'Building a bridge to the future' - Matthew Taylor addresses leaders at NHS ConfedExpo

Thank you for being here. After two of the toughest years in the NHS’s history. At a time which many leaders tell me is, if anything, even harder than during the pandemic. Here in Liverpool, we have an opportunity to draw energy from each other and to renew our shared purpose.

We’ve heard this morning from Amanda Pritchard and the Secretary of State. One of my challenges is responding rapidly to what they said.

We know that the Secretary of State has his four Ps: prevention, personalisation, performance and people.

Amanda, this morning set out her four Rs: recovery, reform, resilience and respect.

I’ve heard rumours of tensions between NHSE and DHSC so, in order to bridge the alphabetical divide between, I’ve been trying to come up with my own list: Quantity. Quality. Quickness. I was stuck on the fourth, until I looked out of the window this morning and it came to me. Queues.

Sorry that some of you had to wait a while to get in. But now you’re inside I hope you’ll agree that it was worth the wait.

I have been Confed CEO for a year. It has been great to spend time visiting you, whether meeting the inspirational staff of a primary care network in South London; being hosted by the ICS neighbourhood forum in Gloucestershire; meeting the team at University Hospital Birmingham; or being shown the cutting-edge facilities at Chase Farm (if only we had twenty of those). Please keep the invites coming.

I hope we’re doing OK for you at the Confed. As leaders we always reflect on our performance. The Secretary of State urged us to focus on leadership and we at the Confed have been broadly supportive of the Messenger Review. Mind you, it’s reassuring to know that as long as no more than 41 per cent of the people we lead are actively conspiring against us, we must be doing a great job.

My message today is direct and urgent.

We meet at a critical time for the service we love.

Last week, as I was working on this speech, I read two news items over my morning coffee. The first was the dismayed reaction to film of a commendably honest nurse at Princess Alexandra hospital A&E telling patients they would have to wait through the night to be seen and how, anyway, the hospital had no free beds.

The other was the remarkable news of a breakthrough in the treatment of that harshest of conditions pancreatic cancer: a condition that has claimed the lives of two of my friends.

The National Health Service can have a great future. We can build a bridge to that future. But we only get to build that bridge, if … politicians, NHS leaders, colleagues, partners and public accept the reality of our current crisis and commit to what must be done to get through it

Those two stories symbolise the contrast between where we are and where we can aspire to be. The National Health Service can have a great future. We can build a bridge to that future. But we only get to build that bridge, if we all - politicians, NHS leaders, colleagues, partners and public – accept the reality of our current crisis and commit to what must be done to get through it.

Let’s face it, in the NHS it is not always career enhancing to tell the truth. But telling the truth about today is part of our commitment to a better tomorrow.

Realism is not the enemy of ambition - it is its conscience.

The NHS, indeed the wider health and care system, is suffering from a massive and growing capacity gap. Into that gap daily is being sucked the energy and hope of our staff and the confidence and trust of the public.

Whatever the attempts to obfuscate, the reasons are clear: the combination of the short-term impact of Covid, the medium-term impact of austerity and the long-term failure to address the social determinants of health.

That is why, for many of you, no, most of you, managing crisis is an everyday occurrence.

There are the severe challenges in urgent and emergency care. The elective backlog has reached record highs and, despite the heroic efforts of managers and clinicians to target the longest waiters, the list will rise further before it declines.

Primary care is seeing 11 per cent more patients with 5 per cent fewer GPs compared to five years ago. In mental health, record numbers of children and young people are presenting and the prevalence of eating disorders has doubled since 2017. And in community care, over a million children and adults are estimated to be waiting for services. While politicians and the media may focus on particular issues like ambulance delays or long waits, we know how problems in any one part of the system inevitably lead to pressures in others.

On top of this, we have a social care system that it is on its knees. Our colleagues in ADASS reported in May that almost 170,000 hours a week of home care could not be delivered because of a shortage of workers. From restricting hospital flow to demands on community services and increased pressure on primary care, this causes huge issues across the whole of the NHS. And the cost-of-living crisis is making this situation worse as local authorities are outbid by local businesses desperate for staff. The Secretary of State is right about the importance of partnership with local government, and many of you have taken initiatives to try to address the challenges faced by social care. But even the closest partners cannot work miracles. This is why, with our colleagues in NHS Employers, we have called for a higher pay increase for our lowest paid workers and for action to address social care recruitment and retention.

We must face up to the many reasons why we have seen public satisfaction levels drop in recent years

As a direct consequence of the capacity gap, the public is becoming worried and impatient. More than one in ten are waiting for treatment, many living with pain or anxiety every day. Some will be concerned carers or relatives who are unable to secure care for their loved ones. Others will be expectant mothers who are concerned about maternity services following the Ockenden Report. We must face up to the many reasons why we have seen public satisfaction levels drop in recent years. 

As always happens in such times of crisis, those who have never really supported the core principles of our health service see an opportunity. Day in day out, we are seeing concerted attacks on the NHS from parts of the media, policy think tanks and from politicians themselves.  ‘The public have lost faith in our NHS religion’ states one headline. ‘We’ve run out of patience with the NHS’ reads another.

Nothing is more fatal to the spirit of our staff than feeling they cannot provide the service their patients need

These factors are dangerous in themselves, but the greater peril is that they combine to form a vicious cycle. NHS staff leave, services struggle to recover, public disenchantment is exploited by the NHS’s critics, morale drops further.

Nothing is more fatal to the spirit of our staff than feeling they cannot provide the service their patients need.

This is what we face now. To deny it is an act of wilful blindness.

And yet, if we lift our gaze from our immediate troubles, beyond the hazardous waters swirling around us, there is a better future if only we could reach it.

There are concrete reasons for hope.

Our commitment to equity and inclusion. Whatever the public disenchantment with their own experience or what they hear from the media, polling shows support for the founding principles of the NHS remains undimmed.

…health policy alone cannot tackle inequality

There has been a shift in how we approach inequality. Covid taught a painful but vital lesson. The architects of the NHS believed its mere existence would end health inequality. But the pandemic laid bare the intrinsic links between health outcomes and factors such as income, ethnicity and geography. And as we recall the tragedy of Grenfell five years ago yesterday, we are at last paying heed to the voices of those like Michael Marmot who have for decades been telling us that health policy alone cannot tackle inequality.

The Secretary of State should be commended for his commitment to ending what he calls the ‘disease of disparity.’ Some of our system leaders are coping with 14-year gap in life expectancy across their own patch.

Speaking to you about your priorities, I hear a deep commitment to turn the NHS’s egalitarian principles into reality, focusing not just on access and treatment but outcomes. For example, from West Yorkshire to Coventry and Warwickshire, we see concerted action to tackle waiting lists in ways which also address inequality.

And, despite operational pressures we are seeing amazing innovation across the service, whether through better use of data, digital tools, the range of biomedical innovation. Amanda’s announcement today about cancer diagnosis is genuinely exciting and all the more powerful for the commitment to target resources at those who least likely to come forward.

There is significant scope for the NHS to harness innovation further to address some of our biggest challenges. NHS trusts across England are increasingly using complex machine-learning to predict the number of patients expected to be admitted to A&E departments. This will help managers decide how best to allocate staff and resources. We have welcomed the government’s new health data strategy. It is also great to see the development of new roles, for example in primary care, and, as Amanda said, the expansion of others, like pharmacists.

There are real opportunities for a step change towards more personalised, more preventative, more community-based services

The pandemic was a great accelerator, demonstrating both our ability to rapidly roll out virtual services and the public’s willingness to take a more active role in their own care. We must not lose that momentum. There are real opportunities for a step change towards more personalised, more preventative, more community-based services.

And there is the opportunity that system working presents for meaningful collaboration and local engagement. Unusually for primary legislation on NHS reform, the Health and Care Act has had broad support across the sector. We now look optimistically to 1 July, when ICSs will become statutory bodies. Our members working at system, place and neighbourhood levels now have the enabling framework they need to put their local communities at the heart of strategic planning.

From Humber and North Yorkshire, where asset-based community development has led to a significant reduction in non-clinical GP visits for loneliness and isolation. To Leicester, Leicestershire and Rutland, where multidisciplinary team working has protected elderly residents’ health during the pandemic and significantly reduced hospital admissions.

So, we are coping with a huge worsening capacity gap but we can also see a future of a more productive, more innovative, more equal, more collaborative health service.

The question, therefore, is stark and urgent. How do we get from here to there? What do we need to build a bridge to the future?

First, the bridge must be built on political honesty and commitment. As the next election comes into view the NHS is in danger of becoming a political punchbag. Minsters deny the reality or seek to shift responsibility. An opposition sees running down the NHS as a stick to beat the government. Instead, we will urge a political consensus about the tools the health and care system needs. As progress on long waits or vaccination shows, if we have the tools we will deliver the outcomes.

The NHS Confederation will call on all parties for an explicit commitment to the kind of real-term funding increases that were given to the NHS from inception till 2009

We must learn the lessons of austerity and the ‘feast or famine’ approach to funding. We welcomed last year’s settlement for health and care. We may argue with the Secretary of State and Treasury over its adequacy given the impact of inflation, but we can surely agree that it was only the first step back to financial sustainability. We are accountable to the taxpayer and we all want to flatten the demand curve and get to a position of financial sustainability. But we won't get there until we close the capacity gap. This is why the NHS Confederation will call on all parties for an explicit commitment to the kind of real-term funding increases that were given to the NHS from inception till 2009. That means at least 4 per cent per year in real terms for the next decade. This is in line with pre-austerity averages and the amount that the Health Foundation estimates is needed to ensure quality of care in the face of rising expectations, rising costs and population ageing. Demand will continue to increase. In ten years, for example, as the Secretary of State acknowledged, it is expected that a third more people than today will be entering the final year of life.

And just as important as revenue, we need more action on capital funding. Yesterday we released a flash poll in which nearly 200 of you answered questions about capital investment.

Nine in ten of you said your efforts to reduce the size of the waiting list are being hindered by a decade-long lack of investment in buildings and estate. 

Nine in ten of you said you cannot transform patient services to meet current NHS England Long Term Plan targets without further capital. 

None of this is surprising given how badly per capita capital funding in the NHS compares with other OECD health systems. 

Alongside revenue and capital, we must have a fully costed and funded workforce plan to get us through the next few years. This should be the first step in a long-term strategy to re-imagine work in health and care. By next year it will have been a remarkable 20 years since we had a national NHS workforce strategy. Today, we are living with the consequences of that neglect.

If politicians want to see real impact from significant NHS policy changes like the Health and Care Act, they must be wise and patient enough to allow implementation, learning, development

The clear and overwhelming responsibility of our politicians is to help us close the capacity gap. We welcome Amanda’s commitment to review the challenge of capacity. But still too often it feels like the energy of policymakers goes into headline grabbing and tinkering. The temptation is to publish more and more white papers asking further, often conflicting things of the NHS. If politicians want to see real impact from significant NHS policy changes like the Health and Care Act, they must be wise and patient enough to allow implementation, learning, development.

And our political class must see that health policy is not just about what the Department of Health does. We need action across government to tackle the social determinants of health and to exploit the potential of health to contribute to social justice, environmental sustainability and prosperity. The government promised cross-Whitehall action on health disparities, but this is hard to square with ministers backing away from measures to address our obesity epidemic. The burdens of ill-health and caring are now the biggest reason for working-age adults to be out of the labour market, something which contributes directly not only to economic exclusion but to a shortage of workers, including health and care workers. Could the links between health, care, inclusion and prosperity be any clearer?

Second, a bridge to the future will rest on the right support from our own national leadership. We at the Confed work very closely with our friends and colleagues at DHSC and in NHSE. I want to commend Amanda and her team for the work they put in to support leaders across the system and also when necessary to challenge their political masters to be realistic about what is achievable. And now with Chris Hopson on the inside, we look forward to planning guidance being issued in the form of extended Twitter threads.

…the centre should not require systems to embark on significant change without first getting the broad agreement of ICSs and their boards. It is time to treat leaders like the grown-ups you are

But, as Sir Chris Ham described in his report for the Confed, and as Richard Meddings implied this morning, the reforms at the heart of the Health and Care Act demand a different kind of centre, one that is more about empowering and less about instructing. The Long Term Plan refresh is, we believe, an opportunity not just to tweak some targets but to signal new ways of thinking and working. It needs to be a plan that speaks to the immediate priorities of a service under strain, but also offers a compelling vision of a service transformed. It must be a plan that underscores a commitment to system working and the need for system and place leaders to develop local partnerships and priorities. The Confed was pleased to work closely with Dr Claire Fuller on her excellent primary stocktake. Based on the work Claire did with systems, I want to suggest a new principle – the Fuller principle – namely, that the centre should not require systems to embark on significant change without first getting the broad agreement of ICS and their boards. It is time to treat leaders like the grown ups you are.

Third, the bridge will be built from a new conversation, a new contract, with our partners and the public. We need to be honest about what we can and what we can’t deliver. We need to explore how services and clinical practice can best summon up and draw on the assets, insights and resilience of communities themselves. I read Partha Kar, a consultant in diabetes and endocrinology from Portsmouth Hospital saying recently that managing chronic disease is founded on three basic principles: self-management, peer support and access to trained professionals. We often acknowledge the challenges of providing the last of these, but we need to be equally committed to the first two.

We can learn from local government about how to have conversations that aren’t simply about we do but about how we need citizens to help us. In the past, from care in the community to online consultations, too often we have failed to engage the public fully in understanding the implications, opportunities and risks of change and, equally, of not changing. Now, from virtual care, to patient-initiated follow up, to tackling inequalities in access, we need to bring patients and the public with us.  As a director of public health puts it: “The NHS has tended to see its engagement with the public as an occasional date which we can walk away from if it goes wrong. Instead working with communities should be marriage in which we are committed to working things out in bad times as well as good.”

Fourth, building a strong bridge demands more from us. The NHS record on productivity has been strong in recent years but we need to continue to demonstrate that we are making the very best use of the money we receive. Innovations like the new surgical hubs and diagnostic centres show how we can use our estate and our staff more effectively. With more capital investment we will unlock greater productivity.

We need to acknowledge and act in areas – from maternity services to tackling the blight of racism and other forms of exclusion – where we have not lived up to our values

Our leadership culture must fully reflect the beliefs we hold and the hopes we share. We need to acknowledge and act in areas – from maternity services to tackling the blight of racism and other forms of exclusion – where we have not lived up to our values. Victor spoke passionately this morning about the need for concerted action on inequality. A report we will publish tomorrow from our BME Leadership Network will say the vast majority of BME leaders are still not confident the NHS is delivering on its commitment to combat institutional racism.  

Our new ways of working will only succeed if we commit to a different kind of leadership. A strong tradition of the NHS has been of hierarchical, paternalistic cultures too often focused on professional and organisational interests. But the most inspiring leaders I speak to lead through empowering staff. You work generously with other leaders in systems, collaboratives and places. If we want the centre to let us lead, we need not just to support but to challenge each other to be the best we can be.

Genuine political commitment, focused national leadership, a new conversation with communities and the public, questioning and renewing our own culture. These are the foundations for the bridge to the future we need.

To accept less is knowingly to jeopardise the future.

We want to be part of creating a continuously self-improving NHS

Which takes me finally to the role of the Confederation. We are here to be your voice. To challenge our political masters to tell the truth to the public. But that isn’t enough. That’s why – following engagement with our members – we have developed our own impact goals covering integration, population health, innovation, workforce and the wider economic impact of the NHS.

We want to be part of creating a continuously self-improving NHS. One that is less reliant on top-down instruction and more able to mobilise our collective insights and draw energy and ideas from the communities we serve.

It is why we are committed to working in close partnership with colleagues in the LGA and other agencies.

It’s why we have developed ambitious programmes and working methods for collaboratives and place leaders.

You are busy people. When we ask for your time and engagement, it must be because we are confident we have ways of thinking and acting that will materially help you.

We are your organisation. If we can do more or better tell us.

I am delighted that all 42 ICS have chosen to join us. We will be working with you and with our other networks – acute, community, mental health, primary - to ensure that every system is clear about its role, its priorities and how it can add value to the work of providers.  It will take years for the full value of system and place working to be seen but we also need to show quick wins in those areas the public most cares about.

The other day someone asked me about the mood of NHS leaders. I thought for a moment.  What I hear from you can be captured in a phrase: ‘realistic optimism.’ Realism about the challenges now and over the coming years, optimism about our destination.

Today we call for that same spirit of realistic optimism, from our political leaders, our national organisations, our partners and the public.

Then, as this conference will show, together we can build that bridge to the future.