Lansley Vs Nicholson Round 12

Any health secretary hoping to force untested free-market health reforms on a resistant NHS needs a chief executive with a similar ideology to push them through. Unfortunately for Andrew Lansley, he’s got David Nicholson, a command and control former member of the Communist party. At this year’s Patient Safety Congress, MD asked Nicholson whether he supported Lansley’s reforms. He said: ‘I lack the imagination to have come up with them.’ Even more damning was that not a single one of 700 delegates thought the Health and Social Care Act would make the NHS safer for patients, and a majority thought it would make it less safe.

Massive structural change at a time of massive debt creates a perfect storm in the NHS for Mid Staffs type disasters, as staff take their eyes off patients to balance the books whilst endlessly reorganising. In August 2009, David Cameron promised : ‘We will not persist with the top-down re-structures and reorganisations that have dominated the last decade in the NHS.’  In government he has done the opposite, implementing reforms that Nicholson says ‘are so big, you can see them from space.’

Nicholson remains in office to oversee the NHS debt crisis – £20 billion must be saved over 5 years – but it’s given him a golden opportunity to scupper Lansley’s reforms. Lansley promised GPs they could organise themselves into groups of any size and reshape the NHS by innovating, closing down unprofitable hospitals and developing services closer to patients. Bullish GP consortia of all shapes and sizes popped up with corporate brands like Bexley Clinical Cabinet, the Red House, the Fortis Group, Cumbria Clinical Senate and Principia.

Fast forward 2 years and these clinical commissioning groups (CCGs) have been rounded up by Nicholson and forced to merge until they’re the same size as the Primary Care Trusts (PCTs) they replaced. They have been given a measly running cost allowance that will minimise their chances of commissioning locally. The new National Commissioning Board is starting to enforce top down financial targets and micro manage GPs, just as the Department of Health currently does. The GPs have been forced to accept centralised commissioning support advice from new organizations that are almost identical in size and personnel to the Strategic Health Authorities they replaced. And the CCGs have been ordered to abandon their lovingly chosen names to become identikit PCTs. So Principia will become NHS Rushcliffe CCG.

The battle between Lansley and Nicholson has ensured vast amounts of time, money, stress and anxiety have been expended dismantling organizations to rebuild them under another name. Clearly one of them has to go, but who? Both could both be undone by the Mid Staff’s inquiry report, due in the autumn. Its recommendations could strongly contradict Lansley’s reforms. Nicholson has his fingerprints on Mid Staffs – he was chief executive of Shropshire and Staffordshire SHA – and has overseen an NHS culture where whistleblowers have been repeatedly suspended, sacked and silenced, senior NHS managers protected and bad news buried under a pile of legal threats. (See Shoot the Messenger).  Two of the Eye’s ‘cussed quartet’ – Dr Jayne Collins, chief executive of Great Ormond Street and Cynthia Bowyer, chief executive of the CQC, have now resigned from their jobs and DH director of commissioning Barbara Hakin might have to follow suit if the Health Select Committee takes evidence from the gagged former Lincolnshire chief executive Gary Walker.

The noose is tightening on Sir David Nicholson but he’s sure to leave with a gold-plated pension. Meanwhile, Lansley can only bully doctors into ill-advised industrial action over theirs, and hope that when he leaves office he’ll be rewarded with some lucrative directorships and consultancies for opening up the NHS market. Back on earth, the proportion of patients waiting more than four hours in A&E has increased by more than a quarter over the last year, reaching its highest level since 2004.

Shoot the Messenger has been shortlisted for the Martha Gellhorn Prize for Investigative Journalism