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

Boris Johnson and the Art of the Headline Grab

Boris Johnson has never been shy of grabbing the headlines, he has certainly never knowingly turned away from a photo opportunity. When he was Mayor of London, it sometimes felt like all he did was try and grab the headlines, with one stunt after another.

At the end of January the press revealed that Boris would be demanding an extra £100 million a week funding for the NHS, at a Cabinet Meeting (1). That would have resulted in an extra £5.2 billion a year. Now he was quickly slapped down by both Theresa May and Philip Hammond, the Chancellor (2). Since then Boris does been very quiet on the subject, it obviously didn’t get him the good headlines he was after, but it did highlight this government’s failure to fund the NHS or even look realistically at future NHS funding.

This Government has under funded the NHS since 2010. Since 2010, when the Conservatives came back into Government (In coalition then), they have cut the increase in NHS funding to 1.1% (3), after last year’s autumn budget the NHS yearly increase in funding was increased to 1.2% (4). Previous to 2010 NHS funding was increased by, on average, 4% a year since the NHS was founded. NHS funding increases have been cut by nearly 75% and yet demand has not decreased. A&E attendance in December 2017 was up 3.7% on December 2016 (5), and that was just A&E attendance. All areas of the NHS have seen increases in demand, year on year.

This all has had a knock-on effect on the service the NHS can deliver, it’s now failing at all its mayor targets. The four hour A&E treatment target hadn’t been met since July 2015, the 62 day target from urgent cancer referral to treatment hasn’t been met since 2014 and the 18 week target for referral-to-treatment for elective care hasn’t been met since February 2016 (6). Good quality healthcare is not cheap, and repeatedly providing the NHS with below inflation funding increases has a direct affect on patient care. There are no more “efficiency savings” to be made, the fall in funding cannot be absorbed in any other but by cuts to patient care.

The Government had a chance to at least begin turning around this chronic under funding with November’s Autumn Budget. In the run up to the budget there was active campaigning for more NHS funding, at least £4.6 billion to stop the shortfall in NHS funding (6). Simon Stevens, head of NHS England, called for extra funding too, warning that NHS waiting lists will soar to five million by 2021 if its funding isn’t increased (7). Yet when Philip Hammond announced his budget, in November, the NHS only received an extra £1.6 for the next year (8). Officials at the Treasury have leaked to the press that Philip Hammond was angry at all the campaigning for extra funding, especially that of Simon Stevens, and this is why he didn’t provide all the funding the NHS needs (9). I am left speechless with disgust and anger at his petty and vindictive actions. Instead of listening to the reasoned arguments, he followed his ego. What kind of politician is he? Unfortunately he’s typical for this government.

Boris Johnson’s attempt to grab the headlines pushed a much more important NHS policy story out of the back pages. A cross-party group of ninety MPs wrote a letter to Theresa May calling for a cross-party convention on the future of the NHS and care social and the funding they will need (10). The letter was organised by Sarah Wollaston, Conservative MP and chair of the Commons health committee, Norman Lamb, Libdem MP, and Liz Kendall, Labour MP (11). It was signed by 90 MPs from all parties, a third of them were Conservative MPs (11). This was a golden opportunity for Theresa May to tackle the problems dogging the NHS and to do it with the full support of Parliament. This would have provided cross-party support for raising taxes to fund the NHS. So far the Conservative party has shied away from raising taxes, seeming to fear losing political face doing so, but with cross-party support all parties would have taken the “hit”. This was a political initiative that has been long overdue. But Theresa May, in her usual limp-handshake-way, dismissed this call for cross-party action, saying the government were managing the NHS themselves (12). Another typical failure and missed opportunity by Theresa May, and I’ve lost count of how many there have already been.

70% of Conservative voters, in a recent pole, said that the NHS was their main concern (13), and yet this government constantly ignores the problems of the NHS staring them in the face. Even when their own supporters are worried about it, it still doesn’t appear as a high priority for this government. Theresa May does not seem very bothered about it and rarely comments on the NHS. What have we done to deserve politicians so apathetic and uncaring about the NHS? For so many voters, the NHS still remains such a major concern, but to listen to our politicians you would think that there were no great problems with the NHS, beyond a few people moaning about it.

What can we do to finally make this government take the NHS’s problems seriously? Yet another winter crisis in the NHS certainly hasn’t done that (14).

As for Boris Johnson. During the 2016 EU referendum the Leave campaign, which he was the leading light of, claimed that £350 million a week extra funding would go to the NHS (15). Last month Boris only called for an extra £100 million a week for the NHS. So it seems his concern for the NHS has fallen by over 70%. As I said, what can we do to make these politicians take the NHS seriously?

Drew Payne

The Computer Says No

Who could have failed not to notice that the NHS was the victim of a cyber attack, last weekend? It was been splashed across our media that 40 NHS organisations and many GP practices were hit by this cyber attack (1).

The story broke on last Friday (12^th May), ransomware hit computers worldwide, ransomware encrypts (locks down) all the files on a computer and the hackers demand a ransom payment to unlock it, in this case it £230, but that payment was demanded for each computer not just for one organisation. The ransomware used a weakness in the Windows XP operating system at attack these computers (2), meaning older computers using this old operating system were more vulnerable.

Very quickly, over the weekend, our newspapers pointed the finger of blame, and it wasn’t at the hackers who created this ransomware. The Daily Mail quickly blamed managers for ignoring “warnings” (3). The Times claimed that failings in the NHS allowed the hackers to “walk in” (4). The Sun too blamed the NHS for being the victim of this attack and claimed patients’ record were in danger (5). Everywhere there were stories about the patient misery this cyber attack caused.

Amber Rudd, the Home Secretary, on Sunday, also pointed the finger at the NHS. She said the NHS “must learn” from this attack, and claimed that Jeremy Hunt (Health Secretary) had already instructed NHS trusts not to use Windows XP (6).

From reading all these reports you could be forgiven for thinking that this cyber attack only affected NHS computers, but that isn’t true. This cyber attack affected 200,000 victims in 150 different countries (7). Those affected by it included the Spanish telecommunications giant Telefónica, who owns the O2 network (8), Deutsche Bahn, Germany’s national railway service,  French carmaker Renault, a local authority in Sweden (9), and the Nissan car plant in Sunderland (10). I didn’t notice the tabloids or our government waging their fingers of blame at any of these companies or organisations.

But why was the NHS so vulnerable to this cyber attack?

Support for Windows XP ended on the 8^th April 2014 (11). Basically, Microsoft no longer issues up dates for it, updates that could protect against this sort of attack. Now the NHS had an agreement with Microsoft, it would pay Microsoft a flat fee, each year, and Microsoft would provide the software the NHS needed and keep it updated (12). In 2010, shortly after the Conservatives came back into government, in coalition, that agreement was suddenly cancelled (12). This moved the responsibility and cost of buying software and updates onto individual NHS organisations.

In 2011 the government cancelled the NHS IT system (13). This system was principally for patient records, but its cancellation meant individual Trusts had the responsibility for buying their own IT systems. This gave us different Trusts with different IT systems, many of them not compatible, and also again put the responsibility for maintaining these systems back onto the individual Trusts.

In 2014 the government warned NHS trusts that they needed to move away from Windows XP (14). On 8^th April 2014, the Cabinet Office issued a letter to all NHS Trusts telling them to “migrate” away from Windows XP (15), or if they couldn’t then to take out a Premier Services Agreement (PSA) with Microsoft, which each Trust would have to pay for themselves. The government did purchase 12 months of Custom Support, but Trusts would have to have a PSA to access it and Custom Support finished in April 2015. After then Trusts were left alone to make their own arrangements, and there was no extra money to help Trusts buy upgrades or even whole new computer operating systems for all their computers, which is never cheap.

NHS IT has never been the best, it has always lagged behind other industries. Since 2010, though, NHS funding has been cut, in real terms. Since 2010, NHS funding has only risen by 0.9% each year (16), less than inflation, and far less than the rising demand on the NHS and rising healthcare costs. Faced with increasing demand and increasing costs NHS managers had no choice but to reduce spending on capital projects, such as updating computers.

Jeremy Hunt was nowhere to be found over the weekend of the cyber attack (But they say Hunt never works weekends). It was left to Amber Rudd, the Home Secretary, to give the Government’s response to this latest NHS crisis, on the Sunday, instead of the Minister of Health. Hunt was door-stepped by the BBC on Monday morning but refused to answer any questions (17). He later gave an interview to the BBC (18) were he too wagged the finger of blame, claiming “lessons will be learned.” Under repeated questioning, Hunt denied that the cyber attack was due to underfunding of the NHS, and at one point tried to say the hackers actually targeted to NHS.

What seems to have coloured the response to this cyber attack is the opportunity to bash the NHS. So much of our media used it as a chance to attack the NHS, claiming it was the fault of managers and that “warnings” were deliberately ignored. The government was quick to point the finger of blame at the NHS, implying that they had done everything they could and the fault for the attack lay with NHS Trusts. Very few people sat back and asked the real questions about why the NHS was so vulnerable, why was the NHS still using such out of date software?

Again the NHS was vulnerable because of it chronic underfunding, it the same course that lead underpinned last winter’s crisis (19), and yet it was ignored again by our media and politicians. It seems that it is far easier to bash the NHS than admit a very uncomfortable truth.

Drew Payne