This morning, Sue Cameron wrote in the Telegraph that she did not believe that Sir David Nicholson should be sacked from his job as Chief Executive of the NHS Commissioning Board (and of the English NHS) because of failings in his old job as Chief Executive of Birmingham and The Black Country Strategic Health Authority, West Midlands South SHA and the Shropshire and Staffordshire SHA where the Francis Report recently made clear that patients were “routinely neglected” and as many as 1,200 people had died unnecessarily because of failures in management and clinical performance. She makes what seems a logical argument – that he didn’t make the regulations, that he oversaw more than 50 individual hospitals, that he was not responsible for clinical decisions or the catastrophic lack of care delivered by medical staff, and that he is admirably suited for his current task in delivering the changes to the NHS under the 2011 Health and Social Care Act.
And yet… He was paid to manage those hospitals. He was paid to lead the people who worked in them. He was paid to ensure that the founding principles of the NHS pertained. He should have known what was going on. He should have been sufficiently interested in the care his hospitals were providing and the outcomes they delivered to notice that their mortality rates were significantly higher than could have been expected. As an aside, this is where the value of open data comes into its own – if only there had been more people able to see the patterns and draw the conclusion that that hospital was dangerous.
Perhaps, though, the biggest lesson for all of us to draw is a more complicated one – that where we can see that public services are failing, we must speak out. As we elect MPs to legislate, to decide in our collective best interest, and to hold the executive to account, they too must speak out when they know that a hospital is not doing its job properly. As medical care generally becomes both more and more specialised and more and more advanced, we must accept that smaller hospitals, with fewer patients needing particular specialisms, are not always the best way to provide the best care. It is incumbent on MPs – and other community leaders – to argue the case for the best possible medical care for their constituents, not just the same buildings and offering as have been there for years.
One of the very best things about this government was their initial radicalism on public services – that they should serve the public, that the public should be able to make informed choices, and that innovation and choice and control should not only be allowed but encouraged. The way to drive up standards is to allow people the information to enable them to make choices, and for those choices to drive the provision of services because those which are not good enough close down, thereby driving up standards overall.
But the only way that this can happen is if firstly, there is accountability for outcomes and secondly we actually mean it when we say hospitals which aren’t good enough will close. And the only way that that will happen is if MPs stop protecting inanimate objects and vociferously argue for the best public services for their constituents.