Nicholson argues he should survive to implement Mid Staffs recommendations

10 January, 2013 | By Alastair McLellan, Dave West

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.

David Nicholson

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

Readers' comments (83)

Anonymous | 12-Jan-2013 7:44 am
The process of applying to be an FT exposed MId-Staffs as an unviable hospital - financially & clinically. Nicholson, as Chief Executive of the SHA should have engineered a service rationalisation that would have created a viable service in MId Staffs. he didn't. Instead he imposed cuts of £10m p.a. without understanding the likely consequences - which proved to be disasterous.

He's done the same nationally. The QUIPP programme is creating the conditions for more service failures and is widely regarded as a serious mistake. It's right to press providers and commissioners to be more productive, but random cuts are not the way to do it. Overall the programme will not increase productivity, but in some areas intense pressure on individuals - NIcholson's style - will generate cuts in expenditure with unknown consequences for patients.But, because NIcholson surrounds hiself with cronies, he is told what he wants to hear not what he needs to know. Anyone who challenges him is got rid off. This is a major failing in a leader.

NIcholson knows that Francis will criticise him for serious failures in his SHA and national roles. His appparently casual remarks is an attempt to burn off the criticism before the report is published.

He was kept on and appointed to the NCB at No10's insistence to keep control of waiting lists and expenditure when Lansley's reforms were thought to be a serious risk to both. He's delivered on control of the money - he always does. He's failed on service delivery and rationalisation. And he's created pressure for more and more money to go to healthcare rather than incentives for higher productivity.

He should step down now. Keeping him on can only harm Cameron, Hunt and Grant
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Anonymous | 12-Jan-2013 9:54 am
In my experience I have learned a lot more from my mistakes than from my successes. When you are successful you keep on doing the same thing to achieve more success but when you fail you have to really think about what went wrong and take steps to do things differently next time. I don't know David Nicholson personally but I have seen him speak at conferences and he has struck me as having deep knowledge of the system and wanting to improve it for patients. It is easy to just hang the blame on one high profile individual but in doing that we support the 'string 'em up and shoot 'em down' brigade and we do nothing to really learn from the failure or change the culture.
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Anonymous | 12-Jan-2013 10:55 am
So based on these comments, Nicholson has marginally more support than Stalin did in Ukraine in the mid 30's. (With about the same probability of the politburo replacing him?)
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Anonymous | 12-Jan-2013 11:30 am
Of course Nicholson has a deep knowledge of the system-how could he not given his position and years in the machine that is the NHS? The key thing is that he holds a degree of personal responsability for Mid Staffs (not all of it but some nevertheless) and he has fostered a very unhealthy managerial culture. He needs to go because with people like him at the top of the organisation there is no real chance of fundamental and much needed change.
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Daphne Havercroft | 12-Jan-2013 11:35 am
Anon 12-JAN-2013 9:54 AM - Got any examples of where Nicholson has admitted failing, really thought about what went wrong and demonstrated to the public that he's done things differently?

Just talking about wanting to improve things for patients achieves nothing.

Is the country so devoid of top talent that he and his cadre of senior NHS executives can't be easily replaced by people who are capable of taking action to improve the culture and service?

As for giving patients more clout, under the Nicholson regime those who speak up for safe care are treated to the same attempted bullying and gagging as NHS staff.

In the words of one anonymous and eloquent public contributor to the Patients First online blog:

“The NHS can be very bullying and intimidating if you step out of the craven, acquiescent role far too many of its staff expect you to play. This can never, ever be right in a democracy. It can never, ever be right when a body charged with nurturing health and curing illness can behave in ways that seriously prejudice the health, well-being and safety of anyone who dares to politely and intelligently challenge anomalies.”

The most revealing aspect of the HSJ interview with David Nicholson is the absence of any remorse for what happened at Mid Staffs.
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Anonymous | 12-Jan-2013 8:52 pm
Nicholson is not fit for purpose nor should be allowed to even attempt to fix what is broken; would we have let Hitler fix Germany after the war? I was astounded when I read that Nicholson had described Stafford as a singular event. Cure the NHS was born in Stafford, many tried to discredit them (Peter Carter , Andy Burnham & the rest). He should be fired not given the opportunity to resign with a big fat pay off. Surely Nicholson’s intel will have warned him there are now groups scattered across the UK made up of grieving families, victims of care, that as gone wrong, all fighting for their loved ones and it goes on to this day. They want a safe NHS that includes, Accountability, Honesty & Transparency. Please let’s not forget those doctors and nurses, health professionals, whom have blown the whistle and paid the price by losing their careers, just for being honest. Relatives are absolutely pig sick of hearing that quote “lesson will be learnt” even worse the arrogance of some CEO’s when they offer an apology for your relative dying as if saying sorry makes it ok. The buck stops at the top, let some one be brave enough to sack him and may the rest fall like a stack of dominoes.
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Anonymous | 12-Jan-2013 10:22 pm
Nicholson is not fit for purpose nor should be allowed to even attempt to fix what is broken; would we have let Hitler fix Germany after the war? I was astounded when I read that Nicholson had described Stafford as a singular event. Cure the NHS was born in Stafford, many tried to discredit them (Peter Carter , Andy Burnham & the rest). He should be fired not given the opportunity to resign with a big fat pay off. Surely Nicholson’s intel will have warned him there are now groups scattered across the UK made up of grieving families, victims of care, that as gone wrong, all fighting for their loved ones and it goes on to this day. They want a safe NHS that includes, Accountability, Honesty & Transparency. Please let’s not forget those doctors and nurses, health professionals, whom have blown the whistle and paid the price by losing their careers, just for being honest. Relatives are absolutely pig sick of hearing that quote “lesson will be learnt” even worse the arrogance of some CEO’s when they offer an apology for your relative dying as if saying sorry makes it ok. The buck stops at the top, let some one be brave enough to sack him and may the rest fall like a stack of dominoes.
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Anonymous | 13-Jan-2013 12:26 pm
If Nicholson stays, everyone knows that the same bullying closed culture will persist. Simple as that.
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Anonymous | 13-Jan-2013 11:33 pm
I am disappointed by all the negative comments that have posted here. Have people got nothing better to do? Be careful what you wish for - David Nicholson is 100% committed to the NHS and is trying to ensure that it doesn't fall apart. His successors may have a much narrower view and we may well look back fondly to the time when we had someone in charge i.e. David Nicholson, who really believed in NHS values.
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harry.longman@patient-access.org.uk | 14-Jan-2013 8:56 am
Look at this quote: "the commissioning board’s legitimacy needs to come from its connection with patients and the public." That is dangerous. Its legitimacy comes from its accountability to a democratically elected government. Any dilution of this means they can spend our money for whatever interests they have, good bad or indifferent, and a written mandate will not hold them to account.
Jeremy Hunt, you cannot duck this.

There is no point me adding to the comments on Sir David, and I can see why many of you who are NHS employees may wish to remain anonymous. However, using this cloak to make personal attacks, one even calling for a charge of homicide, is disgraceful. You are the anonymice. HSJ Editor, time for action please.
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Anonymous | 14-Jan-2013 9:06 am
Jan 110th 1:21 PM - PR advice? - Attack is the best form of defence....!!!
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Anonymous | 14-Jan-2013 10:52 am
What comes next is usually "Lord" from "Sir" - look what happened to Nigel Crisp!
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Anonymous | 14-Jan-2013 1:35 pm
Anon @ 11.33 pm are you Sir David
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Anonymous | 14-Jan-2013 2:15 pm
Anon - 2:19 I'm a senior nurse
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Anonymous | 14-Jan-2013 2:16 pm
I'm going to wait and see what the report says before singling out one man for the chop. As a PCT director who resigned in part because the values and the way of working didn't suit me, I was tired of being told when I asked ny CEO to challenge some new directive from the centre and enacted by the SHA, that I couldn't because I had taken the king's shilling. The truth is that, with mortgages and families, the middle managers who will probably take the fall in Mid Staffs were only 'following orders. And yes, this is anonymous because I still have a mortgage.
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Anonymous | 14-Jan-2013 2:51 pm
After 30 years in the nhs, the last 15 on Trust Boards, I can honestly say that the gap between rhetoric and reality has never been greater. The bullying culture thrives, a culture driven and encouraged by the very top, so those whose philosophy and style fit the profile get promoted and those that don't get bullied into submission. Let me tell you about one senior manager who confessed to me that he was so terrified every day at work that he vomited his breakfast. Is it any wonder that our nurses are exhorted to remember Compassion, they work in system totally devoid of any such feelings. Sir DN, behave according to your stated values - resign now
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Anonymous | 14-Jan-2013 6:51 pm
As someone who has never worked in the NHS but given years to health based charitable work to improve the health of others it is obvious David Nicholson can not remain in his post, unless the Treasury is responsible for the appointment to The Commissioner!

I fail to understand how a figure of need is calculated for the NHS, the service is falling apart, hundreds of people have died who needed care and yet billions are returned to the Treasury "Have this back we do not need it"!

There can be reasons good and bad for being the blue eyed boy, but this repayment will count for nothing if the right decision is made and David Nicholson is asked to step down....that is how they politely word it....oh yes and thank him for his input! Just think of Libya and Egypt if you lose your support.....well

Living as I do in the area of South London Healthcare NHS Trust it is difficult to see what we have to be grateful for I might add.

I personally suffered for three years under David Nicholson in a charity case which ended in the HIgh Court a Judicial Review application which after three years the SLHNHS Trust having spent over £300k caved in on the eve of a three day hearing.It was clear from evidence obtained under FoI it went right to the top.

Nobody should suffer as so many have done , many losing people dear to them and the guy running the show carries on in the same belief only I can do this.

I tire reading of the same old cast Antony Sumara, Mike Marchmant, Darren Cattell, etc etc they all made my life very difficult. Perhaps this is another group whom nobody else can do the job......they could for less !

Having( pro bono )top lawyers, QC and charity law barrister we won our case and today the centre is wonderful www.primrosecentre.org.uk.

At one stage having to call on the Charity Commissioners to step in as the trust had used £34k of our charitable funds to pay their lawyers is not good. They had to repay it.

Paid to manage
Fail you are out

There may well be less fear and more openness as a result

If the Secretary of State needs to know how the public feel I can make myself available!

I would love an apology from David Nicholson and by the way I would still like the FoI request of 2009 and 2010 agreed to better late than never! and lets hope I am not called worse than Primrose Bore as defined in FOI from NHS London ...all 600 pages!

I doubt the SoS will need any input from me but could he also look again at the case of John Watkinson --a travisty of justice.. even a condemned prisoner can ask for his case to be reviewed ....maybe we should wait until David Nicholsons successor is in place for progress on that one.

A great CEO, hugely wronged, come back Bromley needs you!

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Mary Spinks | 14-Jan-2013 7:01 pm
Sorry it was not my intention to sign off anonymously!
Mary Spinks
www.primrosecentre.org.uk
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Anonymous | 15-Jan-2013 8:28 am
Let's tackle the thorny issue of obesity and its cost to the NHS..........
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Anonymous | 15-Jan-2013 2:33 pm
Question to HSJ - are you reading this reader commentary surely thats a news story in itself
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