In their latest In The Loop podcast Niall and Roy have a revealing exchange with NHS England Chief Executive Sir Jim Mackey. In a wide ranging discussion Jim admits just how challenging it will be to meet the government’s ambitions for the NHS. If they deliver, he thinks books will be written about it and that it could be the greatest public sector turnaround of all time. “We are trying to do a lot in one go, we are trying to do major change on pretty much every front, very quickly and what feels like in a rush, and at times it feels a bit overwhelming.” But he remains optimistic and argues that they have no alternative but to address a whole series of fundamental challenges. Sir Jim makes clear he did not know NHS England was going to be abolished when he took on the role. He supports the plan but says it would have been reasonable to assume that when the announcement of job losses was announced everything about the redundancy programme would have been ‘boxed off’ and ‘lined up’. But it wasn’t. And he says that matters have become more complicated as the year’s gone on and as other things have changed politically and economically. He insists that redundancies at NHS England and for staff at Integrated Care Boards (ICBs) should be achieved through voluntary deals, but admits they are still negotiating with the Treasury and that it has taken too long, with lots of argument and this issue becoming tied to other negotiations. According to Sir Jim “The delays on the redundancy costs have added complexity and drift and we do feel we are trying to do too many things at once. The big problem we’ve got is we do not have the time because the public aren’t as patient with us as we’d like them to be, because of the mess we had go into.”“I am as irritated and annoyed as anyone else is about how long it has dragged. It’s no way to be treating people but it is complex and it is not about compulsory redundancies. We are going hammer and tongs to get things resolved as quickly as we can. It has gone on too long.”On ICBs he says he always thought 42 was too many with too much difference in their sizes, and that they were given too much to do and had to work with a very expensive and incredibly complicated operating model In future ICBs will concentrate on commissioning rather than performance management – Sir Jim admits he did not love commissioning but feels the absence of it in recent years has been a problem and that they need to restore its value, with performance management largely sitting with regions On resident doctors “We are in bad way, where there is significant dislocation between them and what they need and what they want, versus what we as employers want and need, versus what the population want.” Sir Jim says they need to fix some of the stuff that is causing irritation but also take a fundamental look at how the training and rotation works ‘as they clearly don’t like it’
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Claire Murdoch.
In their latest venture In the Loop, Niall and Roy turn to mental health and conduct the first interview with Claire Murdoch, NHS England’s outgoing mental health director since she dramatically resigned earlier this month after nearly ten years on the job. In the podcast, Claire says she quit because she felt she no longer had political support and reveals her dismay at the failure of the new government to maintain the share of NHS spend on mental health. In a strong defence of what has been achieved on her watch, including more than doubling the number of professional staff working in child and adolescent services, much improved access for young people, despite a huge increase in demand, and great progress on a nationwide roll out of mental health support in schools. Looking forward, she says the share of NHS spend has been phenomenally helpful and must be protected and that as far as she is concerned it was ‘job begun not job done’. But this discussion also reflects the reality of mental health care in England today with services desperately struggling to meet the explosion in demand and with patients of all ages unable to access the support and treatment they need.
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Dame Jennifer Dixon, CEO of the Health Foundation.
The latest podcast from Niall and Roy sees a somewhat different take on the current state of the NHS from Dame Jennifer Dixon, the longstanding and respected Chief Executive of the Health Foundation. Jennifer, who once practised in paediatrics before moving into public health, accuses the government of being disrespectful and menacing in its approach as it seeks to reform the service and argues that the system needs to use its principal asset which is human capital. She also questions whether it will be possible to deliver all that is being promised, arguing that while technology will help it is possible to be unrealistic about what it will achieve. Dame Jennifer also questions whether the current approach to prevention will work suggesting that there is a limit to how much the NHS can do given its funding constraints and she warns that if autonomous Integrated Care Boards could go upstream and spend funds in that way it could be at the expense of basic services. She says that while we are not there yet, if improvements don’t come fast enough, we may get into a situation where we need to look at getting much more money into the system from some other routes. On her own profession, she says she understands why young doctors are angry but reveals how she saw at one hospital how disrespectful they were to their chief medical officer, switching off their online cameras and putting barbed comments in the chat box. Jennifer calls for much more practical support for resident doctors but predicts that technology will mean more tasks will be protocolised and that as a result in the future there may be a need for fewer physicians, with those who are there working at the top of their licences. The next five years she says will be the most critical in the NHS’s existence.
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Lord Ara Darzi.
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Professor Tas Qureshi.
In this episode of their Podcast In the Loop Niall and Roy step on to new ground in a fascinating discussion with Professor Tas Qureshi. a General and Gastro-intestinal Surgeon at Poole Hospital in Dorset. But Tas has another role – he has made a number of trips to Gaza as a volunteer, giving up his free time to support his fellow surgeons there as they deal with the most horrifying of trauma injuries, as well as helping to train staff in the treatment of cancer. This is a personal story, not a political statement but by telling it Tas hopes to highlight the plight of all those who are suffering, including so many children. In doing so he gives us a mental picture of what it is like to operate, medically and in every other way, in a war zone. You will have seen many terrible pictures of the suffering in Gaza, but this account, with words only, is in some ways more illuminating, more powerful. He reveals the impossible choices he and his colleagues face of which child to treat and which ones must be left to die, sometimes in agony, the so called safe houses which are not safe from bombs and bullets, and the resilience of humans in the face of impossible odds. Many UK doctors do incredibly valuable pro bonowork, but Tas is one of a smaller band who are also prepared to risk their lives to relieve suffering. And like Tas, they are not keen to promote themselves, but are keen to tell the story of what they have witnessed.
In this podcast series, Roy and Niall leverage their extensive experience in health and social care to engage in insightful conversations with influential figures. They explore the sector's critical issues and challenges, cutting through political rhetoric and hype. Each episode offers a deep dive into the realities of healthcare, providing listeners with a clear understanding of the complexities involved.Who is Niall?Niall Dickson CBE is a prominent health and social care figure. He has held several key positions, including Chief Executive of the NHS Confederation, Chief Executive and Registrar of the General Medical Council, and Chief Executive of The King’s Fund. He has also worked as a journalist for the BBC and was awarded a CBE for his services to patient safetyWho is Roy?Roy Lilley is a health policy analyst, writer, broadcaster, and commentator on the National Health Service (NHS) and social issues. He has held various influential roles, including vice-chairman of West Surrey and North East Hampshire Health Authority and chairman of the Homewood NHS Trust. Roy is also known for his popular eLetter, which reaches around 300,000 health and care managers, and for founding the Academy of Fabulous Stuff, a repository of best practices in the NHS.
UK