Today at 12.00 Cure the NHS and Patients First will be handing in a devastating critique of David Nicholson’s leadership of the NHS. It throws down the gauntlet to the PM – are you prepared to put the reform of the culture above his own reform programme.
Full text below
The Rt Hon David Cameron MP
10, Downing Street
London SW1A 2AA
14th February 2013
Dear Prime Minister
We represent the views of concerned patients, concerned clinicians and NHS whistleblowers and believe that we can talk with authority about the NHS and its culture.
We are writing to you because of our extreme disappointment at the Government’s response to the latest report into Mid Staffordshire. We wish to draw to your attention information you may not have been aware of when you expressed your support for Sir David Nicholson, the Chief Executive of the NHS.
The Francis report condemns the ‘culture’ of the NHS but any organisational culture is set or heavily influenced by its leaders and in this case specifically the Chief Executive of the NHS.
In 2008 the Joint Commission International Report said of the Department of Health/NHS culture that
A ‘shame/blame’ culture of fear appears to pervade the NHS and at least certain elements of the Department of Health.
Furthermore it stated that this culture ‘stifles’ the development of an organisation and its ability to deliver ‘quality and safety’. A damning indictment.
In the same year the Institute for Healthcare Improvement report to the Department of Health gave an example of the mindset in the NHS:
The NHS has developed a widespread culture more of fear and of compliance than of learning, innovation and enthusiastic participation in improvement.
They highlighted typical comments:
The risks of consequences to managers is much greater for not meeting expectations from above than for not meeting expectations of patients and families.
Given this was the national culture it is hardly surprising that the first Mid-Staffordshire report stated:
This evidence satisfies me there was an atmosphere in which frontline staff and managers were led to believe that if the targets were not met they would be in danger of losing their jobs.
It is not clear whether the senior leaders of the NHS have created this culture or whether they are simply incapable of changing it. Sir David Nicholson was put on notice of this dangerous culture and its potential impact on patient safety as early as 2008. There is no evidence that he changed such a dangerous culture, indeed the reverse.
More recent reports (November 2012) in the Health Service Journal suggest the culture persists with a headline:
NHS Chief Executives highlight a ‘climate of fear’.
We would cite a notorious example of a failure of moral leadership. Mr Gary Walker the brave Chief Executive of United Lincolnshire Hospitals NHS Trust personally blew the whistle to David Nicholson and other senior NHS staff about the conflict between targets and safety. The result was that he was sacked and around £0.5m intended to be spent on patient care was instead spent on gagging Mr Walker and his witnesses to keep highly damaging papers implicating senior NHS staff from public scrutiny. Given the involvement of very NHS senior staff in the planned Employment Tribunal it is inconceivable that such a cover up was not sanctioned at the highest of levels.
You have been written to separately with very serious complaints about the involvement of senior civil servants in this particular cover up and the failure to investigate those complaints, first made in July 2012.
Sir David’s repeated failures to support whistle-blowers is indicative of concerns that he will not command the respect of staff in creating the open and transparent culture called for in the latest Francis report. His assertions to the Inquiry that Mid Staffordshire was ‘singular rather than the systemic’ was described as ‘a very dangerous attitude to take’ further underlining the lack of confidence we have in him taking the culture change forward.
Our call for Sir David to go is not scapegoating; it is asking for the accountability called for in the Francis report.
There is media speculation that your support for Sir David is driven by his importance to the government in driving through the current reform programme. With respect there is no reform programme more important that a change in the culture of the NHS. We hope that in the light of this new information you will appreciate that Sir David will not command the necessary respect of patients, or staff confidence, in leading that cultural reform programme and that he should stand down.
It is often said that opinion polls show that the public do not regard the NHS as being safe in the Conservative Party’s hands. You have the opportunity of taking the sort of decisive action which could change that image.
Yours sincerely,Dr Kim Holt, Consultant Paediatrician MBCHB BSc DCH MRCP MSc, Chair of ‘Patients First’ and Lead Consultant. Julie Bailey, for ‘Cure the NHS’ Jennie Fecitt, RN, BSc (Hons), Specialist Practitioner (Adult Nursing), NMP, PGCE Lead Nurse, ‘Patients First’.