NHS chief Sir Jim Mackey delivers candid message at MJA annual lecture 

More than 100 MJA members and guests had the chance to grill the new NHS England chief executive last night at the MJA’s second annual lecture, in partnership with MHP. 

At the event, Sir Jim said the NHS had normalised too much poor care and had in effect “learned to walk with a limp” in recent years and this was not good enough. 

Promising a major new transparency drive with more published data on patient outcomes, Mackey delivered some news lines for our working members.  

The lecture, which was held at the Royal College of Surgeons, included a lively Q&A discussion with Sir Jim in his first public outing since starting the role. 

The evening concluded with a networking reception, allowing attendees to continue conversations and forge valuable connections with peers and industry leaders. 

The MJA extends its thanks to Sir Jim Mackey for his contribution and to MHP Group for their generous support of this signature event in the MJA’s increasingly busy calendar. 

Planning is already underway for the 2026 Annual Lecture. Below is a snippet of Sir Jim’s comments. 

NHS “Maxed Out” on Funding 

In perhaps the most headline-grabbing moment of the evening, Sir Jim stated that the NHS has “maxed out on what is affordable” and called on the service to “accelerate” improvements while stamping out unacceptable care which has become “normalised.” 

“The NHS is such a big part of public spending now we are pretty much maxed out on what’s affordable,” he told attendees. “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.” 

While expecting “some growth” from the Treasury in the upcoming spending review, he acknowledged that “it’s never enough” and the service faces “big choices” to tackle variation and improve service standards. His comments suggest the health service will not receive a substantial increase in next month’s comprehensive spending review. 

Financial Challenges 

Sir Jim revealed the “shock and worry” of discovering that “undeveloped” plans for the NHS in England projected a multi-billion deficit for this year. 

“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,” he explained. 

Standing Up to Ministers 

In a pointed comment about NHS England’s merger with the Department of Health and Social Care, Sir Jim asserted he would not “roll over” to Health Secretary Wes Streeting as the Labour government takes direct control of the health service. 

“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,” he stated firmly. 

He also called it “naive” to believe that an organisation which “is the biggest consumer of public resource in the country” could be politically independent. 

Tackling “Normalised” Poor Care 

One of the most sobering parts of Sir Jim’s lecture was his criticism of “unacceptable” care that has become normalised, particularly for elderly patients. 

“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,” he noted. “We’ve got to get ourselves out of that, and everybody wants to get out of it.” 

He expressed concern that staff had become “desensitised” to poor care, describing it as “learning to walk with a limp” as they find ways to work around systemic problems. 

Re-educating NHS Managers 

Sir Jim also revealed that managers are having to be “re-educated” after losing skills in recent years, particularly in areas like waiting list management and emergency department flow. 

“We are having to re-skill [and] train people again in things like waiting list management, some stuff on flow and ED management, those sorts of things. So, they are being rebuilt, and people are being re-coached and re-educated,” he said. 

For more coverage see: 

The Times, Ellie Hayward and Poppy Koronka: New NHS England boss: I won’t roll over to Wes Streeting 

The Guardian, Denis Campbell: Ministers have ‘maxed out’ health service funding, says NHS England boss 

The Independent, Rebecca Thomas: Poor care and long A&E trolley waits becoming ‘normalised’, new NHS chief warns