NHS has ‘maxed out on what is affordable' – says new service chief

Independent

09-05-2025

The NHS has 'maxed out on what is affordable', Sir Jim Mackey has said as he called on the service to 'accelerate' improvements and stamp out unacceptable care which has become 'normalised'.
The new chief executive of NHS England described the 'shock and worry' of discovering that 'undeveloped' plans for the NHS in England projected a multi-billion deficit for this year.
While expecting 'some growth' from the Treasury in the upcoming spending review, he said the service faces 'big choices' to 'tackle variation' and 'improve service standards'.
Meanwhile, Sir Jim said he will have 'no problem' expressing his views to Prime Minister Sir Keir Starmer and Health Secretary Wes Streeting.
Speaking at an event for the Medical Journalists Association in London, Sir Jim slammed 'unacceptable' care – particularly for the elderly, which has become 'normalised'.
He also expressed concerns over staff being 'desensitised' to poor care – such as elderly people facing long waits on trolleys in A&E departments.
On spending he said: 'The NHS is such a big part of public spending now we are pretty much maxed out on what's affordable.
'It is really now about delivering better value for money, getting more change, getting back to reasonable productivity levels, but in a way that's human and is about standards and about quality.'
He went on: 'In the planning round, it was starting to look like, on a nearly £200 billion pound budget, we were going to go into this year with undeveloped plans – but they were plans at the time – with a £6.6 billion deficit, £2.2 billion that could come off that for deficit support. But that's still a huge deficit.
'And the shock that that was creating, the worry that was creating, the anxiety about what that meant for the economy, and the international instability that we've got, what it meant for growing a society in this country, and with that the real expectation and need for us to improve much more quickly.
'I think we could argue we've been improving gradually over recent years, but this is a time for a really big wake up moment about we need to really accelerate improvement.'
He went on: 'In the end, it will be about how we get better value for money for the for the money that we've got, and we'll get some growth in the spending review, but it's never enough.
'So we'll have choices to make and the biggest choices we have to make about how we tackle variation and improve service standards and productivity in this next period.'
On unacceptable care, Sir Jim said the service must 'try to get beyond things that have become a bit normalised over recent years that we would never have accepted'.
He added: 'Ten years ago, we would have never accepted old ladies being on corridors next to an (emergency) department for hours on end and they have become normal in the NHS.
'We've got to get ourselves out of that, and everybody wants to get out of it.'
He said that even in places 'delivering excellence' there are 'still things going on there that are completely unacceptable' as he said that driving down variation would help to improve care.
Sir Jim continued: 'There's lots of examples like that where I think we just sort of gradually moved to a point where we've accepted things that we should not really have accepted, and we need to stop accepting.
'The hard bit is what we what we do about it, most people know that, the worry is when they're desensitised to it… it's actually not their problem, they have found a way of walking around it.
'Colleagues used to describe it as 'learning walk with a limp'.'
Asked about independence from politicians, Sir Jim said: 'I'll have no problem telling anybody what I think – if I have a view, I'm going to express it, and if I think something's wrong, I'm going to say it.
'But I'm very confident in the way that I've seen Wes work his political team and the Prime Minister, that they actually don't want somebody to just sit, just go along with everything, and just roll over and not say if they have a they have a view, and I'll take that seriously.'
Speaking about the demise of NHS England, Sir Jim also said that 'naive' to believe an organisation which 'is the biggest consumer of public resource in the country' could be political independent.
'I understood the logic at the time, I think it was probably, in hindsight, a bit naive to think that we could make something politically independent and less directly controlled by the political system for something that is the biggest consumer of public resource in the country,' he said.