Patients are an “inconvenience” to the NHS, which has “built mechanisms to keep them away”, said the new boss of the health service.
Sir Jim Mackey, who was made chief executive of the NHS on 1 April, spoke of the 8am daily phone scramble for a GP appointment as one example of the difficulties patients face in seeking help.
“We’ve made it really hard, and we’ve probably all been on the end of it,” he told The Telegraph.
“You’ve got a relative in hospital, so you’re ringing a number on a ward that no one ever answers. The ward clerk only works nine to five or they’re busy doing other stuff; the GP practice scramble every morning.
“It feels like we’ve built mechanisms to keep the public away because it’s an inconvenience,” he said.
And he warned that failing to listen to public frustrations could mean the end of a national health service.
Failings in maternity services, he said, were cultural and “thinking we know best when mothers know best, listening to them and families and building the service around them”.
He said: “The big worry is, if we don’t grab that, and we don’t deal with it with pace, we’ll lose the population. If we lose the population, we’ve lost the NHS. For me, it’s straightforward. The two things are completely dependent on each other.”
Sir Jim, who earlier this month said the NHS should “tear up” the way it offers hospital outpatient appointments, said cutting back millions of routine follow-ups would be a priority, since the NHS spent more on hospital outpatients than on the whole of the GP system.
“Outpatients is glaringly obvious. Of 130 million outpatients a year, about 85 million or so are follow-ups,” he told the paper, adding that it felt wrong that the NHS diverted so many resources to follow-ups at the expense of patients waiting for diagnosis and treatment.
Moving care out of hospitals into local neighbourhood centres was crucial, to tackle waste and make care more convenient, Sir Jim said.
Shifting treatment from hospitals to the community will be a key aim of the government’s major 10-year health plan, which health secretary Wes Streeting is set to unveil next week.
Mr Streeting has also pledged to “end the postcode lottery” of care, focusing more on working-class communities.
Trials will be set up of “patient power payments”, under which hospitals receive the full payment for treatment only if the patient is satisfied, The Telegraph reports.
The Times also reports that funding for hospitals could depend on patient feedback.
Sir Jim, who from 2003 to 2023 was chief executive of Northumbria Healthcare NHS foundation trust – the most highly rated trust in the health service, said that in that role he tried to read every email and spoke to every family that approached him.
He described the 8am race for a GP appointment as “that heart-sink moment, someone’s got to sit by the phone, they’ve got to ring forever, don’t get through and then have to do it all again tomorrow”.
He said: “It feels like we’ve built mechanisms to keep the public away because it’s an inconvenience.
“We’ve got to somehow reorient it; think about how do we find people who need us, how do we stop thinking ‘it’s going to be a pain in the arse if you turn up because I’m quite busy’ and instead think about how do we find out what you need and get it sorted.”
But he said the NHS performs best when money is tight. “There’s got to be some tension in it, otherwise we’ll waste money.
“There is a strong argument that we have wasted a lot of money in the last few years, we haven’t spent it as wisely as we could have done.”
The NHS needed to be “de-layered” because it was expensive and slowed down decision-making, he insisted, warning that the NHS has too many “fossilised” ways of working.
And he said: “We’ve got too many people dying in hospital when they want to die at home.”
He told how the system “failed” his elderly mother, with inconsistent care over seven days, a lack of weekend services and a “disjoint” between services.
He praised the staff involved, but said “a hell of a lot of learning” was needed.
“My dad died in a hospital where the local folklore was terrible about the hospital, but the hospital was deaf to it and didn’t know what was actually being said,” he recalled.
“I wasn’t long into the NHS, it was a long time ago now, and I felt really powerless.”
