Sir David Nicholson’s silence on how he can turn around the culture of the NHS, and our columnist’s anonymity, are disappointing, says one HSJ reader

It is a pity that HSJ’s anonymous columnist (‘Nicholson does not deserve the Mail’s vilification’) apparently lacks the courage of his or her convictions and feels the need to hide behind a veil of secrecy. Also, am I alone in finding it bizarre that the editor saw fit to grant the author’s request for anonymity?

‘Sir David’s position is now only tenable if he can demonstrate he has the will and capability to turn around the culture of the NHS’

The Francis report points to systemic and cultural failures at all levels of the NHS. Mid Staffordshire may have been where the disaster occurred but Robert Francis left us in no doubt about his conclusion that the fault lines ran throughout the whole of the NHS from top to bottom.

A key responsibility of leaders is to mould the culture of the organisation, in this case ensuring that it is aligned with the fundamental values of the NHS. So far, no top leader has stepped up to the mark and accepted accountability for the long-term failure to address this problem.

If one looks back over the NHS scandals that have been the subject of inquiry reports in previous decades, the issue of systemic failure has been a common theme.

The NHS deserves better

The usual response of the system has been to find a handful of front line staff guilty of professional negligence or other misconduct. These individuals were then disciplined by their regulatory bodies while the senior managers responsible for the way the system operated escaped largely unscathed and carried on much as before.

What seems to me different about Francis is that he has pointed to NHS cultural failure so unequivocally as the root cause of what went wrong at Mid Staffordshire.

Despite this it looks like the outcome is going to be pretty much the same as on previous occasions: nit-pick over the conclusions of the report, make unsubstantiated claims that things have changed since the time of the events in question, and find a few people relatively low down in the system to carry the can.

Patients and the NHS itself surely deserve better leadership than this. Sir David Nicholson’s position is now only tenable if he can demonstrate he has the will and capability to turn around the culture of the NHS. So far he has been disappointingly silent on this score.

Michael Powell, Stanhope

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