The outgoing chair of NHS England has warned that a recent exodus of senior leaders poses “a real risk” to the service as the government tightens its grip on the cherished public health system.
The comments by Richard Meddings follow the resignations of several of the most senior officials running England’s NHS, whose operational independence health secretary Wes Streeting is moving to curtail.
NHS England’s chief executive, national medical director, chief financial officer, chief operating officer and chief delivery officer have all tendered their resignations in recent days.
“It’s always a real risk to lose that raft of significant talent, all in one go,” Meddings told the Financial Times. He announced his own departure in October and is set to leave later this month.
The turnover of top leadership is just the start of a new and painful period for NHS England. Staff working in central operations at the service have been warned that as many as 50 per cent of them could lose their jobs.
Streeting’s Department of Health and Social Care, which oversees NHS England, is also expected to be hit by his efficiency drive, which echoes efforts by US President Donald Trump’s administration to cut the American federal bureaucracy.
Meddings cautioned that “the scale and pace of the reduction” envisaged by Streeting needed to be “measured against the breadth and complexity of the obligations that the NHS has today”.
The health secretary has demanded a “new relationship” between the government and the NHS, a £192bn-a-year health service that was granted operational independence just 13 years ago.
That relatively short period in the service’s seven-decade-long history has been among its most challenging, as the NHS grappled with an ageing population, expensive new medicines, tighter funding and a pandemic.
Streeting has said he wants to do what multiple health secretaries have failed to achieve: shift the balance of the service away from treating illness to preventing it. He has made clear he is not considering formally ending NHS England’s operational independence, which would require primary legislation.
But the full extent of Streeting’s ambitions for the NHS will not be revealed until later in the year with publication of the service’s 10-year plan. Reforms unveiled so far include measures to introduce a culture of greater accountability, including league tables for underperforming hospitals.
In February, NHS boss Amanda Pritchard unexpectedly said she would step down this month. National medical director Sir Stephen Powis last week announced he would exit in July. On Monday, three other senior leaders said they would leave by the end of March.
In an email to staff on Monday, Pritchard said Streeting had instructed her successor, Sir Jim Mackey, and incoming NHS England chair Penny Dash to deliver “significant changes in our relationship with DHSC to eradicate duplication”.
“As part of this, they will be looking at ways of radically reducing the size of NHSE that could see the centre decrease by around half,” Pritchard wrote. Officials said around 6,500 jobs were at risk but the 50 per cent cut would not apply to frontline clinician roles.
Pritchard added that “all vacancies will be indefinitely frozen” and that NHS England would recruit only in a “very small number of exceptional circumstances”.
Meddings said he agreed with the direction of travel, which could lead to more resources being directed to frontline care. He also supported closer collaboration between NHS England and DHSC: “The idea of closer working is a good one.”
But he argued it was valuable for the service to keep some distance from politics and politicians, who were “often driven by shorter-term rhythm and by the need for, often, announcements . . . I think it’s very healthy to have a separation in terms of how things get delivered and executed.”
Meddings suggested that the NHS had a far better story to tell on productivity — increasing by about 2.4 per cent this financial year — and cost savings than was often acknowledged. Last year, the health service had saved £7bn in costs, “and this year, I think by the time we get to the end of March, we’ll probably save close to £9bn”, he said.
He also highlighted the improvements achieved under Pritchard’s tenure, saying the service was providing record levels of healthcare to meet extraordinary demand.
Meddings said he understood why Streeting, looking at patients’ experiences, had described the NHS as “broken” upon taking office last July. But the word he would use is “overwhelmed”.
He pointed to the massive shortfall in capital investment at the NHS over the past decade, which has led to a maintenance backlog of £13.8bn, the highest on record.
Meddings, a former top City banker, said he “would plead with the Treasury for more latitude in models that they would be willing to run, that would allow us to access private capital”.
The reason he would argue for that “is the condition of the state of the NHS, its physical infrastructure. It’s not just the hospitals, it’s also in primary care”
“I keep saying there aren’t any swords that cut the Gordian Knot of the NHS, there is no silver bullet. But the closest thing would be the ability to access private capital at pace to remediate this historic under-investment.”
Meddings said he knew “from lots of meetings I have that a lot of private money would come”.
“Some sort of ambitious capital programme” needed to be part of the 10- year plan for the NHS, due to be published around May, Meddings said.
He also made clear that, despite a relatively generous settlement for the NHS in the Budget last year, a big gap remained. The NHS was given an additional £22.6bn a year for day-to-day spending and a £3.1bn increase to its capital budget.
While the service had been pleased to receive the day-to-day spending boost, when pay inflation, non-pay inflation, medicine prices and employers’ national insurance were taken into account, “actually we were about £8-9bn in the hole, in other words it did not cover those costs”, he said.
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