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| Sir David Nicholson: I'm staying to see NHS reforms through | Sir David Nicholson: I'm staying to see NHS reforms through |
| (35 minutes later) | |
| The under-fire NHS boss, Sir David Nicholson, has said he is "absolutely determined" to lead the NHS through the coming health reforms despite calls for him to resign. | The under-fire NHS boss, Sir David Nicholson, has said he is "absolutely determined" to lead the NHS through the coming health reforms despite calls for him to resign. |
| Nicholson said the NHS was at "maximum risk" as the controversial changes were implemented throughout the country. | |
| But the NHS chief executive said he would stay in his role to see the reforms through. | But the NHS chief executive said he would stay in his role to see the reforms through. |
| Campaigners called for his resignation following the publication of the Francis report into serious failings at Mid Staffordshire NHS foundation trust. | Campaigners called for his resignation following the publication of the Francis report into serious failings at Mid Staffordshire NHS foundation trust. |
| Nicholson was in charge of the regional health authority for part of the time that patients were being mistreated at Stafford hospital, where hundreds of patients may have died needlessly after they were "routinely neglected". | Nicholson was in charge of the regional health authority for part of the time that patients were being mistreated at Stafford hospital, where hundreds of patients may have died needlessly after they were "routinely neglected". |
| "At the moment the NHS is facing its greatest challenge," Nicholson told the health select committee. | "At the moment the NHS is facing its greatest challenge," Nicholson told the health select committee. |
| "In the next few days we will abolish over 160 organisations and we will set up another 211 local organisations and a whole myriad of national ones. We'll completely change the way in which we allocate resources and incentivise the NHS. | "In the next few days we will abolish over 160 organisations and we will set up another 211 local organisations and a whole myriad of national ones. We'll completely change the way in which we allocate resources and incentivise the NHS. |
| "At the same time, we have already lost 13,500 administrative and management staff that have all that corporate memory in them. | "At the same time, we have already lost 13,500 administrative and management staff that have all that corporate memory in them. |
| "So it is at maximum risk over the next few days. | "So it is at maximum risk over the next few days. |
| "I said two years ago that I would take the responsibility of leading the NHS through this enormously complex set of changes. I promised both the government and the NHS that I would see that through and I am absolutely determined to do that over the next period." | "I said two years ago that I would take the responsibility of leading the NHS through this enormously complex set of changes. I promised both the government and the NHS that I would see that through and I am absolutely determined to do that over the next period." |
| As the embattled NHS chief executive was grilled in the televised hearing, committee member Valerie Vaz told him: "Please don't feel that this is a trial." | As the embattled NHS chief executive was grilled in the televised hearing, committee member Valerie Vaz told him: "Please don't feel that this is a trial." |
| She then launched into a tough examination of his time as chief of the regional health authority in charge of Staffordshire, telling him: "What struck me about your statement is it is very much like you are a process man and a procedure man. I can't find anything about patients in there and what you are going to do on quality of care." | |
| Nicholson rejected this description as unfair. | |
| At the time, national targets meant that NHS managers had to concentrate on issues such as casualty waiting times and hospital superbugs like MRSA and C diff, he said. | At the time, national targets meant that NHS managers had to concentrate on issues such as casualty waiting times and hospital superbugs like MRSA and C diff, he said. |
| Nicholson told the committee: "During that period, across the NHS as a whole, patients were not the centre of the way the system operated. | |
| "For a whole variety of reasons – not because people were bad but because there were a whole set of changes going on and a whole set of things we were being held accountable for from the centre, which created an environment where the leadership of the NHS lost its focus. | "For a whole variety of reasons – not because people were bad but because there were a whole set of changes going on and a whole set of things we were being held accountable for from the centre, which created an environment where the leadership of the NHS lost its focus. |
| "I put my hands up to that and I was a part of that, but my learning from that was to make sure it doesn't happen again." | "I put my hands up to that and I was a part of that, but my learning from that was to make sure it doesn't happen again." |
| Many of those in charge of Mid-Staffs – including the chairman, non-executive directors, finance director, corporate affairs director and medical director – had all gone as a result of the scandal, he said. "It is not true to say that people weren't held to account in the NHS. They were." | Many of those in charge of Mid-Staffs – including the chairman, non-executive directors, finance director, corporate affairs director and medical director – had all gone as a result of the scandal, he said. "It is not true to say that people weren't held to account in the NHS. They were." |
| Nicholson said the regional health authority had "no idea" what was going on at the trust. "The information was not brought to the strategic health authority, we did not see any of the information which would lead you to believe that there was all of this going on in Mid Staffordshire." | Nicholson said the regional health authority had "no idea" what was going on at the trust. "The information was not brought to the strategic health authority, we did not see any of the information which would lead you to believe that there was all of this going on in Mid Staffordshire." |
| He said he did visit the hospital during the time when problems were emerging but was not alerted to the issues of neglect and poor care. | He said he did visit the hospital during the time when problems were emerging but was not alerted to the issues of neglect and poor care. |
| Committee member Dr Sarah Wollaston asked: "How far do you take personal responsibility for an organisation that has been shown to minimise patient complaints, to gag whistleblowers, to massage mortality data, and bury bad news and frankly to lose sight of the patient in the bed?" | Committee member Dr Sarah Wollaston asked: "How far do you take personal responsibility for an organisation that has been shown to minimise patient complaints, to gag whistleblowers, to massage mortality data, and bury bad news and frankly to lose sight of the patient in the bed?" |
| Nicholson replied: "First of all I don't accept the way that you have described the NHS … but secondly, I have spent 35 years being a chief executive in the NHS and I am completely dedicated to improving services for patients. | Nicholson replied: "First of all I don't accept the way that you have described the NHS … but secondly, I have spent 35 years being a chief executive in the NHS and I am completely dedicated to improving services for patients. |
| "Of course, when I hear bad stories about the NHS, of course I feel responsible. | |
| "I have got the privileged position when I can try and do something about it which it seems to me is what I need to focus my attention on." | "I have got the privileged position when I can try and do something about it which it seems to me is what I need to focus my attention on." |
| He told the committee he believed he was "absolutely the right person" to lead the NHS. "I think I have a duty and a responsibility to manage the organisation over these great changes." | He told the committee he believed he was "absolutely the right person" to lead the NHS. "I think I have a duty and a responsibility to manage the organisation over these great changes." |
| He added: "I do believe that, given my commitment to the [NHS] constitution, given my understanding of the way the NHS operates, given my commitment to patients and the way I conceive things like transparency and opening up the NHS, I think I am absolutely the right person to take that forward." | He added: "I do believe that, given my commitment to the [NHS] constitution, given my understanding of the way the NHS operates, given my commitment to patients and the way I conceive things like transparency and opening up the NHS, I think I am absolutely the right person to take that forward." |
| Nicholson said gagging clauses to stop staff blowing the whistle over patient safety issues were "unacceptable". In a message to staff, he said: "If they want my permission to speak out in public – speak out. Because we will protect them in whatever way we need to do." | Nicholson said gagging clauses to stop staff blowing the whistle over patient safety issues were "unacceptable". In a message to staff, he said: "If they want my permission to speak out in public – speak out. Because we will protect them in whatever way we need to do." |
| Asked about the £500,000 deal reached by United Lincolnshire Hospitals Trust with former chief executive Gary Walker, which required him to keep quiet about his concerns about the trust, Nicholson said: "It is completely and utterly unacceptable. I would never sanction anything of that sort." | Asked about the £500,000 deal reached by United Lincolnshire Hospitals Trust with former chief executive Gary Walker, which required him to keep quiet about his concerns about the trust, Nicholson said: "It is completely and utterly unacceptable. I would never sanction anything of that sort." |
| He stressed that Walker's account of events was "bitterly contested" by the trust. But he added: "I have made it absolutely clear that it is unacceptable and also illegal for organisations to gag people for issues around patient safety and improving services to patients." | He stressed that Walker's account of events was "bitterly contested" by the trust. But he added: "I have made it absolutely clear that it is unacceptable and also illegal for organisations to gag people for issues around patient safety and improving services to patients." |
| Nicholson said Walker's payoff had been undertaken through a process of judicial mediation, which meant it did not have to be signed off by the strategic health authority, the Department of Health or the Treasury. | Nicholson said Walker's payoff had been undertaken through a process of judicial mediation, which meant it did not have to be signed off by the strategic health authority, the Department of Health or the Treasury. |
| "If it's a loophole to get round the department, then it needs to be closed," he said. | "If it's a loophole to get round the department, then it needs to be closed," he said. |
| He insisted the Department of Health was not involved in a last-minute bid by the trust to prevent the broadcast of an interview with Walker on BBC Radio 4's Today programme by sending him a solicitor's letter warning him that he could forfeit his payoff. | He insisted the Department of Health was not involved in a last-minute bid by the trust to prevent the broadcast of an interview with Walker on BBC Radio 4's Today programme by sending him a solicitor's letter warning him that he could forfeit his payoff. |
| "The response of the trust was wrong. They shouldn't have got their lawyers to write to him to say he shouldn't talk about that compromise agreement. He was absolutely right and free and proper to speak out." | "The response of the trust was wrong. They shouldn't have got their lawyers to write to him to say he shouldn't talk about that compromise agreement. He was absolutely right and free and proper to speak out." |
| Nicholson also said he regretted not having met Cure the NHS campaigners when they first raised concerns about standards at Mid Staffs. | |
| "One of the things that I do regret very much is that when all this blew up … I should have made efforts to meet Cure and I didn't," he told the committee. "I dealt with them through intermediaries and that was wrong and that is a big lesson for me to learn. | "One of the things that I do regret very much is that when all this blew up … I should have made efforts to meet Cure and I didn't," he told the committee. "I dealt with them through intermediaries and that was wrong and that is a big lesson for me to learn. |
| "It became almost impossible during the inquiry to do it. I have tried afterwards but, for obvious reasons, they don't want to meet me." | "It became almost impossible during the inquiry to do it. I have tried afterwards but, for obvious reasons, they don't want to meet me." |