The must read stories and debate in health from Wednesday

Mackey backlash

Chief regulator Jim Mackey has stepped into controversial territory by talking about cuts to clinical staff numbers, and suggesting the 1:8 nurse to patient ratio is unaffordable.

In an interview with HSJ, the NHS Improvement chief executive said interventions in the coming weeks to regain financial control in the health service could result in some providers having fewer clinical staff.

And in comments that have been jumped on by numerous readers and clinicians, Mr Mackey said trusts exceeding the ratio of one nurse to every eight patients could be told “we can’t afford that”.

The regulatory message appears to have hardened since August 2015, when trusts were told to “ensure vacancies are filled only where essential”. This rather vague communication was quickly clarified by Monitor (now rolled into NHSI), which said it was “not telling trusts to stop recruiting clinical staff”.

But trust finances have worsened significantly since then, and Mr Mackey said cuts to clinical staff numbers were “possible” at some trusts, such as those which have gone “beyond the safe staffing requirement”.

He said: “A lot of providers ended up using bank and agency [staff] to try and get close to the safe staffing recommendations, but I’ve met with some that went even beyond that 1:8 ratio from a nursing point of view.

“A lot of providers ended up using bank and agency to try and get close to the safe staffing recommendations, but I’ve met with some that went even beyond that 1:8 ratio from a nursing point of view.

“And in that case we’ll be saying we can’t afford that, that’s not something that justified, there’s no evidence for it, it’s not delivering better outcomes, we expect that to be reined back.”

This drew speedy criticism on Twitter, including from safe staffing expert Jane Ball, who said: “Mackey seems unaware of NICE guidance: Trusts should consider 1:8 a warning level of possible insufficiency. NOT a goal/max.”

Mr Mackey also described royal college standards on staffing as “aspirational”, which drew stinging criticism from professional bodies, including the Royal College of Paediatrics and Child Health, which described the comments as “extraordinary” and “shabby”.

Setting aside Mr Mackey’s comments on the evidence behind the 1:8 ratio, others in the system may well welcome his honesty about the situation and what the is NHS is able to afford.

With the finances as they are, something surely does have to give. The trouble is no politician has yet dared to tread this ground.

Naylor’s successor named

University College London Hospitals have finally managed to find a successor to Sir Robert Naylor – who was supposed to leave in March but stayed on after the high profile teaching trust was unable to find a suitable replacement.

Now we know who will be stepping into some of the NHS’s biggest shoes: Professor Marcel Levi, who will be joining from the Academic Medical Centre in the Netherlands, where he has been chair of the executive board for 16 years, as well as being dean of the faculty of medicine at Amsterdam University.

Sir Robert will step down in September and Professor Levi starts in January 2017, with deputy chief executive Neil Griffiths covering the role in the interim.

Professor Levi is the third senior medic from overseas to be appointed as a chief executive role at a Shelford Group trust in recent years, following Dr Bruno Holtfhof at Oxford University Hospitals and Dr Tracey Batten at Imperial College Healthcare Trust.