NHS managers feel a deep sense of unease at the resignation of Bedford Hospital trust chief executive Ken Williams. If any at all think he deserved to lose his job because bodies were left in his hospital's chapel of rest when the mortuary was full, they must be precious few in number.
Mr Williams has received 200 letters and messages of support, while a petition on his behalf has attracted 800 signatures. In addition, he has the conspicuous backing of his consultants - a noteworthy privilege to which not every chief executive could lay claim.
Mr Williams very honourably fell on his sword, as HSJ understands, after 'an order to go from the top'. That is a disturbing development for every chief executive in the NHS. It raises profound questions about the limits of accountability: in an organisation with more than 1,600 staff, can the chief executive realistically be held personally liable at all times for the actions of every one?
No-one argues that Mr Williams' resignation is anything other than a symbolic sacrifice: it is not suggested that he caused the problem, and his departure will not contribute to its solution. Indeed, the loss of a conscientious and committed chief executive of long standing - at a time when the service is finding it ever harder to recruit to senior posts - is a high price to pay, even acknowledging the distress the incident caused bereaved relatives.
That the 'order to go' came in advance of the inquiry and in the wake of classic 'trial by tabloid' headlines adds to the nasty taste in the mouth. Where exactly did the order originate? Regional office? If so, why did it ask Mr Williams to go before its inquiry had reported? Or did the order come from the secretary of state's office? Surely not!
That would be an improper and unsettling precedent, as he has no powers to dismiss a chief executive. Yet Alan Milburn's comments in Parliament similarly preceded official findings, and he had unequivocally made up his mind that 'management' was to blame.
Health service managers are always convenient soft targets, and pandering to popular prejudices about pen-pushing bureaucrats is guaranteed to play well. All the more reason why managers need to feel confident that those at 'the top' will support them when the going gets tough - especially as it tends to get toughest when they are in the thick of implementing changes ordained from above.
That confidence, already at a pretty low ebb, has now dwindled to vanishing point. If a trust is unfortunate enough to attract unfavourable headlines, the chief executive can expect ministers to dart for cover before demanding their head on a plate. In the understated phrase of Mr Williams' consultant colleague, Richard Rawlins, this is 'not conducive to good healthcare management'.
So how many more chief executives are about to resign over improvised measures for storing bodies in their hospitals when winter pressures lead to full mortuaries? For as every NHS manager knows in their heart of hearts, what happened at Bedford was hardly unique. And now, as we reveal on our news pages this week, there is research evidence to support the concern that NHS mortuary facilities are inadequate on a wide scale. According to Clinical Pathology Accreditation (UK) Ltd, about more than one-third of mortuaries it has visited have problems similar to Bedford's. Can we expect a proportionate number of trust chief executives to resign as a result?
That would be nonsense. And it is equal nonsense, we suggest, for Mr Williams to have to sacrifice his post in response to an 'order to go from the top'. The NHS's most forward-thinking leaders are trying to foster a 'no-blame' culture in the service, mindful that errors are rarely the sole responsibility of a single individual: the systems in which they work are almost always contributory factors, too - in this case, 20 years of under-investment in the NHS and its mortuaries in particular. Their efforts have been severely undermined by Mr Williams' treatment. Reinstating him, or appointing him quickly to one of the numerous vacant chief executive's posts, might help retrieve this lamentable situation.