Pre-appointment hearing for the position of Chair of NHS England

1 Appointment of the Chair of NHS England

1. On 26 November 2024, the Secretary of State for Health and Social Care wrote to inform us that the current Chair of NHS England (NHSE), Richard Meddings, would be stepping down early. Mr Meddings had been expected to remain in the role until March 2026. The Secretary of State told us that Mr Meddings now intended to stand down as Chair by 31 March 2025.¹ The Secretary of State wrote to us again on 14 February 2025 to notify us that the recruitment process had concluded, and that his preferred candidate was Dr Penny Dash.² The pre-appointment hearing took place on 26 February 2025. A transcript of the session is available on our website.

2. Dr Dash is currently chair of the NHS North West London Integrated Care Board and has worked as a hospital doctor and a public health doctor. She has also worked as a senior manager in the NHS and as a consultant to a wide range of organisations across healthcare. In accordance with the Liaison Committee’s guidelines for pre-appointment hearings, our hearing and written questionnaire addressed Dr Dash’s professional background; her personal independence; her priorities if appointed; any relevant conflicts of or financial interests, and whether there were any areas where she felt she would need to develop additional skills or knowledge.³

3. The appointment is taking place at a time when NHSE is expected to go through significant change following publication of the 10-Year Health Plan. Dr Dash was asked about the overall approach she would bring to role of the Chair and to the delivery of the 10-Year Health Plan. Dr Dash said that she was ambitious about delivering change and cared deeply about improving the quality of care and making better use of resources. She acknowledged that her personal style could be more interventionist, and that she liked to engage with the detailed data and modelling, but said that she was trying to step back to avoid encroaching on the role of the Executive team.

4. We questioned Dr Dash on how, if appointed, she would prioritise the delivery of the Government’s three shifts for NHSE.⁴ She stated that she would like to see a shift in funding towards primary care but acknowledged that this would be challenging to deliver given the current financial outlook. She also emphasised the need to redesign local care, including an emphasis on delivering via multi-disciplinary teams, which she felt were being successfully deployed in some areas but could be rolled out more broadly. She also spoke about the importance of “getting the basics right” to provide the NHS with the digital tools it needs to operate effectively, but was still considering what the right accountability and delivery mechanisms were to drive that change.

5. We asked Dr Dash about her comments that she wanted to “clarify” the relative roles of NHSE, Integrated Care Boards (ICBs) and providers in the function of ICBs. Dr Dash said that she wanted to see an improvement in the strategic commissioning skills of ICBs and better management of the mix of contractual and management relationships between ICBs and providers. She also said that she would want to drive greater focus across the system on quality and productivity.

6. Reflecting on the relationship between NHSE and the rest of the health system, Dr Dash said that she wanted to devolve more power to local teams to deliver, with the centre focussing on delivering things that it makes sense to do once at a national level. She said that she saw her role as Chair as empowering and challenging local leaders and undertaking analysis to identify opportunities for improvement to drive the spread of good practice across the system.

7. We explored Dr Dash’s comments on the future of NHSE’s relationship with the Department and her willingness to defend NHSE’s operational and clinical independence. She said that she was comfortable with having challenging conversations and emphasised how she would use evidence and data to push back and provide challenge to Ministers.

8. Given the centrality of partnership working to delivering the Government’s three shifts, we asked Dr Dash how she would go about ensuring that the NHS works effectively with Integrated Care System (ICS) partners, such as local authorities. Dr Dash said that there were opportunities to improve the relationship with local authorities and for greater joint working with the social care sector by promoting stronger relationships and shared dialogue. She said that she would be keen to get more exposure to work that was already happening in the social care sector, with a focus on looking at action that could be taken to pre-empt care needs.

9. We asked Dr Dash how she would see herself working effectively with the NHS Executive team, including the Chief Executive. She said she saw her role as being to support and challenge the Chief Executive, particularly on investment decisions and whether the right people with the right expertise were in place to deliver change. Following the resignation of the current Chief Executive, we asked what qualities she would want to see in their successor. Dr Dash said she wanted someone with expertise in the system, who was comfortable working with data, was alive to wider changes outside the NHS and was able to work effectively with others.

10. We asked Dr Dash how we should judge whether she had been successful in the role. She said that her success would be measured by delivering the Government’s three shifts, within the framework set by the Department, in a way that delivered improvements to access, health outcomes and quality of life.

11. We explored the potential conflicts of interest that arose from Dr Dash’s questionnaire, including her financial interests in some digital healthcare start-ups, and her advisory work with two venture capital organisations which invest in digital healthcare businesses globally. Dr Dash said that she has made some small investments in some healthcare start-ups, which she was going through with the Department and that she would divest from any investments that the Department feels represents a conflict. Speaking about her work with the Cambridge Health Network, Dr Dash said that she felt her involvement with that organisation was a great way of staying connected with the broader sector and that she would want to continue with it. However, she said that she would no longer be remunerated for her involvement in the future.

Appendix 1: Letter to the Chair of the Committee from Wes Streeting MP, Secretary of State for Health and Social Care, 26 November 2024

Richard Meddings, the current Chair of NHS England (NHSE), recently announced his intention to stand down as Chair by 31 March 2025.

The role of NHSE Chair is on the list of appointments subject to pre-appointment scrutiny by the Health and Social Care Committee.

We plan to advertise the role in December, with January and February dedicated to assessing applications. We propose the hearing is held with the Committee in March, if that is suitable for the Committee and if so, we would welcome your report soon thereafter.

In advance of advertising the role, I would also welcome the Committee’s comments on the role description and person specification for the role (attached separately) by 4 December 2024 or earlier.

The role will be advertised on the Cabinet Office website and the online edition of The Times/Sunday Times and promoted through diversity networks.

We will publish the proposed assessment panel for the role when it is advertised, which will include a Senior Independent Panel Member (SIPM). We will consult the Commissioner for Public Appointments on the appointment of the SIPM.

I have copied this letter to the Rt. Hon Nick Thomas-Symonds, Minister for the Cabinet Office, and to the Clerk of the Liaison Committee.

Appendix 2: Letter to the Chair of the Committee from Wes Streeting MP, Secretary of State for Health and Social Care 14 February 2025

I am writing to inform you that following the conclusion of an open recruitment process, my preferred candidate for appointment as the next Chair of NHS England is Penny Dash.

Penny is the Chair of the NHS North-West London Integrated Care Board and is currently leading a major review into the regulation of quality of health and social care in England. A former NHS doctor, Penny was Senior Partner and co-lead of the Global Healthcare Systems and Services Practice within McKinsey and Company, with a focus on Europe. Penny was also Head of Strategy for the Department of Health and Social Care. I have attached a copy of Penny’s CV.

I have also attached a background paper on the recruitment process and copies of the candidate information pack and advertisement.

It would be helpful if a pre-appointment hearing could be held with the Committee on 26 February 2025, which I understand is being held in the Committee’s diary. Penny Dash will attend, and I look forward to receiving your report following the hearing.

I have copied this letter to Penny Dash; Libby Watkins, Senior Independent Panel Member and to the Clerk of the Committee.

Appendix 3: Candidate CV

Dr Penelope J Dash

A highly experienced senior leader in the healthcare industry with extensive global knowledge and expertise across the wider healthcare industry–as well as commissioner/providers/health systems

CURRENT ROLES

May 2024 - current. Lead reviewer, Care Quality Commission and wider Quality/Safety Landscape

Invited to lead a major review into the regulation of quality of health and social care in England

Sep 2021 - current. Chair–North West London Integrated Care System

Chair of the Board responsible for overseeing health and care system serving a population of 2.5 million to deliver improved health, quality and productivity of care & reduced inequalities in health, with a £6bn budget covering four acute, three community/mental health & one specialist trust plus 40 primary care networks, in partnership with local government, academia (Imperial and Brunel Universities), the wider life sciences industry and local employers. One of the most improved systems in terms of financial performance and access.

Sep 2022- current. Advisory Board member, Brunel Medical School, Alzheimer’s Society, London Life Sciences

June 2004 - current Founder and co-Chair, Cambridge Health Network–group bringing together ~1,000 senior managers and clinicians for discussion and debate from across the healthcare landscape.

Sept 2001 - current Freelance Consulting–own company through which I provide advice and consulting support to a range of organisations.

PREVIOUS ROLES

Feb 2002 - Aug 2021 Manager, Contractor, Partner and Senior Partner, co-Lead of Global Healthcare Systems and Services Practice & Lead for Europe–McKinsey and Company

One of four leaders globally responsible for strategy, client impact, knowledge, and opportunity creation. Led teams across six continents to deliver impact at scale to governments, health systems, payors (commissioners) and providers, focused on improving population health, innovating and improving services, driving use of data and adoption of digital.

Co-Led major global research piece to set out the key interventions required to improve health and economic performance: Prioritising Health: A prescription for prosperity. Chair of several personnel committees responsible for the evaluation of Partner colleagues.

2006–2015 Trustee and Vice-Chair, The King’s Fund

Highly regarded think tank developing and influencing health policy

2004–2006 Non-Executive Director, Monitor, the Independent Regulator of NHS Foundation Trusts

Played key role in establishing regulatory regimen with a focus on quality of care

Jan 2000- Sept 2001 Head of Strategy–UK Department of Health

Co-Led development of the NHS Plan–key national strategy for future of the NHS Co-Led work on genomics strategy and on opportunities for the NHS to adopt novel technologies.

Sep 1994 - Dec 1999 Manager/Associate Partner–Boston Consulting Group (BCG)

Management consultant serving a wide range of public and private sector clients

Aug 1987- Aug 1992 House Officer, Senior House Officer and Registrar–National Health Service (NHS)

Junior Doctor in several London Teaching Hospitals, public health doctor in NW Thames

AWARDS

Voted “Advisor of the Year” by Health Investor, 2011

Cosmopolitan Magazine Woman of Achievement Award, Fulbright Scholar, George Washington Business Scholar, Amulree Scholar, King’s Fund Travelling Fellow

EDUCATION/FELLOWSHIPS

1990/2010 Member/Fellow of the Royal College of Physicians of London (FRCP)

1992–1994 Graduate School of Business, Stanford University, USA Masters in Business Administration (MBA)

1991–1992 London School of Hygiene and Tropical Medicine MSc in Public Health Medicine

1984–1987 University College and Middlesex School of Medicine, London Bachelor of Medicine, Bachelor of Surgery (MB BS)

1981–1984 University of Cambridge MA (Hons) Medical Sciences, Upper Second Class Degree

Appendix 4: Candidate questionnaire

Motivation

1. What motivated you to apply for this role, and what specific experiences would you bring to it?

I have spent most of my career passionate about, and committed to, improving the NHS. I care deeply about the founding principles of equality and equity, have witnessed some of the best and some of the worst care across the system and have spent many years seeking to address the latter while continually improving the former. I believe that a single payor model is a substantial structural advantage and would like to build on that to bring the best of the NHS and the world to the whole population. I would be delighted and honoured to become Chair of NHS England.

Over the last 40 years I have acquired the skills, capabilities and experiences to enable me to be an effective chair. These are: a) an ability to provide robust strategic leadership based on extensive knowledge, experience and insights; b) an understanding of how to coach and support the CEO and top team; c) outstanding communication skills; and d) a deep commitment to deliver change. I have outlined each of these in more detail below.

a) Extensive knowledge, experience and insights

I have spent much/most of my career working with and in the NHS, initially as a healthcare assistant during student holidays and then as a doctor, manager, advisor and non-executive. My enthusiasm for positive change started early, as a house officer on the first AIDS ward in the country and evolved through me establishing a pioneering management training programme for junior doctors and advocating for, and being involved in, clinical audit and front line service change. This led to me being invited to join various young leaders groups and winning scholarships allowing me to go to business school where I learnt an enormous amount about change, operational improvement, leadership, culture and management - and met some of the leading thinkers in healthcare reform globally.

I have supported many of the major reform programmes in the NHS over the last 25 years–both nationally and locally. I have worked with patients, clinicians, managers and wider stakeholders to develop and deliver strategies and plans to improve population health and redesign care with significant benefits to patients and staff, across every region and most ICS footprints. While not as extensive as my healthcare experience, I have worked with a number of social care and voluntary sector organisations to support strategy development, quality improvement and board governance. My recent review of CQC and the wider quality landscape has provided further insights into the regulatory landscape for both health and social care.

I bring an understanding of what good looks like globally in improving the health of the population and the delivery of outstanding care. I have worked with health systems around the world to deliver improvements in health and healthcare. I am a passionate advocate for the widespread adoption of digital technologies and greater use of data to improve the quality and efficiency of healthcare services.

b) An ability to coach and support the CEO and top team

I have spent the last twenty plus years mentoring and coaching CEOs, senior executives, clinical leaders and boards to develop a vision, articulate that vision and deliver against it. This typically involves analysing data, assessing, coaching, developing, facilitating and summarising/agreeing actions.

I have extensive experience of participating in and leading boards. I was one of the original Non-Executive Directors on the board of Monitor and played an instrumental role in developing, implementing and assuring governance in the boards of NHS Foundation Trusts; I led board development for Primary Care Trusts as they became active commissioners; I was a Trustee and vice-Chair of the Kings Fund for nearly 10 years; I have coached numerous CEOs to understand and prioritise what matters, to communicate effectively and to implement. I have supported, facilitated and led discussions at Board level in multiple healthcare settings–voluntary sector organisations, large hospital groups, commissioners, and state/regional/national bodies.

More recently I have led NW London Integrated Care System, working with local authorities, NHS providers and the voluntary sector to establish the Integrated Care Board and associated committees, putting in place a clear operating model and building a strong sense of cohesion around our core priorities.

c) Outstanding communication skills

All of the roles I have described required robust communication skills–written and verbal–in order to convince large groups of often disparate stakeholders of the case for change, how to achieve and deliver improvements, and the benefits therein–for patients, the wider population, staff and the economy. From explaining the benefits of redesigning stroke services to a (highly articulate) 95 year old lady in Birmingham, to working with the prime minster of Malaysia and his cabinet to agree changes to improve population health and access to healthcare for the 32m citizens–a key focus over my career has been on communicating, using compelling data and stories, setting out the benefits of change for people.

d) A deep commitment to change

While my experience and knowledge base is broad, my commitment to the NHS is deep. As above, I bring energy, enthusiasm and insight to transform the NHS into the healthcare system which it could and should be.

2. If appointed are there specific areas within your new responsibilities where you will need to acquire new skills or knowledge?

Yes

• Working more closely with politicians. While I worked with the Secretary of State for Health and Care 25 years ago when I was Head of Strategy for the Department of Health and Social Care and have worked with political leaders in much of the work I have done over the last 20 plus years, this will be a different dynamic. This is my first experience of a select committee hearing and, should I be successful, presume it won’t be my last!
• Working with the sheer complexity and scale of the whole NHS and central government.

3. How were you recruited? Were you encouraged to apply, and if so, by whom?

I applied through the advertised process.

It was my own decision to apply but many people encouraged me to do so–friends, colleagues, acquaintances, family members.

Personal background

4. Do you currently or potentially have any business, financial or pecuniary interests or commitments that might give rise to the perception of a conflict of interest if you are appointed? How do you intend to resolve any potential conflicts of interest if you are appointed?

I have invested in a small number of digital healthcare start-ups. I own a small percentage of shares (less than 1%) in any one company.

I do a small amount of advisory work (less than a day a month combined) with two venture capital organisations which invest in digital healthcare businesses globally.

In relation to the above investments and advisory work, I will include details on my declaration of interests for consideration by the Department of Health and Social Care. If I were to be appointed to the role, I will agree with the Department any necessary actions that are required to either remove potential conflict of interests, such as by divesting from investments, or to mitigate the risks associated with potential conflicts. My interests and any mitigations will be publicly declared on NHS England’s register of board member interests.

I sit on advisory boards at Brunel University Medical School, London & Partners Life Sciences and The Alzheimers Society. I plan to relinquish the first two of these roles should I be appointed.

I am Chair of NW London ICB. I will resign this position if I am appointed.

I am co-Chair and co-Director of the Cambridge Health Network–a networking and discussion group which runs about about 10 events a year. The costs of running the events and providing hospitality are covered by organisations which host events or sponsor the Network or both. I would like to continue be involved as it provides an effective and efficient way of staying relevant but recognise I may need to change my role to avoid any perception of conflict with supporting organisations.

5. If appointed what professional or voluntary work commitments will you continue to undertake, or do you intend to take on, alongside your new role? How will you reconcile these with your new role?

As above. No plans for anything else!

6. Have you ever held any post or undertaken any activity that might cast doubt on your political impartiality? If so, how will you demonstrate your political impartiality in the role if appointed?

No

7. Do you intend to serve your full term in office?

Yes

NHS England

8. How would you assess the public profile and reputation of NHSE?

I will seek to differentiate between the public profile and reputation of the NHS in England and that of NHS England given not everyone is aware of the difference between the two.

In terms of the NHS in England, recent consultation work for the 10 year plan suggests widespread support for the principles of the NHS (free at the point of delivery, consistent across the country) but concerns about access, user experience and wider quality of care.

In terms of NHSE, my current sense–from my own experiences and input shared with me to date–is that while there is recognition of the enormity of the role, there are concerns about the size of NHSE and the ways in which NHSE both “empowers” and “enables” the wider system.

9. If appointed, what will be your main priorities on taking up the role?

I currently have six priorities:

1. Support and challenge executive colleagues to deliver the three shifts

As many others have said, there has been much talk and little action with regards to the three shifts over the last 10–15 years. The reasons why will need to be tackled if real and sustainable change is to happen now.

2. Support and challenge executive colleagues to deliver broader changes to enable delivery–workforce, estates, digital, data, payment/financial reform, capital regimen, productivity, regulatory reform, wider quality & operational improvement

The three shifts will not happen without wider reform. Each of the areas above are fundamental and leadership of these will sit in NHSE, working closely with the DHSC and ministers and the wider system.

3. Clarify relative roles of NHSE (national and regional), ICBs, and providers with clear, robust and effective relationships based on principles of subsidiarity (empower and enable)

The current model can be confused, duplicative and frustrating. It does not help with delivery. A key focus of the 10 year plan is to consider the operating model across the system and move to a much clearer system based on core principles of empowering local teams to deliver change locally–and enabling them to do so by tackling wider changes as outlined above and giving them the skills, capabilities, and practical tools to enable change.

4. Work with the wider system (including, for example CQC) to significantly improve governance, accountability and performance across all ICBs and NHS providers

Change won’t happen without clarifying governance and accountability across the whole system–this means the relationships between different parts of the system as above–and accountability for delivery which sits with boards, teams and individuals.

5. Align NHSE against the functions required

The agenda above is enormous–a major turnaround of one of the largest organisations in the world. While local organisations and staff are clearly critical, NHSE has to be able to set out clear and robust plans, empower local organisations, enable change and hold to account. That means clarifying the functions required to enact those roles and ensuring the organisation is able to deliver against those functions.

6. Clarify and simplify the relationship between NHSE and DHSC

At the moment the relative roles are confused and overlapping. I have committed to DHSC colleagues to work with them to clarify and simplify objectives, roles and day to day working while recognising the legislative statutory requirements of NHSE.

The timing and sequencing of these six priorities is critical and, will be dependent on the final outline of the 10 year plan.

I have already heard many views–from the public, patients, users and carers, staff, colleagues, partner organisations–re what they think needs to change across all the six areas above. Should I be appointed I will seek to get the balance right between listening and acting.

10. What risks to do you think NHSE will face over your term of office? How do you intend to manage them?

I see four major risks.

1. Failure to recruit and retain high calibre specialist staff–both clinical staff and experts in digital, data/analytics, operational improvement and transformation

Mitigations are to be very clear on skills and capabilities required, to set out clear expectations and to make case for investment and change.

2. Inability to invest/spend in the highest value/highest impact areas

Mitigating will require continual review of data and performance to know where the opportunities for change and where improvement is and isn’t happening, rapid review and changes of policy and plans where required, close working with DHSC and ministers and very open and honest conversations.

3. Economic challenge, recession, trade wars and barriers

Mitigation requires getting the NHS into as robust a place as possible such that the impact of a significant downturn in funding/resources can be minimised. I would like to see a number of scenarios developed for a range of economic situations with associated options for action such that the whole system (including wider stakeholders) have transparency.

4. External/black swan event such as another pandemic or a major terrorist attack or significant disruption to global supply chains

Mitigating requires ensuring detailed horizon scanning, in conjunction with others, and having robust plans in place to manage potential events.

11. Could you outline how you intend to approach working with NHS England’s Executive team?

I would approach this through four overlapping areas of work:

1. Ensuring an effective executive team

As outlined in question 9, the executive team as a whole needs to be able to deliver against the functions required to deliver substantial change.

2. Creating an effective governance structure

The Chair is only one part of an leadership team. The board as a whole, with expert non-executive directors, is required to support and challenge executives–as well as each other (including the Chair). This takes place through board meetings, board committees, informal meetings and informal interactions–for example by allocating NEDs to work with individual execs and their teams

3. Formal mechanisms

Setting clear objectives for executives, agreeing performance attributes (what does good look like, what do we value as an organisation), evaluating against them and providing regular feedback and coaching are critical functions of a Chair and CEO. There need to be robust incentives–formal and informal–aligned to agreed performance attributes.

4. Informal mechanisms

Many people talk about the culture of an organisation. Culture is not an accident–it comes about through formal mechanisms as outlined above combined with role modelling (do I see others behaving in an appropriate way?), informal support and encouragement, and transparency.

12. Could you tell us about your approach to ensuring that NHSE works effectively with ICB partners across the country: for example, social care and local authorities?

Local teams are best placed to build relationships with critical partners–from local authorities to social care providers to voluntary sector organisations.

NHS England should seek to empower local relationships through, for example, supporting local decision making, local resource allocation, local operational improvement.

NHSE should enable local joint working through sharing best practices, developing modelling tools to support analysis and option appraisal, changing workforce models and seeking regulatory change.

The interface between NHSE and DHSC should be better utilised to build opportunities for closer working and change

13. How will you protect and enhance your personal independence and the institutional independence of NHSE from the Government/ministers?

NHSE is an arms-length body but needs to work closely with a wide range of organisations to be effective, including DHSC, wider government and ministers.

At the same time, personal and institutional independence is crucial and likely built through:

• Being clear on challenges faced and what is required to deliver
• Setting out options and implications of different options
• Drawing on robust data–ensuring transparency, openness and clarity

14. What criteria should the Committee use to judge NHSE’s performance over your term of office?

NHS England is responsible for NHS performance which should be assessed against both:

1. Delivery of the SofS three shifts

2. A balanced scorecard of user/patient satisfaction including access/waiting times, staff satisfaction, wider clinical outcomes, productivity & use of resources

You could also look at measures of NHSE directly but if the above isn’t improving, then NHSE isn’t performing.

Formal minutes

Wednesday 26 February 2025

Members present:

Layla Moran, in the Chair

Ben Coleman

Dr Beccy Cooper

Josh Fenton-Glynn

Andrew George

Paulette Hamilton

Joe Robertson

Gregory Stafford

Appointment of the Chair of NHS England

Draft Report (Appointment of the Chair of NHS England), proposed by the Chair, brought up and read.

Ordered, That the draft Report by read a second time, paragraph by paragraph.

Paragraph 1 to 13 agreed to.

Appendixes 1 to 4 agreed to.

Resolved, That the Report be the First Report of the Committee to the House.

Ordered, That the Chair make the Report to the House.

Adjournment

Adjourned till Wednesday 5 March at 9.15 am

Witnesses

The following witnesses gave evidence. Transcripts can be viewed on the inquiry publications page of the Committee’s website.

Wednesday 26 February 2025

Dr Penny Dash, Government’s preferred candidate for Chair of NHS England

List of Reports from the Committee during the current Parliament

All publications from the Committee are available on the publications page of the Committee’s website.

Session 2024–25

Number	Title	Reference
2nd Special	Expert Panel: Evaluation on meeting patient safety recommendations: Government Response	HC 617
1st Special	Pharmacy: Government Response	HC 602

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Footnotes

1 Appendix 1

2 Appendix 2

3 Appendix 4

4 The three shifts are moving more care from hospitals to communities, making better use of technology in health and care, and focusing on preventing sickness, not just treating it.