Sir David Nicholson testimonials this week"s healthcare news

‘Working with large pharma is usually difficult,’ says David Nicholson, who says AstraZeneca was ‘streets ahead’ of Pfizer. Photograph: William Vazquez/AP

It has been a very good week for information in the sense that, for as soon as, the focus has been on the genuinely essential challenges to bettering health and healthcare.

Final week BBC Newsnight interviewed the existing poster boy of economics, Thomas Picketty. In his guide Capital in the Twenty Initial Century he analyses the developing gap between rich and poor.

The starting of this week noticed the direct impact on the wellness of children of inequalities, with the publication of data showing the UK’s bad record on kid mortality. The response from Royal College of Paediatrics and Youngster Health (RCPCH) was swift. Dr Ingrid Wolfe explained:

“Crucially, risk of child death disproportionately impacts poorer families. So the emphasis has to be on minimizing the gap in between rich and poor. Britain is a single of the most unequal societies in western Europe and it truly is no coincidence that our youngster mortality price is also the worst”.

A main challenge to healthcare programs in North America, Europe, and more and more in India and China, is the boost in the number of people struggling from 1 or more lengthy-term conditions and here this week, the Every day Mail and the Every day Telegraph have not let us down.

There is no doubt that the NHS and overall health experts could do much more, and without a doubt high quality would go up and cost would come down, nevertheless the consequences – ie men and women taking much more control of their very own well being and healthcare and reducing the size of hospitals – are not explored.

A major way in which companies for men and women with long-phrase conditions can be enhanced is via integration. The Far better Care Fund (BCF) is an critical plank in the government’s ideas and this has been a week of: “Is it on or is not it?” Chris Ham and the Kings Fund have weighed in. The best source of info is on the Integrated Care These days internet site. There is no doubt that the BCF has the prospective to minimize through several of the obstacles dealing with folks integrating services on the ground but the truth that half of it will come from cash currently invested in the hospital sector will usually make it risky. My guess is all of this, including regardless of whether it is merely extremely hard to provide, will be clear in the summer time when some tough choices will need to be made.

So a week of tackling massive problems in the information – health inequalities, youngster mortality, diabetes, asthma, integration – ends with a major problem for healthcare in this country, innovation and, in certain, innovation in pharma. There has been a lot comment this week, the most exciting in my view coming from Guardian columnist Seumas Milne. All I can say on the matter is that functioning with large pharma is constantly tough. Over the years, I have worked with each Pfizer and AstraZeneca we produced great relationships with the two but AstraZeneca was streets ahead. They “got” the NHS, they understood it and although they needed to make funds, they bought into the mission of enhancing outcomes for sufferers, and they place their income where their mouths are, funding posts and working with us strategically. But hey, possibly that isn’t going to matter to shareholders.

Are you a member of our online community? Join the Guardian healthcare network to obtain typical emails and unique offers.

Sir David Nicholson testimonials this week"s healthcare news

David Nicholson - the man who believed in becoming ruthless with the NHS

At a time when there was no actual-phrase growth in overall health spending, 168 NHS organisations have been closed down – and 211 new ones created. Some of the Kafka-esque consequences are only now emerging: this kind of as 4,000 health employees made redundant, with regular pay out-offs of £43,000, before currently being rehired by the NHS. All 48,000 senior men and women in the NHS felt the force of the changes and not all had been content with the Nicholson technique. “The downside of grip is that if the grip is round the throat, it does not leave a lot area for manoeuvre,” claims Mr Dorrell.

Sir David says accusations of his bullying are unfair, then turns to the press officer in the corner and roars: “You wouldn’t say I was a bully would you?” The Nicholson reputation for command and control goes back to his pupil days at Bristol Polytechnic when he joined the Communist Party. He did so because the communists were the only student group ready to welcome refugees from the Pinochet dictatorship in Chile.

But it was the Right-wing Tory Enoch Powell who set youthful Nicholson on the path of modifying the encounter of the NHS. In 1961, Powell, then wellness minister, announced programs for a 50 per cent minimize – 75,000 beds – in the country’s psychological asylums, saying: “If we err, it is our duty to err on the side of ruthlessness.” In the Seventies, 1 of Sir David’s initial jobs was to shut mental hospitals in Yorkshire with money from a so-referred to as alter fund. In his last years with the NHS – tomorrow is his final day – he has yet again been closing hospitals as well being care is moved into the local community. A alter fund of £3.eight billion will be utilised to pay out for added GPs, district nurses and specialist units. Sir David says more will be necessary – some £5 billion a year for many years – to cope with an ageing population and advances in technology. “We need to have gutsy political leadership,” he says. “Beware politicians who say we can muddle by means of.”

Right now, it is more and more officials and not just politicians who are blamed when items go incorrect. Sir David has determined to go simply because the Mid Staffs hospital scandal “created some baggage all around me”. He had been in charge – only for eight months – of the strategic overall health authority that integrated Mid Staffs. When he resisted calls to resign, he was dubbed “the man with no shame”. Nowadays he “bitterly regrets” not going to meet the households of people concerned, but nevertheless believes it would have been “irresponsible to walk away”. As he leaves Whitehall, the dilemma of who should be accountable for what continues to be a pressing issue.

Lavish leaving do

Sir David’s departure has been marked by tips of lavish partying, like a dinner costing £12,000. Mentioned one particular insider: “I really do not know the total value but we have been all asked to pay out £195 to go to the dinner.”

“You need to by no means organise your personal retirement party,” mentioned Sir David. “We had a reception at St Thomas’s for 350 men and women, but it was all paid for by my colleagues. There were 60 or so individuals at the dinner and that was organised and paid for by colleagues.”

Loved ones guy

What is he going to do now at 58? Join the international speaking circuit to talk on his “passionate belief” in socialised medication? He will certainly spend much more time with his loved ones in Worcestershire. He and his 2nd wife have a daughter, Rosa, who is only 14 months outdated. “Even I’m not going to live permanently,” he says. “So she’ll devote a whole lot of time with out me!”

David Nicholson - the man who believed in becoming ruthless with the NHS

Howard Nicholson obituary

Howard Nicholson’s excellent-grandfather was Joseph Skipsey ‘the Pitman Poet’, and Howard was also a guy of culture, with a love of literature and opera

My colleague and good friend Howard Nicholson, who has died aged 102, was a chest doctor, an inspirational diagnostician and a instructor.

Soon after the second world war, as a consultant at two London hospitals – University University (UCH) and the Brompton – Howard began to run patient therapy meetings on what we would now phone multidisciplinary lines. Treatment selections have been produced jointly by doctors, surgeons and radiologists, with physiotherapists and social workers also contributing. Joint care preparing is now taken for granted, but it was pioneering at the time and Howard was instrumental in obtaining it off the ground.

Despite getting a chest specialist he had also studied radiology, which gave him a wider viewpoint than some of his peers. This permitted him to see the worth of bringing in opinions from as numerous disciplines as feasible.

Born in Houghton-le-Spring, Sunderland, Howard was brought up by his mother, Sarah Harrison, a teacher, and his grandmother after his father, Frederick Nicholson, a mining engineer, was killed in the initial globe war. Howard came to London to examine medication at UCH in the early 1930s, qualifying in 1935, and, although working at King Edward VII Sanatorium in Midhurst, West Sussex, he met Winsome Piercy. They married in 1941, shortly before he was sent to the Middle East with the Royal Army Medical Corps thoracic surgical unit, the place he worked with the Scottish cardiothoracic surgeon Andrew Logan.

Howard often spoke of his time in Egypt with Logan, which widened his horizons and information significantly, and some of their experiences have been recorded in two fascinating papers that the pair published in the Thorax journal (1948-49). Howard subsequently co-authored two of the 1st papers evaluating antibiotic therapy for tuberculosis in the Lancet (1955-1960).

His expertise and insights had been appreciated by a lot of, not least Margaret Turner-Warwick, who educated beneath him at UCH and who was later on the initial woman to turn into president of the Royal School of Doctors. In her guide Residing Medicine she wrote of his “logical and analytical strategy” but also of his kindness and his ability at dealing with “hard colleagues, troubled sufferers and truculent students”. In the early 1970s I was a single of people fortunate sufficient to study with him.

Howard’s fantastic-grandfather was Joseph Skipsey, “the Pitman Poet”, and Howard too was a man of culture. He had a fantastic enjoy and understanding of English literature and of opera, settling on retirement with Winsome close to Glyndebourne. Throughout his last years, when he was far more confined to his cottage in Sussex, his Christmas treat was to re-go through the Jane Austen canon, commencing on Boxing Day.

Winsome predeceased him.

Howard Nicholson obituary

NHS chief David Nicholson offers difficult medicine as he stands down

Following 36 many years operating for an employer he joined straight from university, Sir David Nicholson refers to himself half-jokingly as “an NHS lifer”. The lifer, however, is about to gain some new horizons – reluctantly, one particular suspects – after paying the previous eight years as chief executive.

These are his last days in office, as he stands down on 31 March. He gave couple of interviews during people eight many years, in spite of being the boss of a £100bn a yr organisation that has a unique location in British daily life, and grew to become nearly invisible in the wake of final year’s public inquiry report into the Mid Staffs care scandal that noticed him branded “the man with no shame”.

But as he prepares to consider his leave, he is lastly subjecting himself to public scrutiny.

By nature a private man, and someone who for months final 12 months was the concentrate of relentless, almost brutal, criticism by some in the media, MPs and patient campaigners, he is visibly more relaxed.

In Manchester last week he revealed his humourous side by recounting to an audience at the NHS’s yearly Expohow, despite efforts to preserve his anonymity at the diabetes patient group he joined near his home in Birmingham after currently being diagnosed with the condition last year, one more of individuals current appeared to have twigged who he was. “I know you, I’m confident I know you,” she told him accusingly, ahead of dragging her friend more than to verfy her obtaining. “You’re … you are … that butcher from Kidderminster”.

Still only 58, Nicholson gives the impression of becoming nowhere close to prepared to leave his post, of getting a man with unfinished enterprise who, offered his apparent passion for maintaining the NHS as a viable concept in the encounter of acute and expanding pressures – demographic, fiscal and behavioural – would relish the occupation of sticking about to administer the difficult medicine he feels is necessary to make sure the patient survives for many years to come.

He is blunt in his evaluation of the services: “The NHS in its current type is unsustainable.” That is not, he rapidly emphasises, an argument for it undergoing nevertheless another significant reorganisation. Far from it. He described the final 1, the unpopular and barely-understood masterplan dreamed up and implemented by then health secretary Andrew Lansley in 2010-twelve, as “so huge you could see it from outer room”.

In his see the NHS requirements to undergo huge changes, but to the way it delivers care rather than to its complex architecture, if it is to survive as a special model of taxpayer-funded universal healthcare that is free of charge at the point of need. “It is sector-wide alter [that is required]“, he says. “Substantial adjust, on a scale we’ve never seen before, and more than a shorter period of time than we’ve ever observed ahead of in healthcare.” The process, he adds, is “unprecedented”.

Without transforming how it cares for patients it will encounter what he calls “managed decline”.

“I never feel the wheels are going to fall off tomorrow. But we’ll see a position where people have to reduce the quantity of nurses on the wards and have to reduce the drugs that we give to individuals. I can see all of individuals things happening unless we embrace this alter.”

So what adjust, specifically? Amid a blur of bulletpoints typically wrapped in NHS technospeak, a clear program of the Nicholson-envisaged future emerges. There would be huge centralisation of services that are presently presented in numerous hospitals in order to improve the top quality of care. Rather of every single hospital possessing a standard A&ampE unit, for example, there would be “between forty and 70 main emergency centres across the country, with all other centres feeding into them in a network.”

That does not necessarily imply that people other hospitals lose their emergency division altogether, he stresses. They will just no longer deal with the most serious situations. “The others will [nevertheless] consider 70% or 80% of the individuals who currently flip up at A&ampE units and treat them as typical.”

Similarly, the 300 distinct spots which presently give specialised NHS providers, such as cardiac or cancer care or organ transplantation, ought to ideally decrease to between 15 and thirty, he says.

He recognises how controversial any planned change is locally to the assortment of services any hospital gives. But, he adds, “with numerous strokes and heart attacks, ambulances will [previously] go previous their neighborhood hospital [to a specialist centres]. There’ll be a lot more of that.”

He also understands but is frustrated by people’s attachment to the NHS’s bricks and mortar. “For clear factors we get obsessed with buildings in the NHS, but they are not services. Folks are really proud of hospitals and put plenty of time and energy into them. But they want to look beyond them. It’s like hospital beds. Folks are fixated by the variety of them, but I’ve by no means recognized a hospital bed heal the sick.”

A lot much more care needs to be delivered in or close to people’s residences, he says, especially for the 15 million to 17 million individuals with one particular or more long-phrase situations this kind of as asthma or heart difficulty whose care currently will take up 70% of the NHS’s price range. He envisages a long term in which teams of various kinds of overall health and care experts work seamlessly with each other to care for individuals in and specifically out of hospitals, concentrating on assisting them remain well

Technology will be pivotal, as will GP solutions that are obtainable about the clock each day of the week.

It is essential, he believes, for the nation to engage in a serious, urgent and challenging conversation – ideally with medical professionals as the chief persuaders of a reluctant public – about the potential of the NHS.

Without having that, and with out undertaking large alterations, the service’s future might fall into doubt, he says.

“Public support in this nation for our healthcare method is better than in nearly any other nation in Europe, and that is so crucial for a taxpayer-funded technique. My fear is that if it gets worse, just before you know it you get to a place in which a minority of the people help it and then individuals who can afford to [do so] will go elsewhere for their healthcare. In those circumstances the question of how sustainable the NHS is turns into a a lot much more challenging a single to deal with. Which is my be concerned.”

NHS chief David Nicholson offers difficult medicine as he stands down

Shrink our hospitals to give better care, says NHS chief Sir David Nicholson

He stated the well being service cannot afford to hold working its recent program, which does not correctly react to the requirements of an ageing population, and recommended that a wholesale reorganisation of care is required.

“Like each major overall health method in the globe, we encounter a big fiscal problem for the long term: the sums really don’t add up,” he writes.

“If we don’t modify, we face a funding gap that could be £30 billion by 2021.

“We know that centralised, huge units, with concentrated knowledge and technology, work greatest in offering the most successful care. So we need to have to make certain this technique is utilized to other parts of the well being services, for individuals with really rare conditions, and for significant planned surgical procedure.”

He recommended that with out radical modify, providers will not be sustainable.

“Our NHS does a fantastic job for hundreds of thousands of individuals, day in day out, but it cannot stand nevertheless – it demands to adapt to survive,” he writes.

Last yr, NHS England, the organisation he prospects, published a blueprint for adjust which calls for centralisation of key hospital providers. In the subsequent couple of months, it will publish additional programs, setting out modifications for professional solutions, and proposals to make sure GPs supply far more solutions serving bigger populations.

“The NHS proposals for adjust constantly come with controversy,” writes Sir David. “Too often the all round public interest will get misplaced in a debate about winners and losers with too much focus on buildings and not sufficient on solutions.

“This time I hope the NHS, the public, policymakers and politicians will join forces to make it take place. As somebody who has invested thirty years doing work in the NHS, I know it matters also considerably to get it incorrect.”

He said the NHS required to do more to “listen to patients and act on their concerns”. He mentioned the NHS also essential to make alterations in its use of technologies, to guarantee that citizens are “fully empowered and included in all factors of the NHS,” and understand from other sectors, this kind of as banking and retail, to let folks to entry more companies on the web.

Sir David on Tuesday addressed health care professionals and politicians, and manufactured a equivalent plea to Jeremy Hunt, the Well being Secretary, and Andy Burnham, the shadow well being secretary.

Sir David will retire subsequent month after a year in which he has been heavily criticised, following the inquiry into the Mid Staffs scandal, for his earlier function as a senior official supervising the area.

Shrink our hospitals to give better care, says NHS chief Sir David Nicholson