coming days to read more from our interview with Sir David Nicholson

Readers' comments (89)

  • I believe the phrase is: brass neck

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  • Bull neck more like!

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  • Extraordinary. In a regime where as a new chief executive of a trust with lesser problems than mid staffs with a history of lack of attention and support and from the SHA, DH regime over many years I have been threatened with my job and and seen neighbouring colleagues go on a whim from SHA. To read this interview from the architect of that culture which has spread across the NHS arguing why he should stay.......I had always understood Sir David to be a honourable man, clearly not. T

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  • Of course he shouldn't resign and Hitler should be posthumasly awarded the Nobel Peace Prize

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  • Harrods may have a bigger front but...

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  • All we need now is for Cameron to state that he has full confidence in Sir David and he should be gone within a month. Or is that just for Chief Whips?

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  • Quite breathtaking arrogance

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  • It's fascinating how senior people involved with this scandal were elevated to the CQC and high office in the DoH. No wonder the NHS has had a culture in which no one has wanted to speak up!

    If the inquiry outcome begins with some right and proper appraisal of these peoples' performance and then appropriate action to ensure they can never darken our doors again, that would be great.

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  • Brass neck it is. David Nicholson's command and control style crushed the culture of care in the NHS. Why do NHS chief execs report they are bullied? Nicholson regime. Why is the NHS so badly outmoded in all aspects of patient safety? Nicholson regime. (The Cure the NHS concept of Zero Harm Healthcare is way ahead of them) Who designed the sham and charade called the CQC? Nicholson's buddy Bower, no need to say more. Who is mounting the frantic press operation at Stafford Hospital to swamp the media coverage on the day Robert Francis reports? David Nicholson? Who will be a mega-embarrassment to Jeremy Hunt on report day? David Nicholson. For goodness sake David, go now! Ken Lownds, Cure the NHS Stafford

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  • I agree with many of the above comments. However, can't say I'm surprised, sadly. It sums up so much of what is culturally wrong in the senior echelons of the NHS at the moment: "Do it our way or else", "don't rock the boat even if it's the right thing to do" etc etc

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  • Putting emotion regarding Mid Staffs aside for one moment the true reason he should go is that depsite being funded at unprecentdented levels for sveral years under his stewardship the NHS has not reformed nor modernised and so squandered this opportunity.

    In the private sector his board and share holders would have srung him up for that alone!

    Fall on your sword with dignity instead of pleading like most dictators to be allowed to cling to power.

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  • Who is providing David Nicholson with PR advice? No-one with any professional credibility. He is in the top job and this happened on his watch and under his style of management. He should resign with dignity and not wait to be removed. There should be clean sweep at the top and a new leader to take the NHS forward.

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  • What's the next honour after 'sir'? He must be in line..........

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  • Under David Nicholson the NHS has received unprecedented levels of funding and it is as inefficient as ever, it has failed to improve outcomes in most areas that are assessed, it has allowed failing organisations to fail without recourse to the taxpayer and it its staff have been blatantly let down by those charged with improving the system. He has allowed short termism and protectionism to become ingrained in the culture, and has failed to take a "big picture" approach to the system to reform and improve it. How can anyone justify his continuing in the role. Apart from Mid- Staffs, look at the rest of the diabolical mess he has made of things!

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  • In the name of god GO NOW whilst you have a modicum of dignity left........or wait until the bitter end like other narcissistic Dictators without insight.

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  • I'm not quite sure how Sir David was supposed to be beside every nurse, doctor and AHP at Mid Staffs as they failed their patients! When I am on the front line I am the patient's advocate - responsible for their care - it's me that delivers excellent care - or not in the case of some Mid Staffs staff - not a CEO of a HA or the NHS.

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  • I support the comments above, he should without hesitation step down. He is responsible for so much of what is wrong with the NHS.

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  • Even his £20bn is as clear as mud.... no vision on what the 'efficiency' savings will be reinvested in, no clear leadership on how the £20bn should be realised (i.e. too much on staff levels and purchasing, not enough on service reconfiguration and removing costly queuing) and little on improving the patient experience - even in simple things like RTT times. go, now, please....

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  • " I can see a whole load of things that I need to do"
    1 Write resignation letter
    2 Er... that's it

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  • Dear anon 2.01 - I really hope you're not a manager in the NHS

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