Charlotte Leslie is Member of Parliament for Bristol North West. Follow Charlotte on Twitter.
The most important moment of the appearance of Sir David Nicholson, Chief Executive of the NHS, in front of the Health Select Committee this week has gone largely un-noticed. It was the moment when Sir David passed responsibility for covering up vital evidence that urgent change was needed in Labour’s NHS away from himself.
It was when he made the extraordinary claim that he knew nothing about three crucial reports that had been commissioned from international experts by Labour Minister Lord Darzi (and not the Chief Medical Officer, as Nicholson told the Committee) to celebrate the 60th Anniversary of the NHS.
These three reports were damning. They were damning of the target culture imposed by a ballooning management, which put meeting targets and cosmetic language above patient safety. Here are some extracts:
“ .. a pervasive culture of fear in the NHS and certain elements of the Department of Health”
“Because of the fear of what will happen if targets are not hit, it’s not uncommon for managers and clinicians to hit the target and miss the point” (NB. Interesting that in his Select Committee interview, Nicholson says he has not read this report, does not know it exists, but uses this particular phrase that appears at least twice in this ‘Institute for Healthcare Improvement’ report.)
“Although there is an emerging aspirational tone across the Department of Health (‘world class commissioning’, ‘clinical excellence pathways’) there are few indications of sufficient attention being paid to basic performance improvement efforts”
Of the rift between clinicians, frustrated or worse that managers were forcing them to put political or managerial priorities above clinical priorities:
“ ‘far too many managers and policy leaders in the NHS are incompetent, unethical, or worse.’ (This statement made, as were others, with considerable anger)”
And of significant problems with quality assessment mechanisms.
“ The Department of Health’s current quality oversight mechanisms have certain significant flaws… One primary care trust CEO estimated that 120 entities have the authority to undertake on-site reviews at Trusts. Many of these entities have overlapping standards and / or responsibilities.”
And responsibility is placed with the Government of the time:
“ This culture appears to be embedded in and expanded upon by the new regulatory legislation now in the House of Commons.”
The urgent alarm bells sounding in these reports should have been published and acted upon with all speed. But someone, or some people, decided to suppress their publication and to bury them – hiding them even from the Health Select Committee. They were only exhumed two years later after a concerned medic tipped off the think-tank Policy Exchange, who obtained them through a Freedom of Information Request.
Between the presentation of these reports to Ministers, and their final revelation to the public eye in 2010, around 2,800 excess deaths occurred, just across the trusts now under investigation by Sir Bruce Keogh. Had the recommendations in these damning reports been acted upon with the urgency the reports made clear was needed, lives could no doubt have been saved.
So who was it who took the decision to suppress the appalling truth of what was going on in our hospitals? More junior officials? Hard to believe since the reports were written at Lord Darzi’s request. This was a very grave decision indeed as it will have cost patient lives.
If we take David Nicholson’s almost unbelievable claim that he knew nothing about these major reports at face value, he has directed our attention to others to find out who buried these potent reports, putting Labour’s political health above patient safety. I have just secured an all-day debate today on Accountability and Transparency in the NHS.
No one is denying that things go wrong in health-care, and the NHS is a difficult beast to manage. (This is just one of the reasons why we need to move away from the great centralised-control model of NHS management of systems, to a more values, professionals and people-based, localised service.) But the real crime is to cover-up the truth of what’s going wrong, for political gain, costing lives.
Who covered up these potentially life-saving reports is just one of the questions in this dark episode of the NHS, to which I hope to get answers.