The next boss of NHS England is preparing a wide-ranging purge of its senior leadership team as he steers it into a much closer relationship with the health secretary, Wes Streeting.
Sir Jim Mackey, NHS England’s chief executive, is finalising plans for “a big clearout” of the top executives who were mainly hired by his immediate predecessor, Amanda Pritchard, who will leave the post in April.
Mackey’s purge will lead to the departure of many of the organisation’s most senior high-level managers, with only a handful expected to survive, well-placed sources say.
Pritchard surprised the service last week when she resigned after holding talks with Streeting over her and the organisation’s future role.
Prof Sir Steve Powis, NHS England’s national medical director and best-known other public face behind Pritchard, followed suit on Thursday by announcing that he too is standing down.
The 64-year-old became well known in the early days of Covid-19 in spring 2020 when he advised ministers on how to handle the virus and appeared regularly at televised media briefings at 10 Downing Street.
“There’s a changing of the guard in the NHS and that’s really just begun,” said a senior source, referring to Pritchard and Powis’s impending exits. Mackey will oversee “a substantive clearout of the exec team”, with more casualties than survivors, a second source added.
Sarah-Jane Marsh, NHS England’s deputy chief operating officer and national director of urgent and emergency care, is likely to remain in her post.
Mackey, an accountant by background, is also weighing up whether to axe Julian Kelly, the deputy chief executive and chief financial officer. Kelly, who is widely respected, does what some see as “probably the toughest job in Whitehall” – trying to make the NHS’s near-£200bn annual budget meet its needs while reassuring ministers that it is spending it wisely. His future remains unclear.
A source familiar with Mackey’s thinking said: “It will be a pretty total clearout. And there’s an appetite in some quarters to move Julian Kelly on as part of that. But if you’re going to replace the guy who’s in effect the financial controller of a £200bn budget, you need to know what you are doing before you get rid of him.
“Jim will want his own person in that job, but at the same time it’s a risky time to get someone new in, given the NHS’s finances are in a poor state.”
Kelly is respected at the Treasury, where he used to be its director general of public spending and finance. However, he has risked irritating ministers by warning at recent NHS England board meetings that the £22bn extra Rachel Reeves has given the health service over the next two years will be swallowed up by pay rises and not be enough to pay for the radical transformation of how care is delivered, through “three big shifts” that Streeting and Keir Starmer have promised.
Mackey and Pritchard wrote to the chief executives of the NHS’s 220 care provider trusts on Thursday to summon them to a meeting next Thursday to discuss what they warned was a looming £6.6bn hole in its finances in 2025-26. Kelly was not a signatory to the letter.
Mackey plans to bring NHS England into much closer cooperation and alignment with Streeting’s Department of Health and Social Care. A no-nonsense and very experienced local and national NHS leader, he will be tough in demanding that, regardless of its precarious finances, the service speeds up treatment waiting times and somehow balances its books, despite the growing demand for care.
A source close to Streeting made clear Mackey had his backing for his plans to overhaul NHS England.
“While a lot has been achieved together between DHSC and NHS England in the first eight months of this government, Wes has appointed Jim Mackey with a mandate to lead serious, transformative change.
“In order to do so, Jim is going to have to go further faster, and he has the health secretary’s backing to make sure he has the team he needs to bring in that change”, they said.
Announcing his departure, Powis said: “My time in post has been dominated by the pandemic and its ongoing impact. I will for ever be humbled by the extraordinary work of staff throughout the NHS to the greatest health emergency in a century and I am very proud of the support and advice I was personally able to give to staff, ministers and the public.”
Join Wes Streeting in conversation with Pippa Crerar discussing England’s health and social care system and how Labour plans to turn it around. On Tuesday 25 March 2025, 7pm-8.15pm (GMT). Book tickets here or at guardianlive.com
