Report comment

The process of applying to be an FT exposed MId-Staffs as an unviable hospital - financially & clinically. Nicholson, as Chief Executive of the SHA should have engineered a service rationalisation that would have created a viable service in MId Staffs. he didn't. Instead he imposed cuts of £10m p.a. without understanding the likely consequences - which proved to be disasterous.

He's done the same nationally. The QUIPP programme is creating the conditions for more service failures and is widely regarded as a serious mistake. It's right to press providers and commissioners to be more productive, but random cuts are not the way to do it. Overall the programme will not increase productivity, but in some areas intense pressure on individuals - NIcholson's style - will generate cuts in expenditure with unknown consequences for patients.But, because NIcholson surrounds hiself with cronies, he is told what he wants to hear not what he needs to know. Anyone who challenges him is got rid off. This is a major failing in a leader.

NIcholson knows that Francis will criticise him for serious failures in his SHA and national roles. His appparently casual remarks is an attempt to burn off the criticism before the report is published.

He was kept on and appointed to the NCB at No10's insistence to keep control of waiting lists and expenditure when Lansley's reforms were thought to be a serious risk to both. He's delivered on control of the money - he always does. He's failed on service delivery and rationalisation. And he's created pressure for more and more money to go to healthcare rather than incentives for higher productivity.

He should step down now. Keeping him on can only harm Cameron, Hunt and Grant