The outgoing chair of NHS England, Richard Meddings, has expressed concerns over the recent departure of several senior leaders, warning that this mass exodus poses a significant risk to the organization. His comments come as the UK government, led by Health Secretary Wes Streeting, moves to exert greater control over the public health system.

In recent days, NHS England has seen the resignations of its chief executive, national medical director, chief financial officer, chief operating officer, and chief delivery officer. Meddings, who announced his own departure last October, is also set to leave soon.

This leadership turnover marks the beginning of a challenging phase for NHS England, with central operations staff facing potential job cuts of up to 50%. The Department of Health and Social Care (DHSC), which oversees NHS England, is expected to undergo similar reductions as part of Streeting’s efficiency drive—comparable to cost-cutting measures implemented during Donald Trump’s U.S. presidency.

Meddings emphasized that while reform is necessary, the speed and scale of these reductions should be carefully considered, given the complexity of the NHS’s responsibilities. Streeting, who has called for a “new relationship” between the government and the NHS, aims to shift the focus from treating illnesses to prevention. While he has ruled out formally ending NHS England’s operational independence—an action that would require legislative changes—his broader ambitions will become clearer with the release of the NHS’s upcoming 10-year plan.

Planned reforms include greater accountability measures, such as hospital performance league tables. The shake-up has already led to significant leadership departures, with NHS chief Amanda Pritchard unexpectedly announcing her resignation, followed by National Medical Director Sir Stephen Powis and three other senior figures. In an internal email, Pritchard confirmed that her successor, Sir Jim Mackey, and incoming NHS chair Penny Dash had been instructed to implement major changes, including halving the size of NHS England’s central operations. Around 6,500 jobs are at risk, though frontline clinical roles will remain unaffected.

Meddings supports the push for efficiency and better collaboration between NHS England and the DHSC but stresses the importance of maintaining some independence from political influence. He also believes the NHS has made notable improvements in productivity, with efficiency increasing by 2.4% this financial year and cost savings expected to reach £9 billion.

He acknowledges the immense challenges the NHS faces, describing it as “overwhelmed” rather than “broken.” A key issue is the lack of capital investment over the past decade, leading to a £13.8 billion maintenance backlog. Meddings argues that unlocking private capital could help address these infrastructure problems and urges the Treasury to consider alternative funding models.

Despite an additional £22.6 billion in annual funding from last year’s Budget and a £3.1 billion boost to the NHS’s capital budget, Meddings notes that rising costs in wages, medicine, and insurance mean the NHS still faces an £8-9 billion shortfall. He insists that an ambitious capital investment program must be a key element of the NHS’s 10-year plan, set for release in May.