Wednesday 21 February 2018

UK health boss won’t resign after publication of damning mistreatment report

UNDER-FIRE NHS boss Sir David Nicholson has said he is "absolutely determined" to lead the NHS through the coming health reforms despite calls for him to resign.

Sir David said the NHS is currently at "maximum risk" as the controversial changes are implemented throughout the country.

The NHS chief executive said he would stay in his role to see the reforms through.

Campaigners called for Sir David's resignation following the publication of the Francis Report into serious failings at Mid Staffordshire NHS Foundation Trust.

The health boss was in charge of the regional health authority for part of the time that patients were being mistreated at Stafford Hospital where hundreds of patients may have died needlessly after they were "routinely neglected".

"At the moment the NHS is facing its greatest challenge," Sir David told the Health Select Committee.

"In the next few days we will abolish over 160 organisations and we will set up another 211 local organisations and a whole myriad of national ones. We'll completely change the way in which we allocate resources and incentivise the NHS.

"At the same time, we have already lost 13,500 administrative and management staff that have all that corporate memory in them.

"So it is at maximum risk over the next few days.

"I said two years ago that I would take the responsibility of leading the NHS through this enormously complex set of changes.

"I promised both the Government and the NHS that I would see that through and I am absolutely determined to do that over the next period."

Sir David told the committee that the need to motivate NHS staff had been "lost" at the time of the Mid-Staffordshire problems, as the system focused on management systems.

"The first thing - and you can see it absolutely played out in Mid-Staffordshire and you can see it in parts of the NHS where there is poor care - (is that) motivated, supported staff provide great outcomes for patients," he said.

"That connection seems to have been lost in a whole set of discussions about systems and processes."

It was vital that the health service maintains its focus on patients and that it measures its performance in order to see where it is falling short, he told the cross-party committee.

Compared to 20-30 indicators which were measured at the time of the Mid-Staffs scandal, some 600 measures are now published for each NHS hospital, he said.

"That kind of data is really important to get out amongst the population, so we can get really transparent discussions about it," said Sir David. "It's the thing that will drive change in the system."

As the embattled NHS chief executive was grilled in the televised hearing, committee member Valerie Vaz told him: "Please don't feel that this is a trial."

But she then launched into a tough examination of his time as chief of the regional health authority in charge of Staffordshire, telling him: "What struck me about your statement is it is very much like you are a process man and a procedure man. I can't find anything about patients in there and what you are going to do on quality of care."

Sir David rejected this description as "unfair".

At the time, national targets meant that NHS managers had to concentrate on issues like casualty waiting times and hospital "superbugs" like MRSA and C diff, he said.

Sir David told the committee: "During that period, across the NHS as a whole, patients were not the centre of the way the system operated.

"For a whole variety of reasons, not because people were bad but because there were a whole set of changes going on and a whole set of things we were being held accountable for from the centre, which created an environment where the leadership of the NHS lost its focus.

"I put my hands up to that and I was a part of that, but my learning from that was to make sure it doesn't happen again."

At the time, he was responsible for three strategic health authorities, and hospital trusts like Mid-Staffordshire were each statutory bodies with their own responsibilities for what went on within their hospitals, he said.

The chair of the SHA, which included Mid-Staffs, never raised concerns with him about standards of care in the hospital, said Sir David. And he said he appointed a managing director for each of the SHAs to drive improvement on "basic" services.

"As you can imagine, given that I was running three and at the time I was responsible for national work on HR (human resources), the amount of time I could spend in each individual one was limited," he told the MPs.

"The issues we were tackling were that many organisations were having difficulties delivering what you might describe as the basics for the service, as defined for that time.

"At that time, access was the way quality was defined - the ability to deliver A&E targets and access waiting times for patients and hospital-acquired infections. Those were the things that the SHAs were held to account for at that time."

The system required accountability at hospital level, and many of those in charge of Mid-Staffs - including the chairman, non-executive directors, finance director, corporate affairs director and medical director - had all gone as a result of the scandal, he said.

"It is not true to say that people weren't held to account in the NHS. They were," Sir David said.

"My accountability was very different from that, in the sense that I was held to account for delivering the change, for delivering three SHAs into one, for moving 70 primary care trusts into about 40, for making sure that all the organisations delivered what was regarded as the must-be-dones, which is essentially access and MRSA and C diff reduction.

"That was narrow, and I accept that that was a narrow definition of accountability, but that was the way it worked.

"It shows in Mid-Staffordshire, that that was a big failing in the whole system and I was in that system and I was part of it, absolutely."

Sir David said that the regional health authority had "no idea" what was going on at the trust.

"We had no idea," he said.

"The information was not bought to the strategic health authority, we did not see any of the information which would lead you to believe that there was all of this going on in Mid Staffordshire."

He told the Committee that he did not receive any information about high mortality rates at the trust while in the regional role.

"I had not come across hospital standardised mortality rates during my period at Shropshire and Staffordshire nor before that," he said.

"I did not have access to that information.

"At that moment in time, surprising as it may seem in retrospect, it was not part of the regular way in which NHS organisations were monitored in the NHS."

Sir David said that he did visit the hospital during the time when problems were emerging but was not alerted to the problems of neglect and poor care.

During the visit he did raise concerns about the poor relationship between medics and the trust's board and the lack of senior officials helping the chief executive fulfil his role.

He added: "I said that it would take two years for that organisation to become an foundation trust and a critical part of that would be strengthening the relationships between the clinicians and the managers and that they should get a proper medical director in place."

Committee member Dr Sarah Wollaston asked: "How far do you take personal responsibility for an organisation that has been shown to minimise patient complaints, to gag whistleblowers, to massage mortality data, and bury bad news and frankly to lose sight of the patient in the bed?"

Sir David replied: "First of all I don't accept the way that you have described the NHS, it's a much more balanced picture than you have described but secondly, I have spent 35 years being a chief executive in the NHS and I am completely dedicated to improving services for patients.

"Of course when I hear bad stories about the NHS, of course I feel responsible.

"I have got the privileged position when I can try and do something about it which it seems to me is what I need to focus my attention on."

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