Sir James “Jim” Mackey started his career in the NHS in 1990. As it was then the NHS is at the centre of the UK’s political landscape. For executives like Sir Mackey winning the NHS meant winning it all. We sat down with Sir James “Jim” Mackey, albeit on zoom call earlier this week to gain his perspective on the future of healthcare. Throughout our conversation, his energy and enthusiasm for his field was certainly palpable.
In another life, Sir Jim Mackey would have been an accountant. Thankfully for the people of the United Kingdom, the leader of one of the country’s best run health systems and former CEO of NHS Improvement chose a different path. Under the helm of leaders like Sir Jim Mackey, the NHS has remained at the envy of international healthcare. It is the envy of the world because it provides a comprehensive service to millions, with remarkable efficiency and parsimony. Institutions like NHS Improvement, which Sir Mackey oversaw for many years, have enabled the NHS to perform at a world standard.
When Sir Jim Mackey began his career in the NHS in the nineties, public health in the UK was still recovering from the effects of market reform in the decade prior. Documents released by the UK Treasury in 2013 revealed a ‘politically toxic plan’ to dismantle the welfare state and to ‘shelve the NHS’ under late 20th Century austerity. Thatcher and her chancellor Sir Geoffrey Howe intended to introduce compulsory private health insurance and private medical facilities which would have signalled the ‘end of the National Health Service’.
Sir Mackey’s generation inherited a socio-political economy that sought to increase efficiency by eliminating crucial public services. Post-austerity Britain was faced with dealing with organisational rigidities which afflicted the NHS among other public services . The problem of ‘institutional and economic sclerosis’ in Britain, according to political researcher Patricia Day, threatened the integrity of health and social care services of the time.
Sir Mackey led the NHS out of the dark years for public health. Since the nineties, Sir Mackey has held key positions including Chief Executive of Northumbria Healthcare NHS Foundation Trust. He became a champion of Northern healthcare services, particularly in terms of his work to improve primary and secondary community care in the region. Most notably, he was appointed Chief Executive of NHS Improvement in 2015.
Under his tenure, Sir Mackey led the cohesion of crucial health services including Monitor, NHS Trust Development Authority, Patient Safety, Intensive Support Teams and many more. His keen interest in the quality of care, particularly patient community experience, motivated him to stay in health administration, despite multiple offers to return back to private finance. Unsurprisingly, Sir Mackey later earned a knighthood for the years of service and dedication to the wellbeing of the British people.
When I asked Sir Mackey what drove him to stay with the NHS, his answer was simple: ‘to help restore hope’ in people who ‘had given up on the NHS’. This drive to sustain belief in Britain’s public health led him to return to his substantive role as Chief Executive of Northumbria Healthcare. Prior to his 2017 return, Sir Mackey had held this position for ten years. His duty to the health of England’s Northern population led many to dub Mackey the ‘Knight of the North’. In this capacity, he ensured that Northern health services could withstand the shock of being critically overstretched, especially during COVID-19 pandemic.
Last week Baroness Diana Mary “Dido” Harding refused to comment on being in the running for Sir Simon Steven’s role as the CEO of the NHS. Sources tell us that although Baroness Harding would love the role, the damages done with track and track in the world’s worst healthcare crisis may have left a slight smudge on her chances. In contrast, Sir Jim Mackey experience in technically running the NHS successfully would place him well for the role. To date, track and trace is expected to cost the NHS £35 million and has delivered little in the way of innovation or impact on the pandemic. This is particularly true in the north of England, one of the toughest pandemic battlegrounds.
Sir Jim Mackey is what the NHS needs for this battle; certainly on the recovery efforts front. The NHS is taking the lead from the US in creating accountable care systems and accountable care organisations (ACOs). The institution would benefit greatly from Sir Mackey’s expertise during consultation on ICS becoming statutory bodies.
Will Improving Technology Actually Improve Future Healthcare?
Sir Mackey believes that there is room to improve the way technology is used to increase patient engagement. Going forward, he and many health leaders believe that the NHS should aim to empower patients’ engagement with their own health. This can be achieved through digitising the ‘management of their own disease, scheduling, interactions with clinicians’ and much more. However, internal operations won’t facilitate this form of patient engagement on its own; it has to be driven by the patients themselves.
“One of the most powerful things [in healthcare] is the power of agility…of not thinking about internal infrastructure all the time, but prioritising agility driven by patients interacting with technology and clinicians simultaneously…The only way [the NHS] will recover in the pace and the effectiveness that we want to be is through a genuine partnership”.
That being said, Sir Mackey adds that the NHS can only reach this desired level of recovery if it is undeterred by ‘politicisation and polarisation’. The problems we have seen with Track and Trace speak clearly to the way the NHS’s efficiency has been stunted by these issues.
“The principles of Track and Trace were invented during the Plague in the 1500’s. It’s bizarre how 500-600 years later we haven’t managed to figure out how to do this properly. The best thing we can do is to get rid of the politics of it all, and focus on what we need. A test is only useful in that it provides data to inform decisions. But it doesn’t feel like we’ve developed the muscle to understand what that data means, as well we should have done. As of now, we still don’t really know what has driven the rise in infections”.
Localised Intelligence and Data – Unsung Heroes of the Pandemic?
So, how can the NHS augment this situation? Possibly, the answer may lie in the use of localised data and local intelligence. Sir Mackey suggests that information which captures how we live our lives on a daily basis could be more useful than national data systems.
“There has got to be something [in localised data] that harnesses how we think, work and live our lives, to provide intelligence and decisions. That moves away from a national heavy system and towards agility. It will help us understand that certain kinds of activities will put you more at risk. If you’re in a certain kind of environment, you might be at more risk. This information could differentiate on a behavioural level and provide data on a system level that will drive decisions”.
Given the wealth of information that could be derived from understanding localised behaviour, there is now an appetite to build capabilities that can harness this data. Sir Mackey is leading the effort in the NHS to bridge these gaps in understanding, and to empower the interaction between local communities and national bodies. This will be crucial in a few months’ time, when many of the UK population will (hopefully) be vaccinated against COVID-19.
Battling the Coronavirus Pandemic
In the summer of 2020, Sir Mackey published an opinion piece that described learnings from the COVID-19 first wave. The key point that he stressed was the importance of collaboration. Particularly, he extolled the effects of organisations of working together and the synergistic potential of technology. He credits the successful output of the NHS to the digital acceleration we have seen in healthcare. In the early months of the pandemic, he states that recalibrating technology to increase the efficiency of ‘digital consultations in primary care’ has helped to make the NHS more agile. Further, he considers the realised benefits of ‘simple advancements’ aiding vaccine programmes to be invaluable in combating the virus.
However, the most valuable lesson that the pandemic has taught Sir Mackey and other health leaders, was technology’s role in improving NHS systems. According to him, digital acceleration has allowed for the NHS to quickly ‘embed some of the big changes that were made during the extremes of COVID’. This is particularly true of dealing with backlogs in primary and secondary care:
“One thing is certain in terms of recovery. If you look at backlogs, the NHS isn’t going to recover by everyone just working harder for five years. We’ve got to change the game. We’ve got to work to transform, to try different things.”
On a local and national level, Sir Mackey’s organisation has used technology and data to ‘transform’ and ‘simplify’ NHS output. Under his leadership, digitised outpatient care, triage and clinical innovations are being embedded into NHS systems. Additionally, digital diagnostic techniques such as capsule endoscopies are widely being trialled across various local communities. These accelerations are particularly useful for those in rural or outlying areas, away from larger, metropolitan hospitals. The use of drones to move test result data is also being investigated by Sir Mackey and his partners for those in remote locations.
Final Thoughts
Because of the gross scale of data that the NHS will act on to effectively immunise the UK, there is more work that needs to be done. The public will need to be involved in resource decisions and managing their own health. There is great potential from a technology standpoint to connect the public with systems to make informed healthcare choices in tandem with the NHS.
Sir Mackey is optimistic about early examples in Western digital developments, especially in the digital consort space. However, these technologies cannot yet be integrated into national systems. They need to be modified and equipped to be more agile for the customer and healthcare provider. According to Sir Mackey, it is ‘incumbent’ on both the health sector and the tech world ‘to understand how they help us to adopt their technologies’:
"We have to find some common ground where the tech world can share with us usable technologies in a way that we can digest them […] perhaps build them together over time. We have to be more responsive and more embracing of those changes, rather than being so risk averse. We can’t go back to normal; we have to build new innovations to move forward.”
