Dash claims NHSE ‘very reluctant’ to tell local leaders what to do

The chair of NHS England has told a patient safety event that the national body is “trying to avoid” telling every part of the country how to work.

Penny Dash said there was a “reluctance” to mandate, dictate and measure from within NHSE.

She said NHSE chief executive Sir Jim Mackey was “very, very antimandating” and that the term would “have many of her colleagues shaking”.

Dr Dash pointed to resistance that officials had experienced from local authorities, health and wellbeing boards, and local authority commissioning services, adding: “They absolutely do not want us to mandate.”

She was responding to a question about how NHSE could regulate effectively with a “mandate-averse philosophy”, while addressing the Public Policy Projects’ Patient Safety Forum on Wednesday.

She said: “We are a national health service, there is quite rightly an expectation that there is some consistency in care, there is quite rightly an expectation that all of these things matter and that us, as NHS England, we should be mandating, dictating and then measuring.

“I can completely see how we can get to that point, and yet, we then have a very, very, very strong view from many people, ‘no, no, no, devolve, devolve, devolve’, and it’s live, and it’s playing out an awful lot…” 

She added: “It’s a really hard balance to strike, and we’re going to have to continue to work our way through it. We don’t want to be overly mandating – there are real negatives of mandating too much…”

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Source: HSJ, 27 February 2026