Stafford Hospital: Does NHS boss have case to answer?

Sir David Nicholson has been chief executive of the NHS for the past six years

For a man who is so renowned for keeping a tight control on the health service, the past few days have been undoubtedly uncomfortable for NHS chief executive Sir David Nicholson.

Campaigners have been calling for his resignation from his £270,000 post following the public inquiry into the failings at Stafford Hospital.

And on Thursday he found his picture splashed on the front pages of two national newspapers.

Both included critical articles about his role in the scandal.

But what is the evidence against Sir David?

Anybody in charge of an organisation that has just had its culture criticised in the way the public inquiry did with the NHS would find themselves being asked questions.

But what makes Sir David even more vulnerable is the fact he had contact with Stafford Hospital when he was a regional NHS boss - as has been documented in the the 1,700-page report.

In fact he was on the panel that appointed a new chief executive for the hospital in the second half of 2005. The panel chose Martin Yeates, the man who would subsequently order a deep round of cost-cutting at the trust that contributed to the "appalling" levels of care.

Sir David actually became interim chief executive of the health authority that oversaw Stafford Hospital in August 2005. At the time, a number of health authorities were being merged and Sir David had been leading a neighbouring once since 2003.

The inquiry report makes clear that even at this time it was apparent that the Mid-Staffordshire Trust, which ran the hospital, had problems with finances and management structures.

Plain Mr Nicholson, as he was then, met with Mr Yeates and the chairwoman of the trust, Toni Brisby, soon after he took charge, to discuss what was being done.

Documents from the time show he was concerned about the performance of the trust and wrote to the trust to say so.

A letter back to him from Ms Brisby convinced him that new leadership at the trust was engaged with tackling the problems. The inquiry questioned this, suggesting the letter could be interpreted as the trust being in denial.

Top job

But Mid-Staffordshire was soon someone else's problem, as Sir David left the West Midlands in June 2006 to take up the reins of the NHS in London.

Within months he was on the move again after being appointed to the top job, chief executive of the whole health service in England,

The next time Stafford Hospital loomed large on his horizon was in the summer of 2007.

It had been put forward for foundation trust (FT) status - elite status that gives hospitals freedom from government control.

A Department of Health committee recommended the trust was in a fit state to be put forward for FT status.

Without any objections forthcoming, it was left to Andy Burnham, then a junior health minister, to sign off the relevant paper work and pass the application off to Monitor, the body that makes the final decision on FT status.

The following summer Sir David again found himself discussing Mid-Staffordshire in a meeting with the Healthcare Commission, the NHS regulator, which had just started an investigation into the trust following concerns about high death rates.

He is reported to have told officials from the regulator to beware of the Cure the NHS campaign, the group set up by local patients upset about the care provided by Stafford Hospital, suggesting they were "simply lobbying" as opposed to representing widespread concern among patients using the hospital.

Sir David denied using the phrase, leaving the inquiry to conclude that it was not possible to determine exactly what was said after all this time.

But the inquiry report did warn that care needed to be taken in these sort of situations to "avoid the impression that the Department of Health was seeking to influence an independent regulator".

'Cultural leader'

By March 2009 the Healthcare Commission published its findings on Mid-Staffordshire. They were devastating, lifting the lid for the first time on what had been happening.

A year later an independent inquiry was adding more harrowing detail to the picture. According to those who were close to him at the time, both reports are said to have shaken and upset Sir David.

The public inquiry also raised questions about the power the Department of Health wielded over the health service.

Of course, this will be influenced by ministers as well as senior officials such as Sir David.

The inquiry report described the department as a "cultural leader" but said the evidence did not suggest it was an organisation that bullied.

Instead, it concluded that "well-intentioned decisions and directives... have either been interpreted further down the hierarchy as bullying, or resulted in them being applied locally in an oppressive manner".

None of this was enough to convince inquiry chairman Robert Francis QC that Sir David - or anyone else for that matter - should go.

Mr Francis stressed in his statement to the media immediately after publication of the report that the blame game should be avoided, saying: "What has been found to be wrong here cannot be cured by finding scapegoats."

But this is not enough for Julie Bailey, the woman who set up Cure the NHS after losing her mother at Stafford Hospital.

She is adamant Sir David, who has apologised for what happened, should lose his job.

Ministers though are sticking by him.

As well as being chief executive of the NHS, he is also the head of the new NHS Commissioning Board, which will take charge of the health service from April.

As one government adviser put it: "Even if there was an appetite to get rid of him we couldn't afford to. We have a major restructuring on our hands and growing financial problems.

"He is the man who has a grip on the system. Without him we would be in real trouble."