Amanda Pritchard: what are the challenges awaiting the new NHS boss?

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Amanda Pritchard is the new chief executive of NHS England, replacing Sir Simon Stevens, the current boss, who steps down after seven years in charge. 
 
Pritchard’s appointment comes at a critical moment for England as the country’s struggling health service attempts to recover from the pandemic.
 
The race to succeed Sir Simon saw her competing alongside some controversial candidates including track and trace boss Dido Harding.
 
But in many ways, the fuss around Harding was a red herring. Pritchard was always the hot favourite to take over. Indeed, her appointment was forecast by our very own Maggie Pagano back in June.
 
Pritchard, who is currently deputy to Stevens, is an NHS veteran. After attending a comprehensive school in Durham and reading modern history at Oxford, she – like her predecessor – joined the NHS as a graduate trainee. 
 
NHS insiders say she is widely respected. After gaining much credibility from running Guy’s and St Thomas’ – one of the biggest NHS trusts in England – she has effectively been running the NHS on a day-to-day basis during the pandemic. 
 
Her appointment provides continuity during a troubled time. 
 
But no amount of experience can detract from the daunting nature of her role – often said to be the fourth most important job in the UK after the PM, the Chancellor and the Governor of the Bank of England – moving forwards. 
 
It’s a job that carries enormous responsibility at the best of times – the NHS is Britain’s biggest employer and the world’s fifth largest.
 
And while public regard for the NHS has never been higher, the problems facing it are greater than ever.  
 
Over 5.3 million people are currently marooned on NHS waiting lists – the largest backlog since records began. Thousands have been waiting more than two years for surgery.
 
Chronic staff shortages urgently need addressing, alongside the problems caused by an overstretched and under-resourced workforce. “Emotional and physical exhaustion is running rife,” amongst existing staff, warns Jonathon Holmes, a senior health and social care policy advisor at the King’s Fund. “Embedding compassionate and caring leadership will be a big challenge for Pritchard.”
 
Resolving many of the issues facing the NHS will bring forth political challenges. 
 
The cost of recovery from the pandemic is set to be substantial and the autumn spending review is fast approaching. But securing billions of pounds in extra funding for the NHS during a time of restrained public spending will be an enormous feat. 
 
This begs the question: will Pritchard have the bargaining skills and political nous of her predecessor who leaves behind an impressive legacy on this front?
 
Twice, Stevens managed to secure multi-year increases in NHS funding during periods of public sector spending restraint – in 2014 and again in 2019. 
 
Another long-term challenge for Pritchard will be overseeing the ongoing reform of NHS structures and the move towards the integrated care model. This model is being pushed in the upcoming Health and Social Care bill which will very much be seen as Stevens’ legacy project. 
 
“It has potential to be a very positive change,” says Holmes, “but it will require a lot of work.”
 
Its aim is to join up hospital and community-based services, in order to improve out-of-hospital care. 
 
A big part of this will involve tackling the social care mess. But the integrated care vision extends beyond the elderly; more generally, it’s about addressing social and economic determinants of health and focussing on wellbeing rather than just acute illness. 
 
This means investing in community services to stop vulnerable people’s health deteriorating to the point of hospitalisation and preventing many of the chronic illnesses which so many of the most economically deprived suffer from.
 
Crucially, this will involve tackling regional health inequalities, particularly those in the North of England. Only this month, Sir Michael Marmot, the eminent public health expert, released a new report describing recent falls in life expectancy in Greater Manchester as “jaw-dropping”, warning that a “levelling up” agenda that ignores health will ultimately fail. 
 
Pritchard has a herculean task on her hands.  Andy Cowper, the founder of Health Policy Insight, has warned – rather gloomily – that anyone taking over from Sir Simon should be prepared for the “high probability” of having to either very publicly resign or be sacked. 
 
Why so? Because, Cowper says: “The likelihood of getting the resources to sort out the backlog problem that’s been many years in the making is slim.” And, given the scale of the backlog, there will be “insufficient time to deliver a meaningful performance recovery before the next General Election.”
 
Pritchard stands warned. 
 
Yet given the incredible amount of operational insight Pritchard already has, if anyone is up to the challenge, it is her.