NHS England CE Amanda Pritchard's speech to NHS ConfedExpo 2022
This September, it will be 25 years since I started in the NHS.
I know that, to many colleagues, I’m still a relative newcomer.
But clocking up 9,000 days does, I think, give you the right to look back, at least briefly.
1997 was very different to today in lots of ways.
We’ve made so much progress in so many areas of healthcare since then.
But some of the challenges and the ambitions from that time will be familiar to everyone in this room.
The New NHS White Paper, published that year, talked about promoting more integrated care…
…preventing ill-health and reducing health inequalities…
…and harnessing the transformative potential of information technology.
On all of those things and more, we have come really far…miles have done huge amount
…but there has always been further we can go.
And it’s that which perhaps defines the NHS and its staff the most.
The constant drive to…
…yes, do the very best possible job for those patients in front of you now…
…but also, to find and create new opportunities to do better in future.
There are always challenges.
But there are always things to be excited about too, to spur us forward.
That is the great renewable energy of the NHS.
I felt it on my first day in 1997, and I feel it today too.
2. Our story
I know lots of you here today…
…hopefully all of you…
…will feel the same.
And I strongly believe that is because of the unique nature of our National Health Service…
…the people it brings together…
…and the benefits it can deliver for patients and communities.
In all my 9,000-plus days, I’ve never seen that more clearly at work than I have during the almost-900 days since Covid was first reported.
Before I explain why, I just want to take a moment to, once again, thank all of you for the role you have played over the last 900 days.
For lots of our colleagues, COVID 19 has brought with it real difficulty…
…whether personally, professionally or both…
…and we know that doesn’t just go away overnight.
But it is also true that, collectively, we have achieved great remarkable things together.
And it was the benefits of a national health service…
…an agile network of organisations…
…bound by a shared mission…
…but able to innovate, and to build partnerships locally…
…which helped us achieve them.
It is because we are the NHS that we were able to rapidly create the capacity needed to prepare for the unknown quantity that was the first wave.
It was co-ordinated action, clinical leadership, and franky sheer effort from all of our many different staff groups…
…which meant the NHS has been able to provide care for three quarters of a million COVID-positive patients in hospital, and many more in the community.
___
It is because we are the NHS, that we were also able to lead the global fightback.
The RECOVERY trial was was able to quickly connect 177 sites and datasets across the UK, turbo-charging research.
Because of that we were able to quickly establish the evidence for dexamethasone, which is thought to have saved over a million lives worldwide…
And importantly, when that evidence was available meant it was approved for use,
…two years ago this week…
…because we are the NHS, we could roll it out across the country on the same day.
And it is because we are the NHS, that we were able to deliver the decisive blow.
Being the first health system in the world to deliver the Pfizer vaccine was a moment of hope for the nation.
But it was in the roll out that followed where we showed our value…
…creating a national network of vaccine centres…
…using data to ensure we were targeting doses to where they could save most lives…
…and using our relationships to address inequalities in uptake.
124 million vaccine doses delivered…
…Well over 100,000 lives saved…
…and the foundations laid for the Government to lift restrictions, bringing huge benefits for our economy and society. And enabling us to be here today
Of course, the NHS was never a COVID-only service…
…with at least twice as many inpatients in hospitals for other reasons…
…and tens of millions of non-COVID appointments, tests and treatments taking place.
It was, again, because we are the NHS, that we were able to rapidly adapt to provide as much care as possible, safely…
…whether through creating surgical and cancer hubs…
…or rolling out mental health crisis hotlines, video consultations for outpatient clinics, or at home monitors and other devices..
Life-saving and world-leading achievements…
…all delivered over the last 900 days…
…because we are the NHS.
3. Our future
That is our story, or the last 900 days of it.
But what of our future?
3.1 The challenges
We certainly faced challenges in 2019 before COVID-19, many of which are set out in the NHS Long Term Plan. Still with us and further exaccerabted
While we delivered many of our LTP commitments early in response to the pandemic, none of those challenges went away.
In fact, we know that many of them will have been exacerbated, and new challenges have emerged.
Obesity, alcohol and smoking are still the biggest causes of preventable illnesses.
Cancer Research UK estimate that by 2040, well over a third of the population will be obese.
Because we are the NHS we have already provided over 600,000 adults with support to manage their weight through the Diabetes Prevention Programme and other initiatives.
But as many people as we can offer this secondary prevention to, we know that…
…without wider action to reverse the trend…
…we will continue to store up problems for the future.
We also see the need for mental health services growing.
Because we are the NHS, we have been able to fast track new services like mental health teams in schools…
…24/7 crisis lines…
…and digital tools.
And we are now taking action to increase the ability of primary care teams to provide first-line support…
…with funding for up to 2,500 additional mental health practitioners across the country.
.
But the scale of the challenge is such that demand continues to outstrip capacity…
…a reminder that NHS treatment cannot be the only answer to our national mental health challenge.
And we have new challenges like Long COVID, too.
Because we are the NHS, we have been able to rapidly open 90 clinics and 14 hubs for children and young people…
…and at least 45,000 people have had an initial assessment.
But we know there are many many more who will need these services and other ongoing support as a direct result of COVID infection.
The post-pandemic climate is bringing further challenges, still.
The rising cost of living will be felt most by those who are already living with or vulnerable to poorer physical or mental health.
Cold homes…
…debt and financial insecurity…
…barriers to accessing care…
…experience tells us that these factors and more will show up through NHS services over the coming months.
These external challenges have a direct bearing on the internal questions the NHS always grapples with. always has in my last 25 years
Access.
How can we make sure the people who need it can get care in a timely and convenient way…
…something we know is particularly important in addressing health inequalities.
Quality.
When they do access it, how do we ensure the care they get is safe…
…that it’s clinically effective and early enough to prevent more extensive care later…
…and also treats them as an individual.
And the third is financial sustainability.
Not just how do we balance the books from year to year…
…but find the headroom to invest to improve services and save money in the future.
There are more challenges of course.
But I know that there is a determination in this room…
…and in colleagues across the country…
…to take every opportunity to meet those challenges.
And we have particular opportunities now… to set out some of the scale of the challenge
…the huge amount of innovation and learning from the last 900 days...
…the demonstrated promise of data and technology...
…the power of the relationships formed and strengthened by common purpose…
…and now, in the Health and Care Act, the legislative backing for greater collaboration locally.
The crucial part is to turn those opportunities into improvements for patients.
The Secretary of State has described his vision for reform – people, prevention, performance and personalisation – which are important.
But I want to frame my reflections on the wider challenges and opportunities for the coming years around four Rs: recovery, reform, resilience and respect.
3.2 Recovery
Starting with recovery.
No services were untouched by the impact of COVID.
But every service has emerged with useful learning and innovation we need to lock in.
I discussed mental health earlier.
The same can be said of learning disability, maternity, community services, and screening and immunisation services.
But I want to focus on three service areas now.
Electives/diagnostics
I’ll begin with electives, because it is here where we are most visibly applying the lessons and the can-do spirit of the pandemic response.
We have the shared goal to tackle the inevitable COVID backlog.
We have a clear national plan, drawing on the successes colleagues were able to achieve over the last 900 days.
And, crucially, we have a significant amount of investment to deliver it.
Because we are the NHS, we have other huge advantages, like the ability to…
…collaborate across providers, regions and nationally to deliver patient choice and speedier care…
…to rapidly spread proven innovations, so patients everywhere can benefit…
…and to use technology and data to identify those who need treatment the quickest.
And it’s working.
We have already reduced the number of people who have been waiting 104 weeks for treatment by two thirds...
…putting us on track to meet our first milestone of eradicating two year waits over the coming weeks, other than by patient choice or for very complex cases.
I’ve been lucky enough to see lots of this for myself over the last few months…
…In Blackburn, I saw how they had remodelled their intensive care unit so they could use it more flexibly across emergency and planned care…
…At Lymington New Forest Hospital, they demonstrated how they are linking up other services with their Community Diagnostic Centre to deliver thousands of additional tests…
…And in Norwich, staff showed me how they are using robotic surgery, virtual wards and personalised outpatients to maximise their capacity for treatment.
Cancer
We see the same in cancer care, too.
We know the crucial factor in good outcomes is catching cancer early.
It’s fantastic that more people than ever before are coming forward for cancer checks.
And because we are the NHS, we won’t rest in finding new ways to ensure more people with worrying symptoms can get checked sooner.
There are two main lessons we learned rolling out the COVID vaccine.
Number one, good communication and engagement…
…and our latest cancer symptoms campaign is already paying dividends already.
But the second lesson was convenience…
…and that means services being in more places.
From liver trucks travelling around the country…
…to genetic testing and high street checks…
…we want to make it as easy as possible for those most at risk to get vital, lifesaving tests.
So today I can announce a new pilot programme, enlisting high street pharmacies in the fight against cancer.
We will be supporting investing in pharmacists to have more conversations with people who have potential cancer symptoms…
…and if the pharmacist is worried that it might be cancer, they will be able to refer them directly for specialist checks.
These plans have the power to transform the way we find and treat cancer…
…and ultimately spare thousands of patients and their families from avoidable pain and loss.
And wider than that, they can be a great example of how the NHS can and should make every contact with the public count…
…the kind of approach we need to replicate for finding and preventing other conditions.
Primary care
This pilot is also another way in which the role of community pharmacy is being recognised as a vital part of NHS primary and community care.
But it can’t be the only part of the solution to how we improve access to primary care.
General practice will always be the bedrock of the NHS.
GPs and the rapidly growing team of other primary care professionals provide treatment, advice and support to more than a million patients every day.
But it’s the current model of general practice isn’t working as well as it could.
That’s why I commissioned Claire Fuller to do a stocktake, to ensure that as we join up services through Integrated Care Systems…
…we make it as convenient as possible for everyone to get the right care for their needs at the right time…
…and can deliver more personalised and preventative care in the community. As well as immediate access
Claire did a very impressive job…
…and it’s all of our job now to take that forward
3.3 Reform
ICS development
So that’s part of the plan for recovery.
But as you’ll have picked up, key to delivering it will be reform.
And central to reform will be ever-deeper collaboration.
Integrated Care Systems are the most obvious expression of that, and we are all looking forward to July 1st.
They’re not though are they ends in themselves, but they are important means, and are going to be the primary drivers of delivery of better health and services for every community.
So It’s my job, and the job of my colleagues at NHS England, to provide them with the right support and incentives to be successful.
And that is our primary focus as we work through the coming-together of NHS England and NHS Improvement with Health Education England and NHS Digital.
Data and technology
One of the most important ways we will be doing that is in helping systems make the most of the opportunities offered by data and technology.
I won’t restate just how much they contributed to the pandemic response and the vaccine rollout because you’ve heard that already.
The task is now to get the infrastructure and the ways of working in place that makes that kind of utility the norm.
And because we are the NHS, we are at a huge advantage when it comes to taking these opportunities on a national scale.
Data is already case-finding for preventative treatment like heart disease, and identifying opportunities for proactive, pre-emptive care…
…it is already helping us ensure we are reducing health inequalities…
…and it is already helping to drive recovery and performance, too.
Importantly it can also deliver a personalised patient offer for those who want it.
At-home monitoring, virtual wards and outpatient video consultations have already brought more services into people’s homes.
And through expansion and improvement of the NHS App and NHS.uk, over the coming years we will increasingly be in people’s pockets, too.
A world-leading ambition, deliverable on a national scale, because we are the NHS.
Life sciences
Our unique ability to collect real-world, population level clinical data…
…combined with our increasingly confident relationship with the medtech and life sciences sector…
…is also already putting NHS patients at the front of the global queue for more effective and personalised tests, treatments and therapies.
And today I can announce that the NHS is using its purchasing clout and unique infrastructure to help tackle the global challenge of antimicrobial resistance.
Until now, innovation in antibiotics has been limited, despite the serious and growing risk of drug-resistant infections.
But through our world-first NHS subscription scheme, we have a real chance of turning the tide.
By providing guaranteed payments at fair rates for the taxpayer…
…we can give the life sciences sector the confidence to develop new and effective drugs…
…and we can make those drugs available rapidly for NHS patients who need them now…
…while, crucially, stewarding their use, so that they can remain effective for as long as possible.
This world-leading agreement is another example of how, because we are the NHS we can make it, and are making, England one of the best places in the world to undertake research.
And by doing that we will not just provide better care for patients
…but also make a significant contribution to the economy.
3.4 Resilience
Recovery and reform, the obvious forward-facing priorities.
But we can’t ignore the fact that resilience is fundamental to maintaining improvements.
Having the people we need is a major part of that.
We have more staff working for the NHS than ever before.
But we also have over 100,000 vacancies.
We are using the advantages of being the NHS to do what we can do now…
…through training record numbers…
…recruiting to new roles…
…supporting Trusts to recruit from overseas....
…and improving retention.
But we know that having the right number of people, with the right skills in the right jobs, remains a key question mark over our future plans.
That’s why we are now working with Health Education England to develop a Workforce Plan…
…not just to come up with numbers…
…but also the right approaches to how we can best deploy people to deliver the new kinds of care patients want and need, over the next five, 10, and 15 years.
Capacity
If step one is people, step two is places.
The NHS has long had one of the lowest bed bases among comparable health systems…
…and in many respects this reflects on our efficiency and our drives to deliver better care in the community.
But it was true before the pandemic, and it remains true now…
…that we have passed the point at which that efficiency, actually becomes inefficient.
So the point has come where we need to review how we right-size our capacity across the NHS.
That will of course look at the whole picture of hospital, community and virtual capacity.
Most people would much prefer being in the comfort of their own home than being in hospital if that was an option.
And because we are the NHS, we have the ability to give that option to patients who would benefit, wherever they live.
Collectively we have already rolled out 53 virtual wards to cover every part of the country…
…freeing up 2,500 bed spaces for those who definitely do need them…
…and providing a better experience for those patients who can recover at home.
I was at Alder Hey and Liverpool Heart and Chest yesterday where they were telling me about the success they have had, and the positive feedback from patients and their families.
So rapidly expanding this innovation will make a major contribution to our resilience, but also to improve patient experience too.
UEC Strategy/this winter
But alone, they are not the whole solution.
And we know we will need to make more progress before winter.
Frankly, the situation we see at the moment in emergency departments and ambulance services is as challenging as any winter before the pandemic.
To those colleagues to those of you who are immersed in this every day, let me assure you…
…when you tell us about the immense pressure you are under, we hear you.
April was the busiest ever for ambulance services in terms of calls and Category 1 incidents, and the second busiest for Accident and Emergency Departments.
But demand isn’t the whole story here.
The unacceptable rise in 12 hour waits for admission from A&E underlines that the issue is, as you know, flow.
You can trace the line from delayed discharges…
…to A&E crowding…
…all the way through to slower ambulance response times.
It’s difficult to see social care capacity being significantly expanded ahead of winter.
So the NHS must do everything in its power to tackle this.
We are working on an Urgent and Emergency Care Strategy by the Autumn.
But right now, we need to continue doing those things we can do because we are the NHS…
…working as whole systems to ensure people are treated in the right place for them…
…making maximum use of Urgent Community Response teams, Urgent Treatment Centres, and community pharmacy…
…fully reinstating things like same day emergency care and acute frailty services…
…and making sure we are doing everything we can to speed up those discharges which are to other NHS services rather than social care.
Greener
The daily news is also a reminder that we need to be more resilient in terms of our energy use…
…and we have already had to find as you know an additional £1.5bn this year to deal with the rising costs of energy and fuel, as well as wider inflation.
Because we are the NHS, we already have a world-leading drive to reach Net Zero by 2045…
…leveraging the ingenuity of our colleagues locally…
…binding in supply chains…
…and securing hundreds of millions of pounds of capital to local energy reduction plans.
Continuing this incredible progress is a ‘must do’ if we want a resilient health service for the future.
3.5 Respect
So recovery and reform, underpinned by greater resilience against the shocks of the future.
But we also need to talk about respect.
Respect for all those who have made sacrifices over the last 900 days, and are still making sacrifices today.
Supporting our workforce
Our existing workforce, firstly, who have faced such a tough couple of years.
We have learned a lot from the pandemic.
Because we are the NHS, we were able to rapidly roll out national offers to complement those provided by individual employers to support staff.
Dedicated staff mental health and wellbeing hubs, bespoke support for critical care staff, 24/7 text support services and free access to apps…
…all have played an important role and supported tens of thousands of colleagues.
This kind of support needs though to be part of an ongoing offer, increasingly tailored to what staff tell us they want and need.
And as part of that we know we still need to tackle the unequal experience of working in the NHS that many of our colleagues face…
…as shown in today’s survey from the BMA spoken powerfully by Victor earlier
Last week’s report from Gordon Messenger and Linda Pollard was a timely reminder that tackling discrimination should be every leader’s business, from ward to board.
We remain completely committed to continuing progress in this area…
…because we know that if we are to meet our goals for patients…
…then we must meet the ambitions of the NHS People Plan for our colleagues, too.
Secondly, respect for the taxpaying public, who have been asked to contribute more for the NHS over the next couple of years.
We must continue to take very seriously our responsibility to deliver the maximum possible benefit to patients for every pound of funding.
The NHS is already one of the world’s most efficient health systems.
Just 2 pence in the NHS pound is spent on administration.
In France, it’s double that, and in the USA, it’s 4 times that amount.
We have shown time and time again that, because we are the NHS, we deliver ever greater value for money, too.
In the decade before the pandemic, our average annual growth in productivity was more than double that of the wider public sector, and seven times that of the wider economy.
But we have, of course, needed significant extra funding to see us through the pandemic.
But now as we transition back to business as usual…
…and with residual COVID costs and inflation to deal with…
…we need to press on with delivering the best possible return for the public’s investment.
At 2.2%, we have already set very ambitious efficiency targets.
because we are the NHS we have an advantage over many other health systems in meeting them.
We can move as one in reigning in agency and consultancy spend.
We can negotiate the best rates for the whole service when it comes to new and effective medicines, access to independent hospitals for tests and treatments.
And we can use our buying data and power to find and deliver savings on the everyday items that are services need, and in how we use our estate.
But we must be realistic.
So far, we have absorbed the current inflation spike.
But budgets can only ever stretch so far.
Thirdly, respect for patients, who have given us their understanding and their support as we have responded to the pandemic.
Patient experience
Cost is one part of the value equation.
Improving quality is the other…
…and this has been one of the NHS’ guiding principles since 1948.
A little over a year after I started my NHS career, the Government published A first class service: Quality in the new NHS.
In his foreword, the then-Health Secretary, Frank Dobson, wrote:
“Fair and prompt access to modern and dependable treatment, should be the goal. And it must be delivered with courtesy and a real understanding of patients’ fears and worries.”
Now, it’s not how we would express it now, but the fundamentals are right.
Patient experience is as much a part of quality as effectiveness and safety.
So we should acknowledge that individual patient experience has not always been what we would have wanted it to be in the last 900 days.
Often for very legitimate reasons, to prevent infection and save lives.
But we’ve all seen and heard of the incredible compassion that colleagues have shown to patients and their families separated by those measures.
But now with IPC measures now relaxed, we need to get on with rolling back remaining restrictions.
An important example is allowing visitors for inpatients, as well as loved ones accompanying those attending planned appointments, and that really needs to become the norm again.
There have always been examples of where we need to balance safety considerations.
But the starting point has to be: what do patients want and need.
And the vast majority of people who are in hospital will want and need to see visitors.
And it’s that ethos which needs to guide how we develop services for the future.
Not asking “what’s the matter with you”…
…but instead, “what matters to you”.
Because by giving people a better experience, we can give them more effective care, too.
I heard a great example of this on Friday, when I visited the Sickle Cell and Thalassaemia service at the Whittington.
They have redesigned their pathways based on what their patient community told them really matters, resulting in a far more personalised care plan for their patients.
But I also heard really powerful stories from patients living with sickle cell disease about their experience of the wider health service…
…how they have been treated appallingly when they have needed to go to A&E in crisis
…so much so that they told me they have to think twice and often delay coming forward for care when they need it.
And this brings us back around to tackling health inequalities.
One of the patients I spoke to asked: “If I was white, would I be treated like this?”
She didn’t trust that the NHS as a whole viewed her as an equal.
That has to change.
I’m determined that we need to make things better for that particular patient group…
…and we’ll be saying more this weekend about some of the things we will do.
But this also speaks to how we need to improve experiences for all patients…
…and earn the trust needed to ensure that every individual feels able to seek help when they need it…
…and feels they will be listed to if they tell us something isn’t right.
Safety is an issue in every health and care system in every country.
The NHS comes into contact with literally millions of patients every week.
And not everything will go right every time.
What’s important is that we listen to patients, and staff, when they raise concerns…
…and that we use what we learn to improve for the future
Because we are the NHS, we are already the largest learning organisation in the world.
But the recent Ockenden report, the experience of families in Nottingham, shows that we still don’t get it right, quickly enough, all the time.
So as we go forward, we need to ensure that truly hearing the voice of patients, and being respectful of their experience, and that is central to everything we do.
4. Peroration
So those are my four ‘R’s:
…recovering from the inevitable impact of the pandemic…
…reforming and improving care for the future…
…building resilience to future shocks…
…and doing all of that with a guiding principle of respect for all of our staff and patients…
…and the wider public who support us.
That is our mission, and that is what the plans we have already published and are developing now…
…including an update to the NHS Long Term Plan…
…will all support.
The last 900 days have been tough.
I think the next 900 could be tougher still in many ways.
But the pandemic experience has not only shown us that the NHS can weather a storm.
It has shown us that when we work in partnership with communities…
… when we take full advantage of the opportunities available to us because we are the NHS...
…we can lead the world…
…we can make an unrivalled contribution not just to the health of the country, but the wealth of the country, too…
…and we can justify the public’s continued faith in who we are, what we do, and what we stand for.
Because we are the NHS, I know that we can do all of those things.
And I have confidence that, because we are the NHS, we will.