'Ruthless' rationalisation of regulators and CCGs could save £1bn, says Mackey

In an interview with HSJ, Jim Mackey also said there was now a “once in a lifetime opportunity” to bring his Northumbria trust together with Newcastle upon Tyne Hospitals Foundation Trust.

In a major interview with HSJ marking the end of his tenure at NHSI, Mr Mackey also:

• called the Department of Health’s 6 per cent interest rate charges on bailout funding for some trusts “absolute madness”;
• criticised “negativity” in the NHS following the budget settlement and called for emergency services to be prioritised when spending the new £1.6bn next year;
• revealed getting the provider sector into the black had always been “impossible” during his tenure at NHSI;
• admitted he was “out of my depth” when he began his national role; and
• criticised the leadership at one of the largest trusts in the country over financial performance.

Asked whether he wanted to see NHS England and NHSI become more integrated, including joint board appointments, Mr Mackey said: “Absolutely.”

He said “at a provider or local system level, it is incredibly chaotic”, noting that “frazzled” managers in his trust were having to field multiple calls from regulators despite being within a percentage point of hitting the four hour accident and emergency target.

He said accountable care organisations and systems, and sustainability and transformation partnerships, were “far too bloody complicated for most people”.

“Let’s simplify that and work out what do you actually need in the local system, and then work out what kind of oversight and support they need, working back up through the system, and make sure it’s getting simpler, cheaper and more effective.

“That will drive you to the things that we need to do once rather than three of four times across the national bodies,” Mr Mackey said.

He said he “couldn’t believe the cost of the architecture” when he took over at NHSI. Mr Mackey returned to Northumbria Healthcare FT last week after two years on secondment at the regulator.

He continued: “It would need to be done properly but I think if you did it really ruthlessly, the way that in a provider you go at your overheads, we should be able to get a billion quid out. It’s really serious money.

“You [would] get loads of spinoffs, of lots of people having time to do what they need to do.”

Asked about continued allegations of bullying by national bodies, Mr Mackey said: “We put a lot of effort in at NHSI to try and make sure our interactions are professional and respectful. I did have a couple of direct examples of people feeling they’d been bullied and that was dealt with.

“[After last month’s NHS Providers conference] I did three calls and physical meetings with chief executive colleagues who were under a lot of pressure. It wasn’t from [NHSI] but they were feeling under a lot of pressure and were very nervous about how they said what they needed to say.

“They were under pressure from other parts of the system, a mix of different bodies, and that’s not good is it?”

Mr Mackey said national leaders should focus on alternatives to the existing tariff payment system, which he said was “pointless” because it was “so far out of sync with actual cost”.

“We have to have a conversation about mechanisms that we know work. We know that incentivisation in primary care works. I think incentivisation in social care, around discharge would work, if we could come up with mechanisms to do it.

“If I was still in the national system, I’d like the next six months or so to have a big focus between both of the main national bodies on finding new mechanisms,” he said.