21st February 2013 

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News and Comment from Roy Lilley

The result of our poll will come as unwelcome news to the Big-Beast. 91% of you think he should step down. Is it fair to say he has lost the confidence of the work-a-day NHS?


I recognise him as the man who did his best to blunt the worst excesses of LaLa's stupid reforms. Nevertheless, the mess on the ground is unbelievable and a top-down empire is being rebuilt with the bricks from demolished PCTs. The Beast only knows top-down.


You could argue that he spotted the need for NHS austerity and the so-called Nicholson Challenge was an attempt to put some rationale behind the use of resources. The QIPP agenda an attempt to give savings some shape and purpose. The reality is the scramble to save money and the fear of not doing so, has descended into cuts, redundancies, damaged services and the NHS running on the vapour of vocation.


It is equally possible to say that the NHS is a loose federation of the awkward squad and managing it with anything other than an iron grip would be impossible. The problem is 'grip' has been translated into control and as the situation turns more desperate has become rule and command. Where inspiration and management talent runs out, force and bullying takes over.  Bullies always work for bullies.


I know the Big-Beast has been an unfortunate victim of circumstances; a busted economy and ham-fisted political meddling. What might he have done differently? Everything or perhaps nothing. He is what he is. His know-how comes from years, unchallenged, at the top. The Carbuncle won't challenge him. Too many owe their positions to him and the others know too little about running one of the world's largest healthcare systems.


Some say, in time, all NHS staff end up hating the boss. Wrong. Many NHS leaders have been held in high esteem and affection right to the end.


In Pulse Magazine, so-called, GP leaders backed the Beast; Laurence Buckman (BMA), said blaming Sir David was not 'useful'.  What would be? Mike Dixon, NHS Alliance, twaddled on, blaming 'the system'. Er, whose system if not the Big-Beasts?  RCGP chair Lady GaGa, confusingly said 'leaders should be held to account' ... but, 'Sir David should not resign'. Er?  


Maybe they all benefit from too close a relationship with the Carbuncle and DH and have more than a small interest in buttressing an establishment that they are part of.


The HSJ rushed to the Big-Beast's aid, commissioning an old-school opinion piece by another Knight of Healthcare John Oldham (Who?).  Normally a good guy but this is just hopeless; 'Leaders do shape the culture of the organisation,' he says.  Er, isn't that the problem; 'the culture of the organisation'?  He should have read another Knight's comments in the Telegraph!  Oldham seems to imply the NHS is too dislocated and big to manage.  Nevertheless, a good tactical move for the HSJ; if the Beast stays they remain his friend and stay in the tent.  If he goes, they were 'striking a balance', and stay in the tent.  


We are now left with the hope that the dark-art of changing 'culture' will save us. No one knows how.


Will whistle-blowing phone-lines, law and regulations encourage people to say the things that they have seen cost others their jobs, homes and families? Culture takes years to cultivate and grow. We have just months to change the working climate.  


The NHS needs an urgent fresh start. The Carbuncle won't do it, it is merely a branch of the DH; full of ex-DH staff who owe each other.  The sensible ones have jumped ship.  


The NHS is badly damaged. If LaLite had any sense he'd make a clean sweep at the Carbuncle.  If Malcolm Grant, chair of the Carbuncle, had any nous he'd do it first; before he is sucked into the vortex of yesterday's management proclivities.  The pressures of money, morale and muddle creates a toxic cocktail that will corrode the NHS and eat into the heart of the service.


I'm sure the Big-Beast thinks he alone can save the day and there is no one else.  Others take that view, too. Not true; were he to be run over by the apocryphal Number 9 bus, there are several who could step-in.  


David Nicholson is a good man but emblematic of a past the NHS needs to scrape from its boots. We cannot have a fresh start and mean it, without new leaders who mean it.


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