Richard Meddings chairman of the NHS | Extraordinary Life Stories

0:10Hello, my name is John Reynolds. Welcome to Extraordinary Life Stories. On this episode, I'm talking with Richard Meddings, the Chairman of the NHS. Richard is a distinguished leader, bringing decades of expertise from the financial and corporate sectors to one of the UK's most vital institutions. Known for his strategic vision and ability to drive transformation, Richard has held senior roles at some of the world's most leading financial organisations. Appointed Chairman of the NHS in 2022, Richard has been instrumental in addressing the challenges of modern healthcare, focusing on innovation, financial sustainability and improved patient care.

0:51I'm really looking forward to talking with Richard, so let's get into it. Richard, thank you for joining me. Thank you for asking me. Tell me, who is Richard Mennings? Goodness, that's a question, isn't it? So I am the chair of NHS England, and I come from the financial services industry before I came from the NHS. But before I started work, I was born in Wolverhampton, one of five children. Actually, we had a very interesting, difficult, in some ways challenging background, because my father died when I was 11 or just turned 12, actually. And then my mum was quite ill for a couple of years. And there were five of us in a six-year span.

1:38Because I'm one of twins, so I've got an older sister. I had a younger sister who's passed away, and I've got two brothers, one of whom is a twin. So we grew up in Wolverhampton. And my dad actually was the town clerk in Wolverhampton and also came from a very interesting background, I think, challenging background. But as I say, he passed away. And the thing that first, I think, helped me was actually my school, which was Wolverhampton Grammar School. I didn't realise until after I'd left, actually, was really good at pastoral care. And so my twin brother and I had arrived at the school in September, and my dad died in April.

2:18and they basically asked two prefects to look sort of man to man mark us really and look after us without us even knowing they were doing that and just to make sure that we were brought into as much of the school's activities as possible so as the academic stuff playing in the sports singing the choirs and the school basically put its arms around us actually and I think that was really important in my life, actually, while my father dying and then going through a very difficult two-year period when my mum was so ill. But the school was a real supporter. I'm hugely proud of my father and my mother.

2:58My father had been born in 1917 into real deprivation, actually. left school at 13 and he was a bright little boy and a local solicitors firm told him to the head teacher of the school was told that young Ronnie, he's called Ronald, Ronnie Meddings, was a bright little boy, really little bright and they sort of picked him up as a messenger. So he worked as a messenger and was doing that and then started doing basic clerking and then on comes the Second World War. So he joins up, goes into the Lancashire Fusiliers as a private and at end of the war he's a major and he's commanding in a sort of a Gurkha regiment, not the whole regiment, but commanding in a Gurkha regiment fighting in Burma.

3:43And then he comes back out of that, out of the war, and re-engages with a professional life. But he'd never been to university and he basically self-taught and sat the Law Society exams, where he was obviously a very clever man, because he came first in the country, so he He won the gold medal in the Law Society exams, never having actually been to university or having self-taught. So then he was, I think, quite driven, I suspect. He was clearly very clever, very amusing. Lots of people, the letters about him after he died, about speeches he gave. And he was very funny. And one of my great memories of him actually is coaching our football team, under a level of football team, standing on the touchline.

4:27But he basically came into local government and worked his way through and became town clock in Wolverhampton. And then he was struck down by a brain tumour. Now, my mum had left school at about 15 and her, and she grew up in Wolverhampton, stayed in Wolverhampton. She has a sister, sister there. So she has five children with us. She was 14 years younger than my dad. And then she gets struck down by breast cancer pretty quickly after he passes away. and so we go through that or she goes to that and she's bringing out five of us but her sister and her sister's husband basically really stepped in and helped us and her mother stepped in and helped us and looked after us but they also come from real sort of working backgrounds my mum's dad was a council carpenter her mum had actually had her mum and her mum's sisters had been in service you know but I was service and so on and they came through but my mum was clever and so one of these you can tell from me, I do think being clever and being hard working and using your talents is really, really important.

5:30So my mum, after she recovered, trained as a teacher and then taught reception in primary schools, in a primary school in Wolverhampton for about 25 years. So it's a bit of a, sorry, it's a bit of a Morkish type of description, but that's where I come from. And I've got a twin brother who's just retired as a consultant surgeon who won a medical scholarship to St Andrews from Wolverhampton Grammar School, a younger brother who's just retired in Canada and I'm very proud of him. He became the second most senior civil servant in Canada. Again, very clever. My older sister, very politically active, was very senior, running further education colleges, governor on schools, very, very committed.

6:10And then my younger sister, actually, she passed away actually just before COVID began. So it's an interesting family. It gives great context as well because as the chairman of NHS England, there's a lot of people that would want to know about the person, about the individual. And there's a corporate career that led into that. But as Richard Meddings himself, I really appreciate you elaborating that and giving people a chance to know who you are. So the school was brilliant. And so I talked about parcel care, but because of the education I was fortunate to get at Wolverhampton Grammar School, I then was fortunate I got to Oxford where I studied history and I went to I remember going to Oxford to this day.

6:53My mum drove me there and this yellow triumph dolomite we brought a new trunk which had my name stenciled on it. I'm not sure that's what everybody else did but I was at a state school I think I'd been abroad for a week in my life which was on a choir tour in Belgium. and I arrived in a really rather loud pinstripe suit, my first suit with hair down to my shoulders and pretty naive about the world actually but you know pretty driven and hard-working and so on and Exeter College Oxford also completely opened my horizons and showed me much more of the world than I'd ever really seen. My gap year I'd spent working for the Department of Health and Social Security.

7:31And then I did a three-week cycling tour of East Anglia studying medieval parish churches. So that was me arriving at Oxford. So rather narrow, actually. And then after Oxford, I did accounting, and so we go into the corporate world. And ultimately into finance. Yeah, so I'm not very rebellious as an individual. So I often say that when I was leaving Oxford, that I didn't really know what to do. And my mum kept saying, be a lawyer, be a lawyer like your father was. And the extent of my rebelliousness was actually to become an accountant. So that's how rebellious I was. So I actually trained as an accountant.

8:07And I did that because I didn't know much about the commercial world. My family wasn't in a commercial world at all. And I just thought it was probably the best way to learn it and to get qualified. I do think actually it's important to continue to develop and continue to demonstrate skills, even if you can evidence them with certificates, or just continue to develop their skills. And I think that's really, really important. So for me, it was getting a qualification, which was an important qualification, and getting an insight into a commercial world where I thought I was probably heading. So I did that at Pricewaterhouse, stayed in the training department, tutoring in, not really in the subjects, but how to pass exams in accounting and tax and law, and then went into merchant banking in corporate finance, doing M &A.

8:53and IPOs and capital markets work. And I did that then for a dozen years or so. That's interesting because that makes you multifaceted. It does because you haven't just done one thing, right? And then, of course, leading into, as we sit here now, again, Chairman of NHS England, there's so much experience you can bring into that. But it's interesting because you haven't got, I guess, the medical background. Not at all. But you don't need that. You're surrounded by, dare I say, advisors and people that can help you with that. But those skill sets, crisis management stands out for me, 2008 financial crisis.

9:30I'm interested to know how you were drawn to the NHS, whether there was a desire and an intrigue to get involved and whether there was an element of them pulling and headhunting and wanting you to come in. So, I mean, I partly have a reputation for being willing to run into burning buildings, is something that's said about me. So I do like challenges. And after I'd been working as an executive in financial services, which I did over that in 2014, I then had developed a non-executive plural career with a number of other financial services, predominantly financial services businesses, but also importantly, HM Treasury.

10:07So I sat on the Board of Atrium Treasury for seven years and also did a piece of work for the Department of Education for four years. And so I was approached by headhunters for the NHS England role and without it sounding biblical I said no three times and I said, you know, I've got absolutely no relevant skills. I've got no medical knowledge. And the answer really was a very good one. It was actually the last thing we need in the chair is medical knowledge, because actually we have an abundance of medical knowledge around the system. What we actually need are other skills, sort of more corporate skills, value for money, prioritisation, managing a board, mentoring and assisting not just the chief executive, but the executives.

10:53So there's skills that you build up over time. And could I apply those into the NHS? So I threw my hat in the ring and after about six interview rounds, to my great surprise, my wife's surprise, I ended up with the role. I think one of the ingredients which not many people know and I hadn't realised for some time that they were looking for in the interviews was actually experience of mentoring a female CEO, a new female CEO, serendipity if you like, that in my past I'd also worked with and shared or mentored a female CEO and then worked with others, which is quite important, actually. It's amazing how the experience prior to suffocations come together, particularly in your case, so well to be the right fit.

11:37It's good that clearly people recognize that. There's obviously good people that knew what they were looking for, what they needed, and then to ultimately go and find you. Yeah, I took the role, yeah. So the role that you've got and the whole fit with where the NHS sits right now. You came in 2022. Yeah. So through the COVID lockdown kind of experience and the praise the NHS got for how they coped, how needed the NHS was. And then I feel like there's been a lot of press post and a lot talked about how NHS is in crisis and is struggling and on its knees. I really want to hear from you how it really is and what's really happening and what you're doing to help, if you like.

12:32So I think it's obviously a very small political world and narrative around the NHS. And when I speak about it, I go in two broad directions. One of them is I talk about the way the NHS England board thinks about the task it has. And I can come to that. And the other is I tend to talk about actually four themes. The first actually is it faces exponential growth in demand, surging levels of demand. And there is a quote from Gladiator 1. I saw Gladiator 2 on Sunday, actually, but Gladiator 1. And the quote is whatever comes through those gates. And actually, that's what NHS has to deal with. We deal with whatever comes through those gates.

13:18And what we're seeing is increasing levels of demand from a population in England that's 15 % greater than the turn of the century. It's older, 28 % of the population is obese. That triggers 13 cancers, diabetes 2, muscle, skeletal, cardiac concerns. Mental health issues are just really surging, particularly amongst our children and younger people. That's really, really difficult. So we face this lift in demand. So that's the first thing. The second is that the NHS meets it with under-invested capacity. And what do I mean by that? Well, if we looked at our hospital beds and scaled to population, in the NHS, we have a third of the beds that Germany has, half the beds Italy and Spain have in our secondary care.

14:11And when you think about that allied then with a growing population which is also older, right at the heart of the system we don't have enough beds. But it's not just the bed capacity, it's also the estate. So many of our hospitals need significant work. There's a backlog maintenance of about£12 billion at the moment,£5 billion of which is critical safety. So we need to get that investment. In diagnostics, we have less than half the average diagnostic capacity for the OECD. So you begin to see this capacity challenge that we have. And it's too glib to say it's austerity. It's not only austerity, but it is underinvestment.

14:50But also on the beds, there was a decision made 20, 25 years ago that we were going to be good at prevention. So the hospital beds, we said we'd be good at prevention. But the senior establishment then decided, the medical establishment, that we therefore wouldn't need the beds because we're going to be good at prevention. Well, that was a mistake because actually population continued to grow and the range of conditions continued to grow. And our medical scientists find ever new ways the condition can go wrong, so new treatments. So actually the growth in demand continued. And, you know, if you took the bed numbers, I think it was 144 ,000 at the turn of the century.

15:27It's now 97 ,000. So the bed capacity is much, much lower. The other two factors, very quickly, because I realise I'm taking far too long on this, but it's exponential demand into a system which has not sufficient capacity. It's actually today the NHS is providing absolute record levels of healthcare. And it's a testament to the sheer effort and commitment and passion of not just the frontline workforce, but the workforce of the NHS, the workforce that enables the frontline, we're providing absolute record levels of health care. So I know accessing primary care can be difficult in parts of the country, but today, or last year, the NHS provided a primary care appointment.

16:14Well, it's the equivalent of one in eight of the population of England has an appointment in primary care every single week. Every single week. Wow. And that's massively up on what it was five years ago. It's about 20 % up on what it was five years ago and even more up on what it was before that. On cancer referrals, last year we did 3 million cancer referrals, checks. And 10 years ago it was about 1.25 million. So it's 130, 140 % increase in the number of people we are identifying and scanning for potential cancer. So you see those sorts of statistics. And what you realise is that whilst under huge pressure, the NHS today is providing absolute record levels of healthcare.

17:01But the question is, can we keep up? Can we catch up? And can we keep up? And the thing that gives me optimism is innovation, actually. And I hadn't realised. And there's all sorts of amazing innovations that the NHS introduces all the time. Are we talking technology and AI here? Well, we can do. So on AI, if you want technology, AI, so we use... Just to elaborate really on what the innovations are. So let's go AI. So today that we are experimenting with something called ambient documentation, which is quite interesting, on technology. On AI, we use it for histology, pathology, retinal scans, dermatology, x-ray, pattern identification, screening, so brain scans.

17:44So we're increasingly using AI in terms of its very good pattern recognitions. and then tech more broadly as I say ambient documentation which is essentially voice to text but allows me your doctor examining you to talk and as I talk it loads it directly into the into my report about what about you and then it produces and sort of edits that down and allows you simply to read is that the right is that the right diagnosis and and so on and it saves the clinician having to write it out or type it all out and then check it it just can save 15 to 30 percent of a clinician's time. So we're doing that.

18:21But the innovation I find really exciting and in many ways moving, actually, emotionally moving, is that this last year in the UK, the NHS has developed and produced a cancer vaccine. And we mustn't exaggerate, But actually, it was a cancer vaccine for bowel cancer, and I think we did one for breast cancer, where actually the vaccine is produced based on the DNA of the patient and the DNA of the tumour. And we could now conceive a world, probably conceive a world, where we fight the scourge of cancer with surgery and chemotherapy and radiotherapy. But actually, we could add vaccination. Now, we won't be able to vaccinate for every cancer.

19:14even subsets of a category of cancer. We can't get all of them, but you could imagine a world, conceive a world where actually vaccination against cancer for a number of cancers becomes very real. Wouldn't that be absolutely remarkable? I've always been crying out for years. Yeah. And then genomics. We're a world leader in genomics, one of the leaders in genomics. It's Genomics England. I sit on that board. It's a great privilege to sit on that board. It does whole genome sequencing for us. It's a custodian of what we're building, a National Genomics Research Library that makes the data available to researchers to find new treatments or the way that the genome can actually...

19:52what do we spot in the genomic sequence about why people have particular conditions. But in addition to Genomics England, there's a Genomics Medicine Service, which does over 90 % actually of our genomic activity. And so last year we did over 700 ,000 either whole genome sequencing or panel tests or single gene tests. And we now scan in this country for 200 cancers and 7 ,000 rare diseases. And we've just completed the 100 ,000 whole genome sequencing, so 100 ,000 patients. We've had the whole genome sequenced, available in the NGRL, and we've just launched the newborns. So we're launching a program, we have launched a program where newborn babies, we ask their parents permission, we do the whole genome sequencing on them, and we're beginning to build that database that allows us to be much more forensic, to allow our brilliant medical scientists to engage and to find, again, different treatments for different conditions based on real science.

20:54So you look at all that and you think the innovation is just remarkable. And I do think it's one of the reasons that I remain optimistic about the NHS, very optimistic about the NHS. But we need to go back and make sure we fix the basics. So urgent emergency care, waiting lists, access. We need to get all those performing better. Waiting lists is probably the biggest thing. In the build-up to talking to you today, I've mentioned we're going to be having a conversation just to friends, family, colleagues. And the waiting list is probably the biggest thing. that if you take the people, if you like, that's the one thing that they're all saying is the challenge, the frustration.

21:32I have a question for you that's slightly reverse engineered. You mentioned prevention earlier. Is there anything that people can do differently in how they interact with the NHS that would actually prevent so many people putting so much pressure on the resource? And I don't quite know my question specifically. I'm trying to sort of say, do people need to be contacting the NHS to have an appointment at a certain time when there might be other information available? I hope I've made my question clear. You know what I mean? There's a lot of people that just flood the NHS. And actually, is there any sort of preventative ways of these people saying, well, actually, you could get this information.

22:11You don't need an appointment. Save that for the people that absolutely do. Well, you can. And so an immediate example with the NHS app and putting nudge behaviour and information into the NHS app, the NHS app is absolutely revolutionary and it actually was created as one of the sort of silver linings on the cloud of what was COVID, the pandemic, because here comes the app. Most people signed up to it because it's what you needed to show to go to various locations and in the last two or three years we've absolutely turbocharged the investment in it and now there are 34 million subscribers, a huge number of people, so I'm one of them, manage my repeat prescriptions via the app So I can simply sign up with it.

22:50It provides much more information. I think in July this year, there were about two million appointments in hospital and secondary, which individual citizens were able to see on their app and to manage on their app. Now you can't book the appointment on your app, and nor should you actually, because the population would overwhelm consultant capacity. But they can manage it. In other words, if there's a problem with that date, they can indicate that they can't get to it. so we can gradually improve appointment and diary management in hospitals. Which will help waiting. Absolutely. Prevention more broadly, I often get in trouble if I say, which I'm going to say now, I would bring on the nanny state.

23:31And I'm sorry that people don't like that. But if I look at obesity and I look at ultra-processed foods and fats and sugars that are out there, I look at social media. I think that the Australian government, their recent initiative about regulating social media for either under-16s or under-14s. I forget which of those they're going for. I think these are wholly necessary because the population's ability to withstand big industry and the way big industry is essentially managing what we eat, how we drink, our social media interaction, I do think actually we should have a much more preventive willingness in our legislation amongst our politicians.

24:14But I realize that's quite a bit easy to say. It's hard. It's hard to do. Yeah. I mean, it's a culture, isn't it? You walk into the supermarket and you get to the checkout and you've got lines of sweets. You have to go down a queue of crisps and chocolates. I'm guilty of it. Typically, I'm in a shop when I'm hungry. It's Henry Dimbleby who says, isn't it? Why are we having it? I mean, his example is Kit Kat cereal. What on earth are we doing, eating Kit Kat cereal to our children? And in the last of a way, if I'm guilty of it, you might be guilty of it. then there's people that are going to be piling into that and then you'll just, you know.

24:46So we've opened our third, so going back to that, whatever comes through those gates, the NHS has opened its 30th centre for severely obese children. We've opened our 15th gambling centre, so centres to handle gambling addiction. So whatever comes through those gates, the NHS is having to deal with it. And so I do think we can change engagement, can we tilt the demand curve? But actually, I think in some of these, I do think it's a role for two things actually. One, if I were brave, I'd have parliamentary legislation driving harder at prevention, frankly protecting the population's health. We have seat belts.

25:25But also I do think we can intervene differently. I do think this is a call for a different social contract. So what should a citizen, what's a citizen's responsibility to the society in which they live. And part of that is actually how healthy are you? How do I engage? And we've got to help them. But how do I engage with my health rather than just turn up in any condition? And so I think that would be an important... It's an education piece there, isn't it? Big education piece. Big education piece. And just bringing that back to Richard, how do you and how have you prioritised your own kind of physical and mental fitness?

26:02Well, if you look at me, I'm not doing too well, but I do try. Yeah, but you look well here. You've got a twinkle in your eye. You You can tell a lot from that. You've got drive, you've got passion, you look like you've got purpose with what you're trying to achieve with the NHS. I think purpose is really important actually. And I do think that that's one of the challenges. I mean, I think the government's very good initiative around trying to get our 16 to 24 year olds, those who are not entering the workforce to be economically active, is a really important step. I agree. And without it, I think the pressures on society more broadly, the institutions of other sort of the struts of the way our society operates, including the NHS, will just come under much, much, much more pressure.

26:42So I think that's a hugely, hugely important initiative. To me, I, what do I say? I always say to my children, actually, I think, if you're willing to work hard and you're lucky with your health, you'll always be okay. But I think hard work is, actually, one, it's important and two I think you get great satisfaction from working hard and consistently. In terms of me more broadly, I am blessed with a brilliant wife actually and she laughs at me and with me. She's very clever. She has brought up, so when I was doing banking I was traveling every second week long haul away. She's brought up our three children and they are excellent, they're great.

27:32So I have a very good family and as I say, they do laugh at me and with me, which is really good. The other thing I say to them is never judge someone by their money and I think that's also important that people will sometimes end up with money and they either inherit it or they just haven't been in the right job at the right time, frankly. So you judge people, it's less the money point, it's judge them on their values and what they do and what they contribute. So that, I think, is really important. And then I care most of all, actually, second to my family on peer respect. And I've got a smallish group of very close friends, and I care that they think that I'm engaged positively and doing a good life.

28:19And since it's small, there's a group called the Gurus, where I used to play cricket with badly, and now we play golf with their older. but they're a very close group of friends and we see each other once or twice a year probably and then close friends locally and it matters I think how we engage, what we talk about. That's camaraderie and you get perspective. Peer respect, peer respect for people who know you I think. Have you got something that you'd particularly like to achieve during your tenure as chairman of NHS England? Is there one thing that stands out that you really want a problem to solve or something that you want to benefit?