NHS in England needs 3 more years to recover from Covid, says chair

The NHS in England needs three more years to recover fully from the Covid-19 pandemic as a lack of investment in hospital buildings and medical equipment hampers its ability to capitalise on an influx of new staff, according to its chair.

Richard Meddings told the Financial Times that the taxpayer-funded service, where patients are waiting for 7.5mn hospital appointments, faced a “Sisyphean” struggle to meet demand fuelled by “the behaviours of a modern world” including gambling and consumption of ultra-processed foods.

Although about 8 per cent of NHS posts are vacant at present, the number of consultant doctors increased by 16 per cent in the four years from December 2019. Nurses and midwives rose 17 per cent over the same period. Yet the NHS was failing to secure a corresponding increase in patient care, Meddings suggested.

“We still have insufficient staff, but actually the pace at which workforce has recently come in is not driving the commensurate output,” he said in an interview, adding that part of the reason was a lack of capital investment.

“Post the pandemic, and the surge in demand that comes from . . . having closed down a lot of the support to focus on Covid, actually it’s a five-year recovery and we’re only a couple of years through that,” the former banker added.

Although chancellor Jeremy Hunt in March announced an extra £2.5bn for the day-to-day budget of the health service in 2024-25, the NHS is suffering from an estimated £12bn shortfall in spending on buildings and equipment.

Highlighting the impact on staff’s ability to care for patients, Meddings said: “They might be queueing up to get access to a diagnostic machine, or there might not be the [operating] theatre capacity that they can activate.”

Although the NHS had since 2021 opened about 160 community diagnostic centres — one-stop shops for checks and scans — England still had one-fifth of the diagnostic capacity of Australia and less than half the average diagnostic capacity compared with the OECD group of rich nations, he said. 

Local NHS officials are now preparing a 10-year strategy for capital investment. Integrated care boards, in charge of buying care for their local populations, have been given a July deadline to calculate the investment needed to drive productivity.

Waiting lists for “elective”, or non-urgent, hospital care have fallen from a peak of 7.7mn in July last year but remain well above the 7.21mn outstanding treatments in January 2023, when Prime Minister Rishi Sunak made falling waiting lists one of his pre-election promises to voters.  

Meddings, who previously held board roles at Deutsche Bank and Credit Suisse, said the health service’s budget was flat in real terms, with industrial action slashing capacity by 12 per cent since junior doctors — with whom the government is yet to reach a deal over pay — first went on strike in March 2023.

While conceding that the marginal fall in the overall elective waiting list was “not good enough”, Meddings insisted the NHS was providing record levels of care. He said more than 1.5mn non-emergency procedures were being carried out each month and that the NHS was “gradually reducing the longer waits: the two years, the 18 months, the 65 weeks”.

A key plank of the NHS’s current infrastructure plan is the “new hospital programme”, backed by more than £20bn in government funding.

Asked if he was confident all 40 schemes would be delivered by the 2030-31 target, Meddings said “at the moment, yes” but cautioned that it could be difficult to keep money flowing for big public projects.

“You get given £100mn but . . . actually you’re only allowed to spend it in £5mn increments. And [at] each £5mn stage you have to resubmit a business case. So there’s quite a sclerosis around the way government spends,” he said, adding that he understood officials’ need to police spending.

In addition to population growth and ageing, Meddings said the NHS was having to deal with “changing patterns of demand, some of which comes from the behaviours of a modern world, with its ultra-processed foods”, which typically contain additives and sweeteners.

About one in four people in England was obese — a condition linked to 13 different cancers — forcing health chiefs to buy “larger ambulances, with wider beds”, he said.

The NHS recently opened its 15th gambling treatment centre, while the number of children and young people seeking help for anxiety and mental health disorders has surged by 48 per cent since 2019-20 — an increase Meddings suggested could be linked in part to social media use.

“I think it’s a Sisyphean task for the health service,” he said. “However much you roll the boulder up the hill, you’ve got to keep going and the boulder may change, but it always rolls back and on you go again.”

A government white paper on gambling last year proposed a levy on companies that is expected to raise about £100mn a year for NHS treatment, raising questions over whether the approach should be widened to other sectors. 

Meddings said: “It’s not for me to do policy. But if you and I are chatting as citizens . . . should there be a different compact with some of the industries which might cause health issues? Probably.”

This story has been amended to clarify that the NHS has opened 160 community diagnostic centres since 2021.