Matthew Taylor's speech at NHS ConfedExpo 2024

Matthew Taylor, chief executive of the NHS Confederation, addresses delegates on day one of NHS ConfedExpo in Manchester.

12 June 2024

Thank you all for joining us at this biggest and best ever ConfedExpo event. Thank you to our headline sponsors, Google and Novartis and to all our partners and exhibitors. 

But most of all to you our members for making the journey to Manchester. 

In case you’re worried how taking a few hours away from the front line might look, don’t worry, I’ve told Julian Kelly where you are. 

In her rousing speech Amanda paid warm tribute to your efforts, but on behalf of the Confed can I also thank you for the support you have given us this year and for all you have done to sustain and improve services in incredibly challenging circumstances. The Confed has drawn public and political attention to the immense financial challenges you face. We understand all too well the dilemmas that led Sarah Wollaston - chair of Devon ICB and a long-time champion of the NHS - to feel she could not sign up to an undeliverable plan. 

Yet, despite this, on every one of my weekly visits to members I see inspiring examples of innovation and ambition. 

Raising our sights

For you it can often feel like the short term is today, the medium term tomorrow and the long term next weekend, but over the next 20 minutes or so I am going to try to raise our sights a little

But I should start with a painful and drawn-out procedure that we and the people we care for are having to endure– without anaesthetic - right now. Yes, the election campaign.

Over the last year we have provided an in-depth and comprehensive election service. We’ve stayed in close contact with the parties, made your case to them, carried out polling and prepared you for a lot of what has been said in the campaign.

In some ways our job during these fevered times is to be boring. When she heard me practising this part of the speech my daughter piped up: “At last Dad, a task you are suited to.”

Whether it’s one party claiming we invest heavily in rainbow lanyards or another that NHS leaders are more interested in their reputations than caring for patients. 

When the debate over industrial action is about who to blame for it rather than how to end it. 

When national politicians tend to think the best way to drive change is to pull levers in Whitehall.

Then our duty to you and the public is to be honest and realistic and to demand the same from our political leaders. 

Five priority asks

Talking of industrial action, we at the Confed have been supportive of the case made by junior doctors. We have repeated our call for political leaders to commit to positive talks with the BMA and other unions. But holding five days of strike action during a period when nothing can be done to resolve the dispute, is futile as well as very damaging. 

Of course, this is manifesto week. We at the Confed could have had a manifesto as long as that published by the parties. But based on our conversations with you we have focused on five priority asks:

First, no major reorganisation of the health service. Not because everything is perfect, but because restructuring is a weapon of mass distraction. It leads to confusion, cost and disruption. 

Second, after an initial stabilisation plan, a commitment to more stable longer-term funding, to invest more in capital and to make it easier to access. Capital investment is critical to meeting the productivity challenge. 

...we must see action to fulfil the long-held vision of a health service that invests better upstream in prevention

Third, we need the new government to recommit to the long -workforce plan ahead of a refresh next year and to fund the workforce expansion it is based on. And, also recognising the financial plight of our neighbours in social care and local government, we need an equally ambitious social care workforce plan.

Fourth, we must see action to fulfil the long-held vision of a health service that invests better upstream in prevention, in primary and in community-based care. 

Fifth, we need a cross-governmental action plan to improve the nation’s health, recognising the importance of social determinants and of health promotion and prevention beyond the NHS.

We will continue to drive home these points. 

But this is not about expecting other people to solve our problems. Health leaders are willing and ready to make hard choices about how to maximise productivity, efficiency and quality. 

A distinctive model of progress

Over recent months we have been working with our members on opportunities for an incoming Secretary of State. We are exploring how a new government could use its democratic legitimacy to support leaders passively - by allowing you to act - and positively by targeted reform to put the health service on a stronger, more financially sustainable path.  

As I hope you have come to recognise, we in the Confed believe in a distinctive model of progress. One which better balances top-down, lateral, peer-to-peer and bottom-up drivers of change. This has meant being willing to challenge ministers and NHS England when we feel that short-termism and micro-management are stifling improvement and collaboration. But it has also motivated us to develop and grow our own member-led improvement offer.

Improvement in the health service tends to be about doing things better. But shouldn’t it be also about doing better things?

We are encouraging our member networks to be more robust in offering challenge and support, For example, we are helping integrated care partnerships evolve and establish their role as leaders. 

We have developed a system improvement offer in partnership with the Q Network and the Health Foundation. 

We have innovative and practical projects in areas like the primary secondary interface and tackling health inequalities.

We are exploring the development of an analytics and knowledge network, starting with acute hospitals. And this too will be member-led, modelled on the world’s largest health improvement collaborative in Australia and New Zealand. 

Improvement in the health service tends to be about doing things better. But shouldn’t it be also about doing better things?

In the conversations I have with you as leaders I hear a lot about day-to-day challenges, but I hear something else: I hear a yearning for a vision of a health service that, as well as balancing the books and investing wisely, is achieving better outcomes and restoring that lost public confidence.

At the centre of such a vision there needs to be a recognition that our current approach to health policy and the NHS is no longer fit for purpose. 

It’s the time not just for new policies and commitments, but for a fundamental re-imagining. 

We could be at the dawning of the biggest change in the way we think about health policy and the role of the NHS in our 75-year history. 

A decisive move to proactive health

Since 1948 our method has been fundamentally reactive. 

Over the next ten years we can make a decisive move to proactive health. 

There are three fundamental problems with that reactive model. 

First of all, waiting until people feel worried or sick is generally the least clinically effective and most expensive way of improving health outcomes. 

Secondly, being reactive reinforces inequalities as it means we tend to respond to demand not need.

And third it means that when we engage people – when they are worried or unwell – they are less likely to feel a sense of agency and more likely to feel dependent.

Why is the time right for radical change?

First, because the platform is burning. 

Like every developed-world health system, we face the twin challenges of an ageing population and rising expectations of access to new and often expensive forms of treatment. But there are factors that make our situation in the UK particularly difficult. 

...this is the danger we see unfolding before us: a vicious cycle of higher sickness, lower growth and an NHS stuck in perpetual crisis management. 

As a society we are living longer but not living longer with good health. Figures yesterday show nearly a quarter of working-age people are not in employment, mainly for health and care related reasons. Add to this modest economic growth and hostility to high rates of immigration, and we face the NHS and care system eating up a higher and higher proportion of public spending and one-in-five of our national workforce. 

So this is the danger we see unfolding before us: a vicious cycle of higher sickness, lower growth and an NHS stuck in perpetual crisis management. 

Just before government announcements stopped for the election, the Department of Health sneaked out a summary of the report of Professor John Deanfield, appointed by Steve Barclay (remember him?) as government champion for personalised prevention. His report states the following: 

‘Our current approach to health is unsustainable, both for the health of the population and for the economy. A reorientation towards prevention is the only way to avert the growing health and wealth crisis’.

But the good news is this: necessity is matched by opportunity. 

Change in three broad areas

The combination of greater collaboration, new policy, data, digital, biotech, changing public expectations offer us huge scope to do things differently and better. 

I think we need change in three broad areas.

First, in the context in which the NHS operates. 

As we highlighted in our State of ICSs report and in our paper on health and devolution, in places and systems there have been significant steps to collaborate across sectors and agencies. From Somerset to Frimley to Nottinghamshire, I have seen great work on integration and population health management. 

But, generally, this desire for local joining up both within and beyond the health service has not been replicated in central government. Last year, planned cross-Whitehall strategies on health disparities and mental health were both abandoned.  

Yet joining up across government can make a difference. At the Confed we are actively supporting the 15 ICSs chosen as vanguard sites for the Department of Work and Pensions Workwell programme. In designing the scheme the government has recognised the role the health service can play in supporting people into work. It is the fourth ICS purpose in action. 

This programme should be bigger and more ambitious. And as well as health, welfare and employment, what about the potential synergies between education and health? Between environment and health? Between criminal justice and health? 

But there is one part of government that has always tended to see health investment as pouring money into a bottomless pit. This is our friends in the Treasury. This is why we worked with Carnall Farrar to make an evidence-based case for health and care as investable propositions, central to both raising productivity and addressing inequality. 

Unless we improve the health of the nation, the NHS will be stuck and the country’s economy held back. The failure to act on this irrefutable fact is made more frustrating when important wins could be achieved at relatively little cost. 

Determined action and prevention

History tells us that concerted and determined action can make a difference. In living memory we have removed lead from petrol, halved teenage pregnancy, slashed smoking rates. Now why can’t we use the same determination to tackle the obesity crisis?

Equally, there are areas of prevention such as vaccines, cardiovascular diagnosis, and treatment, type two diabetes where we know that a concerted national drive – supported by the whole of government – could reap rapid gains in health outcomes and investment returns. Remember, 40 per cent of the NHS budget is spent on treating preventable disease.

Yet, still too often we measure success in terms of NHS activity not health outcomes. The major parties make commitments to improve population health, but day-to-day policy rarely reflects such commitments. 

There is an 18-year difference – shocking - in healthy life expectancy between the most deprived and affluent communities. Halving that gap should be the centrepiece of health policy over the next decade.

A lot could be done nationally to improve the nation’s health and work on social determinants and prevention, but it demands ideas and action at the local level. So, another important change in context is to devolve more power and resource to the level of systems, places and neighbourhoods. 

Devolving from the centre is not about evading accountability, it is enabling us to be more accountable to our local partners and more responsive to the communities we serve. 

Following the model of leaders like Oliver Coppard, Mayor of South Yorkshire, we need to empower the NHS, local government, other public services, the voluntary and business sectors to create healthier places across Britain. 

Devolving from the centre is not about evading accountability, it is enabling us to be more accountable to our local partners and more responsive to the communities we serve. 

This commitment to open up the space for local collaboration links to the second shift from a reactive to a proactive model - one we have talked about for years, which we know from recent Health Foundation polling that the public supports, but one we have failed to achieve. 

This is a shift in priorities and investment in the NHS so that a higher proportion of money is spent upstream in prevention, in primary and in community-based care. 

The political parties seem now to be listening to this message, even repeating it. 

But as we have seen over the last two decades, too often, even now, policies and priorities drive in the opposite direction. 

As we argued in the Confed’s report on payment systems, if the strategy is to shift resources upstream but the incentives are to invest it downstream, little will ever change. That has been the story of the last 20 years. Vision needs to be matched by action.

Examples in primary care

Take primary care.  Despite the productivity challenges in the NHS, primary has provided a massive increase in appointments and activity while consuming a smaller share of the health budget.

I have seen great practice from community outreach in Sheffield or Oxford, to an out-of-hours service in Herefordshire designed to provide the right care at the right time, to a brilliant multi-disciplinary team working and great use of population health data in Somerset, to entrepreneurial GPs in Gloucestershire or Kent enabling the transfer of acute services into community-based health centres. 

Trust leaders in acute, community, mental health understand the opportunities that can be created for services and patients from unleashing the entrepreneurial, community-focused spirit of primary at its best. 

When I asked Daniel Elkeles, the chief of London Ambulance Services about his commitment to expanding services and strengthening triage he told me ‘most of all it’s so that primary can concentrate on what only it does best’. 

But as well as the innovation and ambition, I’ve also heard stories of perverse incentives, inadequate estates, practices going bust, GPs unable to find work. 

So I fear we face a tragic irony:  just as we are starting to appreciate the full potential of general practice and wider primary care in terms of data-driven population health management, holistic care and prevention, digital access and virtual care, at the same time in many places primary is facing an existential crisis. 

The best primary practice of course often goes hand in hand with community services. This is core to integrated neighbourhood working, which is another area of research and improvement for the Confed. But according to the Nuffield Trust, real-terms spending on community services has dropped more than 4 per cent since 2016/7. Even though the Confed’s own economic analysis shows that for every £1 spent on primary or community health care, the economy is boosted by up to £14.

Engaging with patients and the public

The third and perhaps most important element of shifting from a reactive to a proactive model is how we engage with patients and the public. 

There are so many aspects of this it deserves a speech of its own (don’t worry I’m not going to do one) but let me pick out some of the key points.

A proactive model seeks to personalise care. Through advances in population health data, bio-medicine and biotech, we are seeing the emergence of ever-more targeted treatments, particularly for cancer, with the recent announcements of trials for personalised cancer vaccines. This is exciting but it is only the beginning of the coming genomic revolution.

As Lord Ara Darzi has argued, within the next generation the combination of genetic profiling and better diagnostics will mean that for the first time in history most people will be able to discover they need treatment before they have symptoms. 

Personalisation is also about the way we provide services. The NHS could and should match the convenience and flexibility of other digital services. As Amanda and Richard said, the NHS App is an unfolding success story. With over 34 million register users, the app is being used to manage hospital appointments and view waiting times and order repeat prescriptions, but the possibilities are far greater.  Integration with other smartphone apps and wearable technology, improving and supporting mental wellbeing with access to digital talking therapies, strengthening two-way communication between patients and the NHS. 

So how about, as a symbol of joined-up thinking, how about schools offering year 11 pupils after their exams, before the summer holidays, a session where they are encouraged to download the app and shown how they can make it the health service in their pocket. 

The goal is that patients, like water, flow better around the fixed banks and rocks of the health service. Shouldn’t our aspiration instead be for services to flow around the needs and lives of patients? 

As we all know, an ever-greater proportion of our resource is focused on the needs of people with long-term conditions. 

What these patients need most is holistic and continuous care based not just on their different clinical needs but on enabling them to live their best lives. As inspiring examples from Rob Burrow to Esther Rantzen remind us, there is nothing inevitable about the relationship between people’s health status, what they can achieve and their quality of life. 

A new approach requires changes in both clinical practice and service design. 

There is rightly a lot of emphasis in planning guidance and elsewhere on the importance of patient flow. But dwell for a moment on that metaphor. 

The goal is that patients, like water, flow better around the fixed banks and rocks of the health service. Shouldn’t our aspiration instead be for services to flow around the needs and lives of patients? 

A friend of mine has had long Covid since the first wave of the epidemic. Over four years her travels around both the NHS and – in desperation – the independent sector has involved multiple visits to different GPs with very different views of the illness, referral to the cancer pathway, long waits for consultations with a neurologist, a cardiologist, a rheumatologist and a couple of long waits in emergency departments during flare ups. Yet, her symptoms are pretty standard for the illness. 

Developing holistic, person-centred care can give patients and carers agency, enable more proactive preventative care and avoid expensive unplanned interventions. I have seen great examples of this approach from work with frail people in East Cambridgeshire, to a diagnosis-to-end-of-life dementia service in City and Hackney, to maternity services in Bradford. 

Building services round people both enables and is enabled by patient empowerment. Giving patients and carers voice and agency is vital in ways that stretch from safety to service design, from prevention to access. 

Change moves at the speed of trust

The Patients Association, National Voices and Health Watch play a vital role in bringing patients into national and local decision-making.  Diabetes UK has developed an award-winning self-management tool that more than 100,000 people have used to improve their lives after a diabetes diagnosis. Macmillan Cancer Support runs an online community where people living with cancer provide each other with mutual support and information. Peer mental health counselling turns patients into carers and creates new job opportunities. 

To move from a reactive to a proactive working demands a fundamental shift in the way we think of people. The reactive model sees people as collections of body parts, a source of demand and largely passive. The proactive values them as human beings, as partners whose aspirations, insights and assets help us improve services and outcomes. 

As well as individual patients and patient groups, a proactive approach also requires a step-change in how we engage with the public as a whole. 

Last year on this platform I made the case for a new social contract, one which emphasises the need for a more honest, more ambitious conversation at every level; a conversation about how we deliver care and how we target investment. But also, crucially, the role our fellow citizens can play in making those decisions easier and their consequences more positive. 

From supporting a shift to a digital default on 111 – which is faster, cheaper and more accurate - to working with local leaders to configure services in the safest and most cost-effective way, to patients and carers helping us plan the last days of life – in all those cases having a relationship with the public accelerates the possible. 

Change moves at the speed of trust. 

Due to the election, the government’s consultation on amending the NHS Constitution has been paused. But I think to signal the importance of our relationship with patients and the public, the constitution should be renewed in the context of and integral to a new plan for the NHS.

So, by joining up better in government to improve public health, by devolving to enable stronger local collaboration, by renewing primary care and moving resources upstream, by personalising care, empowering patients and engaging the public. Through all of this we can aspire to create over the next decade a radically improved model of health policy and healthcare. 

Split-screen thinking

But we need also need to heed the insights of everyone from Sir Chris Whitty to the IFS. We simply cannot go on with a model that no longer works. 

To quote a politician you may not associate with me: There is no alternative. 

In our leadership and improvement work with you we often talk about the need for split- screen thinking. 

In screen one, the all-too concrete daily challenge of addressing the demand capacity gap with over stretched budgets. 

In screen two we need a compelling vision; one that encourages us to answer today’s questions by building a bridge to tomorrow’s possibilities.  

Visiting you every week. Talking to you every day. I have no doubt that NHS leaders have the skills and the commitment to transform health care over the next decade. 

Now we need national political leadership that shares our hopes and works with us to make it a reality. 

Thank you.