No Experience Required

 

For so many jobs prior experience is so important that it is a must, it is often the first thing employers ask for. I have seen so many job adverts, especially on the NHS Jobs website, that start with a list of prior experience that the applicant MUST have before they can even be considered for it. So why is the job of chair of NHS England any different?

Recently, Richard Meddings was chosen as the new chair of NHS England (1), but he has no NHS or healthcare experience, his background is banking.

This is Richard Meddings’s CV:

• He earned a degree in modern history from Exeter College, Oxford
• He trained as a chartered accountant with Price Waterhouse (one of the big four accounting companies)
• He then worked for Hill Samuel (a merchant bank) and BZW (part of Barclays Bank) before becoming financial director of Woolwich plc in 1999.
• He was a board member of Standard Chartered (a multinational bank) for 11 years and its finance director for seven years.
• In January 2014, the Standard Chartered "stunned the city" by announcing his resignation, this did come after a period of high losses, a rights issue and a cancelled dividend from the bank. He said it was "totally my decision to leave."
• In February 2018, Meddings succeeded Will Samuel as chairman of TSB Bank.
• He is a non-executive board member of HM Treasury.
• In 2020, he joined the board committee at Credit Suisse (a global investment bank).
• Meddings was appointed Commander of the Order of the British Empire (CBE) in the 2022 New Year Honours for services to the financial sector. (2)

Nowhere in here does he have any experience of healthcare or the NHS, this is the first time he has worked outside of the world of banking or finance.

It is argued that he will bring an “outsider’s eye to the NHS” (1) but this is one of the most important roles in the NHS; he will be responsible, ultimately, for setting the strategic direction and goals for NHS England, setting the priorities and direction of travel, and yet this is the first time he has worked for any NHS organisation. How can he realistically be expected to do all this?

Why should the chair of NHS England have NHS experience?

Firstly, part of the essential criteria for the role, as stated by the NHS, is: “An understanding of the pivotal role NHS England plays in improving health and care outcomes for patients and the public” (3). But how can Meddings demonstrate this without any first-hand experience of working in the NHS at any level? Banks are not hospitals. Privately owned banks are not the same as public owned hospitals.

The chair of NHS England is the most important role in the NHS in England, they are the person who reports to the Secretary of State for Health and Social Care about the state of the NHS (3).

In brief, the chair of NHS England’s role is:

• Provide leadership and strategic oversight throughout the NHS England Board.
• Hold the executive to account for performance.
• Provide strategic oversight and scrutiny of NHS England’s performance.
• Provide direction to board members on NHS England’s performance issues.
• Set an example of integrity and ethical leadership for NHS England.
• Be responsible for the annual assessment of individual performance by the chief executive and the board’s non-executive directors.
• Chair board meetings.
• Ensure the effective induction and development of new non-executive directors.
• Represent the board in the public arena.
• Provide counsel, advice and support to the chief executive.
• Establish productive working relationships with a range of key stakeholders including ministers, senior public officials from across the government, as well as leaders from the wider UK healthcare system, local authorities, regulatory bodies and the media (3).

Now, some of these responsibilities could be carried out by someone with no NHS experience. Chairing a board meeting and representing the board to the public could be fulfilled by someone with no NHS experience, but they are the only parts of the role that I can see could be. All the other parts of the role need some or a lot of NHS experience and extensive knowledge of the structure of the NHS, which certainly does not resemble that of a bank.

It could be argued that Meddings could be briefed and educated on how the NHS works once he takes on the role, but how long will this take? The NHS is not a simply structured organisation and it has complicated roles and responsibilities; providing healthcare is not just one activity, it is a multifunctional and multidisciplined responsibility. Just look at the differences between acute hospital care and the care provided in primary care, they are not the same and not delivered in the same way. How can you educate someone with no NHS experience to the level of knowledge they will need to chair NHS England in any reasonable time scale? Meddings will be working a two to three-day week in the role, being paid £63,000 a year for that work (3).

He will succeed the Conservative peer David Prior, who had previously been a health minister and chaired two NHS trusts (1). Lord Prior had much more NHS experience before he took on the role, why now is this level of experience no longer required for the chair of the NHS England?

Why worry that a banker is now in this role?

The NHS is in debt, actually it is chronically underfunded. In 2018, The Health Foundation, The Nuffield Trust and The King’s Fund think tanks all said that the NHS’s funding needed to be increased by 4%, in real terms, that year just so that it could carry on delivering the same level of service (4). In the financial year 2018–2019, the deficit of the 230 NHS trusts was £2.1 billion (5). In 2019/2020, the NHS provider sector alone had a deficit of £910 million (6). This was all before the Covid-19 pandemic.

The Nuffield Trust calculated that in 2020–2021 Covid-19 alone cost NHS England £5.18 billion (7).

In 2015, as part of the NHS Five-Year Plan, the NHS was required to find £22 billion in efficiency savings (cuts) by 2020 (8), yet this has proved difficult. Part of the 2018–2019 deficit came from failed efficiency savings (7).

Also, because of the Covid-19 pandemic, there are now six million people on hospital waiting lists (9) and reducing this figure is going to cost money and resources.

NHS England is in financial trouble, costs are outstripping funding and the costs of the Covid-19 pandemic keep mounting—the direct costs of treating Covid patients and the indirect costs of the patients who weren’t able to be treated because of the pandemic and the costs of trying to reduce the NHS waiting lists. It seems, looking at Meddings’s appointment, the government wants a financer heading NHS England to sort out the finances, why else would Meddings be given the role? He has no NHS or healthcare experience, yet he has a lot of experience handling the finances of large companies and banks and balancing their books.

Should we be concerned?

Yes, we should be concerned, very concerned.

This announcement was very quietly made; it almost sneaked out with virtually no high-profile media scrutiny. I only found out about it because my partner saw it posted on social media.

NHS England will be in the hands of a man with no NHS or healthcare experience, but he will be ultimately responsible for reducing NHS England’s record waiting lists and balancing the budget, making cuts. What will his priorities be? How can someone with no NHS or healthcare experience, but a lifetime in financial services, know what patient needs should be prioritised?

NHS staff have seen a real term cut in our wages since 2010, due to pay freezes and below inflation pay rises by this government. Nurses are now £3,600 a year worse off due to this (10).

Staff moral is at rock-bottom with all the stress, tiredness and burnout due to working through the Covid pandemic. 27,353 medics left the NHS in the last quarter of 2021 (11). Between April and September 2021, 13,945 nurses left the Nursing and Midwifery Council’s (NMC) register (12), and the NHS is short of 39,000 nurses, 1 in 10 registered nurses’ posts are empty (13). But this could only get worse because a lot of people are considering leaving the NHS because of Covid-19 burnout and the poor conditions we have endured for nearly 12 years. The Royal College of Nursing (RCN), in a recent survey, found that 36% of nurses are thinking of leaving the profession (14), that is over a third. Another survey, by the Healthcare Workers’ Foundation, which surveys all NHS staff across the board, found that 73% of NHS staff are considering leaving in the next year (15).

How will Ricard Meddings turn this low morale and potential staffing disaster around? He only has experience in finance. He has no experience of leading any public sector organisation, he has never been remotely involved with an NHS trust with a staffing crisis. His experience is from the world of banking, and banking has never faced a recruitment crisis, let alone a staffing one.

Meddings’s appointment does show us one very important thing, that the government’s priority for the NHS is controlling it finances, getting spending “under control”. There is only one way this will be achieved, especially looking at the NHS Five-Year Plan, and that will involve cuts in NHS spending. There are no more efficiency savings to be made, the repeated failure to make them in previous NHS spending proves this.

Richard Meddings will be the next chair of NHS England, no wonder the government did not want any scrutiny of this, which they almost achieved.

Drew Payne