Is the NHS model still fit for purpose? The first question asked by Richard Meddings, the Chair of the Board for NHS England, in his address at the 2023 Odgers Berndtson Chair and CEO Dinner.
Richard Meddings, who took the post in March last year, boasts an illustrious career, including PwC, Hill Samuel, BZW, and as the finance director for Woolwich plc. His board roles are just as extensive, serving as FD at Standard Chartered, Chair at TSB, NED at Deutsche Bank, 3i, Credit Suisse, and HM Treasury. The enormity of the NHS role is unquestionable. Richard, who has a track record of corporate social responsibility and philanthropy, has donated his NHS England salary to charity.
Richard gave his views on the state of the health service and how it might change:
“There is growing public dissatisfaction with performance, with public satisfaction at 36%. But still huge support for its foundational principal. 94% of the population believe the NHS should remain free and 84% believe it should be available to all."
"I firmly believe the NHS needs transformation but the principle of free at the point of delivery and accessibility remain essential foundations."
"The sheer scale of what it provides is often lost in the commentary. Over a million GP appointments every day, 100 million outpatient appointments, a quarter of a million cancer referrals each month, of them around ten percent enter treatment.”
On the topic of demand, he said: “The media message is that the NHS is completely broken but I don’t think this is true – it is at the risk of being overwhelmed. We face exponential demand in a system that is under-capacitated.”
Much of this is a workforce issue: “The NHS has 133,000 vacancies, 15% fewer doctors than the OECD average, 25% fewer nurses, and less than half the average OECD number of CT and diagnostic scanners.”
It is an exceptionally lean organization with one-third the acute hospital beds of Germany, half the beds of France: in the summer runs at 93% - 94% occupancy, despite views that the safe level is 85%. Richard said, “but the modeling assumption that 30 years ago we would become much better at prevention with far less drinking, obesity, and mental health issues. The boundary with social care and the fact that it faces its own funding and structural pressures with vacancies of over 160,000 is also a significant challenge.”
This has created massive workforce strain with insufficient numbers of nurses, doctors, paramedics, and medical technicians. The long-term plan to tackle these challenges will look to increase productivity while changing the skill mix to focus on new technologies and reduce supply chain dependence on international recruitment.
“Legacy systems, patient record systems, and access to them are improving fast but the links between primary and secondary care are under-invested. More spending needs to shift to technology,” Richard said.
Commenting on the commonly held belief that the NHS has too many managers, he said the issue was more subtle: “The NHS is in reality under managed, spending much less than France, Germany or the private sector on management. But it is over-administered. The burden is largely a result of manual data collection, often to report on performance KPIs.”
The growth of diseases within society plays a significant factor in demand for services, particularly mental health: “NHS England had four and a half million mental health patients in 2021 and 2022, over 8 million of the population are on anti-depressants, with young people’s mental health interventions increasing about 40% in 2022.”
As chair of the board for NHS England, how is he thinking about these challenges? “The first part of the board agenda is focused on the immediate challenges: emergency care, ambulance handovers, A&E waiting times, reducing the elective waiting lists, access to primary care, and earlier planning for next winter.”
A second part focuses on the NHS head office merger to reduce headcount by 40%: This is partly about cost reduction at the center, but more about de-bureaucratization and decentralization. “The reduction is essential for embedding integrated care systems and giving them increased authority.”
Data and technology are also critical to the future of the health service: “The federated data platform we’ve launched will enable connectivity between trust and primary care systems. There’s also development of the NHS app’s services and functionality.”
In addressing challenges, Richard also discussed the cross-over between private and public entities in the health service, pointing to their shared ecosystem: “A lot of equipment supply, pharmaceuticals, and primary care services such as pharmacies are small private businesses.” The private sector is also reliant on the public sector for much of its workforce, and so isn’t part of the solution in meeting workforce demand.
Asked about training new doctors, Richard said: “It costs roughly £275,000 to train a doctor in the UK so some think it's better to bring in doctors trained at the cost of other governments. But I imagine a world where we train more doctors and are much more self-sufficient, and this includes physician associates, and other skill levels.” The same intent applies to nurses.
Apprenticeships and alternate routes to NHS careers are part of the vision: “There are limited gateways into nursing other than a three-year degree. There’s a whole cohort of people shut out of this option who could gain qualifications over six years, and earn as they learn. Opening these gateways is how we drive greater volume and train more of our own professionals.”
The challenges facing the NHS are significant, yet Richard’s outlook is positive. On joining the NHS he did a night shift with a London ambulance crew, involving 13 incidents. As he noted from that experience,
“It’s often the most difficult times that bring out the best in people, having witnessed that myself, I remain optimistic for the future.”
To discuss the Chair and other Board positions, contact our Board Practice, or get in touch with us here. You can also find your local Odgers Berndtson contact here.
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