Health Service Focus

A ‘fighting chance’ for the future of providers

Jim Mackey, the new chief executive of NHS Improvement, outlined what providers can expect from the regulator in his first major speech. David Stevenson reports.

On day two of the NHS Providers Conference, Ed Smith, the new chair of NHS Improvement, took to the stage briefly stating that he wants to hear more from those who chair organisations across the NHS. “Often they are seen but not heard,” he said. 

Smith, the former global assurance COO and strategy chair of PwC, “truly believes” people are at the heart of any system of leadership, meaning it is behaviours and cultures that are important, not structures and processes. 

Since his appointment to the new regulator, which will come online in April 2016, he said the most important thing he has done is appoint Jim Mackey as CEO. 

Following this introduction, Mackey told delegates in his first major address that NHS Improvement will try to deliver more “realistic expectations” for the provider sector while making a distinction between support and regulation. 

The former CEO of Northumbria Healthcare NHS FT told the audience that the regulator aims to make changes to give the sector a “fighting chance for the future”. 

He hopes to secure a good settlement in the upcoming Spending Review and push for multi-year tariffs, possibly three, to enable providers to plan their recoveries, investments and disinvestments. 

However, unlike Chris Hopson, who said the biggest challenge is to get the sector back into financial surplus, Mackey believes the biggest risk is the workforce – a theme throughout the conference. 

“We have large chunks of professions where people are just not coming through,” he said. “In my old region, roughly half the GP training scheme is unfilled. If this is the scale of the problem now, what will it be like in five years’ time?” 

Discussing safe staffing, Mackey said there needs to be a look at the contribution of all staff, not just nurses. He aims to bring the safety team from NHS England across to the regulator without doing any damage. 

A recent Monitor board paper said the agency will support aligned patient safety priorities across the system, more effective and better-supported boards and leaders, locally-owned improvement methods and sustainable performance standards – including better financial control and governance. 

Realistic expectations 

After discussing the bleak situation providers find themselves in, Mackey added: “There is recognition that providers need even more realistic expectations going into the next year and next few years. 

“We want to get back into balance within a reasonable period. We are probably looking at a two-stage process. 

“Hopefully, an agreed Spending Review and tariff and then agreeing a fairly quick and simple plan that shows how to start stabilising the individual institutions. Then, in the spring, there will be a longer-term, patch-based, place-based planning process that addresses what the long-term issues are.” 

Accessing additional funding 

Mackey thinks it “highly likely” that access to a share of the £8bn promised by the government will depend on participation in that process and getting the right results. 

There is still a lot providers can do, he said: “The Carter review shows there is ridiculous variation in efficiency and productivity – sometimes within the same institutions or those next door to each other. We need to grasp the nettle in terms of long-term planning and we need to reflect that in spending and the tariff.” 

NHS Improvement will try to support providers in improving quality, as largely defined by the CQC, and wants to give them freedom and flexibility to do this as they want to, while ensuring – with NHS England – that the payment system promotes quality. 

“Fundamentally, what we are aiming for is to restore hope in the provider system with a challenge that is challenging but possible, and within reach for most,” he said. 

Despite offering support to providers, Mackey added the organisation is still a regulator, inheriting those functions from Monitor. “We need to be honest about that,” he said. 

“We will do our best to support you, but at the end of the day there is still accountability: we are still accountable and you will be, but I think we can be grown up about that.”

But he did note that NHS Improvement won’t be about giving providers “a kicking” just because they have had an incident. 

After the conference, NHS Providers CEO Chris Hopson praised Mackey’s welcome shift in tone and approach, tweeting that he offered “realism, support and deliverable provider task”. Shane Degaris, CEO at The Hillingdon Hospitals NHS FT, added that Mackey came across as “honest, measured and supportive. Very refreshing”.

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