Latest news with #Sir Jim Mackey
Times
2 days ago
- Health
- Times
Inside the best NHS trust in England — how does it do it?
'When we talk about looking after our own, we absolutely mean it,' explains Dr Birju Bartoli, chief executive of Northumbria Healthcare NHS Foundation Trust. 'We all live on the patch. You have generations of the same family who work here — grandparents, mothers, sons.' The odds are stacked against Bartoli and her team. The trust runs four major hospitals and is responsible for the health of 500,000 people, spanning a vast area from the Borders to the outskirts of Newcastle. The population is ageing, spread across a mix of remote rural communities and deprived coastal towns — areas where recruiting doctors is notoriously difficult. Yet patients here are seen faster than anywhere else in England, with Northumbria consistently topping national NHS rankings for performance and patient satisfaction. About 91 per cent of patients are in and out of A&E within four hours, compared with a national average of 75 per cent. Meanwhile, 81 per cent of those on hospital waiting lists are seen within 18 weeks, against a national average of 61 per cent. The transformation of Northumbria into the best-performing NHS Trust began under Sir Jim Mackey — now the head of NHS England — who was chief executive from 2003 to 2023. 'If anyone can make the changes that need to happen, he can,' said Bartoli, his successor. 'He's competitive, and I'm competitive, in terms of wanting us to do the best we can do, be the best that we can be. Because we have a responsibility to our local population. We are public servants.' Mackey urged other NHS trusts to follow Northumbria's lead, adding that 'we must learn from the best if we're serious about putting the NHS back on track'. He said: 'Many of the things we aspire to nationally exist now [in Northumbria], so show it is possible. Waiting lists are low, patient and staff satisfaction is high, and services are being delivered within budget. 'Northumbria offers clear evidence that cutting waiting times isn't just an ambitious goal — it's achievable. And with that, we can begin to restore public confidence in the NHS.' Staff at Northumbria follow a mantra that 'patients' time is precious', and it's evident from the moment someone turns up at A&E. Some 150 patients per day walk through the front door at the emergency care hospital in Cramlington. But a unique 'streaming' system — a form of triaging — means only about one in three end up seated in the A&E waiting room. Patients are assessed straight away by an emergency specialist in the hospital foyer, who — wherever possible — books them in for treatment elsewhere. This might mean going straight to an operating theatre to have their appendix removed, or being booked for an x-ray for a sprained ankle at an urgent treatment centre. Others are directed back home, or to their GP or pharmacy, after being reassured nothing is seriously wrong. 'We have had people at the front door with a cut finger where we say — 'you need to go to a pharmacy and buy a plaster',' said Dr Sameer Sasidharan, an A&E consultant, stressing that it is understandable why worried people come as 'A&E is the only place that is open 24/7'. This is the first A&E department in the country to link up directly with community services, aiming to ensure people 'don't bounce around in the system' between GPs and hospitals. Dr Julian Coffey, head of urgent care at Northumbria, explained: 'It is about getting patients to the right place as quickly as possible,' so they do not face delays or have unnecessary [and expensive] tests. One classic example is chest pain. 'It is very common and the first worry of everyone is that it could be a heart attack, so they come to A&E,' Coffey said. 'However, we send home the vast majority. Often it is anxiety or stress, or they've pulled a muscle. If the patient can be told really rapidly that they're OK, that is so valuable for them.' The model clearly pays off: a national league table of NHS trusts published last month ranked Northumbria as the best general hospital for four-hour and 12-hour A&E waits. One of the boldest decisions Mackey made during his two decades at Northumbria was to separate completely 'hot' emergency care from 'cold' elective care. In 2015, the region's three A&Es were merged into a single new facility. All emergency patients now go to the £75 million purpose-built emergency hospital in Cramlington, while routine surgery is carried out at Northumbria's three general hospitals in Ashington, Hexham and North Tyneside. As a result, routine care — such as hip replacements, hernia repairs or diagnostic scans — is protected from the pressures of Covid, flu or winter crises. Northumbria now has the lowest hospital waiting times of any non-specialist NHS trust in the country. 'If you think about all of those performance metrics, they're all about time, whether it's time in an emergency department or time waiting for an operation. Within the organisation we view time as being very precious for staff and for patients,' said Bartoli. Centralising emergency care in one hospital also means emergency specialists can be on site 24/7, rather than being 'diluted' across separate hospitals in the region. The Cramlington hospital has dedicated wards for different emergencies, such as trauma, respiratory and stroke, so that patients can start cutting-edge treatment straight away, improving their chances of survival. It has pioneered lifesaving models of care, including providing more respiratory patients on non-invasive ventilation early on when they are struggling to breathe. 'The quicker you start the treatment, the better the outcome for the patients,' said Karen Brewin, the lead respiratory physio. Colin Richardson, 91, was admitted to Cramlington Emergency Hospital in March with complications of heart failure. Typically, patients in his condition would face several weeks in hospital. But instead, as soon as he had stabilised, Richardson was discharged back to his home in Whitley Bay — under the care of Northumbria's virtual wards, or 'hospital at home' service. 'I could get back home to Doreen. She is nearly 90 and we have been married for 60 years so it's hard being apart from each other,' Richardson said. To meet growing demand from an ageing population, Northumbria is significantly expanding this 'hospital at home' service — part of a national drive to shift more care out of hospitals and into the community under the government's ten-year NHS plan. Up to 100 patients at a time are cared for on these virtual wards, including those with lung cancer, heart failure and residents of care homes. Nurses visit them every day, checking on vital signs and delivering medication, with consultants monitoring them from afar. 'If we can keep them at home, they're going to eat their own food and potter around more. Their mobility is going to improve. They tend to be a lot happier. Visitors are not restricted, and there is less chance of catching an infection. They can see their dogs and stand in the garden in the sunshine,' explained Jennifer Whitaker, a nurse who leads the community service. Shifting care into the community is not only better for patients — it is also a financial necessity. Modelling shows that unless care is moved out of hospitals, the NHS trust would have to build a whole new hospital by 2040 just to meet the demands of Northumberland's ageing population. 'Doing nothing is not an option, because we don't have the money to build another hospital. And even if we did have that money, we wouldn't be able to staff it,' Bartoli said. While other NHS trusts consistently overspend against annual budgets, Northumbria reported a £30.5 million surplus in 2023-24. 'We have been very strict on ourselves in terms of that financial discipline. It's a mixture of being rigorous in how we manage money, as well as having a commercial eye.' While Mackey was in charge, the trust negotiated eye-catching deals to save money. These included creating subsidiary companies to manage estates and facilities, transferring 800 staff out of the NHS to save on VAT and pay costs. Mackey has pledged to take the same approach as head of the NHS, ordering hospital bosses to 'get a grip' on overspending and stressing the NHS must deliver better value for its £200 million budget — an amount that he has noted is 'equivalent to the GDP of Portugal'.
Telegraph
24-07-2025
- Health
- Telegraph
Use the NHS as usual during junior doctors' strikes, public told
Junior doctors must face the financial consequences of going on strike, the new head of NHS England has said. Sir Jim Mackey said striking medics should not be able to make up for lost shifts by doing overtime to clear backlogs once industrial action is over. Thousands of junior doctors are expected to join the strike, which is the 12th they have staged since March 2023. They are demanding a 29 per cent pay rise despite already having been handed an increase by Labour. Sir Jim urged hospital leaders to keep routine operations and appointments going if possible and to only cancel if there is a risk to patient safety. He said the NHS would be 'much more resistant' to demands from the BMA, according to The Times, adding that previous strikes had been 'net positive from a financial point of view' for doctors but must not be 'consequence-free' this time. In a call with hospital leaders on Wednesday, he said: 'We've been very, very clear we want to have a different approach this time. 'You have noticed already we are in a different space compared to where we were last time, much more instructive to the BMA, much more resistant to their demands. 'Frankly we and you make decisions about safety, not the BMA. Do what you do best, make sensible decisions and we'll stick together.' NHS England said hospitals and local teams had been preparing before the industrial action by the British Medical Association, which begins at 7am on Friday, and had plans to 'minimise disruption to patient care and ensure life-saving care continues'. During the strike, GP surgeries will open as usual and urgent care and A&E will continue to be available for those who need them, NHS England said. It urged the public to use 111 online as the first port of call for urgent but not life-threatening issues. Prof Meghana Pandit, NHS England national medical director, said: 'There is no doubt this industrial action will take a toll on patients and NHS staff, and it is disappointing it is going ahead. 'While it will mean some appointments won't be able to go ahead as planned, we are doing all we can to limit this, and patients should continue to use NHS services in the usual way. 'The public should dial 999 in an emergency, and otherwise use 111 online, your local pharmacist or GP, and patients should attend NHS appointments unless told otherwise.' The BMA said NHS England's plan posed a risk to patients. Strikes by resident doctors last June led to 61,989 inpatient and outpatient appointments being rescheduled. Since the end of 2022, almost 1.5 million appointments have been rescheduled as a result of industrial action. The BMA said on Tuesday that talks with the Government aimed at averting the strike had collapsed over the core issue of pay. Dr Melissa Ryan and Dr Ross Nieuwoudt, co-chairs of the BMA's resident doctors committee, said in a statement: 'We have always said that no doctor wants to strike and all it would take to avoid it is a credible path to pay restoration offered by the Government. 'We came to talks in good faith, keen to explore real solutions to the problems facing resident doctors today. 'Unfortunately, we did not receive an offer that would meet the scale of those challenges. 'While we were happy to discuss non-pay issues that affect doctors' finances we have always been upfront that this is at its core a pay dispute.' 'Completely unjustified, completely unprecedented' Wes Streeting, the Health Secretary, said: ' We cannot move on pay after a 28.9 per cent pay rise ' but added that the Government was looking at ways to improve resident doctors' working lives. He said there was an opportunity for the union 'to work with us on a range of options that would have made a real difference to resident doctors' working conditions and created extra roles to deal with the bottlenecks that hold back their career progression. 'Instead, they have recklessly and needlessly opted for strike action.' 'All of my attention will be now on averting harm to patients and supporting NHS staff at work. 'After a 28.9 per cent pay hike in the last three years and the highest pay rise in the public sector two years in a row, strike action is completely unjustified, completely unprecedented in the history of British trade unionism and shows a complete disdain for patients and the wider recovery of the NHS.' It came after research suggested public support for the strike is waning. A YouGov poll showed about half (52 per cent) of people in the UK 'somewhat oppose' (20 per cent) or 'strongly oppose' (32 per cent) resident doctors going on strike over pay. A third (34 per cent) of the 4,954 adults surveyed either 'somewhat support' (23 per cent) or 'strongly support' (11 per cent) doctor strikes. YouGov said the proportion supporting the strike over pay has dropped five points since it last asked the question in May, when 48 per cent opposed the strikes and 39 per cent supported them. Daniel Elkeles, the chief executive of NHS Providers, said the decision for strikes to go ahead 'is a crushing blow for patients and for the NHS'. Resident doctors are qualified doctors in clinical training. They have completed a medical degree and can have up to nine years of working experience as a hospital doctor, depending on their speciality, or up to five years of working and gaining experience to become a GP.
