NHS boss was 'incredulous' when he heard Andrew Lansley's health plans

http://www.guardian.co.uk/society/2012/jun/21/nhs-boss-incredulous-andrew-lansley

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Tensions at the top of the NHS were laid bare on Thursday when chief executive Sir David Nicholson called publicly on health secretary Andrew Lansley to make the case for radical changes in health care, including hospital closures.

Amid mounting frustration among health managers that ministers are expecting indefinite salami-slicing of services while denying the need for unpopular closures, Nicholson went on the offensive 24 hours after Lansley had said on the same platform that closure decisions were not an issue for national politicians.

In an extraordinarily candid address to the annual conference of the NHS Confederation, which represents health organisations, Nicholson also confessed he had been incredulous when Lansley first outlined his plans for the structural NHS shake-up now being implemented.

And he spoke of his fury at ministers' repeated criticism of public sector management. "I felt angry every time the government came in, starting to denigrate and criticise public sector leaders – people like ourselves who have spent our whole lives trying to improve public services," he said.

Nicholson has had a 35-year health service career and has been NHS chief executive for almost six years. He is due to become chief executive of the new NHS commissioning board, which from next April will take responsibility for overseeing services as the secretary of state relinquishes day-to-day oversight.

Although his relations with Lansley are reputed to be cool, he is held in high regard by Downing Street and the Treasury for his decisive leadership and popularity in the NHS. His position is thought to be secure.

The forthright nature of his remarks, made without notes but clearly considered in advance, will nonetheless prompt widespread surprise.

Nicholson told the audience, many of whom will be losing their jobs or directorships under the shake-up, that the NHS reorganisation had felt like going through bereavement. He had shared their feelings of denial, anger and depression before moving on to acceptance of the inevitability of the upheaval taking effect next year. The NHS and Social Care Act will mean the abolition of primary care trusts and strategic health authorities and the establishment of GP-led clinical commissioning groups.

When Lansley had informed him of these plans, he said, "my immediate response was that they couldn't possibly be wanting to do that".

Lansley had addressed the conference in Manchester on Wednesday and had clashed with Stephen Dorrell, the Conservative chair of the Commons health select committee and himself a former health secretary, over the issue of hospital closures. While Lansley argued that ministers should stand back from debate and decisions over changes to services, which were a local matter, Dorrell called on them to take a lead.

Citing a speech in 1961 by Enoch Powell, then health minister, in which he proposed the wholesale closure of long-stay mental hospitals, Dorrell said the NHS faced a similar challenge today. Politicians had a duty to explain why radical changes were necessary.

Nicholson picked up the theme yesterday, saying pointedly that Dorrell's contribution had been the most important of the first day of the conference. He said the only alternative to rethinking health care, which would involve service closures, was to carry on making so-called efficiency savings to try to keep balancing the NHS books. The NHS in England already faced making £20bn of such savings by 2015.

Continuing down that road beyond 2015 would be a "dangerous" strategy because it would risk repeats of the scandal in mid-Staffordshire hospitals, on which the Francis public inquiry was due to report in the autumn.

Referring to Powell's speech, Nicholson said: "In lots of ways, it's the sort of speech we need our national politicians to make at the moment. It's being honest with the public about the nature and scale of change that's required in order to live in a world where we have great outcomes for patients, universally available, but within the resources that we have."

Offered the opportunity later to clarify his comments, Nicholson only repeated them. "Without political leadership," he said, "it's quite difficult in the circumstances to have this debate with the public in this country about what services [we can afford], free at the point of use and available to all, within financial constraints that we will have, not just over the next two or three years but probably for as long as all of us will be in the NHS."

A key test of political nerve on service closures will arise next week when NHS leaders in north-west London discuss plans for a public consultation on changes that Nicholson described as the most wide-ranging ever proposed.