Review of 2009: a swine of a year for Mid Staffs, Rose Gibb and the public purse

One NHS manager began the year with more than a Christmas hangover to worry about. Former NHS Stoke director Lee Whitehead was jailed for 12 weeks for lying on his CV.

By June there was palpable fear in the DH over swine flu. PCTs were warned to “test to destruction” their crisis plans

There were revelations about the government’s attempts to improve the health service with no extra money as demand rose, unemployment grew and an unpopular government prepared to face the voters - three decades ago, in Cabinet papers from 1978 released under the 30 year rule.

The NHS constitution was unveiled. Health service staff contained their excitement.

At the end of January the cooperation and competition panel opened for business. Academic Chris Ham said the panel’s guidance looked as if it had been written “by a neo-liberal economist on speed”.

February saw dark days in London with four chief executives quitting - including Tara Donnelly at West Middlesex University Hospital Trust and Julian Nettel at Barts and the London Trust after questions about trust performance.

In the High Court the row over the dismissal of Maidstone and Tunbridge Wells Trust chief executive Rose Gibb rumbled on, with NHS director general for finance David Flory among those asked to give evidence.

The dying days of the Healthcare Commission were marked with bitterness over redundancies. Its chief executive Anna Walker admitted she found out around 400 staff would lose their jobs by reading it in HSJ.

NHS Brent showed what first class leadership could achieve. A year earlier the primary care trust had been condemned as debt ridden, arrogant and isolated. A new review 12 months on described its improvement as “remarkable”.

On 5 March HSJ published a league table of PCT performance in world class commissioning. Birmingham East and North and Tower Hamlets were popping the champagne; Havering and Great Yarmouth and Waveney were left with a lot to explain.

The NHS Confederation described life as a chief executive as brutal and arbitrary. Clinicians were not queuing up to apply, it found.

NHS Yorkshire and the Humber chief executive Margaret Edwards left suddenly. She took the newly created Department of Health post of national director of productivity and efficiency.

Standards scandal

In mid March the Mid Staffordshire Foundation Trust scandal broke. Branded appalling by inspectors, horrors included receptionists carrying out accident and emergency triage, patients not fed for days and others left in soiled sheets.

The trust’s loss of direction - obsessing about financial targets and securing foundation status at the expense of patient care - shook confidence in the FT process, regulators and the strategic health authorities. NHS medical director Sir Bruce Keogh slammed the trust’s “complete failure of leadership”.

April marked the fifth anniversary of the launch of foundation trusts. Managers interviewed by HSJ celebrated the freedom from central control but questioned how many FTs exploited it.

Healthcare Commission chair Sir Ian Kennedy ended his tenure in typically robust style. Reflecting on working with the DH he said the commission was “banging on about safety and quality”, but “it was hard to be heard sometimes against the bustle of restructuring and trying to get the money back into shape during the Hewitt regime”. He also attacked the “corrosive” impact of bullying on NHS staff.

John Watkinson was sacked as chief executive of the Royal Cornwall Hospitals Trust after an independent review found it on course for corporate failure. He had been suspended after a separate review criticised poor financial management and “unprofessional behaviour” in his last post, as chief executive of Bromley Hospitals Trust.

April ended with Rose Gibb losing her claim for breach of contract. She had left Maidstone and Tunbridge Wells in October 2007 after agreeing severance terms. The High Court turned down her bid to enforce this contract, ruling the trust had shown “irrational generosity” in agreeing to pay her £175,000 above the £75,000 she was entitled to in lieu of notice.

Analysis of the Budget left the NHS bracing itself for a real terms cut of 2.3 per cent from 2011. Efficiency became the new management focus. Days later figures from the Office for National Statistics showed productivity had improved.

In May the world teetered on the brink of a flu pandemic. Doctors struggled to get hold of protective clothing and swabs.

Papers released to HSJ under the Freedom of Information Act revealed the NHS had been the focus of a diplomatic row with the Channel Islands after the DH decided to end a reciprocal agreement. Months later the NHS again became a focus for foreign affairs after US Republicans attacked it with the intention of undermining President Obama’s healthcare reforms, accusing the NHS of being “evil” and “Orwellian” and claiming the reforms would lead to NHS-style “death panels”. Professor Stephen Hawking stepped in to defend it, saying: “I wouldn’t be here today if it were not for the NHS.”

NHS chief executive David Nicholson’s annual report blew the debate about the size of the financial challenge facing the service wide open. While politicians from all sides struggled to come clean about the impact the collapse of the economy would have on public services, Mr Nicholson said the NHS would need to find £15bn-£20bn of savings from 2011-14. “All bets are off,” he told HSJ.

The next week health secretary Andy Burnham told HSJ improving service quality was the key to saving money - an often repeated mantra in the months to come.

By June there was palpable fear in the DH over swine flu. PCTs were warned to “test to destruction” their crisis plans.

Efficiency shock

At the NHS Confederation conference in Liverpool hsj.co.uk broke the news that NHS commissioning supremo Mark Britnell was joining KPMG.

Shadow health secretary Andrew Lansley promised a Tory government would increase NHS spending in real terms after 2011.

Anxious not to be the last party left holding the targets baby, Labour announced plans to turn them into patient rights.

In July, as the implications of £20bn of savings began to sink in, talk of pay freezes grew.

Later that month HSJ reported that the NHS was coping well with swine flu, despite complaints over excessive form filling demands. The Care Quality Commission revealed plans to suspend swathes of inspections if the outbreak worsened.

The British Medical Association was quick to see the opportunity for its GPs to make a fast buck from the pandemic. It tried for £7 a shot - making the total bill over £700m. The final deal was £5.25.

Monitor and the DH clashed again, this time over proposals to give the health secretary powers to push for an FT to be deauthorised. HSJ said it amounted to giving the secretary the power “to cave in to media hysteria”.

As the Conservatives surged in the polls the health world eagerly examined every statement by health secretary in waiting Andrew Lansley. The party floated the idea of “organic” mergers of primary care trusts as GPs took more of the commissioning strain.

In the first week of September HSJ’s leak of McKinsey’s report for the DH on the implications of saving £20bn dominated the national media. It predicted 137,000 jobs would go if that level of savings was achieved. Ministers ran for cover.

More trouble awaited health ministers later that month when Andy Burnham used a speech at the King’s Fund to announce the “any willing provider” policy Labour had been elected on in 2005 was being dumped in favour of giving substandard services two chances to improve. Paul Corrigan, Tony Blair’s former health adviser, led the counter-attack in favour of competition for service provision, as civil servants struggled to turn the policy shift into coherent formal advice.

At the Conservative conference in October Mr Lansley promised to cut a third off the NHS’s annual administration costs of £4.4bn. Both major parties moved towards an NHS pay freeze.

The annual health check results revealed stronger performances from PCTs but a sharp drop in the number of acutes rated excellent.

The same week primary care czar David Colin-Thomé described practice based commissioning as a corpse, a comment not universally welcomed in the DH.

As the month came to an end a new safety scandal engulfed the NHS. The Care Quality Commission report exposing filthy conditions at Basildon and Thurrock University Hospitals Foundation Trust was leaked. Then Monitor intervened at Colchester Hospital University Foundation Trust and sacked the chair. Finally, Dr Foster claimed its patient safety ratings showed 27 trusts had an unusually high death rate. The Dr Foster ratings were the most damning story, with some of the scores wildly at variance with those compiled by the CQC. The regulator bore the brunt of the media storm, Andy Burnham and chair Baroness Young fell out and she quit.

The year ended with the pre-Budget report doing little to lift the financial gloom, and prime minister Gordon Brown becoming the cheerleader for those bashing public sector managers over their pay. But an HSJ story revealed one big prize was heading the NHS’s way - a report being prepared by Andy Burnham would promise the health service would finally get its hands on social care.