In one of his first public events since taking the helm as Chief Executive of NHS England, Sir Jim Mackey joined the Medical Journalists’ Association and MHP Health for a wide-ranging conversation on the future of the health service.
Delivering his lecture to an audience of journalists, policy leaders and health experts, Sir Jim acknowledged the scale of the challenge ahead leading the transition as NHS England is abolished, navigating the ‘new world’ of integrated care, and preparing the ground for the NHS’ upcoming 10-Year Plan.
The tone was frank and confident, with Sir Jim combining candour about the system’s weaknesses with a clear sense of purpose and direction. Here are five key takeaways from the lecture:
Sir Jim pulled no punches when it came to the funding landscape. With the NHS now one of the largest areas of public expenditure, he stressed that the system has reached the upper limit of what’s affordable within current constraints.
The NHS began the year aiming for a £200 million surplus, but it is now facing a projected £6.6 billion deficit. This is forcing tough decisions and demanding a more disciplined approach. “There will be choices to make,” he warned, calling for a ‘wake-up moment’ to accelerate improvement and transformation.
While the operating model introduced when NHS England was created may have made sense at the time, Sir Jim made clear it no longer works at this scale of spending: “At a certain cost, the old model was probably right. But not anymore.”
From emergency departments to maternity wards, Sir Jim highlighted a creeping acceptance of unacceptable standards in patient care. “We’ve normalised things we shouldn’t,” he said, reflecting on a system where corridor care and long emergency department waits have become disturbingly routine.
He urged leaders to re-engage with the fundamentals of quality and patient experience, with a renewed focus on “delivering standards” and increasing transparency to tackle unwarranted variation across the NHS.
Calling out the complexity and duplication in the current NHS operating model, Sir Jim made a clear case for devolving power and decision-making. “We’ve ended up with an operating model where a problem that could be solved locally has people nationally involved, which causes delay.”
One of the most striking commitments from Sir Jim was a renewed focus on transparency. He described “incredible variation” in outcomes and access across the NHS and said it was time to increase public visibility of that data.
He pledged to simplify structures, empower trust chief executives, and introduce a rules-based framework that restores local accountability with performance data and clinical outcomes published more frequently. He acknowledged that this approach carries risk while also reducing ICB costs and headcount, but is necessary for transformation.
Asked whether NHS England was a failed experiment, Sir Jim was refreshingly honest. While its independence had some benefits – particularly during the pandemic – he described the model as ultimately “naive,” given the NHS’ vast consumption of public resources.
“In government, it’s strange for an arm’s length body to hold all the spending power,” he said. Instead, ministers should be democratically accountable, and the system should allow for clearer lines of decision-making and responsibility.
Sir Jim also addressed the political dynamics of his role, including his relationship with Wes Streeting. Far from shying away from disagreement, he welcomed robust discussion: “Noisy conversations are the best kind,” he said, adding that the Health Secretary and the Prime Minister don’t want a chief executive who simply agrees with them.
What’s needed now, he argued, is an NHS that doesn’t spend two years “thinking about itself” but gets on with delivering for patients and staff.
Sir Jim’s debut appearance as NHS Chief Executive offered clarity, candour and a sense of urgency. While challenges remain immense, from workforce and funding to system reform, his call for local accountability, renewed standards, and “getting back to basics” struck a chord. As the 10-Year Plan approaches, all eyes will be on how these words translate into action.
