NHS England’s new chair has a wealth of industry experience – but the NHS has its own unique set of challenges
"If Meddings’ leadership can reverse the exodus of NHS staff, that will in itself be a major achievement." Greg Allen, CEO, FCC
A senior banker has been appointed as chair of NHS England. Richard Meddings is a chartered accountant who was previously chair of TSB.
Whilst he has no previous experience of working in the NHS, sources say that the government hopes he will bring a fresh pair of eyes to the NHS, and that his experience will complement that of NHS CEO Amanda Pritchard, who has spent her working life in the NHS.
So, what challenges will Meddings face – and what will he bring to the role? How will his leadership improve the experience of people in receipt of care?
NHS England has set out 10 priorities for 2022-23. This is a large number but perhaps reflects the sheer challenge at hand across the service. These priorities include the critical situation around workforce, tackling the elective care backlog and overseeing the introduction of integrated care boards. The priorities also include more visionary, long-term objectives such as using digital technology to transform care, addressing health inequalities and enhancing services for people with learning disabilities.
None of these is going to be easy. We are seeing the effect of the long-running workforce challenge unfolding in front of our eyes just now, exacerbated by Covid and staff sickness which has led to some trusts declaring critical incidents recently. The NHS is facing a backlog of 5.7m patients waiting for hospital treatment. The chancellor is putting more money into creating facilities to address the backlog, but it will be impossible to do it successfully without staff.
But the problem runs much deeper than that. England faces a shortage of nearly 40,000 nurses and 50,000 doctors. In the last 12 months, the number of fully qualified GPs by headcount decreased by 1,139. There are a number of reasons for the shortfall but these include staff leaving the NHS because they have been under so much sustained pressure for the last two years.
Part-time working in primary care (notably GPs) is also a factor. It is a positive development in terms of balancing work and life demands (notably for women) but this is also now set against a huge demand backdrop in primary care. The workforce is also ageing and therefore a large proportion are nearing retirement.
Brexit has seen some EU nurses depart, and a drop in the number coming into the UK. There have been numerous attempts to address the shortfall over the past few years, but none has been successful, and it looks as if the government will fail to meet its manifesto commitment to recruit 50,000 more nurses,
If Meddings’ leadership can reverse the exodus of NHS staff, that will in itself be a major achievement.
Another area where Meddings might find his work cut out is on the IT side. Fortunately, Meddings has experience in this area – the banking sector has been one of the first to make a successful switch to digital processes, and, shortly after becoming chair of TSB, Meddings had to deal with a botched IT upgrade that left millions of customers without access to their accounts. He was able to turn the situation around, bringing IT systems in-house and improving customer satisfaction ratings. But the NHS is a much bigger beast than even a large bank, and it lags far behind other sectors in IT adoption. Some parts of the NHS still rely on communication by fax. The National Programme for IT, an attempt to roll out digital processes in the NHS in the early 2000s, resulted in failure. Since then, things have improved, and Covid pressures resulted in GP surgeries and NHS trusts speeding up their adoption of digital processes. But Meddings will have to reckon with the fact that the NHS isn’t a single entity, but a multitude of relatively independent but connected organisations, and imposing IT processes from the centre isn’t necessarily an option.
Meeting these challenges will require boldness, imagination and the ability to bring people together. It may be that Meddings’ financial astuteness and history of overcoming crises will stand him in good stead – but he will also need to rely heavily on the talents of others.