By Tony Collins
Sir David Nicholson seems to have a glass half-full view of life as the Chief Executive of the NHS. Perhaps unfairly there are calls for him to resign over the deaths at Mid Staffordshire NHS Foundation Trust. He says he did not know what was happening there.
But he was wrong to suggest the problems at Mid-Staffs were not systemic. Fourteen hospitals are being investigated for unusually high death rates.
Nicholson was also wrong in 2007 when he gave a reassuring briefing to the then prime minister Tony Blair on the state of the National Programme for IT. The paper on which his briefing was based was supposed to have been a secret but it was mistakenly put on the web then removed. I kept a copy.
It showed a bar chart that implied that the main elements of the NPfIT were complete. It said that,
“ … much of the programme is complete with software delivered to time and to budget”.
That wasn’t correct then, or today – which is six years later. The main element of the NPfIT, a national electronic health record, does not exist. Arguably the NPfIT is one of the worst IT-related disasters of all time – and Sir David Nicholson remains its official Senior Responsible Owner. He has defended the NPfIT even after coalition ministers criticised it.
He also personally rejected a call by 23 academics in 2006 for an independent review of the NPfIT. When I was in his company a few years ago he said (politely) that he would not put the idea of an independent review to his ministers.
So why shouldn’t he go? The resignation of one man over pervasive cultural problems within the NHS could be an irrelevance, a harmful distraction. It could imply that the NHS is cured of the pervasive cultural problems highlighted by Francis in his report on Mid Staffs.
Perhaps Nicholson should stay because he is a reminder that the health service’s senior management doesn’t really change however many times new governments impose reorganisations. Particularly at trust board level directors keep the same principles of defensiveness and denial when things go wrong. Nicholson, perhaps, should remain as a symbol of what is wrong with the NHS.
If he resigned, his successor would most likely be appointed by a panel that would be attracted to the virtues Nicholson displayed at his interviews for the job of NHS Chief Executive. In other words Nicholson may be replaced by someone very similar – someone who would, at heart, defend the NHS, and particularly the Department of Health, against whinging outsiders including politicians, the media and patients.
Obviously, David Nicholson should resign, and, ideally, as soon as possible. Ultimately the failures at Mid-Staffs were driven by the target-driven management culture that (Sir) David Nicholson embraced and actively promoted. He is ultimately accountable not only for all the unnecessary deaths in North-Staffs but also at the many other hospitals now under investigation.
If I were Sir David, I would be so embarrassed about the failures on my watch that I’d wish to hang my head in shame and seek to find some other way to add value to society in the UK, rather than running the NHS.
In naval culture around the world, it is expected that the captain goes down with his ship. Sir David needs to follow this well-established precedent, assuming he has any sense of ultimate accountability. However, if Sir David chooses to hang-on, in order to preserve his salary and pension, then he will only serve as a ‘lame duck’ in his new role as Chief Executive of the NHS Commissioning Board and as a brake on much-needed, fundamental improvement across the NHS.
Arguably, “Shouldn’t David Nicholson stay?” is a counsel of despair accepting degrading care and killings by omission. So no.
He should go (where does culpable responsibility lie otherwise), but with a large & secret payoff secured by a gagging contract (“compromise agreement”) and then be immediately hired by a large private sector NHS supplier or pharmaceutical company – Just like so many former Minsters (such as Stephen Dorrell or Alan Milburn, Patricia Hewitt etc).
“In January 2008, Hewitt was appointed ‘special consultant’ to the world’s largest chemists, Alliance Boots. Such an appointment was controversial given Hewitt’s former role as Health Minister, resulting in objections to her appointment by members of a Parliamentary committee. Hewitt will also become the ‘special adviser’ to private equity company Cinven, which paid £1.4billion for Bupa’s UK hospitals.”
Check out the NHS reform history of change upon change here: