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Mack the knife

The man with two hats has taken one off.

Jim Mackey had a lot to say as he headed back to Northumbria to run his trust, leaving NHS Improvement and his role as national overseer of the provider sector.

He told HSJ there should be “ruthless” consolidation of NHSI, NHS England and local commissioners, and that this could save £1bn.

(London has taken some steps in this direction, appointing a “head of winter” who is a joint appointment across NHSI and E. And in a sign of the importance of the role of NHS England London, it has been helmed by NHS England nursing director Jane Cummings on top of her day job since September.)

The billion would go some way to sorting out the provider deficit (estimated at £4bn in some quarters).

But would it help the service manage?

Mr Mackey said his managers in Northumbria were “frazzled”, dealing with multiple calls from the national bodies and local commissioners – all because they were a percentage point off the accident and emergency target.

On Sunday, the chair of King’s College Hospital Foundation Trust Bob Kerslake resigned, saying the financial position NHSI and the government had put the trust in was impossible.

Does Mr Mackey think the London teaching hospital would have, like Northumbria, benefited from less external scrutiny? Or would things be even worse at the trust predicting a £100m deficit? Imagine the frazzledness of the team at King’s.

On the national level, Mr Mackey said the speed with which the provider deficit could be cut was the subject of “very unreasonable expectations” from the government. But he also stressed that the service shouldn’t look the budget gift horse in the mouth and the NHS must prove itself worthy of the extra it was given.

On the regional level, similar criticism of the government and NHSI was made by Lord Kerslake.

His resignation letter in The Guardian said: “The government and NHS Improvement are simply not facing up to the enormous challenges that the NHS is currently facing.”

It is immaterial, really, whether his announcement came before or after he was asked to leave by the new chair of NHSI – Lord Kerslake makes reference to the messenger being shot.

Asked about bullying of trusts by national bodies, Mr Mackey told HSJ “we put a lot of effort in at NHSI to try and make sure our interactions are professional and respectful” but he also singled out the top team at King’s in our interview, which was conducted last Thursday.

Ugly as the whole King’s/NHSI interaction has been, the large-systems-man-turned-local-leader and the local-leader-turned-systems-manager agree on one thing.

Mr Mackey said if he were staying in the national job he’d change the tariff system and “focus on finding new mechanisms”.

Lord Kerslake said: “Fundamentally, our problems lie in the way that the NHS is funded and organised.”