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Sir David Nicholson – A Failure Of Leadership

Today’s admission by NHS Chief Executive Sir David Nicholson that there is a culture of denial in the NHS does not come as a surprise.  In my experience it has been this way since at least 1997.  Nicholson’s evidence to the Commons Public Administration Committee confirmed what I believed then, still believe now and also provided a withering condemnation of his own conduct and leadership.

This is a man who has experience of being a complaints manager in the NHS, with 36 years in the NHS overall.  It follows that this is a man who should understand a few things:

  • The S in NHS stands for Service
  • That when a hospital gets things wrong, it can have a massive effect on peoples’ lives, especially where deaths are concerned
  • That complaints should be acknowledged, fully investigated and fully responded to in good time
  • That the hospital should apologise and change its ways so the complaint never arises again

This isn’t rocket science.  Yet

Asked whether complaints should be viewed as a “good” rather than a “bad” thing in the NHS, Sir David said: “There has been a tradition and a culture in the NHS, for some time which has been counter to that.”

I know from experience that this is the case.  Hard questions need to be asked why this is still the case.

“There is a very strong medical legal litigation culture in organisations and at that time, I know, the answer to any complaint was to deny – because of the potential litigation responsibilities for that…  So you have got a culture of that in the NHS which… you have got to tackle.

And which Nicholson hasn’t tackled successfully if the Mid Staffordshire case is anything to go by.

There is quite a lot of pressure on you as an individual, particularly from your staff, to represent and support your organisation publicly. So they are quite powerful things to combat. My argument is they absolutely have to be combated.

And your point is? Representing and supporting your organisation is one thing but doing so at all costs is unacceptable.  Support and praise where relevant but act ethically and properly at all times.

Nicholson was in charge of the Health Authority responsible for Mid Staffordshire Hospital while patients were being mistreated.  His admission is a savage indictment of his performance there:

“I had an opportunity to meet patients’ groups at some stage and I didn’t take it… that is the only thing I regret.”

As a leader there can be no more dramatic a failure than a failure to behave ethically and do the right thing.

Nicholson also had a blast at those voicing their opinions about the NHS on social media.  Senior NHS people need to be very careful when being critical of the public they are supposed to serve.  I have taken others to task for their misguided opinions and now I will address Nicholson.

As a leader I am sure you believe the maxim “perception is reality”.  I am a great believer that this holds true for everyone – if someone has a complaint then that is their reality and you have to do something about it.

I am a fan of the NHS.  Its emergency service is excellent; I would not be here without it.  However, there are far too many occasions when NHS staff get things wrong, often with disastrous consequences for the patient and/or their families.  And the way complaints and concerns are dealt with has been unacceptably wrong for far too long.  You should have done more to change that reality and that perception.

If, as you claim, the suffering of a loved one is something we can all relate to, why has this continued to be the case?

You say that “the NHS began its difficult transition to openness and transparency during the development of ‘High Quality Care for All’ in 2008” yet there were complaints before then.  My own grandfather was mistreated during his last days and the complaint was brushed aside.  The way NHS staff treated me and my family changed my attitude completely.  That is why I spoke out and continue to do so.

There is always room for improvement, but that the Mid Staffordshire failings happened and that you have not forced through a culture change in the way complaints are dealt with show a failure of leadership on your part.

I hope and pray that your successor will have a better understanding of and approach to these NHS failings.


Published inManagementNHS