The media, and social media, is full of views and comments about the NHS… – David Nicholson

The media, and social media, is full of views and comments about the NHS.  This is my first attempt to add to them from the distinctive position I have in working for the NHS and with patients for 36 years, in almost all aspects of the service.

The thing that characterises the views and comments for me is the lack of balance.  For example, this time last year, in the wake of the Olympic Opening Ceremony, there was an outpouring of praise for the NHS.  It was almost as if support for it had become close to being a religion.  Read the newspapers over the last few weeks and it appears the NHS has become one of the worst health care systems in the world.  In truth, neither of these two things are true, and this is the dilemma.

Over the last few years hospital mortality has fallen significantly. At the same time the NHS has continued to fall short in the care of some of our patients, indeed for a small minority it actually causes them harm.  Both of these statements are true, and if you chose to ignore either than we are in trouble.

This is compounded by the nature of the statements and the hooks they use to draw people in. Hospital Mortality is a system wide issue, only commented on by individuals with system wide responsibilities, people like me.  Harm to patients on the other hand, is an individual issue, the pain and suffering of individuals and their loved ones, something we can all relate to.

We need to find a better way of having a conversation about what is happening in the NHS that recognises both.

At the heart of this debate must be openness and transparency and how it can improve services for individual patients, as well as the overall performance of the NHS.  Although some pioneers can predate their commitment to it, in practice, the NHS began its difficult transition to openness and transparency during the development of ‘High Quality Care for All’ in 2008.

The explosion of data available through NHS Choices, the definition of quality, the focus on outcomes, evidence based standards, ‘giving patients more clout’, together with Freedom of Information legislation, started to transform the environment we all worked in.  Add to that the increasing availability of data, and the use of social media, there is an enormous opportunity, but also an enormous challenge to public sector leaders.  The question is are we up to it?

Categories: David NicholsonHomeNews



  1. I think that everything posted was very logical.
    But, consider this, what if you composed a catchier title?
    I am not saying your information isn’t good, however what if you added a
    title that grabbed a person’s attention? I mean NHS England

  2. Pearl Baker says:

    Like yourself I have also worked in the Mental Health field for over thirty years, providing Advocacy and Advisory in a Psychiatric Hospital and the community.

    I was the carer representative for the Mental Health National Service Framework, and have sat on many NHS Committees.

    I am sorry to report there has been little change in the way those suffering from severe mental illness are cared for. When the CCG state we are not responsible for this group you have a problem.

    Many of my clients are no longer in contact with Psychiatrists, and only see their GP (who according the my CCG are not their responsibility).

    The concept of CPA meetings for this group is foreign to the GP.

    I have suggested that GPs write a report for the CPA meeting on their patient.

    I have also suggested to the CCG that GPs refer over weight patients to the local gym, as they do with heart and joint patients. I understand they have a contract with them. This information should be included in their report to the Care Co-Ordinator of the CPA Meetings. Community support workers should be available to individuals requiring their assistance. Section 117 of the Mental Health Act requires this is provided free to those that qualify.

  3. Paul Cardin says:

    I’ve found some not very helpful articles in the media since Sir David’s article above was published. The details appear to confirm that Sir David and two colleagues were coached by consultants prior to appearing before a Public Accounts Committee on 12th June 2013.

    A freedom of information request learned that the costs of the coaching amounted to £73,563 over a 52 day period. Or £36,500 per hour of committee. Given the level of public money expended, I’m not surprised that Sir David chose not to refer to these costs in the article above, and I’m concluding that once again, the overbearing closed off and defensive culture has intervened to win the day.

    We’re assured by the Department of Health that the decision to coach witnesses was not policy and that it will not happen again, however past experience tells us we cannot take such assurances on face value.

    I’ve lodged three freedom of information requests following the 3rd July 2013 meeting of the Public Accounts Committee where Sir David appeared again, along with two senior colleagues.

    If I’m permitted by the moderators of this blog, I’ll update this thread later with my findings. Hopefully, given Sir David’s recent comments regarding response times, openness and transparency, full replies will appear within the next 20 working days.

    • NHS England says:

      Thank you for you post.
      At the committee you referred to there were three witnesses who appeared, two officials from the Department of Health and Sir David from NHS England who was there to answer questions on his time as NHS Chief Executive. The Department has been clear that the support was procured by one of the officials from the DH and not by Sir David.
      The Department has also been clear that this will not happen again. For Sir David’s three most recent appearances before select committees no external consultants were engaged to help him prepare for his appearances. There was therefore no expenditure on consultancy fees.

  4. I believe engaging with social media is right and it’s inevitable but it also feeds into the blame culture and the impossible pressures exerted within and from outside the NHS and its sub-systems. To address this, we need to take a more social and psychological approach to how groups work and what happens when one group – in this case ‘patients’ – is perpetually perceived as the outside group. Collaborative effort in health care – and that includes dissemination of data and statistics – I don’t believe will be properly achieved until we (they) figure out how to be partners with people instead of authorities over them (us). I would begin by looking at how often the term ‘patient’ (passive, dependent?) is used when just plain ‘people’ would do nicely.

  5. Hi there colleagues, nice piece of writing and nice urging commented at this
    place, I am genuinely enjoying by these.

  6. LYNNE HEAL says:

    UK needs a new direction with multiple scelerosis via Interventional vascular radiologists and move UK forward in the World a new way forward for amuch better quality of life over 40,000 have now had with CCSVI a very undangerous procedure and easy to do too. Aftercare is the most important

  7. Is it true that comments are switched off on this article? Only one way to find out!

    • Seth Edwards says:

      It is not true…
      Valid comments and insights are always sought and published. We do not switch comments off because we do not approve of them -however, where a comment is unhelpful to the conversation we are hosting, we do intervene.

  8. George Brooke says:

    It is a matter of attitude that so angers patients, relatives and of course the media.
    If an organisation such as IBM, were to announce that there were over a thousand deaths due to lack of care in design and quality there would be dismissals of staff responsible and a massive and public scandal. Serious reorganisation of the system which allowed this to happen would follow. However, when the NHS announces such a situation, no one is dismissed, the system carries on as before and the media are accused of “unbalanced reporting”. The attempt to hide behind the barricades does nothing for the many medical staff who perform a good job.
    Having worked with the NHS in several locations, my opinion is that the issues are with management rather than technical. I am sure that I am not alone in this thought.

  9. Irene123 says:

    I work in the Nhs and I am disappointed that Sir David Nicholson has not done more to galvanise his workforce. I have worked in the commercial world for 2 large global companies where the Chief Executives even while travelling the world on business have done fortnightly/monthly webair updates to galvanise staff. So that the corporate ethos is embedded in the workforce. I would welcome Sir David embracing the technology and do staff webair updates on a regular and ongoing basis.i know my colleagues would welcome this as well

  10. Marcus says:

    It would be a good start if you would publish your email address so that people can contact you.

    Look forward to seeing this.

    • Seth Edwards says:

      Hi Markus – I am afraid that it is NHS England policy not to publish idividuals’ email addresses.

      • Marcus says:

        David Nicholson said:

        “We need to find a better way of having a conversation about what is happening in the NHS that recognises both.”

        So, how can people contact him?

        • NHS England says:

          Hi Marcus

          Further to my reply to you of 1 July I can now confirm that Sir David Nicholson does have a public facing email address:

          My apologies for the earlier confusion.

  11. Caroline Jessel says:

    David is right- we need to embrace social media to have a more immediate, direct and “real” conversation with the public -avoiding the distortions often seen in the print media and ensuring all voices can be heard

  12. Marie says:

    A very valid question and I hope with all my heart that we are.

    I am actually pleased to read this, because I have to say I find the unbalance in views shared to be not only concerning but also disconcerting, particularly as they are sometimes shared by colleagues. I like to believe that we are all here to make a difference and to enable the answer to Sir David Nicholson’s question to be a resounding ‘YES!’ but I also believe that we need to start supporting our organisations with positivity, rather than jumping on the bandwagons of despair and ‘whippings’. Realism is about balance, before I am told to ‘get real’.

    We need to become much better at celebrating and sharing our successes, rather than only fuelling the the poor views. Yes, we need to be open about our shortcomings, but why shouldn’t we be open about our successes too? It is something that I have found most perplexing throughout all of the NHS organisations I have had the pleasure of working for – we just dont make enough about what we do well. I don’t believe this would be hiding our shortfalls and areas we desperately need to improve (Mid Staffs should never ever be forgotten), but let’s support those staff who deliver an excellent service and allow them to feel proud.

    I am proud to work for the NHS; a free healthcare service to all at the point of need. I know we can improve and save even more lives; I just hope that when we do get it right, we remember to celebrate and not focus on when we didn’t get it right. We always need to remember the ‘bad’ but that doesn’t mean we should forget the good.

  13. Daphne Havercroft says:

    It seems to me that the newspaper debate is not about the NHS, it is about its leadership.

    It is only when conversations fail or are avoided that the newspapers become involved. They are a last resort for people when their concerns are ignored by NHS organisations and regulators. Similarly many people who take legal action for medical negligence do not do it for the money. They do it as a last resort because they feel their concerns are not being taken seriously and they want lessons to be learned so that others do not suffer in future.

    The Board of NHS England might care to reflect on all the opportunities missed by NHS organisations and regulators to have conversations. Inevitably some conversations are difficult, but the best leaders do not shy away from them.

  14. alan needham says:

    I agree we shouldnt rest on our laurels about our performance and when things go wrong – but we also have to be honest about this recent ‘media onslaught’ and see it for what it really is – a political strategy brought on by those who really don’t have the NHS’s best intentions at heart.

    For many (especially of a neoliberal tendency) the principles behind the NHS will always be anathema – and doesn’t fit well into the post Keynesian world that has been created. Like hawks many are now circling ready to cherry pick large swathes of our services and to divert public funds into private pockets. But to do so it is first necessary to break the public (and staff) attachment to a popular institution (a strategy which seems to be working)

    In my eyes there is no dilemma – the NHS has never been perfect, but in the round its probably as good as can be achieved for the amount of money that is put in. If the public really want quality and well trained (and qualified) staff, the bottom line is that they need to pay for it – THAT is the debate we should be having but which nobody seems to want to start

  15. Mary E Hoult says:

    Having attended lots of board meetings for SHA/PCTs/ Acute Trusts over many years as a member of the public, it is clear things need to change if we are to have openness and transparency,.Some of the Non Executives and Executives don’t even make eye contact with the public let alone acknowledge their presence.
    Questions are not allowed in most organisations there are a few exceptions,I was really pleased when NHS England did allow comment on their website.Sir David is right about a balanced debate but how can that be achieved when the public wanting to engage are treated so badly?

  16. Thank you Sir David for recognising the value of data and means of disseminating it through social media. We all need to make the most of this to put good quality evidence in the public domain, and use it for the improvement of the NHS.