[:en]by Corrina Kane

Having just last month explored the implications of the Lord Carter report on the freshly amalgamated body that is NHS Improvement (NHSI), I was compelled to attend a recent HealthChat starring its Chief Exec, Jim Mackey. Hosted at the almost hip King’s Fund Health Campus, ever so slightly at odds with the suit-and-tie NHS audience; none as dapper as the singular Roy Lilley as compere and inquisitor.

Billed as the first opportunity for Jim to share his transformation blueprint with the NHS community, and with Lord Carter himself Health Chatting later this month, the opportunity to compare and contrast was irresistible. The first surprise was that straight-talking Mackey doesn’t like the word transformation and doesn’t appear to have a blueprint. There may be several points of contention between the pair, but if it’s management grip Lord Carter is after, I would wager Jim has a strong one.

The soft-spoken and intense accountant from South Tyneside has financial discipline and leadership at the top of his agenda, and is certainly in line with Carter on the issues of people, data and reporting. Mackey has seen first-hand the terrible relationships formed between organisations in times of austerity and he spoke staunchly about the need to bring managers, clinicians and finance together to work through solutions at a local level. Rather than transformation he believes in stability, rules and frameworks to generate the right circumstances for excellence. In particular, hardwiring the accountability of Boards into governance. It’s no surprise to me that an abundance of organisations with redundant responsibilities, mixed with a lack of leadership capacity and uncompetitive pay, results in an environment where incompetence can go unheeded. Not a recipe for stability.

“Death by a thousand requests” is a common refrain we’ve heard across the NHS. Mackey is clear in his desire to rationalise data collection and reporting requirements. He is an advocate of rigorous patient-level costing and holds no sway with the detractors who protest that Carter has his numbers wrong. “If you think your number is wrong, work out your number.” Although Mackey and Carter appear to be generally aligned on the end goal, how to get there is a point of contention, particularly when it comes to benchmarking. Mackey is a proponent of “ignoring everyone else and improve yourself over time”. This is apparent in his dismissal of Carter’s new Care Hours per Patient Day (CHPPD) metric as a method of eliminating staffing variations. Self improvement is a noble pursuit. Introspective self-improvement without heed for your environment will not result in evolution. Darwin taught us that evolution arises from variation in an environment with competition for finite resources; the very thing we’re trying to avoid.

Technology is another area of dissidence. Shoehorned in by Carter, who at least recognised technology as an enabler of transformation, he recommended NHSI ensure and incentivise all Trusts to have ‘meaningful use’ of digital systems by 2018. Mackey made no mention of technology or digital systems, let alone meaningful use. His “back to basics” mantra was reminiscent of John Major’s failed traditionalist campaign of the same name. My issue is that we can’t go back, and nor should we. The ‘basics’ have changed. The way we work, communicate, live our lives, get sick and how we die are a far cry from the days when the NHS was founded in 1948. Just as we cannot and should not go back to coal mining and manufacturing, neither can our health service support healthcare for all using outdated means. Technology has transformed the way we live in countless ways, with healthcare the last bastion of archaism and ripe for disruption. If the NHS is to survive and thrive, it must change with the times, and this will take leaders with a vision of the future, not a longing for the past.

Jim’s matter-of-fact style goes down well with NHS staff on the ground and senior executives alike, in stark contrast to the usual management speak, giving him a great deal of influence and support in getting things done. Despite his reputation for coming across as grim, his understated passion and genuine drive to do the best for patients and the community gives hope. Will he achieve all he sets out to in supporting a financially sustainable healthcare system providing high quality, safe, compassionate care? Perhaps. And therein lies the key. Shifting attitudes from despair in the face of the impossible to a belief that it may just be done. We’ll continue to watch this space and explore the developments of Mackey.[:]