Jim Mackey is an outstanding choice as first chief executive of the new provider regulator, NHS Improvement. The problem is that, in the face of a deficit of £930m in just three months this financial year, he has been given an impossible task.
Mackey’s work as chief executive of Northumbria healthcare foundation trust embodies key areas where the NHS needs to succeed. The trust is demonstrably patient focused, it has an impressive level of integration with social services, it is making good progress on working more closely with primary care, and it found a novel solution to its PFI problems – getting help from Northumberland county council, which could access low interest rates. Mackey has also been working on a provider-led “accountable care organisation” to manage population health and is an enthusiast for hospital chains.
But an impressive leader and a beguiling new name to replace Monitor and the NHS Trust Development Authority are scant comfort in the face of the growing and apparently uncontrollable deficit. It is far from clear that yet another reorganisation of the central bodies is going to deliver the scale and speed of change required to avoid a complete loss of financial control.
The new organisation is intended to address one of the central criticisms of Monitor’s remit by linking financial discipline with service quality more explicitly. As well as taking over some of the functions of the soon to be defunct NHS Improving Quality, it is also acquiring NHS England’s safety responsibilities by hosting the new Independent Patient Safety Investigation Service, modelled on the Air Accident Investigation Branch.
Whatever the drawbacks of the current setup, at least Monitor and the TDA have reasonable clarity about their mission. NHS Improvement, in contrast, risks riding off in all directions. In case sorting out a £2bn deficit while improving quality and safety are not enough to keep it busy, it has also been charged with succession planning for NHS leaders, creating a talent pool for the top provider and commissioning posts. There must be a risk this will cut across the growing leadership role for Health Education England, but if regulators feel some responsibility for filling the growing number of vacancies among trust chief executive posts then perhaps it will make them a little less trigger happy when it comes to punishing incumbents.
Perhaps the most immediate benefit from bringing together money and quality will be a new approach to the oversight of procurement, choice and competition. These will now be seen through the lens of the patients’ best interests; there have been times when a puritanical pursuit of choice and competition has seemed divorced from the long-term interests of patients by inhibiting rationalisation of services.
Staffing is, of course, central to controlling both safety and budgets, but advice on safe staffing levels will reside with NHS England. Chief nursing officer Jane Cummings has said: “There can be no compromise on the issue of staffing and its impact on patient safety.” Unless the chancellor, George Osborne, delivers a spectacular and sustained funding increase in next month’s comprehensive spending review, compromising on staffing will be exactly what is required. If NHS England is going to be pushing for more staff in isolation from financial reality, it is going to clash with NHS Improvement.
The most promising aspects of Mackey’s appointment is that he thinks in systems rather than organisations and he is willing to take bold decisions to cut through problems. The formidable range of powers and responsibilities he will be presiding over once NHS Improvement formally takes over next April will force NHS England to engage effectively – something it has not always excelled at with Monitor.
Mackey will no doubt lead a strong and motivated team. But however talented the staff at NHS Improvement, it is all but impossible to see how it can make substantial progress towards eliminating the £2bn deficit without compromising on staffing or quality, let alone deliver sufficient productivity gains to secure the mythical £22bn of savings. A major investment in restructuring care, and a willingness to take unpopular decisions, is the only long-term solution.
Join our network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views.
