Opening speech to NHS Providers annual conference 2019

Chris Hopson profile picture

08 October 2019

Chris Hopson
Chief Executive
NHS Providers


Hello, good morning and welcome to the NHS Providers annual conference and exhibition. Our flagship annual event and the single biggest gathering for provider board members in the NHS calendar.

This event couldn’t happen without our event partners and I’d particularly like to thank Hempsons and Newton for their support.

Can I please encourage you to support all our commercial partners and spend as much time as possible in our exhibition which you’ll find in Exchange Hall.

Can I also thank you for coming. I know how busy and stretched you are and how difficult it can be to take time out. 
 

Where is the NHS up to?

So, where is the NHS up to? I look forward to this speech every year because it’s my chance to step back from the day to day and reflect on the current state of the NHS with a longer term view.

Taking that longer perspective, there’s a lot to celebrate. 

 

Lots to celebrate 

 As a nation we remain deeply committed to the principle of a universal NHS free at the point of use with care provided on the basis of clinical need, not ability to pay. The opinion polls tell us that the NHS also remains the biggest reason why we’re proud to be British.

The service is treating significantly more patients than ever before...
...13% more cancer patients being seen each year…
…6% more diagnostic tests and ambulance incidents attended…
…5% more patients benefitting from NHS talking therapies and A&E department admissions.

And, as the first in our new series of Providers deliver reports will show tomorrow, judged by independent Care Quality Commission (CQC) ratings, trusts have not just maintained, they’ve actually improved the quality of the services they provide.

The majority of trusts are now providing good or outstanding care. And we now have 27 outstanding trusts. Given the challenging context, that’s an amazing achievement.

Providers have, over the last decade, also realised record level of efficiency savings. Last year, for example, trusts realised implied productivity improvements of 2.3% and the NHS is rightly rated as one of the most efficient health services in the world. 

 

An uncomfortable truth

But there is an uncomfortable truth. Despite the frontline working harder than ever before…
…despite the NHS treating many more patients year on year…
…despite the NHS becoming more efficient…
The service is currently unable to keep up with the increase in demand for NHS care.

It’s not just that demand is growing. We’ve also not been growing NHS capacity fast enough to keep up with that demand. If NHS spending over the last nine years had grown at its usual post war rate, we’d now have £25bn’s worth of extra NHS capacity.

Instead, over the last nine years, we’ve had the longest and deepest financial squeeze in NHS history. As a result, growth in NHS capacity has lagged a long way behind growth in NHS demand.

 

Over the last nine years, we’ve had the longest and deepest financial squeeze in NHS history.

Chris Hopson    Chief Executive

 

 It’s like the NHS is in a race with Sir Mo Farah and, even though the NHS is running at full stretch, it just can’t keep up because he keeps going faster and faster and the distance between keeps getting bigger and bigger.

As a result of this demand / capacity mismatch, NHS frontline performance against many of the traditional performance metrics is now the worst it’s been for a long time.

Despite seeing over 900,000 more patients a year in A&E, only 86% of patients are now being treated within four hours compared to the 95% standard.  

 

Despite seeing over 900,000 more patients a year in A&E, only 86% of patients are now being treated within four hours compared to the 95% standard.

Chris Hopson    Chief Executive

 

We’ve had several failed attempts to deliver over optimistic A&E performance recovery trajectories. And there is, legitimately, real concern about the coming winter.

It’s a similar story in elective surgery and cancer. 400,000 more completed elective pathways over the last 12 months, compared to the previous year. But only 86% of patients being seen within 18 weeks, compared to the 92% standard. Though we should remember that this performance is hugely better than it was fifteen years ago, when we measured elective waiting times in months not weeks.

275,000 more cancer patients seen a year. But the 85% 62 day treatment standard missed every month since 2016.

We’ve traditionally focused in the NHS on acute hospital access targets. Rightly, that is now changing. Not before time.

But the pressure on our mental health, community and ambulance services, and the gap between NHS demand and NHS capacity in these services, is just as great.

Ambulance services dealing with 4% more calls and attending 10% more category one incidents a year but still, on the latest figures, missing the two key response time targets.

18% more mental health out of area placements than a year ago and, despite the extra investment and activity, still only treating 30% of children and young people with mental health needs.

59% of community trust leaders saying their trusts can’t meet the demand for adult community services.

The NHS is clearly running harder and faster than ever before. But without the extra capacity to match the extra demand, the NHS is not keeping up.

 

Why we need to discuss the uncomfortable truths 

This is not a source of pride for anyone who works in the NHS. The rocket fuel that powers the service is the commitment of NHS staff to go the extra mile to deliver outstanding care.

This is also an uncomfortable conversation. Uncomfortable for a government that wants to demonstrate it is a successful steward of the NHS. Uncomfortable for senior national NHS leaders who will want to demonstrate they’re leading the NHS effectively. Uncomfortable for NHS frontline leaders, because your mission is to provide great care for every single one of your patients. But if the NHS is to meet the challenges it faces, we do now need an open and honest conversation about where we really are.

 

But if the NHS is to meet the challenges it faces, we do now need an open and honest conversation about where we really are.

Chris Hopson    Chief Executive

 

So we can be clear about what we do next. The other big document we are launching at this conference is the latest in our regular series on the State of the provider sector. A standout figure is that 91% of the frontline leaders surveyed didn’t think that, as a nation, we’re having the debate about the future of the NHS that we need.

A debate about what the NHS needs to preserve that principle of universal free care, irrespective of ability to pay, which is so important to us all.

A debate about how much the NHS can deliver…
…if it doesn’t get the funding and resources it needs…
…if it doesn’t have the workforce it requires…
…and if it has to devote too much of its energy to recovering performance rather than improving and transforming services.

The truth is that…
…despite the enduring power of the universal NHS offer…
…despite the superhuman effort at the frontline…
…despite the enormous range of positive achievements to point to…
The NHS is not performing as well as it should be because it can’t currently keep up with rising demand.

What do we do next? The five things the NHS now needs to do

You might think this makes me pessimistic about the future. It doesn’t. The NHS has proved remarkably resilient across its 70 year history and I am confident that we will meet the current challenges. But there are some important things we now need to do.

They are, and I’ll address each in turn:

First, our health and care system needs to plan much more effectively to meet the demand increases we are now facing.
Second, the NHS has to actually deliver its oft repeated pledge to shift from treating illness to preventing it.
Third, we have to accept that the current, default, approach of working NHS staff harder and harder is simply not sustainable.
Fourth, whilst the NHS has a good set of long-term ambitions, we now need a plan to deliver them.
Finally, given where we are, we have to be more realistic about what the NHS can deliver and how quickly. 

Better long-term planning to meet demand

So, first, planning more effectively to meet the demand increases our health and care system faces… And being honest about the consequences if we don’t build the capacity to match those demand increases. Mostly because of the demographics and more complex needs, and partly because of improved treatments and increasing expectations, demand for health and care services is rising rapidly.

That’s a good thing, not a bad thing, as it means more people are living longer. It’s also not unusual. Most advanced nations face a similar challenge.

But we can only meet that challenge if we properly plan for it. By creating realistic future demand projections. By making those projections a centre piece of effective long-term strategic planning. By having the right capacity in place to cope with that rising demand as it arrives with increasing intensity. By recognising that creating extra capacity takes time, focus and money. And by being honest about what our health and care system can actually deliver if we don’t create that extra capacity.

It doesn’t mean trying to create a perfect 10 year Soviet tractor plan. But it does mean making the best and most realistic guess we can on how demand will develop over a 10 to 20 year period and what capacity is needed to meet it.

And when I say realistic, we need to recognise that the better the NHS is at providing treatment, the more demand it will generate. For example, as the NHS has improved its mental health services, completely understandably, more demand has been uncovered.

Too often in the past, we’ve planned on the basis of artificially low projected annual demand increases to make the money add up each year. We’ve hoped that a succession of demand management schemes would redirect demand or make some of it disappear altogether. We’ve left the detailed work on long-term demand projections undone and rather than adding capacity, we’ve been taking it away.

In reality, none of the demand management schemes has consistently worked in the way or to the degree hoped for…
…actual demand has risen much faster than we planned for…
…and we haven’t been able to afford the extra capacity required… 
…so when those demand increases arrived, the extra capacity we needed wasn’t there…
…as a result, the NHS frontline has struggled to cope.

It’s right to be ambitious about managing demand. We need, in that famous phrase, to bend the demand curve. And in some of our more advanced integrated care systems we are beginning to see that happen.

But we risk putting intolerable pressure on our staff… and we inevitably risk letting down patients… if we are too optimistic about how quickly and consistently that demand curve can be bent.

There is a simple and stark underlying reality here. The single biggest feature of health and care over the next two decades is that demand will increase significantly. 

 

The single biggest feature of health and care over the next two decades is that demand will increase significantly.

Chris Hopson    Chief Executive

 

The single biggest determinant of our success will be how well we cope with those demand increases. If our health and care system is already starting to struggle at the beginning of that demand bulge, what will it look like in five, eight, ten, years’ time, when we’re in the middle of that bulge?

We have got to get better, quickly, at planning for this. Like the Germans and Japanese have done. We have to expand capacity to meet that demand or accept the consequences if we don’t.


Social care

I have deliberately framed this as a challenge for our health and social care system. It’s difficult to find new, more powerful, words about the urgent… the pressing… the overwhelming need to find a sustainable solution to our current social care crisis.

 

It’s difficult to find new, more powerful, words about the urgent… the pressing… the overwhelming need to find a sustainable solution to our current social care crisis.

Chris Hopson    Chief Executive

  

It’s all been said so many times before. We’ve said it. Local government has said it. Our colleagues at the NHS Confederation, with our full support, are running an excellent campaign saying it. This summer, a cross party committee of peers led by Michael Forsyth and including Norman Lamont, both well-known fiscal hawks, said it. Even the Daily Mail has now joined in, saying it in a powerful ongoing front page newspaper campaign. We just need our politicians to get on and deliver a sustainable solution to the national scandal that is our current social care crisis.

 

We just need our politicians to get on and deliver a sustainable solution to the national scandal that is our current social care crisis.

Chris Hopson    Chief Executive

 

 Because meeting the increasing demand we face requires not just a sustainable NHS… it also requires a sustainable social care system too.

Delivering the shift to prevention

A key way of bending the demand curve is for the NHS to actually, finally, deliver its oft repeated promise to shift from treating illness to preventing it. And that’s the second thing we need to do. 16 years ago Sir Derek Wanless, in a seminal report on the future of the NHS, highlighted the importance of moving our health system from treating illness to preventing it. Supporting our citizens to take greater responsibility for their own health and wellbeing.

Every year since that report, one senior NHS leader or another has pledged that this time it will be different and that we will make this shift… And every year since we’ve failed to develop and deliver the plan that would turn those oft repeated pledges into concrete reality.

The evidence on the wider social determinants of health and the drivers of health inequality is utterly compelling.

The air we breathe… The exercise we take… The food we eat… Where we live… The life skills we were taught at school… The job, the friends, the salary or benefits, the social support network we have… All have just as much influence on individual health and wellbeing as the treatments the NHS provides.

Perhaps the greatest contribution that sustainability and transformation partnership and integrated care systems can bring to health and wellbeing is their ability to connect the NHS to our local government partners, local charities and voluntary organisations who have such a key role in education, leisure, housing, transport and wider social support. But the NHS has to make the most of that connection. 

 

Perhaps the greatest contribution that sustainability and transformation partnership and integrated care systems can bring to health and wellbeing is their ability to connect the NHS to our local government partners, local charities and voluntary organisations who have such a key role in education, leisure, housing, transport and wider social support.

Chris Hopson    Chief Executive

 

It’s very striking how, in places like here in Manchester, taking a whole view of place... taking a broad view of health and wellbeing…really is starting to make a difference.

But there’s also a central role for government here. The single biggest step to improve our national health over the last 20 years was the ban on smoking in public places. The obvious next steps on that journey are sugar and salt in food and clean air. There seems to be a battle for the government’s soul on this issue at the moment.

It’s great to have a prime minister who has made the NHS his top domestic priority. It was great to hear his conference speech commitment last week, just next door, to the universal principle at the heart of NHS. It’s great to see progress on the NHS’ pensions and capital crises, though on capital we now need a more strategic approach and one that properly embraces community and mental health services.

But I suspect the single biggest things the prime minister could do to ensure the long-term future of the NHS is to provide effective personal leadership on salt and sugar in food and clean air. 

 

But I suspect the single biggest things the prime minister could do to ensure the long-term future of the NHS is to provide effective personal leadership on salt and sugar in food and clean air.

Chris Hopson    Chief Executive

 

Sheltering behind flowery rhetoric about "nanny-statism" doesn’t cut the mustard.

 

The secondary care sector role

The secondary care sector also needs to play its role too. Trusts spend £80bn of the NHS’ annual £140bn budget... employ 800,000 of its 1.2 million staff... interact with a million patients every 36 hours. They have a very strong influence on how local system strategies will develop in future and are therefore in a unique position to turn a commitment to prioritise prevention into a concrete reality. And, if we take a broad definition, trusts, in their day to day work, also have a key role in preventing illness by treating patients effectively and in a timely way.

If we can only treat 30% of young people needing access to children and adolescent mental health services, we risk creating a whole host of preventable problems later in life. If waiting lists lengthen, we risk conditions deteriorating with more patients in greater pain needing greater levels of support.

So, if the NHS is to make prevention a reality, we can only do so if the leaders in this hall play their part…
…making every patient contact count…
…helping their local system develop the right strategy and…
…ensuring it gets delivered.

 

Trying to get NHS staff to work harder has now become unsustainable

 The third issue is to recognise that the current, default, NHS approach of trying to meet increasing demand by asking our staff to work harder and harder is now clearly unsustainable. 

 

The current, default, NHS approach of trying to meet increasing demand by asking our staff to work harder and harder is now clearly unsustainable.

Chris Hopson    Chief Executive

 

As demand has risen and NHS capacity has stayed static, or actually shrunk, we’ve asked staff to rise to the challenge and fill the gap. Stay on late, beyond the end of the shift, to make the last few calls as a community nurse. Work extra shifts on the mental health ward, or on the ambulance fleet, to make up for workforce gaps. Care for a larger group of patients on the hospital ward, skip or shorten a break, because someone’s off sick. Help look after an inexperienced agency staff member as well as doing the usual tasks.

NHS staff have responded magnificently, as they always do. They’ve gone more than the extra mile. But wherever you look, the evidence shows that NHS staff can’t keep giving as much extra as we are now consistently asking of them. They are growing tired in ever increasing numbers. They are burning out in ever increasing numbers. And they are reducing their hours or leaving the NHS altogether in ever increasing numbers.

Take the nurse I met recently who was almost in tears as she told me that, despite her continuing strong sense of vocation, she couldn’t carry on any longer, as she was constantly waking up in the middle of the night worrying whether she had enough to time to do the right thing for her patients.

Take last week’s Nursing Standard survey. It showed that 52% of nurses go through a shift at least once or twice a week without drinking any water or having the chance to hydrate. And that 76% of nurses regularly go through a complete shift without a break.

This cannot be right. The NHS can’t keep trying to meet increasing demand by asking its staff for superhuman effort day in day out, week in week out, month in month out. So what do we do?

The current workforce crisis has been created by a combination of different factors. And it’ll require solutions across a range of different issues. There are no quick fixes or silver bullets here.

 

The current workforce crisis has been created by a combination of different factors. And it’ll require solutions across a range of different issues. There are no quick fixes or silver bullets here.

Chris Hopson    Chief Executive

 

An important part of the answer is being provided in the people plan. I know that some found the interim people plan slightly underwhelming. I think they’re missing the strategic point. For too long, the NHS workforce debate has just been about numbers and money. Of course they’re important. But they are not, and never have been, the whole story.

As the people plan sets out, making the NHS a great place to work, improving leadership, tackling our current nursing crisis and equipping our workforce to deliver 21st century care are key ways of helping to solve our current issues.

And there’s a vital difference on these issues compared to the money and the numbers. These issues are the responsibility of frontline leaders who can largely control them.

I am struck, as I visit trusts across the country, by how much trust leadership teams now recognise that waiting for NHS England and Improvement… waiting for Health Education England… and waiting for the Department of Health and Social Care… to solve the NHS’ workforce issues isn’t going to work. And that taking more responsibility for these issues is the only answer.

Developing innovative relationships with local colleges to offer nursing courses with guaranteed placements and jobs at the end. Going to local schools to promote the NHS as an attractive future career option. Rapidly introducing new job roles and pushing the boundaries of the work these roles can do. Rethinking rostering to provide staff with greater flexibility and a better work-life balance. Joining with nearby trusts to build a shared staff bank, develop leadership talent and create a common passport to allow staff to transfer hassle free.

These are some of the important answers to our workforce problems. Local leaders creating local solutions in local contexts.

That’s why another key element of the people plan is to equip, enable and support local leaders to take greater responsibility for these issues… Recognising that, if they do, money and resource currently held at national level have to be devolved.

Of course, the people plan does also set out some key areas where the government and their arm’s-length bodies need to play their part as well.

Rapidly solving current pensions problems, not just for senior doctors and nurses but for managers and junior staff too. 

 

Rapidly solving current pensions problems, not just for senior doctors and nurses but for managers and junior staff too.

Chris Hopson    Chief Executive

 

And if government wants to help the NHS over this coming winter, the best thing it could do would be to quickly solve this issue, with retrospective impact, to maximise frontline clinical capacity over the next few months.

We also need government to ensure that our new immigration system recognises the skills and importance of all NHS and social care staff, not just those who are paid above a certain threshold. That trusts can quickly and easily recruit doctors and nurses from overseas whilst we scale up our domestic workforce. And that the legislation covering professional regulators is changed so they can ensure those in new job roles can use their skills and expertise to best effect.

But the key concept at the heart of the people plan is that frontline leaders now need to make strategic workforce management one of their key priorities. 


Improvement

But there’s also another part to the answer here. If you look at trusts rated outstanding by the CQC, many - Surrey and Sussex Hospitals, East London, Western Sussex, to name but three - have had a systematic long-term approach to improvement at the heart of their journey.

For a long time, the NHS approach to improving performance has been to…
…relentlessly focus on a narrow basket of acute hospital targets…
…set top down improvement trajectories…
…specify how they should be met…
…force the creation of a rapid response temporary performance improvement initiative…
…assure from above… 
…and grip harder if that doesn’t work.

These trusts have inverted this top down, short term, command and control, model.

They’ve taken a long-term, systematic, approach to improvement…
…based on a much broader set of objectives…
…empowering their staff to identify and lead their own service improvements… 
…building the skills and the methodology required… 
…focusing on providing better patient care, not just delivering an access target… 
…and changing the management culture from top down operational firefighting to enabling and supporting long-term improvement. 

We know this is difficult. But, done well, it really works.

That’s why we’re delighted to be working with the Health Foundation to develop a programme to support trust boards to lead the adoption of a trust-wide approach to improvement. 

We all need to help Prerana Issar and Hugh McCaughey, the new chief people and improvement officers at NHS England and Improvement and Amanda Pritchard, the new chief operating officer, to knit these people and improvement agendas into a single coherent whole…
…identify what’s needed from a national level framework…
…set out clearly what support is needed at local level…
…and then start to purposefully address the workforce and performance challenges the NHS currently faces.

I think it can be done. But we mustn’t under-estimate the scale of what’s needed… And the time that it will take.

We have the right ambitions - we now need a plan to deliver them

The NHS’ fourth task is that, having developed a set of ten year NHS outcomes, we now need a concrete plan to deliver them.

I want to publicly acknowledge the way that Simon Stevens involved frontline leaders and organisations like ours in the creation of the NHS long term plan. That was an important and welcome step towards the collaboration and co-creation we have been seeking. The result is a compelling and ambitious set of long-term objectives.

We now need to work together - NHS England and Improvement, local systems and individual clinical commissioning groups (CCGs) and trusts - to create a clear, concrete, comprehensive plan to actually deliver those ambitions.  

 

We now need to work together - NHS England and Improvement, local systems and individual CCGs and trusts - to create a clear, concrete, comprehensive plan to actually deliver those ambitions.

Chris Hopson    Chief Executive

 

  Working together we need to bring…
…clarity on what really are the key priorities and what needs to be delivered when…
…clarity on exactly what’s meant by the new commitments on reform of outpatients, digital, and a new integrated community and primary care pathway for older people…
…clarity on how the new financial architecture and the new capital regime really will operate and where the NHS is going on the access standards that, hitherto, have sat at the heart of the way the service has been managed…
…clarity on how the delivery commitments will align with the workforce and financial constraints the NHS faces.

And, underpinning all of this, clarity on the NHS operating model – how the NHS will now work to deliver these ambitions...
…how performance will be measured…
…how the new four tier NHS – nations, empowered regions, local systems and individual providers and CCGs - will work…
…and how accountability, finances and performance will be managed across those tiers.

That’s a huge amount for us all to do, together, over the next six months to be ready to start delivering the long term plan from 1 April 2020.

I welcome how Simon and his team are trying to change the way the NHS plans. In the past, NHS planning has been in danger of resembling Alice in Wonderland.

NHS England and Improvement have asked trusts to complete templates showing how the frontline is going to deliver the impossible. Eliminate a persistent deficit at breakneck speed. Return to constitutional standards in a year to two. The frontline, wanting to keep the regulators off their backs, have given an answer they knew can’t be delivered. The result was a work of fiction and a corrosive, upside down, world that helped no-one. We made some good, sensible, steps at the start of this financial year.

A realistic financial task… at last.
A realistic efficiency requirement… at last.
A realistic recognition of what really could be delivered… at last.

We now need to maintain the momentum away from Wonderland. We’ve just completed the first iteration of a planning process that can successfully marry national top down and local bottom up in a way we’ve not done before.

But we need to recognise the scale of change we are trying to make here. From top down command and control, thou shalt deliver, annual operational plans focused on a narrow basket of acute focused performance metrics. To, rightly, a more strategic, whole system, multiyear process across a much broader range of priorities where local has a much greater role in determining what’s delivered when.

We need to be realistic that it’s going to take time for us all to learn how to develop and use the new set of muscles that will be required here. We also need to recognise that it’s been a difficult first phase.

Many local systems are still finding their feet. The national framework has been sketchy and incomplete, though that’s now changing. And, given other pressures, frontline leaders have struggled to devote the time required.

As a result, the first draft plans submitted 10 days ago will need a lot more work.

What happens next is key. We need three things.

A small collaborative group, including the frontline, to design and oversee the rest of the process. Sensible process, sensible outputs, sensible timelines that meet the need of the frontline not just the needs of NHS England and Improvement.

A quick collaborative way of filling the gaps in the national framework that can be completed at this point.

And mature, effective, realistic conversations when performance or financial gaps remain and need to be closed.

What we must avoid is a reversion to Wonderland where NHS England and Improvement toss back first draft plans, with lots of red pen markings and must do betters and once more demand the impossible via the dreaded templates that can only be completed with the answer they want to hear.

If we do this properly, together, then it can work. But we have to get our skates on as there’s a huge amount to do to complete the work needed by 1 April 2020. 

 

Being realistic about how far and fast we can go, given where we start from

The final task brings me back to where I started. The need to be clear and realistic about how much the NHS can deliver, and how quickly, given where the service currently is. A taxpayer funded NHS brings many advantages.

The power of the universal NHS offer… the equity that brings… And the commitment this engenders among patients, staff and taxpayers alike. This is what makes the NHS so admired across the world.

But taxpayer funding brings some awkward dynamics to navigate as well. It puts the NHS, as we have seen over the last fortnight, at the heart of the party political debate. All governments will understandably want to show how well the NHS is running. Any admission of poor performance makes them electorally vulnerable.

It is the role of national NHS leaders to maximise the level of public funding for the NHS. And governments want to see concrete returns for any extra investment they make. 

 

It is the role of national NHS leaders to maximise the level of public funding for the NHS. And governments want to see concrete returns for any extra investment they make.

Chris Hopson    Chief Executive

 

So there will be inevitable pressures to promise more than can be delivered to win a larger share of a finite public expenditure cake.

But there is a trap for the NHS if it over promises and then under delivers. If we pretend the NHS can deliver every single commitment in the long-term plan in double quick time with a five year revenue settlement that barely keeps pace with growing demand… If we pretend we can transform the NHS at a pace no other national health system has ever been able to achieve… If we pretend that recovering performance standards, returning to financial surplus and solving our workforce challenges are easier than they really are… We risk creating unreasonable expectations that will inexorably turn into unreasonable pressure on frontline leaders. We risk setting the NHS frontline up to fail as they can’t deliver what’s required of them, however hard they try. We risk creating a relentless narrative that the NHS is performing poorly. We risk weakening the bonds that tie the NHS to our nation. And, ultimately we risk the continued survival of that model of universal access to which we are all so committed.

There is a clear argument I hear in some circles that...
…trusts should be trying harder…
…their leaders should be performing better…
…change should be happening faster…
…unacceptable variation should be being eliminated quicker…
…and that the government should be getting a better, more rapid, return on its extra investment.

It’s right that we should have these debates. The NHS should be held to account. It is £140bn of public money.

But the NHS frontline really is working harder than ever. Seeing and treating more patients than ever before. 223 trust leaders really are doing their very best in some of the most difficult, stretching and complex leadership roles in our country. 

 

The NHS should be held to account. It is £140bn of public money. But the NHS frontline really is working harder than ever.

Chris Hopson    Chief Executive

 

There is a huge amount that can be improved. But we have to be realistic about how much can be changed, how quickly, when the sector is 100,000 staff down, is running an underlying financial deficit of £5bn, has been starved of capital for years, and when it takes prodigious amount of energy from staff and leaders to just keep an increasingly unstable ship upright.

And yes, there is plenty of variation to eliminate. But it will take time, capacity and focus that will be difficult to carve out given the current day to day operational pressure.

The current performance challenges in the NHS aren’t primarily a function of trusts and their leaders underperforming. They’re a function of rising demand, insufficient capacity and workforce shortages.

  

The current performance challenges in the NHS aren’t primarily a function of trusts and their leaders underperforming. They’re a function of rising demand, insufficient capacity and workforce shortages.

Chris Hopson    Chief Executive

 

 Which is why I return to my key point here. We need an honest, realistic and transparent debate about what can be delivered given this is where we start from. We need:

…stretching but realistic expectations...
…an ambitious but a deliverable performance and financial task...
…robust and rigorous but compassionate and supportive accountability...
We do now have to make some big and important choices.

We can’t carry on trying to squeeze every ounce of extra performance out of an increasingly tired and demotivated workforce against a narrow basket of acute access targets.

We have to create the space for the long-term approach to improvement that is clearly working in a range of outstanding trusts.

We have to create the space to deliver a broader range of priorities from mental health and integrated care to digital and system working.

We have to create the space to forge a new culture, a new way of working and a new operating model.

  

Summary

So, to summarise my five tasks. If the NHS is to successfully meet the challenges it faces:

We need to plan more effectively to meet rising demand, increasing capacity to meet that demand or accepting the performance consequences.

We need to actually deliver the shift to preventing illness, not just treating it.

We need to recognise we can’t carry on trying to meet rising demand by just working staff harder and harder.

We need a clear plan to deliver the exciting ambitions we’ve now set out.

And we need to be more realistic about how much can be delivered how quickly.

 

NHS Providers

Let me wind up with some reflections on NHS Providers. I hope you feel we continue to work hard on your behalf.

We’ve had a busy year…

…running a major new campaign on the need to increase NHS capital investment that is already bearing fruit…
…influencing the emerging legislative proposals that will form an NHS Bill in the coming Queen’s Speech…
…developing new programmes to support Board leadership of digital, trust wide improvement and neighbourhood level integration of care.

170 events…
…94 briefings…
…15 member surveys…
…34 member network meetings…
…11 member dinners…
…5,000 media mentions…
…30 placed comment pieces…
...670 stakeholder meetings…
…18 consultation responses

All delivered by 50 people. A good year’s work, I think.

And we’re changing as the service is changing…
…a greater focus on system working and integrating care…
…a greater focus on primary care including an exciting new partnership with the National Association of Primary Care we’re announcing tomorrow…
…a greater focus on prevention and digital.

But some things, rightly, remain the same. We remain, as we have always been, here to serve you, governed by you and funded by you. Able to speak truth to power precisely because more than 80% of our income comes from membership subscriptions. And on the latter, we are going to need your help and support as our membership subscription income comes under more pressure as trusts come together.

 

 

 

Optimism

 

 

 

Let me finish with one final reflection. We are all bound together by our commitment to that universal ideal that underpins our NHS. Whatever our difficulties and challenges, however great they may be, I remain profoundly optimistic that that commitment will see us through.


Enjoy the rest of the conference and thanks, again, for attending.

About the author

Chris Hopson profile picture

Chris Hopson
Chief Executive
@ChrisCEOHopson

Chris Hopson is the chief executive of NHS Providers. He joined in September 2012 after a career in politics, commercial television and the civil service. Read more

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