The Accidental Chief Executive: Hils' Sarah Wren on the NHS Prevention Agenda, a £5.8 Billion Frailty Crisis, and How Local Authorities Can Fix Meals on Wheels
Sarah Wren describes herself as an accidental chief executive. A business degree led to a short spell in banking — she grimaces at the memory — then a career she loved as a business and management lecturer, then a stint as a district councillor where Meals on Wheels was a pressing issue. She helped establish Hills as a volunteer chair and never quite left. She is now chief executive of Hils (Health and Independent Living Support), a charitable social enterprise delivering Meals on Wheels and preventative care across Hertfordshire, Hampshire, and West Sussex. This episode was recorded during Meals on Wheels Week.
Meals on Wheels is the largest service, but not the only one: Hils also takes preventative care directly into people's homes, including an exercise programme — eight weeks, building strength, balance, and confidence — that Sarah describes as the only one of its kind in the country. With 400 colleagues, 12 sites, and around 130 liveried vehicles on the road each day, the organisation covers three counties and is actively looking to reach more. Sarah goes out on deliveries herself occasionally. She is, she admits, always late. Clients are always disappointed to see her — and that disappointment, she says, tells you everything about what the service actually is. The annual survey makes it quantifiable: 98% of clients say they are better nourished, and 96% say they are happier.
That gap exists partly because so many councils have axed Meals on Wheels services, citing lack of funding. Sarah's counter-argument is specific: local authorities don't pay VAT and can reclaim it, which means that by working with Hills they can effectively offer clients a delivery service at no cost to them. This is, she says, a complete no-brainer — keep people at home, keep them out of residential care, prevent the malnutrition that leads to falls, hip fractures, and crisis hospital admissions. The employer National Insurance changes introduced by the government have added half a million pounds of costs to Hills' annual budget. \"We have to find a way through,\" she says. \"There is no option. Because the people we serve cannot do without us.\"
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