Defenestration is a regular public spectacle in the NHS. Some chairs, chief executives and finance directors are pushed, while others jump before health department assassins arrive to blame them for debts caused by government underfunding.
However, the resignation of Bob Kerslake as chair of King’s College hospital, London, is in a class of its own. The trust is in deep debt, like so many others – partly as a result of rescuing a failed hospital whose true debts were never revealed. But despite making unprecedented savings, King’s was yesterday put into punitive “financial special measures”.
Indignation at Kerslake’s departure ricochets round the NHS. Chris Ham, head of the King’s Fund thinktank, told me: “This is yet another example of the growing top-down bullying culture.” He says when someone of Kerslake’s repute feels he has to resign, it sends a message about the near-impossible task. “How do they think they can find anyone to replace someone of his stature?”
That is the insanity of the present regime of rule by targets and terror. NHS managers and chairs are, by and large, among the cleverest and most astute in the public sector, but there isn’t an unlimited supply of able people willing to be bullied and blamed for the harshest spending the NHS has ever endured. Ham is right about Kerslake: where do you find anyone with such experience? A maths graduate, he is by training a forensic accountant, was chief executive of Sheffield council, permanent secretary of the Department for Communities and Local Government, and then David Cameron’s head of the civil service.
At the hospital trust he is highly respected and well liked, and his departure leaves staff not only angry, but bereft. His deputy, Sue Slipman, talks of how he “gained everyone’s trust. He’s super-bright, very open and made heroic savings.” The worry is that “special measures” means sending in inferior management consultants, who are described by one King’s manager as “pimply 12-year-olds, overconfident, overpaid and knowing nothing”.
Christopher Smallwood, the former chair of St George’s hospital, London, was also defenestrated for unavoidable debt. He echoes what Kerslake says: “People are working extraordinarily hard in impossible circumstances.” The fault lies with NHS regulators “who send out their bully boys to beat up dedicated managements”, so politicians can deny “the damage their neglect is doing”.
NHS Improvement (NHSI) is another expensive remnant of the disastrous Lansley/Cameron Health and Social Care Act. Once called Monitor, it was originally devised to force competitive private sector contracting on the NHS. Its recently departed head, Jim Mackey, tells the Health Services Journal that £1bn could be saved by rolling it into NHS England, along with the regulators, abolishing wasteful multitudes of commissioners. NHSI is now Jeremy Hunt’s financial enforcer, demanding executives sign up to impossible “control totals” to satisfy the Treasury. Kerslake told them the sums were undoable – but “they’d have fired me if I hadn’t signed”. Now they blame him for missing fantasy targets.
Remember how foundation trusts were supposed to be entirely self-governing, with their own thinly attended public elections to their boards? Now Hunt ignores all that, hiring and firing trust leaders from Whitehall. With 152 out of 233 trusts in debt, he has the whip hand. As Chris Hopson, chief executive of NHS Providers, told his annual conference: “Either we trust and respect chairs and non-executive directors to performance-manage their trust leadership teams, or we might as well not have them at all.”
Bullying Kerslake by putting King’s into special measures is the first significant act of NHS Improvement’s new head, Lady Dido Harding. Why she was appointed to a job that should be abolished is unclear. She was ennobled by her old university friend, Cameron and sits as a Tory peer. Her husband is a Tory MP. She has no experience of the NHS. But she may be remembered as head of TalkTalk when a cyber-attack exposed the bank accounts and personal details of hundreds of thousands of customers. Asked if these were encrypted, she famously said, “The awful truth is, I don’t know.” Which she may soon say about the NHS too.
As her first act, the harrying of Kerslake will not endear her to the NHS. Some Tories muttered that Kerslake was a Labour stooge, though he sits as a crossbencher. He did give the opposition advice about the process of government, as civil servants should, but with no policy or political work. Harding, meanwhile, is a political appointee.
Cold weather blows in, the NHS teeters on the edge – and if the Australian flu arrives, A&E, waiting times and bed shortages will be back in the news. Doctor and nurse shortages, cuts to social care and a million more over-65s than five years ago make this no time to shed NHS managers struggling against the odds. The beleaguered NHS England chief, Simon Stevens, failed to get the £4bn a year the NHS needs, a sum the National Audit Office agrees is required. Tories pretend the NHS is “a bottomless pit”, ignoring that it gets less per capita than health services in France or Germany: they spend 1.5% of GDP more – for us that would be another £25bn, solving all NHS problems. Its staff are lazy and inefficient, the hostile Tories claim, despite the US Commonwealth Fund rating the NHS best on bang for buck.
Hopson says that, despite its debts, the service is more productive and cost-saving than other sectors: “The economy realises annual efficiency gains of just 0.2%; between 2012 and 2016 the NHS improved efficiency by 1.7% a year.” But that’s overtaken by rising need, an NHS “pushed to the brink” says Labour’s Jon Ashworth. Brexit distracts from everything else: Labour would have demanded a statement on Kerslake’s departure if Theresa May’s Brexit statement hadn’t dominated yesterday’s Commons.
Blame-shifting is Hunt’s disreputable habit. And trophy sackings. Last September, when dismissals seemed useful pour encourager les autres, his minions delivered up on a plate the chief executives of East Kent and North Middlesex hospitals, both indebted trusts. But this latest one goes further – it must have required Hunt’s say-so. Kerslake is a big beast. If even he can he hounded out, no one is safe from the winter terror regime.
• Polly Toynbee is a Guardian columnist