In defence of David Nicholson

Calls for the dismissal of Sir David Nicholson are wrong, and not in the interests of patients or the wider NHS. Many will disagree but I say this as someone who has not sought a position in the NHS Commissioning Board with, I hope, an objective perspective. Why do I say so?

‘Sir David is in my experience a caring man who very much has patients at the forefront of his mind’

The Francis report made grim reading. It made all of us in the NHS feel ashamed and our hearts go out to the relatives of those so cruelly mistreated. This is partnered by a burning determination to learn and understand what happened and do all we can to prevent another Mid Staffs. To make sure every patient gets the care we would want for ourselves or our own, nothing less.

Sir David will, I am sure, feel no differently. He is in my experience a caring man who very much has patients at the forefront of his mind. Whilst a fact, the argument to keep him rightly does not depend on his humanity.

The mistreatment of patients and the mishandling of complaints seen at Mid Staffordshire Foundation Trust leads to understandable anger, and that anger leads to wanting blame to be attributed. The truth is that those most culpable were those walking the wards at Staffordshire Hospital and the board − leaders who have gone.

Leaders do shape the culture of an organisation. The management literature is full of such evidence, as are the writings of John Harvey Jones and Jack Welch, to name but two. Equally Charles Handy, Kanter and others eloquently describe how aberrant micro-cultures develop within larger organisations due to misperceptions, mismanagement or mischief. We saw elements of the first two at Mid Staffordshire.

Many micro-cultures

The citizen view of the NHS is that it is an entity. Pull a lever centrally and something happens. The reality we know is that the NHS is an amalgam of semi-autonomous, or autonomous, units and the NHS does not have one culture but many micro-cultures. People forget that today foundation trusts are not controlled directly from the Department of Health or the NHS, but are independent regulated organisations.

‘Some are using the issue of Mid Staffordshire to air long-held grievances’

Even a secretary of state would struggle to direct them what to do − for good or ill. Pull a lever centrally and there is elastic on the end. While recognising that Mid Staffordshire was not a foundation trust for much of 2005-09, there were many hospitals in a similar organisational position in the West Midlands who delivered care very differently. 

In the devolved reality of today, the concept that the leader of the NHS can be individually responsible for the errors in part of it is not a reasonable judgement. It persists the culture of persecution that we wish to get away from. I recognise many will take a strongly opposite view.

However, what we are seeing is some using the issue of Mid Staffordshire to air long-held grievances, fuelling a lynch mob atmosphere. The future is too important to allow that to be the decision mechanism on the role of chief executive of the NHS.

Leader of the leaders

There is a final element to be weighed: the management of change. Again, the literature shows how crucial the continuity of leadership is in delivering a key change in an organisation. The NHS has not yet completed its current upheaval. The effective handling of this transition is essential for patient care, safety and their experience of the service.

‘Sir David’s departure would divert energy and attention from the core purpose − our patients’

This is a responsibility of the leadership of the NHS and the commissioning board. Leadership is as much about teams as individuals. As someone rooted in primary care, contributing to and being part of a leadership team is in my DNA and a self-evident truth, but perhaps not recognised as fully in the world we live in.

The leadership team of the board has recently experienced some senior losses. Capable people remain but as leader of the leaders it is now even more essential that Sir David stays in position to establish the commissioning board as a fully functioning entity, and to begin the process of changing behaviour through structures and commissioning to seek the one, patient-focused culture advocated by Robert Francis.

The corollary is also true in my view. Sir David’s departure would impede that process, and divert energy and attention from the core purpose − our patients, and ensuring there is never a “Francis report 2”.

Sir John Oldham is a GP and the quality and productivity clinical lead at the Department of Health