Lord Victor Adebowale opens NHS ConfedExpo 2025
On behalf of the board of trustees and staff of the NHS Confederation and my NHS England colleagues, I would like to welcome you to NHSConfedExpo – our joint annual conference with NHS England. I’m Victor Adebowale, chair of NHS Confederation and it’s my pleasure to host you for the next two days.
Can I thank our three event sponsors, Accenture, Astra Zeneca and Novartis for their support, as well as our amazing exhibitors.
I am glad you are here. All 9,000 of you! Wow, that’s a huge number. You should be here, in case you are unsure of that. Learning is work - and we must never stop learning. Why? Because our teams, patients, and communities all benefit when we learn as leaders. Because if you are not learning as leaders, no one else is.
So, what can you look forward to over the next two days? There is something for everyone with over 180 sessions to choose from – sessions on improvement, collaboration, sustainability, health inequalities and inequity, accountability - whether it’s something that teaches you a new approach or something that gives you hope and optimism.
Please use this as a chance to recharge your batteries, reconnect with colleagues, rediscover your passions. I always learn something new here. I hope you do too.
This has been an extraordinarily busy year for you all.
So I want to start by saying a heartfelt thank you for everything that you have done over the last 12 months in the most difficult of circumstances.
And let’s be really honest for a moment – with changes at NHS England and across services, we know some of you won’t be here next year. There might not be roles for you, despite our experience and dedication to our communities. And for that I’m sorry, so I want to thank you now whilst I have the chance, for all that you have done for the health and care of others. We don’t take it for granted.
The job of the NHS Confederation, as your membership body, is to support you in any way we can. That involves not just keeping up with what’s happening but leading the way by ensuring your voice is heard in the corridors of power, and that you are equipped to fulfill your roles.
I hope you feel that we do that – I think you do, as 90 per cent of you said in our latest annual member survey that you think NHS Confederation membership is important.
And we’ve responded to what you’ve been asking of us:
- We have launched our system improvement support offer, a service for health and care leaders and their teams to help them transform services and achieve sustainable improvement, now and for the future.
- We have published Excellence Through Equality: Anti-Racism as a Quality Improvement Tool, to tackle persistent racial inequalities in NHS services by highlighting effective anti-racist initiatives.
- And we have held our first Care Closer to Home conference with over 400 leaders, as part of developing a strategy to support our members move care closer to home within their own systems.
Turning to the environment we find ourselves in, I want to focus on three things: the current state of the NHS, where we want to get to and how, in my view, I think we can get there.
1. Current state of the NHS
People with 30-40 years’ experience in the NHS tell me that they've never seen it this tough. I know you know this, so I won’t dwell on it too much. I’m just picking three things that show how hard it is.
Firstly, we still have over 6 million patients waiting for treatment. Less than 60 per cent of patients are being seen by a specialist within 18 weeks.
These figures will not decrease without activity on an industrial scale – we need to reduce waiting lists by thousands a day, not hundreds.
Secondly, many of you are navigating substantial financial pressures and cuts, across integrated care boards, and across provider settings in particular. You’re having to make decisions you really don’t want to, and I get just how hard that is.
And thirdly, public dissatisfaction with the NHS is the highest it’s ever been. That is a real risk for us, because we only serve at the behest and the permission of the public. They give their money for us to work effectively. The NHS is still one of the most powerful investments that this country has ever made in its people, and we know that the alternatives are more expensive and less safe. But we must do better.
And we must do better for our staff - they are demoralised, burnt out and bearing witness daily to care that falls well below the standards we should expect. According to the last round of the NHS staff survey:
- four-in-ten NHS staff felt unwell due to work related stress
- around a third of staff ‘often’ or ‘always’ feel burnt out by work.
What kind of culture do we have?
So this is about culture. Now, I'm in a privileged position. I don’t work for any of the people that are about to come on the stage. I work for you, and I work for the public, and I am well aware of the privileged position I have of visiting many of you, hearing what patients are saying, but also experiencing the culture of the NHS for myself.
My family use the NHS and have experienced the NHS just this year. My sisters, my mum, who worked for many years as a nurse, died earlier this year at the age of 92. It was difficult, it was not the dignified death that we would have wanted for her. It wasn’t the death she deserved. So it makes me clear about the need to address the inequity. I think she got a black service, not an NHS service.
So I have to address the inequity that still exists within the NHS, in terms of the experiences that people who look like me continue to receive. It just hasn't got any better. It is not acceptable that someone who looks like me, on average waits 20 minutes longer in A&E than white patients. To achieve an inclusive, equitable NHS we need an inclusive equitable culture from top to bottom.
2. Where do we want to get to
So we all know where we are at, we’re not sugar coating it. But let’s be clear about where we want to get to. What does a better future look like? Well I’ve seen it, I’ve seen the future, and it’s in Rochdale. Now you weren’t expecting me to say that were you?
I was at the Spotland Community Centre recently hearing about the New Pioneers project and I was just so inspired by what I saw – and it really did feel like the future - designing services with people, not just for people, managing data well, turning into useful information, bending the demand curve, investing in prevention.
Equally I saw a truly patient-centred approach on a visit to Shoreditch Park and City Neighbourhood in Hackney, East London, where patients only have to tell their story once, staff come together as a team to decide the best course of action for each patient, and where they have a one stop shop service that includes debt advice.
In many parts of the country, you are already delivering the kind of health service we want people to experience. In many places the future has arrived, and that’s what gives me hope. I do believe that the best years of the NHS are absolutely in front of us, not behind us. It’s how we do it everywhere and for everyone.
Only last week I was on a visit to King’s College hospital, and I saw a great example of integrated care being delivered. I was truly inspired and filled with hope. The compassion, dedication and professionalism of staff, left a lasting impression on me.
It’s like the Springfield site of South West London and St George’s Mental Health NHS trust, tackling the stigma attached to mental health head on, with welcoming new facilities embedded in the heart of the community, engaged with local schools, using open spaces for patients and their families.
3. So what do we need to get to the future we want?
The examples I’ve given have one thing in common – its integration – working together, tearing down barriers and blockages, collaboration, ending territorialism. Delivering services that are meaningful for people where they are not pulled from pillar to post. I know it can happen because I've seen it. And real integration depends on our partnerships – with local government and with the VCSE sector, to ensure services are seamless and patient centred. All as equal partners.
Secondly - we will get where we need to when we truly value people.
We need to get to a position where we value people. I know that the woman I'm going to introduce you to in a minute understands this. Value for people isn't just about the money, it's also about running our organisations on the basis that people on the front line understand more. They are experts in the work. They should have the power, they should be empowered to rebuild services from the bottom up.
And when I say valuing people, I mean everyone. I stand with my trans colleagues, and our trans patients in these incredibly uncertain times. Trans and non-binary staff are facing more bullying, more discrimination from patients, more unwanted sexual behaviour, more physical violence from colleagues and more physical violence from patients than our cisgender and heterosexual staff. If you allow it to happen once, you allow it to happen everywhere. This is utterly unacceptable behaviour and does not belong anywhere, let alone in the NHS.
Thirdly, we’ll get where we need to when we invest in improvement
For the Confed I can tell you now, it's going to be all about improvement.
We want to be the most comprehensive improvement organisation in the NHS. Why? Improvement is what the public expects.
Fourthly - we get to where we want to when we focus on prevention.
In order to get prevention hard wired into the way we do the NHS, we are going to have to shift our thinking fundamentally. We're going to have to value different people in the system, the voluntary sector. Social enterprises that deliver 38 per cent of community services are going to have to be part of the prevention tool, and it's no good us organising ourselves in our tents to protect what we've got and not understanding that what health does matters to communities.
Take ‘Here’ - a not-for-profit social enterprise based in Sussex that says its purpose is “exceptional care, for everyone”. Their community appointment days have transformed musculoskeletal services in Sussex by delivering same-day, person-centred support in community places.
These are community based, clinically backed, where clinical teams and voluntary services offer joined up care based on asking the question ‘what matters to you?’ This has led to over 50 per cent of patients being discharged to self-care after a single visit because they left with everything they needed. This was down to teams working together, and collaborating with patients. What a powerful question – ‘what matters to you?’. How often do we ask that?
And finally, I want to say where we want to get to is a situation where every organisation in the NHS understands what its unique contribution is going to be. What is it that your organisation can do that no other can do? And how does it design itself to deliver those unique contributions.
If you agree with me, if you think that what I've said is where we should be going, let’s make the change.
We are the people that can make the changes. No one person can fix the NHS. Jim Mackey can’t do it all on his own. This takes all of us. Confed, NHS Providers, NHS England, the government, the VCSE Sector, local government. And that’s why in particular we want to work much more closely with our NHS Providers colleagues, and Matthew will say more about that later.
In order to do that, I can tell you now that the NHS Confederation resources, our access, our communications are at the disposal of the person that I am about to introduce you to, because she's got a hell of a job. As has Sir Jim Mackey, because we either work together or we fall apart, and the people outside this room can't afford us to do that.
Thank you for listening.
Now it’s my pleasure to hand over the baton to Penny Dash, chair of NHS England.
