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Notes from the field of public involvement

Thursday, 09 March 2006

Burnt Crisp - pension and peerage unguents applied

"Events, dear boy! Events!", as Harold Macmillan bemoaned, throw off course even the most able and best intentioned efforts. It was the events wot did it for Sir Nigel Crisp, lately CEO of the NHS in England and Permanent Secretary of the Department of Health. Though there will be a few compensations for loss of office at age 54 - like a stonking great pension and, oh yes, a life membership to what is reputed to be the best club in the world. 

Downhill from July 05

Should we be shocked? Probably not, especially if you've been keeping up with the down-hill run of events since the end of July 2005.  That's when the curiously-titled missive "Commissioning a Patient-Led NHS" over Sir Nigel's signature hit the streets in the dog days of summer.  Came the autumn, when people like Chris Ham, Nigel Edwards and then the Health Select Committee used words like "incoherent" to describe the unseemly rush of reforms and initiatives bundled into CPLNHS, and the Royal College of Nursing took him to judicial review for good measure, then anyone could see that events were brewing into real political trouble.

Panjandrum overboard

And brew they did, driven by the looming spectre of the biggest NHS overspend in history.  After that got into the media, accompanied by increasingly hysterical diktats to Trusts and PCTs to get a "forensic grip" on the deficits, it was just a matter of time before we heard the splash and the cry "man overboard!" as Sir Humphrey Appleby - who knew how these things were done - used to say when a panjandrum was sacrificed to encourage the others.

Blood sacrifices needed

It was the rising tide of red ink flowing through the NHS's end of year forecasts which finished Crisp. There will be others going over the side, but probably without benefit of gongs.  A £1bn overspend is going to require lots of blood sacrifices to wash the public accounts slate clean again.

Accountability and responsibility muddled

On his departure as chief executive, Sir Nigel said: "I wish to acknowledge my accountability for these problems, just as I may take some credit for the achievements." Noble sentiments, but a muddle of accountability and responsibility. In truth the NHS CEO is not responsible for the structural shortcomings of the service which - as a result of unprecedented resources poured into it - perversely produced the largest deficit in its history. That honour goes to Ministers.

The real cause for sadness

The wise Niall Dickson of the King's Fund observed about it all, "If he is responsible, so too are the politicians who oversaw the expensive new pay deals and the other changes that have helped to create the current pressures. The manner and timing of his departure is not helpful."  M-A-C shares his sadness: institutional chaos means poor use of human and other resources. Patients and NHS workers deserve better.

Andrew Craig | Send feedback