On behalf of the trustees and staff of the NHS Confederation, welcome to our annual conference.
This is my second week as the Confederation’s new chief executive. Meeting so many of the Confederation’s members on day seven of my new job is quite an induction.
Over 5,000 of you are together for one of the most important gatherings of health and care leaders in the calendar; leaders from all parts of the health system in England, Wales and Northern Ireland.
It is an opportunity to reflect on the world-changing events of the last year and to chart a course for the future.
Before I share my thinking on that future and the role of the Confederation, I want, first, to take the opportunity to thank our commercial partners.
In particular, our main conference partner, Palantir Technologies UK.
Indeed, I want to thank all our sponsors and exhibitors – there are too many to name individually, but without them this conference would not be possible.
Also, I need to run through some quick logistics.
You can view all sessions on the agenda and can bookmark any to add to your personal agenda over the three days of the conference.
NHS Confederation members have access to exclusive sessions in our Member Zone.
Do try to visit the Partners and Exhibition pages and the Solutions Library, where you can interact and find products, services and solutions.
This event is being hosted on Swapcard, which is great for networking and booking in one-to-one or group meetings with colleagues.
For hints and tips for how to get the most out of networking on Swapcard, visit the helpdesk where we have short videos to guide you.
Finally, some sessions will be available to watch back on demand an hour after they have finished. All Zoom sessions will be available to watch back on demand from Wednesday 23 June.
The opportunity we must grasp
We meet at a pivotal time for the health service. We have an opportunity and a duty. To honour the incredible work of the last 15 months and to build a consensus. Not only on the future of the NHS, but the path to a healthier population. It is an opportunity we must grasp, a duty we must fulfil.
You don’t need me to tell you that the last year has been like no other.
With the virus still with us, and as we head into considerable economic uncertainty, the impact of COVID-19 will be felt for many years to come.
So many of us have lost friends, colleagues and family members, and experienced unprecedented changes in the way we lead our lives.
And we are still not out of the woods.
With the threat from the Delta variant growing, we think that, on balance, it is the right thing to do to delay lifting the final restrictions
With the threat from the Delta variant growing, we asked you, our members, what you felt was right. Your responses showed an awareness of the hardship caused by continuing restrictions and the strength of people’s desire to return to normal. But on balance you called for caution, recognising not only the continuing danger of COVID-19 but also the impact that a new flare up would have on the process of recovery. We are glad that view, your view, the Confederation’s view, has been heeded.
There are, however, grounds for optimism that we will soon be through this, with 30 million people across the UK having been fully vaccinated and over 40 million having had their first jab.
A remarkable achievement.
But what comes next?
From the very beginning of the pandemic, there has been a widely repeated and deeply felt desire to build back better. Now is the time to deliver on that aspiration.
The pandemic has shown that with support from government and from the public the NHS can respond, innovate and collaborate at incredible pace
So, what has the experience of the pandemic taught us?
First, that with support from government and from the public, the NHS can respond, innovate and collaborate at incredible pace.
No one can doubt the resilience and ingenuity of your organisations. No one should underestimate what you have achieved.
We have seen the very best of the NHS over this period, from…
- creating extra critical care capacity, via 33,000 extra beds, in a matter of weeks
- redeploying staff and retraining them to support the COVID-19 crisis
- significantly increasing the amount of care delivered in the community through the discharge to assess model
- continuing to treat thousands of patients with other conditions while keeping them safe
- ramping up how we collaborate across organisations, sectors and professional boundaries
- increasing online consultations in ways unimaginable before the pandemic
- setting up 24/7 mental health crisis support phonelines covering the whole of England in a matter of weeks – one year ahead of the Long Term Plan target
- and, of course, successfully rolling out the largest vaccination programme in the NHS’s history.
It is rightly said that the NHS has delivered in a matter of weeks a scale of innovation that would normally have taken years.
It has taken a crisis of this magnitude to show what can be achieved when we unite behind a single purpose, reach out beyond our organisational interests and enable our local leaders to lead. From mask wearing to home testing, we have also seen how the public can be willing partners with the health service, safeguarding their own health and that of their families and communities.
We need to build on all of this and lock-in the positive changes that we have brought about.
The pandemic has highlighted and exacerbated the profound unfairness and injustice that exists in our society
The second lesson of COVID-19 has been harsher. It is this. The weaknesses in a society, its institutions and policies are cruelly laid bare in a crisis.
The pandemic has highlighted and exacerbated the profound unfairness and injustice that exists in our society.
COVID-19 has foregrounded the issue of health inequalities in the starkest terms. From early on, the warning signs were clear. In May 2020, an Office for National Statistics study demonstrated that the risk of dying from COVID-19 was greater among black and other minority ethnic groups than among the white ethnic population.
Still today black and minority ethnic communities are being disproportionately affected.
And this extends to our BME NHS colleagues who were also dying of coronavirus at a higher rate.
The Confederation is proud to be hosting and working in partnership with the NHS Race and Health Observatory. This means we can provide members with practical support so they can engage with their whole workforce and population and start to close the race and ethnicity gap.
We are delighted that the Observatory has agreed a partnership with the US Centre for Disease Control’s Office of Minority Health and Health Equity. This will allow both organisations to share best practice in reducing health inequalities in diverse communities.
The impact of COVID-19 has also been exacerbated by the scale of economic inequality in our country – for example, the way many people in precarious jobs felt the need to carry on working despite the safety risk. Older people have been at great medical risk, but the economic impact has particularly hit the young. From a rise in postnatal depression to an increase in eating disorders, the pandemic has impacted different groups in different and sometimes unpredictable ways. There is much that we need to understand and much we need to learn.
Tackling health inequalities must be a priority not just for the NHS. But also, in the context of the white paper reforms, it must be a priority for all our local public services and the wider community sector.
The pandemic also turned the cracks in our health and social care systems into dangerous fault lines.
The government cannot claim it did not know of these vulnerabilities. We at the Confed and many others have been drawing attention to them for years.
The NHS went into the pandemic with almost 90,000 vacancies following the failure to deliver a fully funded, long-term, workforce plan.
Large parts of the NHS, particularly in mental health and primary care, have also been left with crumbling estates and a huge maintenance backlog due to the need to raid capital budgets to plug holes in the revenue budget.
Our reduced bed capacity and under-funded diagnostic services meant that there was limited slack in the system to deal with the shock that COVID-19 brought with it.
The failure to keep pace with historical spending increases, alongside the legacy of the pandemic, has contributed to what are now the most significant waiting times the NHS has experienced for more than a decade.
The government rightly talks about levelling up and building back better, but the scale of the recovery challenge ahead is beyond anything we have seen before. It will test leaders and teams in all parts of the country.
Let us be clear about our duty to our staff. The price of caring for others cannot be that they are unable to care for themselves. As a nation, our duty to those who care for others is to care for them.
Our staff could not be doing more to respond to the huge rises in demand for care that they are seeing. But as the work of NHS Employers, which is part of the Confederation, has shown many of them are exhausted and they need support.
Let us be clear about our duty to our staff. The price of caring for others cannot be that they are unable to care for themselves. Government must heed the deeply felt conviction of the public. As a nation, our duty to those who care for others is to care for them.
The NHS and social care system went into the pandemic with these worsening structural challenges – they are not new. But we are emerging from the pandemic with many of them having deepened.
Now, we must commit to building a truly resilient health and care system.
Because the third lesson of the pandemic is that the public want the government to turn its fine words about the value of NHS and social care system, and the people who work in it, into action. Pride in our NHS is as high as ever. Recent Ipsos Mori polling shows three-quarters of the public believe the NHS is one of the best health systems in the world.
To turn the government and the public’s gratitude and faith into action, the NHS must have the resources it needs.
Among the key priorities are underwriting the extra direct costs of COVID-19 in the second half of the year, including extending discharge-to-assess funding from October onwards.
We need much quicker access to capital funding to enable trusts to create ‘red/green’ zones and to invest in high volume elective care clinics.
And this access to capital funding needs to extend to mental health, primary care and other parts of the system.
More fundamentally, the government needs to re-examine the £20 billion revenue settlement in light of the impact of COVID-19 and pre-pandemic pressures that meant this funding was never enough to achieve the commendable and widely supported ambitions of the Long Term Plan.
Also, as a body that represents the NHS, we have no hesitation is identifying the reform of social care as an urgent priority. On his first day in office, Boris Johnson promised to “fix the crisis in social care once and for all”. The Prime Minister and his government must live up to that promise or else our social care system – whose weaknesses were so bleakly illustrated during COVID-19 – will simply reach breaking point.
This is something the Confederation has long been arguing for and we are grateful to our partners in Health for Care, a coalition of 15 national health organisations that we lead, and which is calling for a sustainable social care system.
The NHS and the nation
The NHS represents the best of us. In a country which often feels divided and sometimes pessimistic, the core values of the NHS stand for what we proudly share as citizens
Without reform and funding we cannot recover, let alone rebuild. But that truth should not reduce us to a narrative in which the NHS is always the supplicant holding out a bottomless begging bowl to the government and taxpayer.
As I said, the public’s support for the NHS is deep and wide. The NHS represents the best of us.
In a country which often feels divided and sometimes pessimistic, the core values of the NHS stand for what we proudly share as citizens.
In a country where there is too much segregation and misunderstanding, the institutions of the NHS bring together people from all parts and strata of our diverse country in relationships based on trust and compassion.
The NHS is also hugely important to our economy and its prospects.
It is one of the biggest employers in the world and the largest employer in the UK – 1.5 million staff. As we manage the economic fallout of COVID-19, develop a modern industrial strategy and seek to level up, the NHS will be critical.
In many places the NHS is the biggest employer crucial to the job prospects, security and career development of local people. Health and care is one of the fastest growing global sectors, one in which we already have significant assets like biotech; the NHS can help the UK being a leading player in that sector.
Climate change is the greatest threat to human health we have ever known and the NHS is committed to being the first health service in the world to hit net zero.
So let us not ask only what the country can do for the NHS. It is time to appreciate and accentuate what the NHS can do for our country.
We must not lose the momentum for cooperation, experimentation and change that was so much a part of the COVID-19 response. The good news is that much is already happening up and down the country
The credibility of that argument and the confidence with which we can make it also relies on health service leaders being committed to continuous improvement and accelerated innovation. We must not lose the momentum for cooperation, experimentation and change that was so much a part of the COVID-19 response.
We need to demonstrate to everyone – not least the critical minds of the Treasury – where improvements are taking place and how they are delivering efficiencies as well as improving health outcomes.
The good news is that much is already happening up and down the country.
Take for example the High Flow project in Northern Devon which has brought agencies together to reduce A&E demand among those with complex and multiple needs.
The virtual wards developed by County Durham and Darlington NHS Foundation Trust offering enhanced support in the community to vulnerable people with complex needs.
Or South Yorkshire and Bessetlaw ICS Cancer Alliance working with experts in behaviour science to develop new strategies for people with symptoms which could indicate cancer.
Or examples of successful integration like Collaborative Newcastle in which health bodies, the city council and universities are developing a world-class campus for active ageing.
Or a concerted focus on population health, for example, in the anchor charter of North East London’s ICS signed by all eight local authorities.
Of course, central to the progress of the NHS in England is the integrated care framework already up and running successfully in many parts of the country and soon to be enacted in legislation.
As a Confederation, we have heard and clearly articulated your concerns about aspects of that reform programme, particularly about the dangers of over-centralising power in Whitehall and the need for clarity when it comes to the statutory responsibilities of the ICS NHS body and the health and care partnership board. While it is right for there to be flexibility on the form, governance and interaction between the two, it must be clear in legislation what the statutory function of each body is.
Nevertheless, if we are to tackle health inequalities, to make real progress with population health and if we are to exploit the potential offered by data and technology, then local integration is vital. And this is not just about the integration of health services. NHS leaders understand that employment, housing, education, even planning and public space are all important social determinants of health.
As someone with a background in local government, I know how important effective outcome-focused collaboration is between the local NHS, local authorities, the third sector including social enterprises.
It is only through a more holistic and publicly engaged approach to health that we can really make a difference.
The NHS Confederation
The NHS Confederation is the membership organisation that brings together, supports and speaks for the whole health system in England, Wales and Northern Ireland.
The NHS Confederation will support you as change-makers – highlighting best practice, giving you the spaces to learn from each other, and supporting you when you need help
With government, public and partners, we will continue strongly to advocate:
- for a new financial deal, including for our sister services in social care
- for a long-term, fully costed and funded, workforce plan that supports retention and addresses our long-standing vacancies
- for a renewed commitment to parity of esteem for mental health
- for a much greater emphasis on population health and the wider determinants of health
- for coherent and bold policymaking from the Centre
- and for more devolution to let you, as local leaders, lead.
We will continue to speak truth to power.
But, just as important, we will support you as change-makers – highlighting best practice, giving you the spaces to learn from each other, and supporting you when you need help.
I want us to be a place where leaders from across the system come together to develop insights and solutions to shared challenges.
I am just seven days into my new role, but I can see the progress the Confederation has made this past year.
As our members will know, we launched a new membership offer in April.
In the last 18 months, we have launched new membership networks for integrated care systems, primary care networks and primary care federations and acute providers.
This is on top of the support we are already providing to providers and commissioners across the system, in England, Wales and Northern Ireland.
While we know that placed-based and system working are increasingly important to you, we will continue to support you and your teams with a range of networks and activities dedicated to your sector.
I aim to build on the great progress Danny Mortimer and the team have made over the past nine months – itself adding to the work of my predecessor Niall Dickson. I have already had great conversations with many NHS leaders and I look forward to meeting many more of you in the weeks and months to come.
Before I go, I want to leave you with a final thought.
In five years, how do we want to look back on COVID-19?
Will it be as a crisis that still casts a shadow over us, from which we have still not recovered?
Or will it be as the spur to begin an unstoppable transformation, not just in what the NHS can achieve but in the health of our nation?
Now is the time to fulfil our duty to the 130,000 people who have died and the millions who have suffered or been bereaved by COVId. To honour the memory of the thousands NHS and social care staff who have made the ultimate sacrifice.
That duty is to make this a turning point.
From which we build the best health system in the world and enable the people of this country – all the people of this country – to live the healthiest lives they can.