The knives are out for NHS Chief Executive Sir David Nicholson. In spite of the conclusion of the Francis Report on events at Stafford hospital and public backing from both Prime Minister David Cameron and Shadow Health Secretary Andy Burnham, a growing group of Tory MPs is calling for his resignation, including unnamed ‘cabinet ministers’, and has tabled an early day motion demanding that he ‘face the consequences’ and step down.
The right-wing media chorus has joined in vociferously. The Daily Mail is currently referring to him, with ‘The Sun’-like ad nauseam repetition, as “the man with no shame”, while the Telegraph chips in with claims that a ‘neutered Francis report’ was doctored to protect Nicholson.
At the same time, campaign group ‘Cure the NHS’, in line with a recent article by founder Julie Bailey, is calling for ‘heads to roll. When former Tory health minister Stephen Dorrell dared to express the opinion that Mr Nicholson is a “distinguished public servant”, Ms Bailey criticised the MP, saying that he
should not have made the comments prior to Sir David’s evidence session before the [health select] committee on March 5..
I would also like to call into question Stephen Dorrell’s position in defending Sir David Nicholson when he is chair of the select committee. It calls into question his impartiality when he is speaking to defend him before he has even heard evidence from him.
And of course, every article and statement refers to the “as many as 1,200 patients who died needlessly” at Stafford – even though, as I showed in a heavily-researched article last week, no such thing happened and the Francis Report says nothing of the sort.
Ms Bailey’s comments completely ignore the fact that Mr Nicholson has testified many times to the select committee in his role as NHS Chief Executive and there Stephen Dorrell has ample evidence on which to form his opinion of Nicholson’s stature and service.
But they are sadly typical of the kind of comments that come out of some ‘patients’ groups’ if anyone dares to question whether the facts support their claims. When I wrote my analysis of the Francis Inquiry testimony last week, the reaction on Twitter from some people involved with ‘Cure the NHS’ included many comments along the lines that I was ‘disrespecting [their] loved ones’ by showing that the evidence did not support the many headlines, and that since I had not lost a relative at Mid Staffs I had no right to an opinion. I was even associated with paedophiles and rapists for daring to consider that the facts of the case are important and should affect how we view the events at Mid Staffs.
Bereaved relatives have some excuse for being unreasonable and for ignoring inconvenient facts – grief can easily prevent people from seeing straight or cause people to lash out at the wrong person or people.
Politicians and news editors, on the other hand, have no excuse. The headlines and the ‘Early Day Motion’ calling for Mr Nicholson’s resignation and tarring the man with such cheap jibes as ‘the man with no shame’ involve MPs and journalists ignoring clear facts, which are clear for them to see if they bother to look, in a way which is inexcusable:
The excess deaths that weren’t
First, and most critically, there were no ‘excess’ deaths at Mid Staffs in the 2005-2009 period, in spite of claims by media, politicians and campaign groups. There was poor care in a few areas because of severe understaffing, but Mid Staffs’ mortality rates were actually considerably below the national average once the ‘HSMR’ coding was corrected for glaring errors.
Short-staffing led to basic care failures in few areas of Stafford hospital – but poor basic care very, very rarely kills anyone. The independent physician who oversaw the ‘independent case note review’ (ICNR) was asked by the Francis inquiry how many ‘excess’ (by which he meant ‘avoidable’) deaths he had found during the review. His answer? “Perhaps one”.
Mid Staffs CEO?
David Nicholson was indeed interim Chief Executive of Staffordshire Strategic Health Authority (SHA) – for all of about 8 months, from August 2005 to April 2006. At the same time, he was also CEO of 2 neighbouring SHAs ‘Birmingham and Black Country’ and ‘West Midlands South’.
Mr Nicholson was therefore doing 3 jobs at once and could not reasonably be expected to get to grips with what was happening at a ward level in a particular hospital during an 8-month tenure.
No realistic way to know
Nicholson’s tenure as CEO of Mid Staffs ended in April 2006, well before any of the supposed ‘facts’ concerning mortality rates were in the spotlight – and also well before the sad death of Julie Bailey’s mother.
A visit by the Chief Executive of the Royal College of Nursing (RCN) found the standard of care provided by the parts of the hospital he visited to be excellent – so what poor care did exist at the hospital was not immediately apparent unless a visitor went to the ‘right’ areas at the ‘right’ time – and the problems that did exist were not being reported at that time.
Mr Nicholson was therefore not realistically in a position to know about any care problems during his 8 months as CEO, let alone to fix them.
Those who want Nicholson to resign may also claim that, as NHS Chief Executive, he carries ultimate responsibility for what goes on in any NHS hospital. While this might appear true on the face of things, the real story is far from straightforward.
Mr Nicholson became NHS CEO in September 2006. In July of the same year, the three SHAs mentioned above merged to become the West Midlands SHA (WMSHA) and became the body with overall responsibility for the area that included Mid Staffs.
The NHS website describes an SHA:
Strategic health authorities (SHAs) were created by the government in 2002 to manage the local NHS on behalf of the Secretary of State for Health. There were originally 28 SHAs, reduced to 10 on July 1 2006.
SHAs are responsible for:
- developing plans for improving health services in their local area
- making sure local health services are of a high quality and are performing well
- increasing the capacity of local health services so they can provide more services
- making sure national priorities (for example, programmes for improving cancer services) are integrated into local health service plans
SHAs manage the NHS locally and provide an important link between the Department of Health and the NHS.
SHAs form a layer of management with responsibility for local services – with almost 170 hospitals under them in England. It would be extremely difficult for an NHS Chief Executive to become aware of what was going on at a Trust level unless the responsible SHA flagged it to him.
However, when the high HSMRs at Mid Staffs were reported, the WMSHA employed Birmingham University to evaluate the HSMR methods and results. Quite rightly, the SHA suspected that the primary causes of the inflated mortality statistics were weaknesses with the system itself and with the data going into it. No ‘warning flags’ of increased numbers of unnecessary deaths would have been raised to Mr Nicholson – and quite rightly so, since there was no increased death rate in reality.
Once the Trust became a Foundation Trust in February 2008, the distance between it and the CEO of the NHS grew even wider. Here’s how the NHS website describes a Foundation Trust:
NHS foundation trusts, first introduced in April 2004, differ from other existing NHS trusts. They are independent legal entities and have unique governance arrangements..They are set free from central government control and are no-longer performance managed by health authorities. As self-standing, self-governing organisations, NHS foundation trusts are free to determine their own future.
To expect David Nicholson to resign because of what happened at Mid Staffs would be entirely unreasonable even if there had been hundreds of avoidable deaths at the Trust – and there were not.
For politicians and media maintain calls for his resignation requires holding onto an interpretation of the events that are simply does not stand up to fact-based scrutiny.
So why, then?
If David Nicholson is not to blame for what happened at Mid Staffs, and what happened is not what the media has misleadlingly portrayed – why want rid of him? I believe the answer doesn’t take a great deal of finding – and it has nothing to do with Mid Staffs except that Mid Staffs provides an opportunity.
Who will rid us of this troublesome CEO?
An MP I know personally, and who is intimately involved with health, told me that David Nicholson stands head and shoulders above his colleagues in terms of intellect and capability. David Cameron’s public support of Nicholson is, I believe, a temporary posture for appearances’ sake, but the Shadow Health Secretary thinks highly of him, as does the Conservative chair of the Health Select Committee Stephen Dorrell. But Mr Nicholson has ‘form’ when it comes to being a thorn in the side of the government when it comes to its plans for the NHS,
The Tory front bench is therefore far less well-inclined to him. Nicholson famously described Andrew Lansley’s NHS reforms – which the government were pushing through in spite of a promise of ‘no top-down reform’ – as being so big you can see them from space.
Similarly – and this is the key point – Nicholson has a track record of speaking out against the government’s closure of NHS facilities and warning of the risks they pose to patients. Here’s how the RCN website put it:
David Nicholson speaks out on the government’s health reforms
The Observer reports that the head of the NHS laid bare his fears that the government’s reforms of the health service could end in “misery and failure”. Sir David Nicholson, chief executive of the NHS, said high-profile, politically driven changes almost always end in disaster. He warned against “carpet bombing” the NHS with competition. His comments were made to GPs at a conference held by the Royal College of General Practitioners.
But the most important factor in the Tories’ desire to oust Nicholson lies in how he believes that the government and the NHS should respond to ‘failing’ Trusts.
The Francis report recommends that failing hospitals should be closed. The Tories’ desire to close NHS hospitals is so strong that Health Secretary Jeremy Hunt infamously chose to downgrade both the A&E unit at Lewisham and to turn the whole university hospital into a centre for joint replacements because of financial problems at a neighbouring Trust.
The government has already ‘identified’ a further 14 hospitals that it says have similar problems to those we’ve been led to believe existed at Stafford – over 8% of the total in England. The Tories view Mid Staffs and the Francis report as a prize opportunity to downgrade and even close NHS hospitals before they can be kicked out at the next general election.
Alongside forced privatisation and the massive sell-off of NHS land at knock-down prices, the ‘closure’ option of the Francis recommendations represents a chance to accelerate the dismantling of the NHS that the Tories are simply not going to let pass. The unseemly rush to put Mid Staffs into administration while public sympathy is low demonstrates this clearly.
But David Nicholson? His solution to hospitals ‘failing’ like Mid Staffs would be to re-nationalise them – to bring the ‘autonomous’ Foundation Trusts back fully into the NHS and into public ownership.
And the ‘nub’
In the context of obvious Tory hopes to bring an end to the NHS as we know it before the next General Election in 2015, it’s clear that David Cameron is simply ‘keeping up appearances’ by publicly supporting David Nicholson.
The fact that David Nicholson has the respect of MPs on both sides of the house who are involved with health and in the best position to judge, and that as my MP friend put it, there’s nobody who’d be in the frame to replace Mr Nicholson who is anywhere near as savvy and competent, cannot be allowed to interfere with the ‘greater’ Tory vision.
I therefore believe that it’s only a matter of time – days or even hours – before David Cameron asks David Nicholson for his resignation and we see a statement from Cameron along the lines of:
It is with great regret that I have been ‘forced’ to accept the resignation of Sir David Nicholson as Chief Executive of the NHS. Sir David’s service to this country, and to the NHS that we all love, has been exemplary, but in the wake of the Mid Staffordshire scandal and the deaths that occurred there, his position had become untenable. I thank Sir David for his service and wish him well for the future.
Don’t believe a word of it when it comes. The Tories only ‘love’ the NHS like a cat loves a mouse – and they’ll remove David Nicholson because he’s an impediment to their ‘scorched earth/fire sale’ ambitions before the next election. He may be the most competent option, but they’re more interested in compliance than competence.
As seems consistently to be the case with Mid Staffs, what you’ll hear won’t be the truth but rather a version of it that suits a very dark, hidden agenda – and shame on the Tories and their press supporters for exploiting the grief of a few bereaved families to achieve their goals.