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

Just More Number Crunching

We’ve had the Equality Act since 2010 (1) and for many LGBT people it has been a game changer. It requires that anyone providing a service for the general public, including healthcare providers, does not discriminate who they provide that service to, no more “We don’t serve your sort in here, this is a family establishment.” In October 2017, NHS England has only just waken up to the fact the Equality Act also applies to the NHS, and in response they have released their latest initiative.

They announced that they want all patients’ sexuality recorded, with their other demographic details (2). So at every face to face encounter with a patient with doctors and nurses and all healthcare professionals have to ask patients what their sexuality is, if it does not already state so on their demographies. Patients do have the opinion to decline to answer.

But this is NHS England’s only response to the Equality Act, to gather data on patients’ sexuality, nothing more. We’ve had several studies, in recent years, about the poor treatment LGBT patients have received from the NHS, there have also been studies into what an unfriendly working environment for LGBT staff the NHS is.

Back in 2007, Stonewall published their study Being the Gay One (3), on the homophobia faced by staff working in health and social care, it was more than an uncomfortable read. Since then they have published four different studies on the experience of LGBT patients in the NHS (4, 5, 6, 7) and all of them have highlighted the negative and homophobic experiences they have received, with many LGBT patients unwilling to be open about their sexuality for fear of homophobic treatment from healthcare professionals.

In 2015 Stonewall published Unhealthy Attitudes (8), their report into a survey of LGBT healthcare staff. The findings of this report showed so little had changed since 2007, and Stonewall’s first report (3). Unhealthy Attitudes found that 25% people surveyed had been the victims of homophobic abuse at work. Last year a BMA study found that 70% of LGBT doctors had experienced homophobia at work, and three quarters of them had never reported it out of fear of reprisals (9). Last year we had the unpleasant sight of NHS England itself going to the High Court to win the right not to fund the HIV preventative drug PrEP (10).

Yet we also have areas of good practice and there are resources out there for NHS Trusts that want to turn around this situation. In 2012 Stonewall published Sexual Orientation, A guide for the NHS (11), which is full of practical advice for combatting homophobia in healthcare. Back in 2009, the Department of Health produced Sexual Orientation: A practical guide for the NHS (12), which was designed to help reduce the healthcare inequalities faced by LGBT people.

We already have a lot of evidence about the homophobic treatment many LBGT people have received at the hands of the NHS, NHS Choices acknowledged the problem back in 2012 (13), there is also guidance on how to reverse this, and yet all NHS England can think to do to combat healthcare homophobia is to ask patients what their sexuality is. A third of gay and bisexual men are not open about their sexuality to their GPs (7) and half of Lesbians and bisexual women (5). Why isn’t NHS England launching a high profile initiative to tackle homophobia in the NHS and to make it a welcoming place to LGBT people? Why isn’t NHS England ensuring that the NHS complies with the Equality Act? Instead all they can do is collect data on LGBT people. So typical of NHS England, too little and much so late.

But why should nurses, be concerned about this? How can we say we are providing open and non-judgemental nursing care when so many LGBT people are afraid of being open about themselves in front of us?

(This was originally written for the Nursing Standard)

Drew Payne

Data Protection: Another Jeremy Hunt Failure

"Completely unacceptable", Jeremy Hunt described the data leek (1). He said patients needed to feel confident the NHS would look after their personal data. "If we are going to win that trust we need to strengthen the independent oversight of data security within the NHS to a level that we don't have at the moment." (1)

Hunt wasn’t speaking about the patient data leak that came to light this week (2), he was talking about a patient data leak that happened in 2015 (1). 56 Dean Street, a sexual health clinic in Central London, ran a regular email newsletter sent out to its patients, many of whom are HIV positive. At the beginning September 2015 they sent out an email to 780 patients but the person sending out the email newsletter forgot to hide the recipients email addresses. Everyone who received the email could see all the email addresses of everyone else it was sent to (3). Jeremy Hunt was very quick to condemn it and in very harsh language.

Having your health status outed to 779 other people is certainly traumatic and I won’t want it to happen to anyone, but ultimately no one’s health was damaged by it. I cannot say the same for data leak that was revealed on Tuesday.

On 27th June the National Audit Office published a damming report into the NHS Shared Business Services (SBS) disgustingly poor handling of confidential patient documents (4). Jeremy Hunt was forced to answer questions in parliament about this sorry affair (5). It has all made a mockery of his claims, back in 2015 (1), for patients to be able to trust data protection in the NHS.

In 2008 NHS Shared Business Services (SBS), a private company, was created as a joint venture between the Department of Health and Sopra Steria (4). Though a private company NHS SBS is 49.99% owned by the NHS and the Department of Health had three places on the company’s board, though them only took up one of them, Jeremy Hunt himself took that place (5). NHS SBS’s website boasts that the company will save the NHS £1 billion by 2020 (6).

NHS SBS was contracted to deliver medical paperwork from hospitals to patients’ GPs in many areas across the country. First they had contracts with PCTs and then, after PCTs were abolished in 2010, with NHS England (4).

In 2011 NHS SBS’s own internal audit found that they had 8,146 items of undelivered correspondence (4), yet they seemed to do little or nothing about it. In June and July 2015 an NHS SBS administer raised concerns internally about a large back log in undelivered correspondence (4). They raised concerns, in August 2015, that the backlog was now being destroyed (4). As far back as January 2014 Senior Managers at NHS SBS knew about the clinical risk this backlog of correspondence posed but they didn’t have any plans to deal with it (4). In November 2015 the backlog of correspondence was escalated to NHS SBS’s Chief Executive (4).

NHS SBS told NHS England, their employer, about the backlog on 16 March 2016 and the Department of Health (49.99% owner of the company) the next day (4). NHS SBS’s

Chief Executive told the company’s board about the problem on 24 March 2016 (4), a board Jeremy Hunt himself sits on. In April 2016 the Department of Health decided not to tell Parliament or the public about NHS SBS’s failure to deliver patient correspondence (4). They argued that they didn’t want to “worry” patients and the public, and publicising this would have lead to questions they could not answer (4). The subtext being that the Department of Health didn’t want to be embarrassed by this, they were one of the majority owners of NHS SBS.

The DoH did inform parliament on 21 July 2016 about NHS SBS’s failure but only as a written statement (4), if Hunt had done so in person it would surely have generated a lot more publicity. In the written statement Hunt called it “an issue with a mail redirection service” (4). It not mention the potential harm to patients, which NHS England was concerned about, that this backlog of correspondence could cause.

As of 31 May 2017, NHS England has found 709,000 items of unprocessed correspondence and 1,788 cases of potential harm to patients have been identified, so far (4). They have still not finished checking all the undelivered patient correspondence, and do not expect to do so until December 2017, so far they have only checked a third of the documents (7). The undelivered correspondence included cancer test results, child protection details, patients’ medical records, treatment plans which included changes to patients’ medication and forms registering patients with GP practices (4). NHS England estimates that it will all cost at least £6.6 million in administration alone to resolve (4), they haven’t said how much the clinical follow up of the patients involved will cost, and so NHS SBS has borne £2.26 million of these costs (4). Will this be counted against the £1 billion NHS SBS claims to be able to “save” the NHS? (6)

The National Audit Office’s report into all this was very scathing (4). They criticised NHS SBS for its poor response to the backlog, poor management and low prioritising of the backlog and for being “obstructive and unhelpful” to the NHS England investigation (4). They also criticised Jeremy Hunt for a conflict of interest, he was both Secretary of State for Health and had a seat on NHS SBS’s board, he was in charge of the Department of Health who are responsible for NHS England who were the organisation who employed NHS SBS and he was on the board of NHS SBS.

NHS SBS has now lost the contract to deliver medical correspondence (5).

Jeremy Hunt was forced to answer questions in parliament on Tuesday about this scandal (5). He didn’t go willing to parliament, instead he had to be forced to answer questions by the Shadow Health Secretary, Jonathan Ashworth, had petitioned the Speaker of the Commons to hold urgent questions on this (5). Hunt was accused, during these questions, of being “asleep at the wheel” by Labour MP Clive Efford (5).

Answering questions Hunt justified not originally telling parliament and the public about this scandal because he said if he did GP practices would have been “overwhelmed” by calls from worried patients (5). This is the opposite of what he called for after the 56 Dean Street email breech (1). Hunt did admit that the Department of Health’s oversight of NHS SBS was not good enough (5), but this should fall directly on his shoulders because he was the only Department of Health person sitting on NHS SBS’s board. Will he be held directly responsible for this complete failure? Who will he answer to for this?

Hunt also told MPs the investigation had not found any patient harmed by this paperwork backlog (5), but how could he claim this? NHS England’s investigation into this disgusting scandal will not be completed until the end of the end, and correspondence not sent to GPs included cancer test results and treatment plans that included changes to patients’ medication. Again Hunt has made claims that the evidence does not support.

When I first heard about this scandal I can’t say I was surprised, but I was deeply sickened. Again this was a scandal were a private company, contracted to work for the NHS, was putting profit before patient care, and exercising the most disgustingly low clinical governance. What sickened me most was how deeply Jeremy Hunt was involved in this and how he tried to cover it up. Yet again Hunt has shown poor judgement and even poorer leadership.

This isn’t the first time Hunt has failed and failed to such a high degree. I have worked for the NHS for nearly 30 years (I worked in the NHS several years before I started my nurse training) and I have watched a large number of extremely poor Secretaries of State for Health bungle their way through the NHS but Hunt seems to be the worst in my living memory. Whenever there’s a problem or scandal in the NHS Hunt’s leadership repeatedly fails whatever is needed. His reactions show that he just doesn’t understand the problem (8), or he ignores the problem (9), or his actions make the situation worse (10), or he is very quick to pass the blame (11), or worst of all he spills forth untruths (12).

Why is this completely incompetent man still in such an important job?

The answer is simple, the NHS is such a low priority to Theresa May. Her actions since becoming Prime Minister attest to this, starting by not sacking Hunt from his post.

Our Secretary of State for Health is incompetent and one of the worst in living memory, but his repeated failure in the role only bares testament to the poor quality of the leadership of the Prime Minister who keeps him in this post.

Drew Payne

P.S. NHS SBS’s twitter address is @NHS_SBS, why not tweet them with your feelings on how they managed this scandal? I did.