Sir David Nicholson will retire from his role as Chief Executive of NHS England, and from the NHS altogether, in March 2014.

The announcement of his retirement will relieve the pressure on him to resign following the Francis report, which implicated him in the Mid Staffordshire tragedy.

It also means that he will not have to deal with growing anger over revelations that the ‘Nicholson challenge’ of cutting £5bn from the NHS budget each year means an absolute cut in the NHS budget.

A former Communist Party member, Nicholson has been a strong supporter of current Conservative health policy: he began implementing the Health and Social Care Act prior to its approval by Parliament.

However, last autumn he warned that “carpet bombing” the NHS with private sector providers would lead to “misery and failure”. NHS reform needed to support clinical decision-making, he argued.

The Francis report into the unnecessary deaths at Stafford Hospital between 2005 and 2009 found that Nicholson, as head of the region’s SHA, had not acted on warnings about the hospital’s high death rate.

While the Francis report blamed inadequate staffing levels and bad management for the tragedy, Nicholson pinned the blame on the Labour Government’s infection control and waiting time targets.

Nicholson has worked in the NHS for 35 years, and was NHS Chief Executive for almost seven years. In April this year he became Chief Executive of NHS England, a role effectively continuous with his previous one.

In a letter to Professor Malcolm Grant, Chair of NHS England, Nicholson declared his continued support for the NHS reform process: “I still passionately believe in what NHS England intends to do. My hope is that by being clear about my intentions now [I] will give the organisation the opportunity to attract candidates of the very highest calibre so they can appoint someone who will be able to see this essential work through to its completion.”

Nicholson’s retirement will quieten the controversy over his role in the NHS reforms of this and the last government, and allow recognition of his lifelong commitment to the NHS.

Sir David Nicholson, Chief Executive of the NHS, could be charged with corporate manslaughter in a private prosecution over Stafford General Hospital.

A member of the public has applied to Camberwell Green Magistrates’ Court for permission to charge Nicholson with corporate manslaughter and misconduct in public office, as well as perverting the course of justice.

Alan Edwards of Greenwich, London, a former investment banker, seeks to convince the court that Nicholson has a prima facie case to answer – i.e. that his guilt is plausible on the known evidence.

Edwards hopes to call on witnesses including members of the Cure the NHS campaign; CQC board member Kay Sheldon and former CQC investigator Heather Wood; and patient groups representing families.

“The regulatory system is just not fit for purpose,” he said. “That is why I am doing this and because there are serious failings across the health system which means things like deaths are covered up.

“We will seek full disclosure of all correspondence with David Nicholson’s office to find out about all of the information he received, what information he had and what he did with that.”

Nicholson has already claimed that the Labour government’s infection control and waiting time targets were responsible for the deaths because they distracted healthcare professionals from care quality.

Legislation allowing prosecution for corporate manslaughter was passed in the UK in 2007.

Private prosecutions for serious crimes are rare in the UK, though precedents exist. It is not clear whether Edwards will be cleared to bring the prosecution.

The Department of Health commented: “We see no basis for this case.”

NHS Chief Executive Sir David Nicholson has told the Health Select Committee he does not intend to resign over the Mid Staffs enquiry.

Nicholson, who led the Mid Staffordshire Foundation Trust for 10 months during the period when neglect and abuse of patients caused over 400 deaths, has blamed the Labour government for the abandonment of care.

With the endorsement of PM David Cameron, Nicholson also claimed he is what the NHS needs to see it through the critical period of reform.

An early day motion signed by 40 MPs has called on Nicholson to resign after the Francis report made it clear that he had failed to intervene in the regime at Stafford General Hospital when Chief Executive of the regional trust.

The Francis report made it clear that the trust’s focus on qualifying for Foundation trust status by slashing budgets and cutting staffing levels was the underlying reason for the Stafford General Hospital tragedy.

However, Nicholson – who started driving through Lansley’s NHS reforms on the ground long before the Health Act became law – avoided saying anything to the Health Select Committee that might lead them to doubt the safety of the reforms.

Instead, he placed the blame for the disaster on two policies that were specific to the Labour government: treatment access targets and infection control targets.

“There were a whole set of changes going on and a whole set of things we were being held accountable for from the centre, which created an environment where the leadership of the NHS lost its focus,” he argued.

Furthermore, he claimed, the NHS “is at maximum risk over the next few days”, when the old structures are dissolved and the new ones become fully operational, and he is the only person able to manage those risks.

Critics may suspect that Nicholson has won Cameron’s support by placing the blame on the Labour government and distracting attention from the threats to patient safety that are intrinsic to the current NHS reforms.

A report from the Department of Health shows that the NHS is on track to deliver up to £5.9bn savings this financial year, ahead of its annual target of £5bn cuts per year.

The Quarter 2 report claims that the NHS has maintained or improved the quality of services in eight key quality areas, including infection control.

However, the report does not acknowledge the impact of ‘red lists’ in rationing NHS treatments.

The report sets out NHS financial and quality performance from July to September 2011, and claims key quality successes:

• MRSA infections were reduced by 33% and C. difficile infections by 16% relative to the same quarter last year.

• The 18-week waiting time target continued to be achieved for 90% of inpatients and 95% of outpatients (though increases in waiting times have been reported by many NHS trusts).

• The NHS has continued to meet key cancer treatment standards.

The report predicts a year-end surplus for the NHS of about £1.2bn for 2011/12. PCTs estimate that they can achieve £5.9bn savings in this financial year – a major improvement on the £4.3bn saved last year.

The DH pointed to examples of local NHS initiatives to shift healthcare into the community and give patients more control over their own care, including:

• a home nursing service for children and young adults with asthma in South East Essex

• individual care plans for frequent ambulance callers developed in Kirklees for use by ambulance crews and A&E clinicians.

David Flory, Deputy Chief Executive of the NHS, commented: “The NHS is in the early stages of its plans to deliver up to £20bn of efficiency savings by 2014/15 whilst maintaining or improving quality. The results from the second quarter of 2011/12 are encouraging, showing the NHS continues to deliver strongly for patients while maintaining a healthy financial position.”

However, the health impact of the Audit Commission’s ‘red lists’ of drugs and procedures, restricting availability to the most severe cases, is not discussed in the report since outcome targets do not refer to care that is no longer provided.

Bolton-based medical consumables company Vernacare has emphasised the importance of teamwork and partnership for their development of the world’s first pulp wash bowl, which won a Queen’s Award for Enterprise 2011.

The Vernacare wash bowl (pictured) is used by hospitals in more than 270 NHS Trusts and across the globe for patient care, wound and continence care, hand washing and surface cleaning.

In a study reported in the BMJ, Vernacare’s wash bowls were among a package of measures that led to a 50% fall in cases of C. difficile at Salford Royal NHS Foundation Trust over 12 months.

Karen Haslam, Chief Executive of Vernacare (pictured, left), praised the company’s team and the clinicians who had helped them to develop and trial the product. “We developed our single-use wash bowl in response to customer demand,” she said. “Nurses told us they were concerned that re-using plastic wash bowls without properly cleaning and drying was a significant infection risk.

Vernacare’s previous pulp products were permeable to warm soapy water, she added. “This was a major challenge that took our in-house team two years of painstaking research and trial and error to overcome.”

Heather Dakin, Senior Nurse Infection Control at Colchester Hospital, said of the product: “Nursing staff found that they had more time for patient care and didn’t have to worry about decontaminating plastic bowls. They also found that wards looked much tidier as the pulp can be stacked on racking provided by Vernacare rather than hanging from lockers or beds collecting dust.”

Vernacare provides single-use pulp products for patient waste management and a macerator for disposal. The products are used in over 90% of UK hospitals and more than 50 countries.

The photo shows Karen Haslam and Maria Sinfield of Royal Bolton Hospital with the Queen’s Award.

Collaboration between infection prevention specialist Steris and an NHS trust has reduced hospital infections by two-thirds, using a decontamination technology embedded in new working practices.

North Tees and Hartlepool NHS Foundation Trust has achieved a 66% reduction in C. difficile hospital-acquired infections (HAIs) through a rolling programme of deep cleaning and decontamination of the hospital environment and patient equipment with the Steris BioGienie system.

The team also developed a reactive service whereby a ward hygienist was contacted before or immediately following the discharge or transfer of patients with C. difficile, and the BioGienie system was implemented.

Graeme Kelly, Quality and Decontamination Manager at the Trust, explained: “In October 2009, we established a programme of regular proactive decontamination of all wards using five Steris BioGienie hydrogen peroxide disinfectant delivery systems. This was made possible by the Trust creating a decant ward to allow for the temporary relocation of patients.

“We immediately noticed a significant reduction in all HAIs, including MRSA and norovirus, and data accumulated since then has confirmed a 66.46% reduction in C. diff. HAIs within 18 months of the start of the programme. The BioGienie has enabled us to put easy, effective and safe systems and protocols in place.”

Steris is a leading UK provider of products and services for infection prevention and safe surgery.

 
BioGienie in ward