An NHS Commissioning Board director has said the Francis report shows that “political or other objectives” such as targets trumped concerns over failings in NHS care.

Lord Adebowale, an NHS Commissioning Board director and charity chief executive, has blamed a focus on “political or other objectives” such as targets for NHS care failings highlighted by the Francis report.

In a wide ranging interview with HSJ the commissioning board non-executive director responded to concerns raised by the report of the Mid Staffordshire Foundation Trust public inquiry.

His comments came as the board has collectively given its backing to its chief executive, Sir David Nicholson, who some have said should lose his job over the failures.

He said one of the themes of Francis was that in the NHS there had been a “difference between what people know and what they act on. There’s a difference between what is held consciously in the system and what is held unconsciously”.

He said: “There is a difference between what is known and what is allowed to be acted on, like targets for instance, and what is known but what is not allowed to be acted on because of the anxiety that it will distract from the given political or other objectives.”

Lord Adebowale, who is also chief executive of the health and care social enterprise Turning Point, said there was a danger of “expediency” preventing cultural change in the NHS, and that the Francis report must allow the service to address it “as an active piece of work”.

He said the board should move the NHS “from a risk-averse culture to a risk aware culture”.

He said: “What we want is a system which is continually learning, and continually improving – not one in which mistakes never happen, because that’s fundamentally impossible.

“Things go wrong. The question is how do you mitigate against it, and can people approach the system and stop the conveyor belt – as opposed to [letting the problem] accumulate?”

Meanwhile, speaking about the practical process of establishing the commissioning board, he said it was “pushing hard at the limits of what organisations can really do”. The organisation has acknowledged delays to filling its large numbers of posts, and huge pressure of staff who have been appointed, in recent months.

Lord Adebowale said: “But this is where we are, this is what we’ve got, and we’ve got to do it. There is not a plan B.”

He said he was “never satisfied” about the level of influence he and fellow non-executive directors had over their executive director colleagues and the work of the board as a whole.

He said its operation was “still work in progress” but was working “surprisingly well… given we’ve been forced together in the white heat of massive change”.

The NHS Commissioning Board should not rush to replace the departing operations director Ian Dalton, Lord Adebowale said.

He told HSJ that instead the board should first consider its resources and needs. He said: “It’s an opportunity to just take a pause to look at what’s needed. That’s the wise response.

“That’s exactly the process that’s being continued at this stage. I think we’re doing the right thing.”

Mr Dalton is due to remain in the post until the end of next month APRIL.

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