Nicholson Stays, Jesudason goes

David Nicholson should resign as chief executive of the NHS over the Mid Staffordshire scandal, but he won’t. Charlotte Leslie, the North Bristol Tory MP, has proposed an early day motion calling for him to go, with cross part support, but he won’t budge. The scandal happened under Labour’s watch, but the government owe Nicholson for keeping a handle on the money during Andrew Lansley’s disastrous health bill, and the next few years could be far worse. The market regulator, Monitor, has recommended Mid Staffs goes into administration, 25 more acute hospitals are on the verge of bankruptcy and up to a quarter of Clinical Commissioning Groups may not be financially viable when they ‘go live’ on April 1. The combination of a bust trust and a broke CCG in the same area could quickly lead to another Mid Staffs. Can Nicholson ‘keep a grip’ on it before the election?

Just as problematic for the government is that the vast majority of NHS staff are not ‘engaged’ in its reform program, and many actively oppose it. Section 75 of the Health Act is supposed to explain how procurement should work, saying commissioning groups must “treat providers equally and in a non-discriminatory way, including by not treating a provider, or type of provider, more favourably than any other provider, in particular on the basis of ownership”. In English, this could reduce the NHS to a franchise which licenses private interests to dominate the NHS. Monitor could in theory stop this, but it is run by market fundamentalists, so don’t hold your breath.

Nicholson, a former Communist Party member, is the most powerful person in the NHS and is seen by some on the left as the best chance of stopping the fragmentation of services from market driven reforms. But if he was true to his roots, he would have resigned over Lansley’s bill and publically explained why it is so bad for the NHS. This might even have killed it off. But despite briefing against it initially, he decided to help out the government, force through the reforms on a deeply resistant workforce and walk into the top job on the NHS Commissioning Board (NHSCB) unopposed.

The fact that the NHS CB has given unanimous public backing to Nicholson demonstrates how unaccountable and lacking in insight this unelected uber-quango is. Continuous political interference in the NHS has done it untold damage over the years, but the pretence of setting up an ‘independent’ board appointed by politicians to ‘depoliticize’ the NHS and serve patients is simply deception. Local doctors, nurses and managers need to be held to account at Mid Staffs, as do the regulators, commissioners and Royal Colleges that failed patients. But the overall responsibility for a catastrophic system failure that went on for so long and resulted in nearly 1200 deaths that were clearly flagged up by published death rates rests squarely with Labour and the Department of Health. Nicholson going will clearly not, alone, make the NHS safer for patients. But his staying will simply embed the same culture and politically-driven enforcement that allowed the disaster to go on for so long before action was taken.

Nicholson has now told the Public Accounts Committee three times that the NHS does not have a problem with whistleblowing. It would be hard to be more wrong, as readers of Shoot the Messenger (Eyes passim) will attest. Many of the Eye’s stories have belatedly become headline news across the media, but spare a thought for Professor Ed Jesudason, a brilliant paediatric surgeon and researcher who has never had a patient complaint against him, who blew the whistle on his colleagues at Alder Hey hospital (Eyes  passim), refused to take a gag and has now resigned with his NHS career in tatters.

Jesudason raised concerns about many issues. Fellow surgeons were doing procedures on vulnerable children that were unnecessary and experimental, without any research approval or informed consent. Senior surgeons were complaining of severe stress and burnout due to workload and this was accompanied by eyesight and other health concerns. Children were at risk because major errors went unreported and even those that were discussed went uncirculated as minutes. The senior surgeons and Clinical Director showed no urgency to have better scrutiny so errors repeated themselves. There was a culture of widespread and severe bullying by stressed senior surgeons. And then two colleagues fabricated a suicide claim against a whistleblowing colleague, leading to his suspension. As Jesudason puts it: ‘This was a point where it was clear we were dealing not with misfeasance but clear malfeasance.’ So why did he lose his case in the High Court? Read Eye next.