Thank you, Sathnam. It’s great to be here with you again.
A lot has changed since last year. Resident doctors strikes resolved. Hard to envision then but bringing huge benefits for patients now.
A new, fresh-faced, straight-talking leader has arisen. Stepping boldly where others fear to tread. Carrying the nation’s hopes that he can turn a struggling institution around with his big ideas and can-do attitude.
Julian Hartley, we wish you well at the CQC.
And of course, a new Government…with new ideas and priorities. For us, that means new opportunities to drive better health for our communities. And that is best done in partnership.
We all welcome the strong focus on primary prevention…the Tobacco and Vapes Bill, an important step in improving health and reducing demand for NHS care.
And we welcome the pledge to think and do together with the NHS. Intent expressed in the clear message, from us and from Government:
The 10 Year Health Plan must be produced with you…with frontline staff…if it’s to succeed.
So please do share your ideas and experience, because you’ve earned the right to be heard.
You’ve earned it by continuing to deliver through constant change, and through colossal challenge.
Yesterday I was at the Covid Inquiry, which was a real reminder of just how difficult that time was, for all of us. And, how proud I am, to be part of this NHS team…in what we were able to achieve for patients then.
But Covid wasn’t the only challenge over the past decade.
Lord Darzi listed them:
- A massive organisational reorganisation.
- Constrained capital, leaving buildings crumbling, and staff held back by outdated tech.
- Constrained revenue, eating into our resilience.
- And the needs of our communities, ever increasing, with more turning to the NHS, as other services scaled back.
So, the last decade has been tough.
But it’s also seen developments in our understanding of health and care needs and our ability to respond. The NHS has had to adapt and innovate. Putting new services in for unmet need and overhauling existing services to make them work better.
One number brought this home to me lately.
0.12%.
That was the real terms increase in income for providers in the last financial year.
0.12%
But you really made it stretch. Firstly, by contributing to efficiency savings topping £7 billion…set to be even higher this year. Helped by the £1bn you’re on track to wipe off the agency staff bill in just two years…now the lowest on record.
An important achievement. More money where it matters most. And fairer for our staff.
But we want to go further and we’ll shortly consult on how we best support you to do that.
And secondly, you made it stretch by continuing to adapt how we provide care, as the IFS said today, using the money and staff you had to deliver more for patients.
So thanks in part to treating a growing proportion of callers over the phone (now more than double the pre-pandemic rate), you dealt with 5.8% more ambulance incidents – and brought down response times.
Thanks in part to same day emergency care and hot clinics speeding up tests and treatment and virtual wards, helping people recover at home, you cared for 3.8% more people in A&E – and improved 4-hour performance.
Thanks in part to FIT tests and targeted lung health checks, you provided 9.2% more urgent cancer checks…hit the Faster Diagnosis Standard…and continued progress on diagnosing more cancers early.
Thanks in part to Community Diagnostic Centres, you delivered 9% more diagnostic checks – and reduced long waits.
Thanks in part to surgical hubs, outpatient transformation, and a huge increase in specialist advice and guidance, …avoiding unnecessary hospital trips for patients, you delivered 5.7% more elective treatment…and almost halved long waits.
Thanks in part to Urgent Community Response teams, helping almost 60,000 patients a month to avoid trips to A&E, you delivered 16% more community contacts and care.
And thanks in part to crisis cafes and 24/7 hotlines, now accessible through 111, you delivered 15% more patient contacts in mental health.
So we’re not blind to where we need to do better.
None of us would ignore that too many people are waiting too long to be seen, or that quality and experience of care isn’t where it needs to be.
None of us would argue that ever-increasing activity is the right approach, or that we can’t move more care out of hospital and prevent more illnesses.
And none of us would deny that productivity was hit by the pandemic, or that we have further that we have to continue the recovery, and achieve greater value for money.
But these numbers tell a story of a workforce doing their best for patients. Striving to make every pound go further. And not just looking to the horizon with hope, but putting in the hard yards in to make change now.
Take those Trusts using the Federated Data Platform. Several, using it to better organise theatre lists, delivering an average of 100 more procedures every month.
Chelsea and Westminster are using it to trial AI generated discharge reports. North Cumbria, using it to double the number of people on the waiting list being validated each week. And Bath, using it to help one person do the same work as it used to take multiple.
All showing real benefits and freeing up staff time as well as speeding up care.
Take colleagues I met recently at The Harbour mental health unit in Blackpool, using AI and automation to speed up routine tasks and release time for care…helping to drive great improvement in a Trust that has struggled in the past.
And take colleagues at Great Ormond Street and GPs in South West London, trialling AI voice assistance to automate notetaking. Patients and doctors both reporting benefits.
And we’re working now on guidance to support others to take advantage of all those things I’ve listed. Reform is hard, but changing how we do things matters to people.
People like Norman.
Norman is full-time carer to his wife, Ros. Ros is 73, and she suffers with both MS and dementia.
Over the course of a year and a bit, she was admitted to hospital 16 times…spent 90 days as an inpatient…and had 32 ambulance trips, plus CT scans, MRI Scans and X-rays.
Twice, Norman was told to prepare for the worst. But thankfully…following a breakthrough in her diagnosis, she was able to go to a virtual ward.
That means Norman can look after Ros at home. There have been no more admissions to hospital. Her daily meds have halved.
Far from preparing for the worst, Norman has been able to plan trips to the Shard, the Norfolk Broads, and to York.
Reform is difficult. But reform has made Norman and Ros happier.
And by reforming in all the ways I’ve described and more, you are having a positive impact on people’s lives. As well as on those big numbers around access and around productivity.
You might be thinking, how does this square with the Darzi review?
There’s no doubt his report was hard for anyone working in the NHS to read. But it was a fair picture of the current performance challenges we’re managing and the drivers behind those challenges…that patients and staff alike will have recognised.
Importantly, it also gives us hope. It was clear that while the NHS is in his words a critical condition, its vital signs are strong, because the NHS model is the right one, and because many of the solutions are already being used in the NHS right now.
He was realistic that full recovery will take years rather than months. But he was optimistic that it can be done.
Optimism, I share.
But optimism alone isn’t enough. We can have a better future. But we have to continue working for it.
The 10 Year Health Plan will set out ambitions for the next decade. But the real message I want to leave you with today is this:
All the reforms I’ve mentioned, plus others, like implementing modern EPRs, the NHS App, and cloud telephony, digital triage, multi-disciplinary teams, Pharmacy First in primary care.
They’ve all taken hard work to get to where we are. And that hard work can’t stop.
The 10 Year Health Plan gives us reason to hope for a better future. But it doesn’t give us license to pause for breath.
In fact, it means our relentless focus on delivery is needed now more than ever. To keep the show on the road. But to continue to lay the foundations on which a better future can be built.
So that will take action from all of us. And I count NHS England in that.
I set out some of those things at ConfedExpo back in June. Two main things and I want to come back to them today.
Setting you up to succeed by providing the tools to develop as managers and leaders, and to embed improvement in quality and productivity.
And second, setting the NHS up to succeed by clarifying roles and accountabilities, and supporting the most challenged organisations.
So on the first theme, I said we would develop a new NHS Management and Leadership Framework.
Taking forward the great work of Gordon Messenger, Linda Pollard and Tom Kark. We’re publishing our workplan for that today…and I’m delighted to say that Sam Allen, chief exec of North East and North Cumbria ICB, is working with us to get it off the ground rapidly.
The framework will offer everyone who works in the NHS clarity and consistency on what is expected of them and how to get there, from a single code of practice, set of professional behaviours, and competencies to an official national induction and curriculum.
Leaders and managers shape the culture, experience and outcomes across the service for patients and for our staff. So it won’t be an option. It will be an essential expectation for all managers – both clinical and non-clinical.
Regulation will come. And we should embrace it, providing the same accountability for managers that other NHS professionals have. But it’s critical that it comes with support and that it comes with development. Helping to raise the standards of management and leadership in all organisations.
Supporting better services for patients and better workplaces for staff.
So alongside that, I said we would support all colleagues with the tools to drive improvement in how we deliver. And we’ve been doing that, too. The NHS has outperformed the wider public sector on productivity for the whole of the 21st century. And in the 2010s it outperformed the wider economy too.
But the pandemic hit us far harder, for all the reasons Lord Darzi set out.
While the NHS started to bounce back faster than the rest of the public sector, we’ve got to get back to where we were, and we’ve got to go beyond.
So we’re providing you with the data, the tools and the best practice to drive improvement and reduce variation.
You’ll know this but a couple of months ago we published the first four improvement guides…
…with supporting data in Model Hospital…
…and launched regional learning and improvement networks to spread best practice.
More still to come on that under the banner of NHS Impact.
Learning from you…
…and supporting you, we are really committed to our ambition to be the fastest-improving healthcare system in the world.
Finally on this theme, I talked in June about properly equipping boards.
Making sure they’ve got the right information, at the right time…
…and can use it in the right way to both lead and track improvement, as well as responding quickly to problems.
Over the last few months, we’ve been working closely with those who already do this best.
And today, I’m pleased to be able to launch our new Insightful Board guides for both providers and ICBs…
…providing, in one place, what executives and NEDs should be looking at…
…and how to use it to drive better outcomes, better productivity, better decisions.
The second theme from back in June was getting the plumbing right.
Lord Darzi’s report was clear.
We don’t need another seismic reorganisation…
…pulling focus from the important tasks.
But the system we have needs to be optimised.
And every part of the NHS needs greater clarity on what they’re accountable for.
I said in June, in response to your feedback, that we would continue the work on successors to the NHS Oversight and Operating Frameworks to do that…
…and we were delighted Adam Doyle, chief exec of Sussex ICB, was able to join Steve Russell in leading this work.
Now I know between them they’ve toured the country, spoken to dozens of you, they assure me they have personally read over a thousand consultation responses.
And we’ll shortly set out how we’ve brought all of your views together…
…and how we get to a future that sees systems self-managing, with earned freedoms.
Providers, focused on delivery…
…quality and safety…
…and on working with their ICBs to deliver neighbourhood health.
ICBs, focused on strategic commissioning…
…and creating the environment for more action on prevention and more care in the community.
And NHS England, focused on planning, assurance and support…
…intervening quickly, and providing expertise, as well as using our regulatory levers where needed…
…but also doing those things which are best done once for the whole NHS.
We’ll set that out in a refreshed NHS Oversight and Assessment Framework…
…and a new NHS Performance, Improvement and Regulation Framework.
Importantly, it will also be reflected in planning guidance…
…and in key documents like the Insightful Board guides.
This new way of working will be more coherent, and less duplicative.
Performance management will be more mature, and more focused.
With greater clarity about the oversight and support organisations should expect based on how they’re performing…
…from turnaround teams for the most challenged…
…to targeted improvement help for those in the middle.
And while the best performers can expect greater freedoms…
…we will still be one NHS.
So there can be no return to short-term, organisational self-interest.
Because with the freedom and flexibility, there will also be an expectation…
…that you will continue to work as systems…
…and that you lean in to support others.
So it follows that as the roles of ICBs and Providers are clarified and evolve…
…so too of course must the role of the centre.
We’ve already reduced the size of NHS England by 40% over the last two years.
Not easy.
But the right thing to do.
It’s streamlined how we work with you.
And it’s freed up almost half a billion pounds which…
…supports you to deal with some of the effects of inflation, strikes and pay deals.
There will always be value in the NHS doing some things once at the centre.
But as we continue to evolve our ways of working…
…devolving as much as we can…
…the functions where NHS England adds most value will change, and may reduce…
…and so our form must follow.
That will be an ongoing process, and a long term commitment.
Building on the Hewitt review…
…and working with you to identify and solve the current friction points.
The second thing I said we would work on is how we support the most challenged systems and organisations.
That includes how we can bring in our most experienced and capable leaders…
…those with a track record of turnaround and improvement.
And you know this – the deck is stacked against those organisations.
There aren’t always the right incentives to attract talented leadership teams.
And people worry they won’t get the time, the support, or the space, to do what needs to be done…
…or on a personal level that their careers will suffer.
So we have to change that..
So earlier this year we started work on how we do that…
…systematically and at scale, rather than taps on the shoulder.
We’ll shortly set out plans to identify and develop talented people…
…then match them to roles where they can make the biggest impact.
They will have clarity on incentives and flexibilities…
…and how we will set them up to succeed, with the right support to turn things around.
So, I’m taking up my own challenge.
But I’m asking you too, to do the same.
And there are five key tasks right now.
Living within the money.
Embedding improvement.
Maintaining quality and safety.
Working better with primary care.
And making the most of opportunities.
On all of those, you have the power and the ability to make progress now.
And the NHS needs you to.
On the money, so we got a welcome capital boost in the recent Budget.
And we appreciate the tough decisions Government has made to support revenue.
We’re still working through the details.
But I think it’s no surprise for me to say that it is going to be very tight – tighter even than this year.
So, we need to continue striving to make resources go as far as they can possibly go…
…but we’ll also need to make a tougher set of decisions on what needs to be done.
Financial rigour will always be central to that.
We know it’s taken hard yards to deliver those efficiencies I mentioned earlier. Last year and this year.
And we know delivering more gets harder.
We will have ‘must do’s, like keeping patients safe…
…and working towards the Government’s manifesto commitment on 18 weeks.
Beyond that, you’ll need to look harder at ways to make the money stack up.
For example, using the extra clinicians in post to further reduce temporary staff costs…
…and reviewing all non-clinical growth.
It’s going to be hard.
But it’s vital work to meet our obligation to the public to live within the resources Parliament allocates…
…and provide the headroom for reform.
So that speaks to task number two: embedding operational and clinical improvement.
Again, not easy. But rewarding.
Enabling our colleagues to deliver more, and better, for patients.
And many of you are masters at it.
But it can’t just be some of you.
Every organisation needs to be an improving organisation…
…every team needs to be an improving team.
Because this isn’t about telling frontline teams to work even harder.
Lean methods rely on humility.
On recognising that none of us have all the answers.
Respecting the time, experience and expertise…
…of frontline colleagues, and of patients.
Empowering them to sweep away the things that needlessly get in the way of good care and good outcomes.
Now this is just as much about improving the experience of working in the NHS…
…as it is about improving the experience and outcomes of our patients.
So please, all of us…
…every organisation – including NHS England…
…let’s make continuous improvement central to our day-to-day work.
Number three: maintaining progress on safety, quality and experience.
Core, I know, to what drives many of us.
But far more to do in many areas.
We’ll all be anxious about the impact of a bad winter.
And I know everyone has been preparing extensively.
But we can see pressure building now…
…as flu, seasonal viruses and cold weather kick in.
And that’s why the priority this winter is maintaining quality and safety.
Getting people to where they should be as soon as possible…
…and making sure the fundamental standards of care are in place if they do have to wait.
But winter isn’t the only worry.
Mental health and maternity services, are the obvious ones, and where we have a national plan.
But the example of paediatric audiology highlights how we need to make sure we’re always looking wider.
Having honest conversations about those services which are on the margins.
Spotting signals, and acting, before they let patients down…
…and let the staff who work in them down, too.
Part of the answer is the new Insightful Board guides…
…making sure boards are looking at the right data and guidance.
But the responsibility to use that insight will always sits with you.
Because an important responsibility you carry as well as us is to be curious about these services and how they’re performing.
And a responsibility to be courageous in doing what needs to be done to make them safe and sustainable.
Number four: the interface between primary and secondary care.
We have to make this work better for all parties…
…because it’s patients who suffer when it doesn’t.
So we’re working on this centrally…
…looking particularly at streamlining referrals.
But it’s about much more than that.
Patients unable to get information from hospitals, pushing them to GPs.
Clinics asking GPs to refer to other clinics, to chase test results ordered by the clinic.
Follow-up and monitoring plans, poorly communicated.
Now, I know frustrations can run both ways.
But relying on GPs to solve it won’t work and it’s not fair.
Plenty of places have cracked it, working in partnership…
…and our patients need all of you to commit to this now.
And this is particularly important as a first step to make integrated neighbourhood teams and neighbourhood services work…
…because that will rely on a well-functioning relationship between primary, community and acute care – between physical and mental health…
…focused squarely on the needs and experience of patients.
The kind of services I saw a few weeks ago at the Whitegate Primary Care Centre in Blackpool…
…bringing together urgent care, diagnostics, dental services, sexual health services…
…all under one roof with GPs.
Not everywhere can be a Whitegate.
But it shows those services can work together to provide a better experience for patients…
…and that’s what we need to replicate.
So my fifth and final challenge – for now…
…is we need you to make full use of the opportunities we’re given…
…and that flow from our ability to act as one NHS.
Really exciting ones, like I have already talked about the FDP.
A central resource, that will underpin our ability to benefit from AI in the future…
…and which is already delivering real benefits now.
We can’t afford to miss this opportunity to drive more co-ordinated care, and provide more productive services, at scale.
Nor can we afford single organisation solutions, when this asset is there to be used.
We’re ahead of plan…
…with 40 Trusts now live, and 45 more committed.
And now is the time for those remaining organisations to get on board…
…and to start learning from the front-running Trusts, on how to make the most of it.
Similarly, we’re making massive strides with the NHS App.
Patients getting more information, more conveniently and more control over their own care…
…and helping us to work more productively.
We continue to be ambitious about how it can evolve, and provide more services for patients.
And the next step is to revolutionise access to cancer screening for women.
A life-saving service.
And we want to make it as convenient as possible for people to benefit.
So next month we’re starting the rollout of a new “ping and book” service for breast and cervical checks.
Replacing the cost of letters and text messages with pop-ups on your phone…
…and soon, the tech will allow direct booking into an appointment.
It’s part of our vision for a new normal in how people can interact with the NHS…
…and get personalised support to stay well.
Potentially saving thousands more lives.
Improving access and experience.
Increasing productivity and reducing cost…
…with an estimated £130m saving from digitising screening over five years alone.
We’ll continue to develop the tech.
But we rely on you to use it.
We’re delivering the investment…
…both in modern electronic health records and the App…
…which combined can allow patients to book change and cancel appointments.
48 acute trusts already doing it, and we want it to be all by March 2026.
But only you can go the extra mile…
…go from clinic to clinic to switch on that offer for your patients…
…to give them a more convenient service…
…and at the same time cut down on admin, wasted postage and missed appointments.
We’ll also keep creating more opportunities to make every penny stretch further, using the commercial clout of the NHS.
On drugs, we’re delivering huge savings whilst making more treatment options available.
Just today we’ve announced a new deal with Teva…
…providing generic Varenicline to NHS Stop Smoking services.
That simple daily pill could be a game-changer for people who want to quit.
Cheaper and safer than the old Champix
More effective than current options.
It could support over 85,000 people to kick the habit each year…
…and prevent over 10,000 deaths over the next five.
Smoking remains one of the biggest public health issues facing the NHS, and has devastating impacts on the body…
…from the lungs, to the heart, blood and brain…
…whilst also increasing the risk of cancer, diabetes and stroke.
So this deal is another vital step in shifting our NHS further towards prevention.
Alongside supporting the Government’s ambition to create the first smoke-free generation, we are giving current smokers the tools they need to quit…
…with proven treatment options like this, and specialist care for those in hospital…
…helping to save thousands of lives and billions of pounds in treatment costs.
It’s just one example.
In the last year we’ve saved half a billion pounds by switching to generics and biosimilars.
But the savings could be greater – they could be up to double.
So we need you to act on the unacceptable variation in uptake.
Because every penny you spend on branded medicines over generics or biosimilars…
…is a penny that should be spent on improving care elsewhere.
Finally, the same goes for other things we buy.
Through centralising procurement in the single Health Commercial System, we’ve already saved over a quarter of a billion pounds.
And by tracking purchase orders through our NHS Spend Comparison Service…
…showing what others have paid for the same goods and services…
…we’re helping organisations to avoid overpaying.
So please make sure you’re using these money-saving tools…
…because saving money ultimately means better care for your patients.
So to close, I started by saying some of the things that have changed in the last year…
…and some of the things you have managed to achieve.
Next year I want to come back and say that we have an ambitious plan for the next 10 years…
…and with your help I will.
But more importantly, that we have already made progress on the things that will make it work.
That colleagues are benefiting from the first parts of our Management and Leadership offer.
That we are working together in a more effective way.
That we are improving, at scale, for our patients.
That we have continued to add to the foundations that will support the three shifts.
That we have made the most of every opportunity to increase productivity, and make every penny count.
Because we stand at an important moment.
With our ageing population.
With the economic outlook uncertain.
And with the public’s faith frayed.
At moments like this, leaders need to step up.
At moments like this, working together is not optional.
And at moments like this, we have to do things differently…
…to leap forward, even if just to stand still.
We will help – and I’ve set out some of the ways how.
But the power to make real progress lies with you and with your teams.
It will be hard – you might have picked that up already.
But we have faced hard challenges before.
And we can do it now.
We can meet this moment head on.
We can continue to make resources go further for patients.
We can continue to reform and improve.
And we can be stronger on the other side.
And the reason I know that because I see you doing it, every day.
And as proud as I was to work alongside you now as I was in the darkest days of Covid
Together, now, if we continue to work hard and do the hard yards…
…we have the opportunity to build an NHS that we can all be proud of…
…one which provides better service, better outcomes, better value for the communities we serve.
So let’s take it.
Thank you.
Amanda Pritchard speech to NHS Providers Conference 2024
Liverpool, Tuesday 12 November 2024
