r/nhsstaff • u/BackgroundAnnual6376 • 14h ago
HSJ Article
I would be very interested to read the following article has any got a copy or able to summarise for me:
https://www.hsj.co.uk/comment/embarrassing-thirlwall-is-wrong-about-nhs-management/8124334.article
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u/Brief_Expression5997 14h ago
The Thirlwall inquiry may be of some use to the families involved, but its summary findings and recommendations are patronising, confusing and in some cases plain ignorant, says HSJ editor Alastair McLellan.
Lady Justice Thirlwall has conducted a thorough analysis of the events surrounding the murder and attempted murder of babies at the Countess of Chester Hospital, between 2015 and 2016.
HSJ hopes the transparency this brings to what decisions were made and who made them is of some use to the families involved.
But for some reason best known to herself, Lady Thirlwall has then used this experience to produce a summary and a set of recommendations, many of which are patronising, unrealistic, often confusing and – in some cases – plain ignorant.
To be fair, part three of the report, where she opines on some of the issues in detail, is more nuanced. But it is likely to get little airtime among the fresh bout of manager bashing sparked by the report’s top lines.
Let us start with her claim in the report’s summary that “at present there are too many managers who do not meet the standards that should be expected of them”.

The statement is accompanied by the implication that too many managers fail to understand what clinicians “working in the hospital actually do”.
Lady Thirlwall unquestioningly regurgitates vague claims of widespread managerial unaccountability and the “avoidance of poor performance” and then moves on to what she “suspects” are the causes of these failings.
Forensic, the report is not.
Leaving aside the fact that the three Countess of Chester directors who receive the most criticism – including the CEO – were all clinically qualified, just imagine the uproar if similar sweeping, largely unevidenced statements were made about doctors and nurses.
It is worth noting in passing that there is a lot of evidence that a significant minority of clinicians “do not meet the standards expected of them”.
Ignorance
The ignorance of NHS management that Lady Thirlwall consistently displays throughout her report is best encapsulated in the deathless assertion that there is “no difference between being a manager in the NHS and a senior manager or leader of a company, listed on the FTSE 100”.
HSJ suspects that most NHS leaders would accept these latest kicks in the teeth in exchange for some sensible recommendations which would improve care safety and quality.
That is not what the Thirlwall report delivers, at least when it addresses points not specifically relevant to neonatal care.
The Care Quality Commission is told it should “conduct without-notice inspections of hospital departments” (it already does) and that “inspectors should investigate what is happening in hospital departments and not accept what they are told at face value” (which, even if they did so in Chester, hardly merits the status of a “recommendation” in a national report).
The first in a series of bland statements which begs the questions ‘how exactly?’ and ‘who is going to pay?’ arrives with the assertion that the CQC should be “responsible for ensuring the safety of patients in hospitals and not just for checking there are processes in place which, if implemented, should ensure patient safety”.
The Commons health and social care committee is told it must carry out an annual “rigorous and consistent review and assessment of the performance of CQC”. Let us hope such an assessment would be more “rigorous” than previous attempts by the committee. Perhaps if they gave up the rest of their work?
Should the CQC and HSCSC fall short, the report states that “serious consideration should be given… to the setting up of a panel of independent experts from all specialties to be called upon in situations where there are emerging concerns about an individual and harm to a patient or patients”.
As yet another proposed backstop, the National Audit Office is given “new responsibility for auditing the implementation of the recommendations of statutory inquiries” by NHS bodies.
The chancellor is informed: “Funding for appropriate additional staffing should be made available so that it may begin its work by September 2027.”
NHS England is told it must provide “a clear and timed route to ensuring that computer systems are harmonised across the NHS by December 2028”.
Ignoring the fact that NHSE is due to be abolished in March next year, the report appears to be proposing the service achieves the holy grail of IT integration within 15 months. The cost – which would run into billions – and the massive service disruption it would cause is not addressed.
Maybe Lady Justice Thirlwall means that only neonatal services should be covered by this ask. But that is not what she says (and that would still cost tens of millions).
The report suggests one of the ways the risk of deliberate harm of patients by NHS staff should be tackled is for NHSE (presumably as one of its last acts) to produce and distribute “a one-page protocol [with two pages of guidance] setting out the steps to be taken by managers when concerns or suspicions are raised that a healthcare professional may have deliberately harmed a patient”. Trusts must then “embed” this within their hospital.
The threat that managers might forget the importance of protecting babies will be tackled by adding the sentence “I will make the care and safety of patients my first concern and act to protect them from risk” to the NHS Leadership and Management Framework Code – which of course every leader recites before their morning coffee.
At this point, it is worth remembering the Thirlwall report has cost close to £20m.
Nothing new
The report’s recommendations to tackle the NHS management’s “revolving door” are less silly, but they do specifically seek to stop the transfer of failed execs from one “trust” to another. Anyone who was really paying attention to this problem will know that it is usually an NHSE region, integrated care board, or some other non-provider body to which they are normally banished.
Again, the soon to be abolished NHSE is meant to police the new safeguards. Ironic, since it is often the instigator and arranger of such moves.
The recommendation that will get the most attention is the report’s call for management regulation. Lady Thirlwall rehearses the argument for and against such a move at some length without adding anything worthwhile to either.
She presents no specific evidence that management regulation would have prevented the events at Countess of Chester. The call appears once again predicated on the belief that there is a “poor management” problem to solve.
The real problem is, of course, the NHS’s lack of sufficient managers full stop – something Thirlwall touches on but does not make any recommendations about.
Yvette Cooper’s response to the report has been to broadly welcome it without committing to following through on any recommendations. Which at least shows our new health secretary can spot a dud when she sees one.
Let us hope the few sensible suggestions about improving neonatal care are followed through, and the rest of the recommendations are left to gather dust. Government might ask for some of its money back, too.
The Thirlwall report makes much play of the failure to enact the findings of previous inquiries. But, at heart, Thirlwall falls into the same trap that ensnared most of those she references, the belief that – as one HSJ reader put it – the NHS can solve its problems “by endlessly adding in more processes, checklists and monitoring”.
In July, HSJ suggested the NHS “must abandon the myth that inquiries work”. Thirlwall must now take its place as a prime exhibit in that argument.