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Next few years will be 'really tough' for NHS, warns regulator boss


NHS workforce supply problems will continue for the next “few years” and, despite additional funding to transform services locally, significant financial efficiencies will still be required, the head of the health system’s new regulator has said.

Senior nurses were warned by NHS Improvement chief executive Jim Mackey that, while services in 2016-17 would be under less financial pressure than the last few years, it would still be “really tough”, adding that “nobody is out of the woods yet”.

“I want to get back to a position nowhere nurse leaders can make informed judgements on a local level”

Jim Mackey

Speaking at a senior nurse conference in Manchester this week, he called on leaders to help tackle variation across areas including staffing levels, performance ratings and patient experience, noting the “huge” difference sometimes within organisations themselves.

However, he reinforced the importance of nurse leaders making decisions locally to address these issues, stating: “I want you all to stop feeling like we’re going to turn up and mark your homework.”

Jim Mackey

Jim Mackey

Jim Mackey

He said there was still opportunity for nurse leaders to help develop a new method for measuring nurse staffing levels – the care hour per patient day metric, which was recommended in a major review of NHS efficiency by Lord Carter.

“We do need you to end the confusion on safe staffing. So moving away from the rigid approach we had a couple of years ago to a much more sensible…approach around care hours per patient day,” he said.

“Where I’m going on this is, I want to get back to a position nowhere nurse leaders can make informed judgements on a local level with your other colleagues in your team, rather than trying to comply with something central that doesn’t make sense in your context,” said Mr Mackey.

“We’re trying to do seven-day care and we’ve still not managed to shift care into the community”

Janet Davies

He reiterated the current “terrible” staff supply shortages and acknowledged the health service’s financial situation in 2015-16 was “probably the worst year in NHS history”.

But Mr Mackey pointed to the £2.1bn NHS sustainability and transformation fund, which is due to be allocated to all regions across the country this year as a “once-in-a-career” opportunity to tackle local problems across the sector.

The fund is aimed at helping to change the way hospital and community services are provided through better integration, as set out in NHS England’s Five Year Forward View.

However, Royal College of Nursing chief executive and general secretary Janet Davies, who spoke before Mr Mackey at the conference, criticised the previous lack of funding for the nurse workforce in shifting care away from hospitals and into the community.

Royal College of Nursing

Royal College of Nursing appoints new leader

Janet Davies

“It’s been a written priority now for over a decade but there’s a real lack of evidence in the fact there hasn’t been any tangible investment at all in terms of the qualified nursing workforce in our community setting,” she told nurses at the conference, which was jointly run by the RCN and NHS England.

Despite this, she encouraged nurse directors and deputies to take the lead and look at alternative community nursing models internationally to help shift care provision closer to home.

Ms Davies also said the RCN was “very, very dubious” that the government’s ambition to introduce “seven-day services” could be realised without additional investment.

“So we’re trying to do seven-day care and we’ve still not managed to shift care into the community, and it will mean resources,” she told delegates.

“I do not think we can hide behind the fact that we can increase efficiency and increase quality – in reality how can we do that without some extra boost of resource to get it going?,” said Ms Davies.


Readers' comments (4)

  • Nurse leaders? I couldn't name one

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  • Totally agree. Very aggressive photo of Mackey (lean and mean). He now wants local rubbish management to take the fall for his BS approach at a national level. The only radical leaders are going to come from all out alternatives away from sly management who will also overcome snobbish narrow minded kudos academics, weak unions and greedy government - the odds are overwhelming but not impossible.

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  • Historically, wherever safe staffing levels have been argued for, these lot have said it should be decided "rationally" at a "local level". They're passing the buck cos otherwise people like the RCN would have to start acting like a union and stand up for their workers and common sense and demand legally enforceable nurse:patient ratios.

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  • Rob spot on. RCN must be the weakest union in UK history. They support some Mich that is wrong about nurses then blame them for the action they're a union should take. And what happens when reps stand up they get shouted down by the person in charge - sounds like another useless Peter Carter in my view.

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