Mackey: Regulatory duties must not stop NHS Improvement helping trusts

Mr Mackey was speaking exclusively to HSJ in his first week as chief executive of Monitor, which is being merged with the NHS Trust Development Authority to create NHS Improvement.

He acknowledged that there was a risk of conflict of interest for the new organisation. For example, if something were to go badly wrong in a trust it had attempted to improve. “There’s a risk of conflict, isn’t there?” he said. “That’s going to be present in our system. Let’s recognise it and build a system that manages that conflict as best we can. The important thing is, don’t let that stop us improving, or trying to improve.”

Alluding to the huge pressures currently experienced by NHS providers, he added: “In the phase we’re in now, certainly for the next few years, we need to get our heads around how we help first and manage the conflicts and stuff later on…

“What we shouldn’t do is just say, that’s all so complex, let’s all just stand back and report on how bad it is. And then say that [trust] chief executive was crap so let’s move him on.”

There would always have to be an “accountability edge and a regulatory edge” in NHS Improvement’s work, he said. But he did not want to construct the organisation in such a way that “it’s a performance manager first and if it gets time it’ll do some improvement”, or that “it’s a regulator first and it has to be so distant it can’t do improvement”.

The new organisation will retain Monitor’s statutory duties to enforce choice and competition rules, and to authorise new foundation trusts in the “pipeline” of aspirant FTs.

Asked if he thought competition rules were a driver of improvement or an obstacle to it, Mr Mackey said that in his previous job as chief executive of Northumbria Healthcare Foundation Trust “we came up against this in lots of ways” and an attempt to develop an accountable care organisation, as Northumbria is doing, “really tests it”.

However, he added: “I think we can all do a hell of a lot more than we are within the current legal framework. And at times people hide behind the potential risks and constraints of [competition regulation].”

Asked if he agreed NHS England chief executive Simon Stevens and others who have said the FT pipeline is a distraction from current challenges and should be frozen, he said: “I think there’s a really good argument that if you’ve got financial problems, Care Quality Commission, emergency department or other performance problems, it’s a distraction. In fact you wouldn’t get through the process anyway.

“There’s a hell of a lot in that category, at the minute. So I think we do need to say, let’s sort ourselves out before we start pretending people are going to become an FT within a fixed period of time.”

However, he added that there were a number of organisations that were “quite close” to FT authorisation, so “if you’re quite close, you’ve put all that effort in, let’s find a way of getting you through within a reasonable period”.