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Nicholson and Dacre: Two of a kind

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So, how well did David Nicholson do on Tuesday when he faced MPs on the Commons health committee for that three-hour grilling over the NHS’s Mid Staffs shame? Did he handle himself well enough to satisfy Number 10 and Jeremy Hunt that he is not going to be a liability in the coming battles over reform and restructuring?

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‘Watching Sir David’s testimony reminded me of watching Paul Dacre giving evidence to the Leveson inquiry’

Some officials at the Department of Health were afraid he’d lose his rag when baited by grandstanding backbenchers like Labour’s Valerie Vaz and blow the challenge. It was touch and go once or twice as the red warning light on that choleric face started to indicate overheating. But my feeling was it was good enough to keep him at the helm of HMS NHS. “Hitting the target and missing the point,” emerged as a favourite soundbite − and a good one.

Will it have satisfied Paul Dacre, editor of the Daily Mail, who has now been joined (the Mail is the most influential paper in Britain because it leads the media pack) by the Telegraph, The Times, etc? Or the patients groups who want “The Man With No Shame’s” blood? No, of course not. Watching Sir Dave’s testimony reminded me of watching Mr Dacre giving evidence to the Leveson press inquiry: tough, confident, overbearing but also demonstrating sheer grip. Dave and Mr Dacre are two of an autocratic kind.

Yet the session demonstrated Sir David’s weaknesses as well as his strengths. He always sounded more persuasive on organisational and process issues than on personal ones; managers, patients and families alike. He couldn’t remember exactly who he toured that Stafford Hospital with.

Talking the talk

He did apologise (Ms Vaz was carelessly wrong on that point) but doesn’t use the language of openness and accountability until prodded. Then he talks the talk fluently − even protection for whistleblowers and no gagging payoffs on his beat − but with less evident conviction.

‘It was frustrating to see NHS medical director Sir Bruce Keogh reduced to silence for over two hours’

What did I actually learn? That Sir David didn’t know a lot of what went on at Mid Staffordshire. That the NHS’s culture and structures (plus data gathering) have changed hugely since 2005 to make sure it does now. That it is (I quote) “not an organisation but a healthcare system” with hundreds of statutorily accountable bodies. That Sir David was starting to plan a slimmer, cheaper NHS infrastructure as early as 2008-09 when the banking crisis ushered in a low-growth era.

Of course, he knows so much more than most MPs. Committee chairman Stephen Dorrell has been secretary of state (1995-97), but he was basically on Sir David’s side.

Combative colleagues Grahame Morris (Labour) and Chris Skidmore (Conservative) seemed to be absent. Tory GP/MP Sarah Wollaston, Lib Dem Andrew George and Labour’s Barbara Keeley were all politely tenacious. But when the NHS’s chief executive asserts that some of their facts are wrong, they usually retreat.

Sir Bruce’s reminder

MPs might usefully have set the witnesses off against each other, so it was frustrating too to see NHS medical director Sir Bruce Keogh reduced to silence for over two hours, especially because his testimony − when it finally came − was the most emotionally engaging. Why so? Because he reminded MPs that overseas analysis usually praises the NHS for its medical technology and increasingly for its faster timetable.

Where it fails has been personalisation, being treated as one would be at home. When Sir Bruce was still a surgeon the problem was access (ie: waiting times) and anxious couples’ final question about the operation would be “when”. The answer “18 months” would produce “abject terror and tears”. Today’s answer (“next week”) still generates terror (“so soon?”) but the whole debate has shifted to quality.

Good point. Paul Dacre, please note.

Michael White writes about politics for The Guardian

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