Richard Meddings, a former banker with over 40 years of experience in the financial sector in both public and private sector roles has recently taken over as the new Chair of NHS England. Meddings has been brought in to be watchful over “any waste and wokery” of NHS resources and help deliver the Government’s ambitious agenda of reform for NHS England. The ongoing pressures on the NHS were well documented prior to the pandemic, and concerns over the sustainability of its funding are seldom absent from political discourse. So, is Meddings’ appointment in keeping with Sajid Javid’s ambitions for the NHS in the coming years, who is he, and what can we expect from him?
Those who have worked with him report that he is forensic, exceptionally detailed and pragmatic in his approach to his work. Whilst serving as a Chair at TSB, Meddings was known for navigating them through a turbulent year of crises and restoring public confidence in the bank significantly. It is no surprise these qualities endeared him to Sajid Javid, who sought a skilled operator with experience of reforming and influencing change at the highest levels of business as his ministers have taken a harder stance on holding managers to account for improving services within the NHS.
Others have expressed concern over his lack of experience in the health sector, and the Health and Social Care Select Committee were not unanimous in their decision to appoint him. Meddings countered critics by stating that there was ample sectoral experience in the board already, and his merits would be to bring “to bring fresh insights, strong experience of board governance, digital and financial skills, and courage in adversity and strategic leadership”.
Meddings enters his role with a challenging brief already in front of him. He will quickly have to showcase his understanding of NHS England’s DNA to win over any sceptics in the organisation. Whilst his appointment was unashamedly based on his experience in finance, he will among other things, have to adequately manage the redirection of an expanded workforce back to the day-to-day delivery of services, as well as ensuring NHS boards align with the Government’s wider integrated care ambition.
Overseeing the change from CCGs to ICSs in July will be a significant stress test of his Chairmanship. Across the country several clinicians will end their roles as CCG Chairs, thus creating a large exodus of clinical experience. Without his own established network throughout NHS England, Meddings will have to quickly understand what life is like at the coal face to get an acute sense of the pressures at a local leadership level. Clinicians are typically not engaged in managing systems and overseeing budgets, so in order for Meddings to achieve his ambitions of better managing NHS finances and reducing waiting lists he must ensure that under the new ICS structure they are engaged at all levels of decision-making.
The Government has stated £800m needs to be made in savings across its health departments this calendar year and as such funding for several programmes has been pulled back already. Whilst it seems unlikely that this ambitious target will be met, a more accurate metric of Meddings’ success will be whether he can balance cost savings whilst also producing tangible results for patients.
The Government is eager to demonstrate how the NHS can be run cost-effectively, and how it can be reformed to improve the way it works in addressing the significant backlog it continues to face. It is no coincidence that Meddings’ appointment is one of three recent major Government appointments of officials with backgrounds in finance, with Samantha Roberts (formerly at Legal and General) appointed as the Chief Executive of NICE, and Ian Dilks (formerly at PwC) as Chair of the Care Quality Commission. Given the Secretary of State’s previous experience both in finance and in his previous role as Chancellor, it is unsurprising he is looking to those with a history in the financial sector to support the delivery of his ambitious reforms.
His appointment also reminds us that Javid will need to demonstrate to the Chancellor that Meddings is the man who will deliver tangible improvements to NHS England’s efficiency and value for money to substantiate the controversial health and social care levy introduced in April this year.
Meddings’ first year will be critical in defining whether Javid’s gamble to appoint a rank outsider has paid off. Javid’s optimism in the new Chair’s previous experience to address any “waste and wokery” and see through his reforms may be well placed, but Meddings must be careful to ensure that ruthless focus on finances does not come at the expense of patient outcomes and quality of care.