David Nicholson should step down as Chief Executive of the NHS

Robert Francis stated in his report following the Mid Staffs care scandal that ‘what has been found to be wrong here cannot be cured by finding scapegoats’.

Francis may have a point, but that doesn’t mean that those who are actually to blame for individual acts of negligence and cruelty should not be brought to book and if appropriate, face criminal prosecution. What about the cultural breakdown which has created ghettos that are literally unfit for purpose within our hospitals and care facilities? One definition of scapegoat is ‘one that is made to bear the blame of others’. Yes, the creation of scapegoats would be a bad move, but fixing the NHS is not just a blame game, it’s about shouldering responsibility and accepting individual ownership by staff at all levels. How can it be possible that so many atrocities have taken place in facilities with an abundance of leaders and managers?

What creates a positive, productive and benevolent culture in any workplace? Good leaders. Ultimately who has responsibility for the culture of an organisation? The man (or woman) at the top.

One could ignore the unfortunate fact that the Chief Executive of the NHS, Sir David Nicholson was interim chief executive at the health authority responsible for Mid Staffs Hospital at the time that the high death rate at the hospital was beginning to draw attention. But what cannot be ignored is his tenure at the top job in the NHS since 2006. Nicholson has been ‘in charge’ for over six years. As courage grows within clinical and support staff, more and more shocking and frightening cases of poor management and substandard care are coming to light. On your watch Sir David. On your watch.

Sometimes the best person to fix a major problem within an organisation can be the Chief Executive but more often they are not, especially if they’ve been at the helm as the situation developed and worsened.

I started project management within the NHS four years ago and was surprised to note that despite my dealings with senior clinicians, ward staff and hospital managers, Nicholson’s name was never, never mentioned. Andrew Lansley, the Health Secretary at the time was often pilloried, discussed and on a rare occasion, even supported, but Nicholson was just a non-personality, absent both physically and emotionally it would appear.

Let’s give the Chief Executive the benefit of the doubt and assume that his low profile meant that he was busy working behind the scenes rather than playing an astute political game to protect his position. Anyone can be forgiven a little self-protectionism. Up to a point.

The tipping point for me was watching Nicholson’s interview on the 6^th February following the Francis report. He came across as a cold fish, and he said ‘….At the time I apologised and in a sense I apologise again to the people of Stafford for what happened, but apologies are not enough we need action, we need to make things happen and right since 2009 we have doing things in the NHS, we’ve been tackling healthcare associated infection, we’ve been tackling stroke services…. Heart disease .…we’ve literally saved tens of thousands of lives and the NHS is committed to that….’ What an opportunity missed – this came across as a political speech rather than a genuine concern for the patients lost and sympathy for their devastated loved ones. ‘..in a sense I apologise again’ – cold comfort for the bereaved relatives. At the time I bravely (or maybe foolishly – I really want to continue working with the NHS) tweeted.. ‘Just heard the re-run of the Nicholson interview. What an incredible lack of empathy and humanity. Shocking.’ Needless to say, this was much re-tweeted.

I have no doubt that Sir David does care, in his own personal way, but is he the right person to lead from the front and introduce a new era of patient first? Charismatic? Empathetic? Accountable? Inspirational?

I think not.