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.
Source: Gabriel Szabo, Guzelian
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
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Readers' comments (83)
Anonymous | 10-Jan-2013 2:20 pm
Surely we all have to read the Frances report first, and consider what it has to say, before coming to any judgements on any of the people who were asked to give evidence ? All of us who work for the NHS have a responsibility to patients and we should perhaps reflect on and examine our own actions first before being so quick to judge others.
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Anonymous | 10-Jan-2013 2:21 pm
Nice to see our Chief Executive has the unwavering support of his staff ..!!
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Anonymous | 10-Jan-2013 2:24 pm
The very fact that he is saying that he shouldn't go infers to me that he has to be on his way out. It will only be on the day that the top team and regulators of the NHS learn that you cannot run a complex operation by command and control decree that Boards and CEOs will have the culture and environment in which to lead high quality and efficient organisations.
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Anonymous | 10-Jan-2013 2:31 pm
Just think what the pension reward will be for him,and in all probability a seat in the upper house, as well as a bit of consultancy.....it's enough to make you weep. His autocratic style is awful.
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Anonymous | 10-Jan-2013 2:51 pm
What do you expect from Bob Crowe? ...er, sorry, David Nicholson.
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Kenneth Lownds | 10-Jan-2013 2:55 pm
Dear 2.20. Some of us had to read all of the evidence and attend the sessions as part of our campaign. All my fellow-members in Cure the NHS lost loved ones or were themselves harmed. Believe you me the 'sham and charade' is a well-chosen phrase. The title of Julie Bailey's book 'From Ward to Whitehall' is an accurate summary of responsibility for the disaster. Nicholson acted as mentor to discredited chief exec at Mid Staffs Martin Yeates and as I recall was part of the selection panel for his appoitnment. But please also read our Blueprint for a New NHS. It's a radical plan for you folks on the front line, all of you, to say to the leadership "We accept the challenge! We will rebuild a new, zero harm NHS." Don't wait for the report! Ken Lownds, Cure the NHS Stafford.
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Anonymous | 10-Jan-2013 4:25 pm
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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David Hands | 10-Jan-2013 4:27 pm
He should not resign. He should be sacked.
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Anonymous | 10-Jan-2013 4:31 pm
I always found the 2 Daves funnier than the 2 Ronnies
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Anonymous | 10-Jan-2013 4:53 pm
It is too easy just to blame one individual. The fact is that there were many systemic failures all over the system including local Scrutiny committee people is Stafford. Dont make it "their" fault. We all need to own this issue. And, for the record, I think David Nicolson has done a lot of good stuff in the NHS including focusing attention on health inequalities.
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Phil Kenmore | 10-Jan-2013 5:23 pm
There are probably lots of sections of this interview that will turn out to be very interesting. The headline focuses on one part that may not actually be relevant at all - not because it isnt important but because what Chief Executive (of any organisation) would ever say that the results of a forthcoming report might mean it was right for them to resign? No one would - so in reality this is not yet much of a story. It is not until Francis is actually in the public domain, and we see the reactions of the public and Politicians in the media flurry that will follow, that any of this will mean anything at all.
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Anonymous | 10-Jan-2013 5:51 pm
In response to 4.53 pm, surely the point is that Nicholson was/is responsible for the culture of bullying in the NHS and for making it clear to Chief Execs that their careers depended on achieving savings and targets, and refusing to listen to warnings about the impact on the quality of care. He should go, and be stripped of his knighthood. He has presided over a serious deterioration in emergency care, and loss of compassion in the NHS, resulting in a tidal wave of human suffering in A&Es, assessment units and general medical wards.
HSJ, please ensure all these comments are published more widely.
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Anonymous | 10-Jan-2013 5:53 pm
There is an old saying up North, where there's muck there's brass. Sir D has certainly got the neck, but perhaps hadn't envisaged quite so much down and dirty muck. It strikes me that he really hasn't grasped what went on at Staffs, we failed to provide adequate safe care because of a series of ill thought through cost saving measures, as a result of that people died. Is Sir D really telling us that because he was part of the problem he can help with the solution? Muck unfortunately sticks.
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Anonymous | 10-Jan-2013 5:59 pm
Mid Staffs was on his watch and he should have done the honourable thing a long time ago and resigned. That he didn't and is still resisting that action shows he is absolutely the wrong person to be heading the NHS at this time.
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Anonymous | 10-Jan-2013 6:00 pm
"Grip", "Command", "Bullying", "Control" "Dictatorship" all words used previously to describe DN's style. Those closest to him, Flory, Dalton et al have similar traits and 'horse whip' NHS organisations into line. Little wonder care quality failed. The centre as a result of Mid Staffs is only just waking up to what matters most, Patients, we have had a decade of money and performance comes first and quality second.
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Anonymous | 10-Jan-2013 6:44 pm
Who is going to send an e-mail link for this thread to Secretary of State
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Anonymous | 10-Jan-2013 7:01 pm
New Interview Suit for Mr Britnell *Flurry of CV typing ensues*
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Anonymous | 10-Jan-2013 7:24 pm
Isn't it interesting that we all feel the need to remain anonymous? (except the gentleman from "Cure the NHS). What does that say about Nicholson's regime?
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Anonymous | 10-Jan-2013 7:33 pm
The fact that only one commentator has had the bottle to be named speaks volumes about operating in a command control system. If Francis does recommend a duty of candour a lot more heads will roll than the obvious one.
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Anonymous | 10-Jan-2013 7:41 pm
Nicholson should be fired and charged with homicide. Would love to see how his "I lost the plot" defence holds up. But he and the teflon team at the new NCB will do what they do best, blame those that have gone, demonise, spin and feed the press. If this was a soap you wouldn't believe the plot.
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