Wednesday 6 March 2013

Sir David Nicholson: I am the right man to lead NHS

Sir David Nicholson: I am the right man to lead NHS: Facing MPs' questions over the Mid Staffs hospital scandal, chief executive admits failings but is 'absolutely determined to stay'

David Nicholson has insisted he is the right man to continue leading the NHS, despite MPs on an influential Commons committee accusing him of doing too little to stop the Mid Staffordshire hospital scandal.
Nicholson, who has been under growing pressure to resign, told the health select committee he was "absolutely determined" to stay in his post in order to see the service through the major changes happening in April and ensure that major improvements are made to quality of care, patient safety and NHS regulation.
During almost three hours of occasionally tetchy exchanges with some committee members, Nicholson rejected the doubts about his fitness to remain as chief executive of the NHS and maintained that his track record showed he was well placed to drive through an overhaul of how hospitals operate.
Relatives of some of the hundreds of people who died at Stafford hospital between 2005 and 2009 as a result of poor care have called on him to resign since last month's publication of Robert Francis QC's report into how "systemic failures" in NHS culture meant problems were not identified or tackled quickly enough.
The healthcare investigator who uncovered the scandal has also urged him to go and 20 MPs have signed a Commons early day motion demanding his departure. But David Cameron, health secretary Jeremy Hunt, and deputy prime minister Nick Clegg have all so far stood by Nicholson. Cameron has praised Nicholson's "grip and grasp" of the NHS and ability to deliver "results", such as ensuring it hits key targets.
Nicholson told MPs: "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."
He defended his behaviour both in his role as chief executive in 2005-2006 of the NHS's West Midlands strategic health authority (SHA), which was meant to oversee Stafford hospital, and then as overall head of the NHS. He rebutted suggestions that he knew too little and did too little in response to growing concerns about apparently high mortality rates at the hospital.
Sarah Wollaston, the GP turned Conservative MP, was the first committee member to ask Nicholson – who on 1 April becomes the chief executive of the new NHS National Commissioning Board, which will be in charge of the day to day running of the service in England – about his position: "Do you think, on reflection, that you are the right person to take the NHS forward in the long term, or do you feel that there is genuinely a concern that you could be personally conflicted, given that we have other NHS trusts now where we are investigating excess deaths?"
He replied: "I think I have a duty and a responsibility to manage the organisation over these great changes. I also think that, if you look at my record of what I've actually done, you can see that I absolutely get the changes that need to happen to the NHS.
"I do believe that, given my commitment to the [NHS] constitution, given my understanding of the way the NHS operates, given my commitment to patients and the way I conceive things like transparency and opening up the NHS, I think I am absolutely the right person to take that forward."
Some of the relatives – including Julie Bailey, founder of the Cure The NHS patients campaign group, whose 87-year-old mother Bella died in the hospital in 2007 after receiving poor care – sat close to Nicholson as he answered most of the questions posed by MPs, with a few directed at Sir Bruce Keogh, the NHS's medical director, and Liz Redfern, director of nursing for the NHS in the south of England.
Security was tighter than usual for select committee evidence sessions, with attendees unable to carry all but the most basic personal possessions (such as notebooks) into the Grimond Room, because, as one Commons official put it, the controversy around Nicholson meant his appearance was "a bit sensitive".
Speaking after the hearing Bailey condemned Nicholson's evidence as "shameful" and "embarrassing". She said: "That man is an absolute disgrace."
Asked about suggestions that he would stay in post to lead reform of the NHS, she replied: "I think it's just laughable. He is desperate to carry on in his job." She added: "We need to get rid of him. Nothing will change. He is part of the problem, not the solution."
Under sustained questioning from Valerie Vaz, the Labour MP for Walsall South, about his time in charge of the SHA, Nicholson became visibly riled. At the time (2005-06) the SHA had "no idea" what was going on at Mid Staffordshire NHS Trust, and did not receive data that might have alerted them to high death rates, Nicholson said, and no other NHS body identified problems at the trust. He stressed that he was in charge of about 50 hospitals and faced key priorities, dictated by Whitehall, such as reducing hospital-acquired infections, ensuring hospital waiting time targets were met and pushing through an earlier reorganisation of the NHS.
Pressed on his accountability as SHA boss, he said his accountability was much more "narrow" than that of those in charge of Stafford hospital, "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."
Ex-NHS employees having to sign "gagging clauses" when they leave the service, to prevent them raising concerns about quality of care at a hospital, were "unacceptable", he said.
He also criticised as "completely and utterly unacceptable" the £500,000 payoff and gagging clause agreed with Gary Walker, the former chief executive of United Lincolnshire Hospitals Trust, who has accused Nicholson of ignoring concerns he raised about pressures and standards of care at his trust.
The NHS boss said he would never sanction such deals. Walker claimed on Twitter that he had "evidence" that his payoff was sanctioned by the Department of Health. The Guardian

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