Delivering a keynote speech today at the National Children and Adult Services Conference in Liverpool today, Mackey also expressed a desire for a less ‘fortress NHS' approach and a shift towards rebuilding collaborative capabilities with local partners.
He said: ‘So the neighbourhoods thing ended up being part of a strategy to reorientate the NHS.
‘I think reflecting on the last year, we were probably a bit too structural in the discussions last year, a bit too metricy, for understandable and good reasons, given the mess that we're having to tidy up.
‘If we had to do it again, I think we could have probably done more together about explaining how we need to do this together and sent a stronger signal at the beginning about doing it together.'
He highlighted the need to ‘be doing less nationally and more locally, generally, so [we need to] get better at giving signals nationally, with frameworks to support activities, etc, to enable people to get on and do these things locally'.
Mackey provided context on the NHS's critical finances by the start of the fiscal year, with a massive £6.7bn deficit. He said while it had managed to land without a deficit this year – a first in 10 years – significant structural issues remain. These include a disproportionate amount of funding tied up in expensive hospital care compared to prevention and primary care, performance pressures including industrial action and tensions around the ownership and control of neighbourhood care, leading to ‘tribalism' between different stakeholders.
Speaking in the panel discussion, president of the Association of Directors of Children's Services Ann Graham suggested successful integration would be visible when observers could not distinguish whether a service was being provided by the NHS or a local authority.
President of the Association of Directors of Adult Social Services Phil Holmes said: ‘The point we're all missing is that the population should own neighbourhood health, and we're missing that, I think, in the way that the work has landed.'
