Why did Nicholson decide to step down?

In March 2014, Sir David Nicholson will have served seven and half years as chief executive of the NHS and latterly NHS England. It is the longest anyone has ever spent at the very top of the service.

Sir David is a tough man but the intensity of the role has had an impact. He was actively considering leaving in 2010 as the coalition began to put together the plans to overhaul the NHS and the first Francis inquiry caused him to ponder his responsibility for the failures at Mid Staffordshire Foundation Trust. Only the surprise decision by then health secretary Andrew Lansley to offer him the NHS England job changed his mind as he saw the opportunity to shepherd the service through the reforms.

But he believes establishing the new system which NHS England oversees will be at least a three-year project. That would have taken him to April 2016 – and potentially a fourth change of prime minister.

That would have been a bridge too far.

‘Rarely has a campaign calling for the resignation of a public servant been so sustained’

However, mental and physical fatigue is not the only the reason he has announced his retirement.

The vitriolic reaction to the Francis report led by the Daily Mail had an effect. Rarely has a campaign calling for the resignation of a public servant, as opposed to a politician, been so sustained. This baggage has affected his ability to do the job as well he would like, something which is a daily frustration to him.

In January he told HSJ that he planned to hold his position “for the next few years” and that “I can see a whole load of things that I need to do”.

It is impossible to know what impact the media firestorm had on Sir David’s decision making. He has been grateful for the support of senior politicians from all the major parties and most NHS leaders. But he would also have been bitterly aware of the sustained criticism from many in the service, the media pursuit of him and his family, and the more extreme reactions to his decision not to resign – which in at least one case required the involvement of the police.

One thing is for sure, when he returned from holiday this week he was typically assertive in meetings with NHS England chair Malcolm Grant and health secretary Jeremy Hunt in making clear that he had made his mind up to go.

‘He will be keen to stress his retirement carries no additional financial “package” over and above his existing entitlement’

So why announce his retirement now? He will be keen to stress his retirement carries no additional financial “package” over and above his existing entitlement. But speculation about his successor at the very least will create a lot of noise.

He will have received advice to wait until October before making an announcement, giving a successor a six month run-in. But Sir David is due to give a keynote speech early next month at the NHS Confederation conference at which he reveal more details of NHS England’s strategy. The audience of senior NHS managers are his people, he would not have wanted to mislead them by suggesting he would be the one leading the long term implementation of the strategy.

But how long will he stay?  

In a brief interview with HSJ, he said he would leave before March 2014 if a successor was in place and Professor Grant thought it was in the best interests of the service.

However, HSJ would not be surprised if Sir David remained involved in helping bed in aspects of the new service – in the same way, for example, that former NHS South of England chief executive Sir Ian Carruthers is working on the establishment of academic health science networks.

One thing is for sure, he will not intend to be a lame duck chief executive. Others may be looking past his shoulder, but he will be maintaining his active involvement in the big decisions facing the NHS.