Lack of trust in NHS supremo

His role was not an insignificant one. He headed the strategic health authority that presided over Mid Staffs, where hundreds of patients died because of neglect, and other NHS trusts in the region.

Even though targets are now embedded within the culture of the NHS, he says he did not receive any information about above-average mortality rates and that his primary consideration, during a visit to Stafford Hospital, was the poor relationship between medical staff and Trust bosses.

Perversely, the timing of this admission could be particularly beneficial to the NHS, coinciding with a major report by the Nuffield Trust about productivity issues and the financial crisis which threatens to overwhelm many hospital trusts, despite David Cameron’s pledge to ring-fence funding.

That there has been a steady rise in the number of trusts in debt over the past four years will not surprise patients in Mid Yorkshire and North Yorkshire, two areas that lurch from one financial crisis to another.

Ditto the extent to which spending on Private Finance Initiative projects has spiralled out of control, though the problems are far greater in London than in these parts.

What is significant, however, is that the best performing hospitals are those with a higher proportion of doctors and other medical expertise. In short, front line roles need to be protected at the expense of those convoluted management roles so favoured by Sir David and others.

There are two other remedies that Ministers need to acknowledge. First, competition could be a misnomer – and that those trusts with a near monopoly status are far more effective. Second, larger NHS and foundation trusts – just like Mid Staffs – have a lower rate of productivity, presumably because their management structure is so convoluted.

They are common sense measures that should be embraced, but it is difficult to see how this will happen while the NHS head is so tainted by the unforgivable Stafford scandal.