Read the Thirlwall report on the neonatal deaths at the Countess of Chester Hospital, and two kinds of culpability emerge. Lucy Letby stands convicted of murder. Thirlwall describes a unit in which relations between doctors and nurses at the bedside were collegiate and constructive, but where managers – many originally from clinical backgrounds – were neither. When doctors raised concerns, managers undermined them, and their response protected appearances rather than babies. Thirlwall is clear that if they had behaved better, lives would have been saved. Murderers mean to kill. Hospital managers are meant to do better.

In most of the NHS, the relationship between doing better work and being better rewarded is entirely absent

In most of the NHS, the relationship between doing better work and being better rewarded is entirely absent

Isabel Hardman has written, accurately, that Thirlwall’s inquiry won’t lead to change. We have no end of inquiries into poor performance in the NHS, and one doesn’t need to read many to notice that each repeats the last. The problems recur, the inquiries recur, nothing improves.

After thirty years in NHS hospitals, my conclusion is not that NHS managers need to be given more recommendations, but that they need the powers to manage. In its current form, that is not something the NHS allows.

As a newly-appointed........

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