- Sir David Nicholson has defended himself against repeated criticisms that the health system around Mid Staffordshire Trust, which he ran during 2005-06, failed to spot high death rates
- Ministers announce plan to amend controversial competition regulations
On HSJ now:
- Government to amend controversal competition rules
- Nicholson defends himself to MPs over Mid Staffordshire
- The pros and cons of losing Sir David Nicholson. Mike Birtwhistle and Bill Morgan of MHP Health Mandate argue that the NHS chief executive’s no-prisoners persona is haunting him – but removing him would be an error.
- “Political or other objectives” have trumped concerns over failing NHS care, says NHS Commissioning Board non executive director Lord Adebowale.
- Four former health secretaries - all Labour - say Sir David should keep his job
6.15pm Scandal-hit care provider Castlebeck have gone into administration, it has been announced this evening.
The administrators will seek buyers for the firm’s 16 homes, according to a joint Department of Health, NHS Commissioning Board and Association of Directors of Social Services statement.
“Whether or not buyers are found for all the facilities, the ongoing care of patients and residents will be the priority and Castlebeck and the administrators are committed to working with local commissioners to ensure safe transfer ownership of facilities and continuity of care for individuals.
“Our information is that there are currently 166 people accommodated within Castlebeck facilities and commissioners will include both NHS organisations and local authorities up and down the country.
“Some of the residents should already be having their care needs reviewed as part of the response to the Winterbourne Report and authorities should not make any immediate changes to their plans for reviews or care plans arising from these reviews.
“Castlebeck and their administrators will be in touch with host and commissioning authorities and it is important that CCGs/PCTs and local authorities work closely with them and with people using the services, their families, carers and advocates as future plans for each facility emerge.”
Castlebeck owns Winterbourne View, the privately run hospital in which patients under NHS care were abused by staff.
6.06pm Reporter Branwen Jeffreys said Nicholson’s evidence was “uncomfortable”.
Political correspondent Norman Smith said Sir David is on “borrowed time” and there is an expectation that soon he will “have time to potter about in his garden”
6.04pm The BBC also highlight Sir David’s admission that he did not meet Mid Staffordshire campaigners Cure the NHS.
6.02pm The BBC have gone with the “Nicholson says he’s determined to stay despite calls for resignation” angle.
6.00pm Sir David Nicholson’s appearance in front of the health select committee leads the BBC’s Six O’Clock news this evening.
5.00pm The Royal College of Nursing is also pleased at the announcement on competition. Dr Peter Carter, chief executive and general secretary of the RCN said: “We are pleased to see that these worrying regulations will be amended.
“This legislation will be coming into force in a matter of weeks and these regulations must be clarified quickly. Any competition must be based on the quality of care not price, and it must not become a barrier to collaboration between providers.
“It is vital that clinical commissioning groups feel confident in government assurances that they will be allowed to make the best decisions about delivering quality care, without being forced into expensive and time consuming tendering processes.”
4.58pm More reaction to that government u-turn on competition regulations. Shadow health secretary Andy Burnham said: “Ministers have been forced into yet another humiliating retreat. The government’s policy on competition in the NHS is in chaos.
“David Cameron has been caught out trying to force through the back door a policy he failed to get through the front door last year. That is why Labour took the unusual step of tabling a ‘fatal’ motion in the House of Lords to stop him.
“We welcome this climb-down but these regulations should never have been tabled. They revealed the government’s true ideological intention - driving competition and privatisation into the heart of the NHS.
“David Cameron promised to protect the NHS, but he has failed. If he gets his way, the NHS would be carved open and exposed to the full force of EU competition law.
“In less than four weeks time, new GP commissioners take control. Yet, today, there is complete confusion about the job they are being asked to do.
“It won’t be good enough to bring back these proposals with a few cosmetic changes. The British public have never given them permission to put the NHS up for sale and we will never tire of reminding them of that.”
He writes: “In most organisations the buck stops with the boss, but not the NHS. The buck doesn’t stop with Sir David Nicholson. In fact, he hasn’t even seen the buck. He didn’t know there was a buck. No one, to his profound regret, alerted him to the existence of any buck. During the period under discussion, you see, it was not standard NHS procedure to monitor the buck.”
3.33pm NHS Clinical Commissioners have now welcomed today’s announcement on competition regulations.
Interim president Michael Dixon said: “The minister is to be congratulated for listening to those who will now be leading the commissioning of healthcare in the NHS. It is essential that we have the clarity we need that where it is in patients’ best interests CCGs are able to deliver co-operation and integration.
“We have consistently argued that clinical commissioners must be provided with the freedom to use the full range of procurement tools and a variety of tendering mechanisms where appropriate that are all based on achieving the highest quality and best value for patient outcomes, not price alone.
“We trust that the minister will now ensure that the regulations are drafted in such a way that CCGs are given the necessary freedom to choose when and how to procure new services and that the risk of referral to Monitor or the courts does not place a chilling effect on commissioner’s ability to take a more inclusive route if that is what they feel is appropriate.”
3.29pm A report to Monitor from consultants Ernst and Young has recommended cutting expenditure on Mid Staffordshire Foundation Trust by half, as services are moved to other trusts.
The consultants recommended a trust special administrator take the trust through the reconfiguration process which would leave the organisation with facilities that would treat approximately half of the current accident and emergency attendance and 90 per cent of maternity “patient visits”.
The assessment team put the total “transition” costs at between £60m and £70m.
Transition costs cover staff relocation or redundancy costs, double-running and implementation costs plus some allowance for capital spending, the report said.
3.06pm The Royal College of GPs has welcomed the government’s annoucement to change the competition regulations.
Chair Dr Clare Gerada, said: “We are delighted - and relieved - that the government has listened to us and responded so quickly and positively.
“We are also grateful to the many individuals and organisations who rallied to support the college after we raised our concerns last week.
“We now urge the Government to work with us to develop an acceptable set of replacement regulations that will ensure GP commissioners have the freedom to make decisions in the best interests of our patients and in line with the values that have underpinned the NHS for the past 65 years.”
The RCGP wrote to Earl Howe last week raising concerns about the wording of Section 75. The full letter can be viewed here
2.21pm Two new HSJ stories about today’s events. Ben Clover writes: Government to amend controversial competition rules. Meanwhile David Williams’s account of today’s health select committee session is here.
2.17pm: The Academy of Medical Royal Colleges has been quick off the mark to welcome the government’s decision to revise its competition regulations.
A statement issued this afternoon reads: “The Academy of Medical Royal Colleges welcomes the decision of the Government to withdraw the proposed regulations on procurement and competition.
“We are pleased that the Government has clearly listened to the concerns expressed by the Academy both in writing and in person to Earl Howe about the potential effect of the regulations.
“We now await the revised Regulations which we trust will address the concerns we expressed and more clearly align with the assurances given by the Government during the passage of Health and Social Care Act”
1.53pm: HSJ reporter Ben Clover is discussing the compexities of changing the regulations on Twitter. It is unclear what and how the government is planning to change them. “@BenClover: Lamb says “Co-operation, integration and putting patient interest first” will be at centre of amendments. Regs already require that”
1.25pm: The government’s controversial competition regulations are to be amended, ministers have told Parliament. Norman Lamb has just said the wording of the rules has inadvertently caused concern that commissioners will be required to introduce competition more widely than they want to. He said they would therefore be changed to clarify the government’s intention.
The statement indicates there has not been a change in policy, which in turn indicates Department of Health lawyers have been convinced to agree to change wording which they originally believed was correct.
An HSJ story will follow.
12.21pm The health select committee session has just finished.
12.16pm Rumours of a coalition revolt on competition regulations are growing this lunchtime.
The Guardian’s Patrick Wintour tweets: “Norman Lamb will want NHS [competition] regs pulled before weekend Lib Dem spring conference - the birthplace of nhs reform revolt 2 years ago.”
12.10pm HSJ’s Shaun Lintern tweets: “If I was on [the health select committee] I’d ask Nicholson about meeting he had with #MidStaffs CEO in Oct 05 when he told him trust had to breakeven. £10m cuts followed.”
12.08pm Having cut himself short, Dr Wollaston prompts Sir Bruce to talk about personalisation of care.
12.08pm Sir Bruce Keogh is now extoling the benefits of innovation and academic health science networks. There is a creeping sense that the select committee is losing its focus, although such is the respect for Sir Bruce, no-one seems to want to interrupt him.
12.05pm NHS Commissioning Board medical director Sir Bruce Keogh, who is also giving evidence to the health select committee today, said: “There were failures [at Mid Staffordshire] of leadership, and of professionalism. “If ten consultants go to a chief executive’s office and say, ‘there’s a problem here’, you know which way that’s going to go. That never happened at Mid Staffs.”
12.00pm You can relive the Daily Mail’s pursuit of Sir David Nicholson in this infographic, produced by HSJ’s art editor Judy Skidmore.
11.56am “Targets are not in themselves bad,” Sir David tells the health select committee. “It’s the way you implement them.”
Dr Wollaston: Have we let ministers off the hook? Which ministers were telling you to hit the targets?
11.54am The Independent’s Oliver Wright tweets: “The overriding sense from health select committee is that the NHS is unmanageable. It’s just too big, too diverse and too complicated.”
HSJ’s reporter David Williams tweets: “This health select cttee session is running out of steam. Nicholson now in control, talking about how great the Mandate is.”
11.47am Well placed sources are telling HSJ the government is likely shortly to withdraw and rewrite its competition regulations, which were published last month and have been widely opposed, including by coalition MPs.
11.45am We need to ensure staffing levels on wards are safe, says Sir David. Attempts to set national levels tend to fall apart quickly, he adds. We plan to acredit staffing level tools for chief nursing officers to use, then every hospital should determine ward by ward what the staffing level should be. It should be displayed on the wall what it is, and what it should be. But, Sir David adds, we can’t require hospitals to do that.
11.34am Mortality rates pioneer Brian Jarman, who yesterday called for Nicholson to resign, has tweeted that mortality alerts were available on a website used by West Midlands SHA “from 2004”. “Letters with them sent to all trusts from Apr 2007,” he adds.
11.32am Outside the health select committee, shadow health secretary Andy Burnham has tabled an “urgent question” about the ongoing controversy over procurement regulations.
11.28am Andrew George: Isn’t the Royal Cornwall’s drive to reach foundation trust status a “recipe for another Mid Staffs?” Royal Cornwall is the site of another unhappy chief executive departure - namely John Watkinson.
11.22am Nicholson asked: “Do you think the NHS Commissioning Board is too powerful, too large, too unwieldy?”
No it isn’t, he answers unsurprisingly. He emphasises the autonomy of clinical commissioning groups.
11.16am The committee moves on to the duty of candour. “The spirit of it” is right, says Nicholson. However whether the government decides to do it on a statutory basis remains to be seen, he adds.
11.13am Nicholson: “Death rates weren’t available in the NHS, and certainly weren’t available to the SHA. [The mortality rate] raised more questions than they answered, Nobody was using it at that time. In hindsight that seems extraordinary but we’ve put that right.”
11.12am One select committee member contests Sir David Nicholson’s claim that it wasn’t possible to know how bad care was at Mid Staffordshire. “However bad the reporting process was, there was a process”.
11.10am Gary Walker, former chief executive of United Lincolnshire Hospitals Trust, says his gagging clause was not negotiated through a judicial mediation process.
“Wrong”, he tweets. “It was a free negotiation with parties able to walk away. It was not a court judgement. Nicholson now misleading [the health select committee].”
11.08am Nicholson says any whistleblowers wanting to speak out about patient safety will have his personal protection.
11.02am Asked about former United Lincolnshire Hospitals Trust Gary Walker’s “gagging clause” Nicholson says he would “never sanction anything of that sort” and describes it as “completely and utterly unacceptable”. He reveals the compromise agreement was reached through a process known as judicial mediation so did not need sign off by HM treasury. Nicholson repeatedly stresses the situation at United Lincolnshire was “bitterly contested”.
10.56am Nicholson highlights improvements in percentage of staff who feel encouraged to raise concerns (from 76 per cent in 2006 to 86 per cent in 2012) as evidence whistleblowers are more supported.
10.50am Nicholson: “I absolutely have the skills [to hold hospital boards to account]. I have managed hospitals directly, I have managed clinicians directly. But unless you’ve got the data…”
10.44am Dr Wollaston: “Are you the right person to lead the NHS now?”
Nicholson: “If you look at the record of what I’ve done, I absolutely get the changes that need to happen… I produced the NHS Constitution.
“Given my commitment to the constitution, my commitment to patients, and transparency, I think I’m the right person to take it forward.”
10.43am Nicholson: “Complaints are really valuable sources of information.”
Dr Wollaston: “Has the NHS got it right now?”
10.42am Nicholson: “One thing I regret, very much is when all this blew up, I should have made efforts to meet Cure the NHS. I dealt with them through intermediaries, and that was wrong.”
10.41am Dr Wollaston is probing a “very defensive culture” in the NHS, and has suggested that key evidence about Mid Staffordshire was “swept under the carpet”. Could she be circling the gagging order issue?
10.40am The Daily Mail, which has had its knives out for Sir David since the publication of the Francis report, today reports that prime minister David Cameron has given Sir David Nicholson his full backing again in response to early day motion calling for him to quit, signed by 20 MPs.
It also reports on a speech to the House of Commons last night from MP for North East Cambridgeshire Steve Barclay. Mr Barclay said: “He presided over a system in which officials were effectively cooking the books. By fixing the codes that registered deaths, the true causes of mortality were disguised and death rates were sent plummeting. He shrugged off complaints from staff and patients as simply lobbying while appointing people to whitewash what was actually going on in NHS hospitals.”
10.35am Nicholson denies he was aware of an SHA report to discredit the HSMR.
10.34am Nicholson: “The HSMR is an indicator to go and look.”
Dr Wollaston: “But nobody did.”
Nicholson: “They should have done…. that’s the terrible thing about what happened.”
10.33am “The only way you can make a judgement about how many deaths are avoidable is to go through the patient case notes.”
10.32am Nicholson takes the opportunity to talk about the Hospital Standardised Mortality Rate. “It doesn’t say how many [deaths] were avoidable or unnecessary. To go from that number of excess deaths to saying they’re avoidable is a big step to take.”
10.31am Dr Sarah Wollaston, who has this morning said Sir David should resign, says the evidence shows that SHA staff were indeed looking at mortality data published by Dr Foster from at least 2008.
10.29am Sir David Nicholson is one of the most discussed subjects on Twitter in the UK right now. He’s trending at number six at the moment.
10.28am Nicholson repeats his claim that as the range of data wasn’t available at the time of the of the failings of care at Mid Staffordshire. It wasn’t on anyone’s radar, he said, as patient stories weren’t being listened to. See 10.26am for more on that claim.
10.26am On Nicholson’s point that SHAs weren’t looking at hospital mortality rates at the time of the Mid Staffordshire scandal, HSJ’s Sarah Calkin tweets: “Dr Foster’s Good Hospital Guide, including HSMRs for English NHS trusts, first published in 2001 and annually ever since.” That means the data was out there, but the SHA wasn’t looking.
10.23am Nicholson again stresses the “confusion” caused by system reorganisation. It seems to be the main theme he keeps returning to this morning.
10.20am If there were systematic failings, who was responsible for the system?
Nicholson: It was given to me to make it work. Right from the beginning [of my time taking over as NHS CEO], I’ve tried to make quality the central principle.
10.19am Nicholson: There is a case for better regulation and standard setting for chief executives of [NHS trust] boards.
10.17am Liberal Democrat Andrew George has taken over the questioning. Is it fair that managers have the luxury to reflect, but clinicians are held accountable? Nicholson - most of the senior managers left quite quickly when the first Mid Staffordshire report came out.
10.13am @Oliver_Wright of the Independent tweets: “Vaz show-boating and acting like chief prosecutor in questioning Nicholson. But her grasp of the NHS and how it works (or not) is shocking.”
10.11am @IsabelHardman of the Spectator tweets: “Valerie Vaz started her questions to David Nicholson by saying ‘this isn’t a trial’. Not sure her method of grilling backs that up.”
10.08am Valerie Vaz highlights another piece of evidence to Francis in which Sir David says he cannot remember what was discussed in a meeting. “You seem to not be able to remember a lot of things that went on”, she says Nicholson: “The idea I could recall in detail every single one of those meetings…. it’s not a trick. It’s not a trick.”
10.05am Nicholson appears frustrated at forensic questioning by Valerie Vaz of his witness statement to the Francis inquiry. He tells her: I was cross-examined in public for 11 hours by a QC. The transcripts are available, he adds.
10.01am Mortality rates weren’t part of the way that hospitals were assessed by SHAs during 2005-06
9.59am Nicholson: I wasn’t aware of mortality rates as an indictor as SHA chief. Only after when I became NHS chief executive did I become aware of mortality rates. At the SHA, we weren’t seeing that data.
9.57am Valerie Vaz: “If the system wasn’t chaotic, what was it?” Nicholson: we were going through a process of changes, losing corporate memory, but in an organised and planned way.
He’s talking about the 2006 PCT/SHA transition, although the parallels with the current transition are impossible to ignore.
9.56am Nicholson goes on: I was held to account for merging three SHAs into one, a series of primary care trust mergers, and “narrow” performance targets around hospital acquired infections. “That was a big failing in that system, and I was part of it.”
9.55am Nicholson: There were “no rumblings” about poor care at Mid Staffordshire when he was running the strategic health authority. “The strategic health authority was not operationally responsible” for the trust, he adds, before mounting what sounds like a defence of his position, based on the accountability structures in the local NHS in 2005-08.
9.49am Nicholson: “During that period [2005-06], patients were not the centre of the way the system operated. There were a whole lot of changes going on… which created an environment in which leaders lost their focus.”
9.48am Dorrell hands over to Labour’s Valerie Vaz. “Please don’t think of this as a trial”, she says.
9.48am Dorrell: what about two words - accountability and openness?
9.47am Nicholson answers: highly motivated staff; improvement driven through goals based on a proliferation of performance metrics; patients at the centre, but trusts able to explain what that actually means.
9.45am Nicholson’s answer doesn’t do it for Dorrell, who asks again: what would be the change in culture, in three bullet points?
9.43am The NHS is facing its greatest challenge, says Nicholson, before describing the April 1 transition to the new NHS structure. And, he adds, we’re losing a lot of management staff with considerable organisational memory. “We’re at maximum risk”, he said. “I’m determined to see that through.”
9.42am Nicholson repeats his argument that his pitch to be chief executive of the NHS Commissioning Board was based on wanting to right the wrongs seen at Mid Staffordshire.
9.40am Nicholson responds by talking about the stories of patients who had been on the receiving end of “appalling care” from Mid Staffordshire Trust. He’s talked about this at length before, not least in an interview with HSJ in January.
9.39am Committee chair Stephen Dorrell opens the questioning by asking: What does a change in culture mean?
9.37am Sir David Nicholson is in front of the health select committee now. Watch live here.
9.33am The respected Nick Timmins has returned to his old stomping ground at the Financial Times, where he was public policy editor, to write “NHS chief’s scalp won’t help hospitals”.
“Those vastly closer to the failings at Mid-Staffs – the hospital chief executive and the various health-authority managers who contested the later, much more damning evidence of poor care and high death rates – have all, quietly, gone,” Mr Timmins writes. “Sir David’s is the only scalp available. So it is being sought. He does bear a responsibility for the scandal, but nothing like the prime one. For him to be forced into resignation over this would be yet another injustice to add to the many that the patients and relatives at the hospital have suffered.”
9.27am Dr Sarah Wollaston, Conservative MP, GP and member of the health select committee, has written in the Telegraph this morning that Sir David Nicholson must go. “Should the individual who is so personally identified with implementing the NHS’s targets culture, which led to such abysmal care, be charged with putting things right?” she writes. “How can we trust Sir David Nicholson not to be conflicted when dealing with the scale of the carnage in our hospitals?”
5.50am: Ahead of the appearance, HSJ has published an opinion piece by Bill Morgan, former advisor to Andrew Lansley, and Mike Birtwistle, managing director of MHP Health Mandate, on the pros and cons if Sir David were to lose his job.
5.50am: NHS chief executive Sir David Nicholson is due to appear before the Commons health committee at 9.30am today, to be asked about the report of the Francis inquiry into failings at Mid Staffordshire Foundation Trust. It follows weeks of scrutiny of Sir David’s responsibility for the events, and failings elsewhere in the NHS. There have been increasingly prominent calls for him to lose his job, including from The Times and from Conservative MPs, including two members of the committee. Many in healthcare and politics will be looking to his appearance as a deciding factor in whether he will be able to keep his job. HSJ Live will cover the hearing, and reaction and commentary on it.
5.49am: Four former health secretaries, ahead of Sir David Nicholson’s health committee appearance today, have said he should stay in post.