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Editorial Tuesday 11 June 2013: Comrade Sir David Nicholson's life in exile after abdication

In the words of Lenny Kravitz, "it ain't over till it's over".

Comrade Sir David's life in exile after abdication (ah, Moe Tucker, from Velvet Underground drummer to Tea Partier - now that's a case of 'how are the mighty fallen') looks tricky.

FOI work by Conservative MP and Public Accounts Committee member Steve Barclay led to this Telegraph front page lead story, suggesting that "at least 52 staff have been silenced using the (judicially mediated gagging) orders since 2008, some of which cost as much as £500,000. All are thought to contain confidentiality clauses".

Mr Barclay told the Telegraph "It is simply not plausible that the man who was supposed to be running the NHS was seemingly unaware that employees threatening to speak out were being offered golden goodbyes in return for a vow of silence.

“As the accounting officer who has presided over this culture, he is either complicit in a systemic cover-up or has failed to ask questions. If he knew about them he has misled Parliament. The culture in the NHS needs to change, he has to stand down now. What patient safety concerns have been covered up [by these gagging orders]? How many lives have been put at risk?”

This is going to be tricky for the Comrade In Chief, whose career and alleged indispensability to NHS England were built on grip, or the myth thereof.

The NHS has had a dishonourable tradition of secrecy and sorting problems out without overt noise wherever possible. The motivation by those complicit was presumably to maintain public confidence that all was well in the NHS and all manner of things would be well.

Not embarrassing ministers was also a bit of a priority.

These traditions have created toxicity and a culture of covering things up; one that suited system leaders and politicians. It is difficult not to see such gross system failures as those of Mid-Staffs in this light.

Whistleblowers have been hung out to dry as a consequence.

The era of secrecy is no longer viable or desirable. Ever more data on NHS performance will be published. If clinicians are to lead and drive the changes needed to keep the service effective and affordable, it is unlikely they will go meekly along with cover-ups and gags.

The Comrade In Chief's dramatic conversion to the cause of glasnost and perestroika may suit with his mischeivious love of Soviet imagery, but it looks less plausible again than it ever did before.