An interview with Sir Jim Mackey

Sir Jim Mackey was appointed the National Adviser for Elective Recovery in September 2021. The ‘Delivery plan for tackling the COVID-19 backlog of elective care’ was published earlier this year. Mike Nathanson took the opportunity a few weeks ago to ask Sir Jim about his job as Chief Executive of Northumbria Healthcare NHS Foundation Trust, as well as this additional role.

MN: Jim, you have worked in the NHS for quite a few years and in several posts. What took you back to Northumbria in 2017? 

JM: When I agreed to go to NHSI, it was always on the understanding that it was for two years and that I would return to Northumbria. There were various reasons for this, some family related, some professional and practical. I felt strongly that I could offer something in that phase but NHSI would need something different after that, and there was also a strong pull to stay in Northumbria. 

MN: Does that allegiance to the North East include a favourite football team? 

JM: I am a Newcastle supporter and have all the psychological scars associated with that…. although I am optimistic for the future now (again…). 

MN: I think you are an accountant by training? How did you start in the NHS? Was it chance, or a planned career? 

JM: Yes, I am an accountant and trained in local government. I joined the NHS in 1990 on qualification, fully expecting to stay for two years (there’s the ‘two year’ thing again) and get some management experience. I then got the bug and have been here ever since. 

MN: Your Trust has a reputation for very high staff satisfaction. What is the secret of success? 

JM: So we are, like most Trusts, very focussed on trying to make working here as good as it can be. We set out 11 years ago to get very serious about patients’ experience, and then added staff experience into this programme in 2018 using similar methodology. This has involved lots of structured ways of finding out how people feel here, what the issues are etcetera, and trying to fix them. Really wanting to make things better, good measurement and tenacity are key. You also need to be prepared to hear things that are difficult to hear. 

MN: You have a national role to help the NHS in England to deliver the recovery in elective surgery. But, I understand in Northumbria you’ve had a focus on long-waiters for many years? 

JM: We have always maintained a focus on access in urgent and elective care and our primary care work, and didn’t drop the focus on the standards when they got blurred out a bit. Fundamentally, it’s not good for patients to wait too long and it’s bad for staff to feel out of control. These fundamentals sound unexciting but they are important! 

MN: How long do you think it will take the waiting list in England to get back to pre-pandemic levels, and hopefully even lower? 

JM: So, this is subject to huge debate currently. There are about 10 million fewer referrals in the system from the last two years than we would have expected, and the extent to which they will return is a very big issue. So, the plan focusses on long-wait eradication by 2025 and restoring access to, firstly, out patients and diagnostics. We will have to take a view on list size and ‘referral to treatment’ times when the bounce back risk is more certain, later on in the current year. 

MN: Do you think our politicians understand the perilous state of the NHS workforce at the moment. 

JM: I think everyone does. However, and this will sound odd, the NHS has about 10% more staff than it had pre-COVID (as far as I understand it). It doesn’t feel like that, and we always want more, but that can’t change quickly. The NHS is huge and very complex but, above all else, it’s a people business and I think pretty much everyone gets that now. 

MN: And, do you think the public, that is taxpayers, are prepared to fund the amount of investment in the people we need? 

JM: Mostly but… they want results. I think we can all see public attitudes hardening now, which isn’t unreasonable given the disruption that people have experienced. So, I think people are willing to pay more through their taxes but rightly expect good quality, access, responsiveness, etcetera. 

MN: Of course, it’s not just workforce. We need investment in the estate, in research and development of new pathways of care, and in community services. Do you see this happening soon? 

JM: Absolutely, and it is happening now with huge investment this year in the second half of the financial year via the Targeted Investment Fund process for buildings, separation of streams, technology, etcetera. This will continue but, like people, we will always want more. We need to show we can deliver good value and that we are worth investing in. 

MN: Finally, if you had a magic wand, what would you change about the NHS? 

JM: Honestly, in spite of its challenges and eccentricities, I think the NHS is still the best in the world when you look at things in the round. I think for all of us, both staff and patients, feeling that demand and supply were in balance, and sustainably so, would be wonderful! 

MN: Thanks Jim. It’s been great to hear from you about how you think the backlog in elective care in the NHS will be delivered.

Mike Nathanson
President, Association of Anaesthetists 

Twitter: @Assoc_Anaes