In their latest In The Loop podcast Niall and Roy have a revealing exchange with NHS England Chief Executive Sir Jim Mackey. In a wide ranging discussion Jim admits just how challenging it will be to meet the government’s ambitions for the NHS. If they deliver, he thinks books will be written about it and that it could be the greatest public sector turnaround of all time.

“We are trying to do a lot in one go, we are trying to do major change on pretty much every front, very quickly and what feels like in a rush, and at times it feels a bit overwhelming.”

But he remains optimistic and argues that they have no alternative but to address a whole series of fundamental challenges.

Sir Jim makes clear he did not know NHS England was going to be abolished when he took on the role. He supports the plan but says it would have been reasonable to assume that when the announcement of job losses was announced everything about the redundancy programme would have been ‘boxed off’ and ‘lined up’. But it wasn’t. And he says that matters have become more complicated as the year’s gone on and as other things have changed politically and economically.

He insists that redundancies at NHS England and for staff at Integrated Care Boards (ICBs) should be achieved through voluntary deals, but admits they are still negotiating with the Treasury and that it has taken too long, with lots of argument and this issue becoming tied to other negotiations.

According to Sir Jim “The delays on the redundancy costs have added complexity and drift and we do feel we are trying to do too many things at once. The big problem we’ve got is we do not have the time because the public aren’t as patient with us as we’d like them to be, because of the mess we had go into.”

“I am as irritated and annoyed as anyone else is about how long it has dragged. It’s no way to be treating people but it is complex and it is not about compulsory redundancies. We are going hammer and tongs to get things resolved as quickly as we can. It has gone on too long.”

On ICBs he says he always thought 42 was too many with too much difference in their sizes, and that they were given too much to do and had to work with a very expensive and incredibly complicated operating model

In future ICBs will concentrate on commissioning rather than performance management – Sir Jim admits he did not love commissioning but feels the absence of it in recent years has been a problem and that they need to restore its value, with performance management largely sitting with regions

On resident doctors “We are in bad way, where there is significant dislocation between them and what they need and what they want, versus what we as employers want and need, versus what the population want.” Sir Jim says they need to fix some of the stuff that is causing irritation but also take a fundamental look at how the training and rotation works ‘as they clearly don’t like it’