Once nobody in NHS management is bulletproof anymore, everybody in NHS management is bulletproof. By Andy Cowper

Well, that was another week in the life of the NHS during which the brown stuff continued to hit the rotating thing.

The House Of Commons Library produced this excellent summary of the NHS’s current state. We learned that the NHS Shared Business Services loss of correspondence was actually worse than previously thought.

Analysis by the BBC revealed that the proportion of EU nationals leaving jobs in the NHS is rising, while the share of those joining is shrinking. Hate to say I told you so … oh no, hang on, that’s more or less why I write.

It’s always worth reading Sally Gainsbury, former news editor of this parish, and her latest for the Nuffield Trust on why the money’s in the current mess is definitive.

The “data monitoring the public sector brownstorm” genre got a worthy new dose of reality with the latest release from the Institute for Government/CIPFA collaboration.

Meanwhile, the Sun King of Skipton House, NHS Commissioning Board boss Simon Stevens threw in the towel on defying the Information Commissioner just ahead of getting sued for contempt of court, and released data for an HSJ Freedom Of Information request about his organisation’s staff survey.

Thank goodness, then, that the Labour opposition is coming to save us with the generally sensible Stella Creasy suggesting a windfall tax on private finance initiative companies’ profits; the only slight problem with which is that lots of PFI contract owning companies are actually based offshore because they like to avoid tax. And so they can. Other than that, the concept is flawless.

A little bird told me…

Rather unusually, a couple of interesting things also happened on Twitter this week. One of them was interesting because it’s quite rare: I got a prediction right, which was that the health select committee would endorse the appointment of Dido Harding as new chair of NHS Improvement.

The second is really interesting: apparently unplanned, a group of high profile NHS chief executives made honest comments on Twitter about the performance of NHS organisations under severe pressure.

Birmingham Women’s and Children’s Hospital chief executive Sarah-Jane Marsh tweeted “It’s hard to watch us lose all we have achieved since 2000. But every year of reduced funding per patient and it seems further from our grasp.”

Morecambe Bay’s chief executive Jackie Daniel responded “the current situation is so frustrating. Every CEO I speak to is focussed & doing all they can, but more is needed”.

And Wrightington, Wigan and Leigh chief executive Andrew Foster added “Spot on. A perfect storm of funding & workforce shortages vs an abundance of patients. I see people everywhere working unbelievably hard”.

”I wonder what they meant by that?”

It is, to put it mildly, unusual for chief executives to comment on NHS pressures publicly and with this degree of bluntness.

An interesting thing is going on here: all three are in charge of well run and relatively well performing organisations with good or improving reputations. They don’t need to speak out, but they’re choosing to do so (on behalf of their chief executive colleagues in worse performing organisations) for a good reason.

It’s interesting to note in passing that all three organisations are foundation trusts – and this behaviour is certainly being accountable to one’s community, as the 2003 legislation mandates.

This is that despite their personal reputations and trusts being pretty good ones, they too are struggling to meet the targets and keep the money on track.


I’ll do another column on what NHS management language reveals and conceals some time, but the phrase “bulletproof” is applied to the chief executives of long standing high performing, target hitting and surplus owning NHS organisations.

Once you’re bulletproof, you can speak out a certain amount and act with a certain courage-fearlessness hybrid.

But we’ve all seen the performance data: the NHS is missing almost all national targets. So nobody’s bulletproof. For a while, that loss of bulletproof status would buy chief executives’ silence – either due to fear of being singled out, or because you really, really need one of the few remaining financial bungs that can be had.

We have passed the point of people being bulletproof in the conventional sense. And an interesting thing happens as a result, which Sarah-Jane, Jackie and Andrew have realised.

Once nobody in NHS management is bulletproof anymore, everybody in NHS management is bulletproof.

This means an awful lot of things for how the system works (and doesn’t). And system leaders and Jeremy Hunt have absolutely no idea whatsoever how they can deal with this situation. This is a new game, with new rules.

Things are about to get interesting … and to end up back where we started, the brown stuff keeps on coming, and the rotating things keep rotating. And as we head into winter, brown stuff will increase and the fan speed is going to keep on increasing.