Mackey: I will stick up for the NHS

Sir Jim Mackey formally began in his role as NHSE’s “transition” chief executive today, with the job of improving the service’s financial performance, cutting elective waiting lists and merging with the Department of Health and Social Care.  

In his first interview in the post, Sir Jim said he would work together with ministers to deliver on priorities but added: “If I disagree on something, I will say so.” Elsewhere in the wide-ranging interview, he indicated clinicians who were not serving in front-line roles might lose their posts, and that the NHS needed to turnaround its financial performance as “society can’t cope with it any more”.

He also said he expected “quite big consolidation” among integrated care boards as they made 50 per cent cuts to their staffing costs, and that trusts in a small number of areas were ready to take on delegated “accountable care organisation” style responsibilities for a population. 

HSJ  asked Sir Jim about suggestions from senior sources that he would be in a weaker position to advocate for the health service due to the impending abolition of NHSE and cuts to its staff.

This, he said was “nonsense”. He added: “We have to work together with the political team. They are elected, they have a view – the department has a job [to develop] policy, we have a job about delivering and execution.”

He continued: “I don’t accept these things are binary – that you either have to be completely standalone to have any kind of say or independence, or you’re in the pocket. It’s not true. It’s just not real life.”

Sir Jim also said he had no objection to the demise of NHSE. “The fact that the largest public spending department has so much spending power devolved to an arms length body is really odd,” he remarked.

The CEO added he understood how the arrangement “would frustrate” ministers and complicate government. Sir Jim concluded: “It’s a complication we can [only] justify when we’re smashing everything out of the park and the economy is really stable and we’re not worrying about international security.”

‘Sensible’ cuts

ICBs are due to have their running costs halved, while trusts must cut any growth in their “corporate departments” by 50 per cent.  

Asked about whether the service’s financial woes would also mean cuts to clinical staff, Sir Jim said: “We have got to be sensible about this… In clinical areas, it doesn’t look like there’s been huge growth in direct clinical areas. I don’t think it’s the case that we’ve got huge numbers of extra nurses on wards. Quite a lot of it’s in the hierarchy, in our system, in new roles, education, practice, development, in the national recruitment. All those things that work around it all.

“You can see all that growth, and you can see that it was necessary at the time or [the NHS was] driven to do it at the time for good reasons. But times have changed. We’ve got to readjust now.”

Sir Jim said it would be “unfair” to say there has been a lack of grip in financial performance in the NHS. But he said: “I think there’s a bit of normalisation of things have just got a bit worse.

“I remember once I replaced somebody as a temporary chief exec who got moved on for a £2m deficit in the early 2000s. And now the numbers are just massive. So we’ve become used to these things. We’ve got to get unused to them, because society can’t cope with it anymore. We can’t cope with it any more.”

He confirmed NHSE and government are considering alternatives to the current block contracts for urgent and emergency care activity, as previously revealed by HSJ. 

Sir Jim said the block UEC payments “are massively out of sync now with patterns of care and what’s actually happening,” and “as a start we should try and reset them”. However he said he was “not totally convinced” a direct move to a full “payment by results” system would be the solution.

The new NHSE CEO said he hoped to agree with ministers that by 2026-27, “deficit support” money — worth about £2.2bn this year — would be repurposed into basic allocations, but said “we’ll still need some degree of deficit support” for severely overspending systems. It may be phased out over a three-year planning phase, he indicated.

Asked whether revenue money would be shifted from acute to community care this year, Sir Jim said “it’s going be hard to shift things materially” this year but said “we’ve got to start the process”.

Sir Jim said the NHS would “have to find a way of making it possible” to deliver the 78 per cent interim four-hour accident and emergency target by March 2025. Citing his organisation Newcastle Hospitals Trust achieving 87 per cent on the target on Sunday, he said: “It can be done. It can be more delivered through things that are hard to measure, like leadership, or clinical alignment, or presence. We need a leadership push now to try and find new ways through this.”

Sir Jim said the national urgent and emergency care recovery plan could be agreed as soon as this week.