Editorial Monday 18 March 2013: ComradeShambles - not with a bang, but a whimper

Vicarious masochists, sadists and health policy geeks (you do the Venn diagram) can enjoy re-watching Comrade Sir David Nicholson's evidence session to the Commons Public Accounts Committee this afternoon.

The only possible description of the session was a ComradeShambles.

Ignorance or incompetence?
When the only defences open to you are that you were ignorant or incompetent, you are not in a good place. That is where the Comrade-In-Chief finds himself.

Over the course of the session, the Comrade-In-Chief's evasive techniques, including clouds of waffle and failing to answer the questions, became screamingly obvious.

On the basis of evidence to the PAC, the argument that Sir David Nicholson has essential, omnipotent and unique grip over the NHS is also utter bollocks.

Mid-Staffs? Remind me again ...
He was ignorant of whether Martin Yeates (CE of Mid-Staffs) had a gagging clause with his six months' salary pay-off.

Comrade Sir David, however, said that he inferred Yeates did not have a gag from the fact he gave a statement to the Francis Public Inquiry.

Dear oh dear.

Firstly, that statement displays what most people would probably regard as a chronic lack of curiosity about what's happening inside the very NHS of which he was the Comrade-In-Chief.

Secondly, the Comrade-In-Chief has evidently not looked at the Francis Public Inquiry website, which states that "The Chairman is required to take such steps as he thinks reasonable to secure public access to the hearings and evidence taken by the Inquiry.  He may also compel people to give evidence and has powers to require production of evidence  to the Inquiry".

Yeates didn't have a choice about providing evidence to a public inquiry.

Barbara Hakin in "female" shock
It also emerged that Comrade Sir David knew Barbara Hakin was being investigated by the GMC when he appointed her as interim deputy chief executive of the NHSCB, making it very clear to the committee that he regarded her as uniquely able to do the interim job, adding that she is "a very talented female clinician".

Thank goodness we have that on the record. It would be terrible if Dame Barbara were merely a very talented clinician: they are famous for their inability to be interim deputy chief executives of the NHS Commissioning Board.

There was a very funny moment during the exchanges about the consultant contract, when Comrade Sir David claimed that the private sector skews payment rates for elective care upwards. Sadly, no-one on the committee had the nous to call him on the fact that the UK private sector is a tiny boutique with no control over NHS tariff prices (and indeed would be largely bust without the NHS work it does at these prices).

In general terms, it was deeply obvious that no-one on the PAC had read Nick Mays and colleagues' analysis of the New Labour health reforms published by The Kings Fund.

Comrade Sir David also said that he didn't know about the judicial mediation 'loophole'. Ignoratia legis neminen excusat: ignorance of the law is no excuse.

The Comrade-In-Chief asserted that his finance hombre David Flory didn't dismiss Don Berwick's 2008 report on the NHS's "shame-and-blame culture". One MP cited Flory's quotes from the Francis Public Inquiry that the Berwick findings were "outrageous".

Don't run before you can Walker
Towards the end of the session, Comrade Sir David specifically denied that former United Lincoln Hospitals Trust CE Gary Walker's 2009 letter to him said that Walker was making a protected disclosure and so should be regarded as a whistleblower. MP Steve Barclay, who has evidently seen the letter, told Sir David it was in the final paragraph.

Gary Walker is giving evidence to the health select committee tomorrow, which is likely to be fun.

Oh, and after an inordinately long waffle, Nicholson confirmed that all NHS staff with gagging clauses are to be un-gagged. Expect caveats galore once the lawyers get to work.

Stupidity on stupidity
All of this is quite bad enough, but arrives hot on a letter the Comrade sent to trust chairs, which very much appears to ask them to do something that very probably contravenes quite a few employment laws.

It says, "PCT Chief Executives and SHA Chief Executives and Directors are likely to receive substantial redundancy benefits from their employers under the existing rules, however public interest in their payments will be high and I would like you to ensure that this group are individually prepared for the eventuality that information on their packages may come into the public domain.

"I understand the entitlements of such individuals under the rules; however, I would ask you to remind this group of individuals whose redundancy benefits are likely to be significant, of the wider NHS and public sector financial climate. I would ask these individuals to be mindful of this and of the possible reputational damage to themselves and to the NHS should they seek to gain paid employment or consultancy work in the NHS soon after they receive their redundancy payments and after their 4 week statutory break of employment.

"It is my expectation that staff who receive substantial redundancy payments should voluntarily consider not returning to paid work for the NHS for a minimum period of 6 months from leaving or sooner where the redundancy compensation period is less than 6 months. Each case of course must be decided locally on its individual merits taking account of local business needs; the field of candidates available and the circumstances of individuals. We would expect employers to ensure selection processes be transparent and legally compliant in all cases".

That looks unbelievably much like an effort to ensure restraint of trade. Any half-decent employment lawyer will have a field day if people are refused NHS contracts for this reason.

Enough of this. They do say that laughter is the best medicine: perhaps this is Comrade Sir David's attempt to single-handedly create the new NHS culture called for by Robert Francis's recent report.

Though I'm pretty sure Francis didn't think it would be a culture of ineptitude to the point of laughability.

This is the way the Comrade-In-Chiefship ends: not with a bang, but a whimper.