NHS Improvement chief executive Jim Mackey promised a renewed push on earned autonomy when he addressed the NHS Confederation annual conference in Liverpool.
Referring to the drive to get deficits under control he said: “It’s been an incredible effort; you have all done things that looked impossible.”
But he acknowledged that it had involved using tools such as control totals which were “short term” and “blunt and grippy”.
“None of us should think that is sustainable for ever. The methods we are using are not sustainable,” Mackey said.
“I want to see more movement in this next phase back towards earned autonomy, to get local systems into a place where they have a better chance to build their own agendas… with much less reliance on central support.”
But he stressed he wanted autonomy for systems, not autonomy in “the old-fashioned FT way”.
This would include development of “distributed leadership” and further blurring of the roles of commissioners and providers through approaches such as accountable care systems.
We have definitely got a problem with morale across the NH
Referring to the relentless financial pressures he said: “The bad news is that we have to do it all again. The good news is that we will find ways to do it which are more sustainable.”
Mackey warned the conference: “We have definitely got a problem with morale across the NHS.”
He was concerned that staff were routinely working without respite: “We should all be concerned about the resilience of our staff… This needs to be top of everyone’s agenda.”
It was also proving difficult to recruit leaders to some of the toughest trusts, he said.
He promised that the next phase of NHS Improvement’s work would have a greater focus on service quality.