Intended for healthcare professionals

Views And Reviews Acute Perspective

David Oliver: Contentious comments from NHS England’s chair

BMJ 2019; 364 doi: (Published 13 March 2019) Cite this as: BMJ 2019;364:l1082
  1. David Oliver, consultant in geriatrics and acute general medicine
  1. Berkshire
  1. davidoliver372{at}
    Follow David on Twitter: @mancunianmedic

In February NHS England’s chair, David Prior, waded into the debate on the state and future of the NHS. At a meeting hosted by the Reform think tank he said that relentless edicts and targets from NHS central bodies had left local clinicians and managers feeling “learned helplessness” instead of exercising professional leadership.12

Prior also criticised the commitment and discretionary effort of staff, lamenting that they wouldn’t stay at work to help out beyond contracted hours—for instance, in the emergency department when they were ready to go home—and that some were retiring too soon.1 His comments were widely reported in print and broadcast media, as he surely knew that they would be.

One might ask, “Why shouldn’t he speak out?” Some may even find his frankness refreshing in a sea of technocratic uniformity and management speak. But Prior is chair of a public body responsible for overseeing the entire NHS. Grandstanding, controversial comments about the staff who do all of the patient facing work don’t sit well with such a role. His job description includes “stakeholder engagement,” “ensuring commitment from external bodies on cross organisational priorities,” and the need to “represent the board in the public arena” (note: the board, not personal views).3

I’m not sure how well qualified or wise Prior is to be so critical of frontline staff, having never worked in a clinical or operational management NHS role. However, his experience should have given him some insight into public comments on record. He has worked in banking and law, as a Conservative MP, as a hospital trust chair, and briefly as a health minister in the House of Lords. Still, his comments and their tone would be no surprise to anyone familiar with his previous media forays.4

When chairing another public body, the Care Quality Commission—an organisation whose purpose and usefulness as a health regulator he now seems to criticise and disown—he made numerous provocative public comments despite the gravity and supposed neutrality of that role. These included his call to close more hospital beds to save the NHS5 and his prediction that the CQC would find hospitals to be failing and ripe for being taken over by “US-style hospital chains.”6 He claimed that doctors were not “stepping up to the mark,” instead “bitching on the sidelines.”7 All of this seemed bizarrely inappropriate for a man in his role. He was appointed to NHS England, regardless.

The body Prior now chairs has recently produced its 10 year plan which, while it does seem to promote greater localism and devolution of leadership away from Whitehall, is nonetheless chock full of top-down edicts, priorities, investments linked to “must dos,” and talk of “control totals.”89 And NHS England just further tightened central grip by becoming the dominant partner to NHS Improvement and, in effect, Health Education England.10 So, unless he disavows his own organisation, the “learned helplessness” claim doesn’t wash. And I’m not sure that the language of blame in his comments is the way to “engage” the healthcare workers and managers who make up NHS England’s stakeholders.

Only three days after Prior’s remarks the Health Foundation published a study showing that more staff than ever were leaving, retiring, or going part time because of burnout, long hours, and the impact of the job on their own health or family life—making his intervention especially ill timed and misguided.11

I suspect that the real reason he spoke out was to presage the subsequent announcements on possible relaxation of waiting time performance targets, which the NHS hasn’t been able to meet since 2015.12 I’d guess that some of the other comments were thrown in, impromptu, and not in any script supplied by communications teams, who were probably banging their heads on tables, if not entirely surprised. His only saving grace would be that most NHS frontline staff are too busy coping with workload and workforce gaps to know who he is, what he does, or what he said.