The charts that show how the NHS has languished under Amanda Pritchard

Telegraph

25-02-2025

When Amanda Pritchard took on the role as chief executive of NHS England in August 2021, she inherited a health service on the brink.
The NHS was still reeling from the worst pandemic in a century, with an abundance of structural problems, from an ageing population to rising costs, adding fuel to the fire.
As she hands in her resignation, little has changed: the system is as chaotic and near to collapse as it was on the day she took over.
This is despite a record high of £176 billion in planned spending for the service in the current financial year – up by 1.6 per cent in real terms on 2021-22 levels.
Backlog hits record highs
The most constant reminder of the NHS's failure to recover under Pritchard's leadership has been the constant flow of doom-laden statistics.
In her first year in office, which started five months after the end of the third national Covid lockdown, the NHS England appointment backlog increased from 5.7 million to seven million. It peaked in August 2023, almost two years after the final Covid restrictions had been removed, at 7.7 million.
Since then, patients awaiting routine appointments and check-ups at hospitals have faced glacial progress. Backlogs have effectively plateaued, with the current rate of reduction requiring 15 years to return it back to the size of the waiting list before the start of the pandemic, in March 2020.
Emergency care in chaos
These statistics are repeated across every part of the health care system.
At their worst, the average ambulance wait for stroke patients reached an hour, before settling at 35 minutes in January this year – exactly the same as when Pritchard took over and up from 22 minutes pre-pandemic.
More than a quarter of patients waited for more than four hours to be seen in A&E in January 2025, according to the latest figures, up from 20 per cent in August 2021. More than 61,000 patients waited in trolleys before being placed in suitable wards.
These war zone-like conditions have become the norm across the country: not one trust meets the three key targets on waiting times for A&E, cancer treatment and hospital appointments. It is unsurprising, then, that patient satisfaction has plummeted, falling from 60 per cent in 2019 to 24 per cent in 2023 – the lowest in 30 years of the King's Fund survey.
Pritchard is unlikely to be the cause of these problems, but it seems she is not the solution either.
Community care crisis
Care away from the front lines has faced similar pressures during Pritchard's time at the helm of the NHS.
Less than half of patients found it easy to reach their practice on the phone in 2024, down from 81 per cent a decade ago, according to the long-standing GP Patient Survey. Overall patient satisfaction has plummeted from 84 per cent to just 71 per cent.
This is despite there being some progress in the recruitment crisis facing general practice. Recruitment rates under Pritchard surpassed those seen before the pandemic.
Equally, there was a surprise increase in the number of community pharmacies during Pritchard's time as chief executive, after five consecutive years of declining numbers. In 2023-24, there were 12,009 pharmacies, the highest since 2016, according to the NHS Business Services Authority.
Reliance on overseas workers
Amanda Pritchard's tenure saw record pay rises for NHS staff, encouraged partly by strikes and reversing the impacts of coalition-era austerity cuts.
These pay rises might explain the fall in vacancy rates to their lowest levels in years.
In 2018-19, one in eight nursing roles was unfilled. By the end of last year, it had fallen to just one in 13. Turnover rates, however, remain high.
This gap has, however, been partly filled through ramped-up overseas recruitment. Since 2021, 277,255 NHS and care visas have been issued to workers, bringing with them 389,462 dependants, according to Telegraph analysis of Home Office data.
The proportion of doctors with foreign nationality increased from 28 per cent to 36 per cent – Wes Streeting, the Health Secretary, criticised this over-reliance on workers from abroad, with home-grown talent increasingly lured to higher-paid jobs outside the UK.
Productivity challenges
Despite these record staff levels, the workforce is marred by inefficiency.
Official NHS productivity figures measure how effective the system is at doing its job. The statistics compare the growth in the quantity of outputs, such as the number of patients seen and treated by the health service, with inputs, from staff and medicine numbers to infrastructure spending.
Even before the pandemic, figures from the Office for National Statistics show public health care productivity in England had slumped.
Productivity did bounce back in 2021-22, the latest year for which data are available.
But the challenges facing the service make it unlikely that productivity has improved since then. The estimated cost of the NHS's capital maintenance backlog increased by 13.7 per cent during Pritchard's first year, staff sickness rates remain stubbornly high and the average number of patients discharged per day fell by 4 per cent last year.