Earlier this month we hosted our first ever virtual conference and exhibition – a busy three days, jam-packed with insight, debate and sharing.
As well as a unique conference, we find ourselves in a unique year – with the challenges of COVID-19, and the resilience and innovation shown by trusts and frontline staff a central theme to all of our sessions.
Here are my ten key reflections from the conference:
- Centre stage for equality, inclusion and diversity
As well as the coronavirus pandemic, 2020 has brought into razor-sharp focus the racial inequalities facing us as a nation, and within the NHS. Two seismic events particularly shone a particularly bright light on this. Firstly, the disproportionate impact of COVID-19 on the Black, Asian and minority ethnic community, and secondly the murder of George Floyd and the Black Lives Matter protests this triggered.
It was central in our planning that our programme tackled and reflected this, and took forward the debate about how we in the NHS can listen, learn and change to better serve our Black, Asian and minority ethnic patients, service users and staff.
On day one, Patricia Miller, chief executive, Dorset County Hospital NHS Foundation Trust, and Roger Kline, research fellow, Middlesex University, led an insightful discussion on diversity in NHS leadership and the importance of initiatives that tackle inequality. Patricia also contributed to one of the most compelling sessions of the week – a panel on confronting white privilege, along fellow chief executives with Raj Jain, Richard Mitchell and Roisin Fallon-Williams. We’ve had overwhelmingly positive feedback from delegates on this session and the stories that were shared here. We feel it’s important to share these with a much wider audience, and will shortly release a podcast of the session. Do keep an eye out for that.
A personal conference highlight for me was a keynote address from John Amaechi OBE, who spoke about racism and inclusive leadership in the NHS. Drawing on his experience as a trust non-executive director, he challenged delegates to be 'connected leaders' and elevate people not just based on their technical expertise but also other qualities such as emotional intelligence, positivity and trust. He encouraged all NHS leaders to recognise that the contributions of those who are different are essential to our survival and to look beyond the usual suspects in recruitment and career progression.
We know that some of the stories and issues that were discussed here by our panellists were difficult to share and upsetting to relive and we are so grateful to those that contributed to these sessions.
- Where we are now: The state of the NHS provider sector
On the first morning of the event, we published the findings from our annual survey of NHS trust and foundation trust leaders, focusing on the impact of the first wave of the pandemic. Trust leaders are worried about their staff, with 99% of respondents saying they were worried about burnout across the workforce. There has been no let-up in the pressure NHS staff have been under and many leaders felt that the health service was heading towards a ‘perfect storm’ – a rise in COVID-19 cases, the coming winter and depleted staff and capacity.
It was therefore remarkable to hear from speakers and delegates about the unflagging commitment amongst staff to ensure patients are safe and continue to receive high-quality care – as well as the tireless work from leaders to find ways to build resilience and capacity amongst their workforce.
We, as a country, owe a huge debt to our frontline workforce, and the admiration and gratitude for NHS staff was absolutely palpable through the conference.
- Digital transformation and the future of digital
The impact of COVID has seen us all change how we work – using Zoom, Teams and other forms of virtual communication.
Trusts have accelerated the adoption of digital across health and care services, with impressive scale and speed. From virtual appointments and clinical innovations to a wealth of podcasts, videos and evolving social media strategies, trusts and their staff have adapted to new ways of working.
And digital advances were a central theme of our conference. We published a new Spotlight on… briefing, which highlighted great examples of work by trusts using digital resources to help ensure safe, high-quality care at a time of exceptional pressure on the health service.
On day two we held a plenary session on what the new era of digital leadership may mean for the NHS, with contributions from Andrew Greenway, partner at Public Digital, Navina Evans, chief executive at Health Education England, and a number of trust leaders. Discussions on what ‘digital’ actually means, as well as how we embed these at a leadership level in all NHS organisations, proved particularly relevant and helpful for delegates.
- Resilient and resourceful: innovations in response to COVID-19
Facing a spike in demand for services and an unprecedented pandemic, the NHS has performed remarkably this year. Key to that has been the willingness shown by trust staff and leaders to adapt and innovate to overcome challenges posed by the pandemic.
We felt it was important to highlight and celebrate this in our latest Providers deliver report. This includes eight case studies from trusts around the country on important innovations they’ve undertaken since March to continue to provide safe, high-quality care.
For the member showcase area of our conference, Providers deliver live, where we promote more examples of best practice and innovation, we were inundated with incredible examples from trusts about the work they’re doing, with more applications than ever before. We’d normally highlight ten key case studies in this area but chose this year to present 40 examples which reflect the amazing breadth of work happening in the sector. It felt important to be able to continue to share the learning on this, so we’ve made this area accessible on the NHS Providers website now too, which we hope will be a useful resource for trusts.
- The importance of leadership and building a good culture
Strong leadership and an engaging, inclusive culture is vital for the success of the NHS.
Roger Kline spoke about the role of leaders and how they are pivotal in influencing a trust’s culture. Leaders must put themselves in others’ shoes, show they’re serious about combatting prejudice and tackle problems head on. This isn’t an easy or quick fix. Roger said leaders need to stop looking for silver bullets - adding people to a panel or doing something as a one off - it doesn't address the actual problem.
Speaking about how we begin to ensure there is a full representation of people from minority communities at board level, Patricia Miller emphasised that there is no point in recruiting more staff in higher roles if the culture isn't there to respect them, treat them with dignity, and support them psychologically. She said trust boards should be held accountable to ensure that happens.
Our new programme on Inclusive leadership examines how healthcare leaders can help to address structural inequalities, particularly for Black, Asian and minority ethnic people working within the service. In our first blog, Patricia and Raj Jain shared their thoughts on why equality diversity and inclusion should be a golden thread running through organisational strategy, which I recommend all NHS leaders read.
- Looking after our staff
NHS staff have been praised by the public for their efforts throughout the pandemic, and rightly so. We wanted our programme to focus on the physical and mental wellbeing of NHS staff, who have given so much.
The recent resurgence in cases of COVID-19 has underlined yet again the pressures staff face, and the need to protect their wellbeing and prevent burnout.
On day one, our breakout session on how we can support the workforce through the pandemic and beyond, looked at how trusts can protect staff safety, the impact the pandemic has already had on staff wellbeing and what can be done to protect frontline workers going forward.
I chaired a session on supporting the workforce, with excellent contributions from Charlie Massey, chief executive at the General Medical Council, and Andrea Sutcliffe MBE, chief executive at the Nursing and Midwifery Council.
The results of our recent The state of the NHS provider sector survey showed that staff wellbeing is a top concern for trust leaders, be they acute, mental health, community or ambulance services.
A director of nursing at one trust told us: “Staff have been working in high stress circumstances for quite some time, long hours and not having leave. Despite wellbeing offers, this is a real concern”.
Our session for communications leads also highlighted concerns about wellbeing. The pandemic has presented extraordinary challenges for people working in trust communications, with. many working under incredible pressure and facing severe scrutiny. The session offered a reminder of the support and camaraderie that exists across the NHS trust communications community.
- The impact of COVID-19 on mental health
We know the impact of COVID-19 hasn’t just been physical – there’s been a much wider socio-economic effect, particularly on the nation’s mental health.
Our closing plenary session explored the consequences of the UK’s response to coronavirus. Our panel highlighted that COVID has accelerated mental health trends and members are seeing increasing demand for these services.
Panellist Angela Hillery, chief executive, Northamptonshire Healthcare NHS Foundation Trust, spoke passionately about the need for public health and prevention to be enhanced to assist with mental health support.
We have made, and continue to make, equity for mental health services one of our top influencing priorities. While the announcement on 10 October of funding to eradicate mental health dormitories is welcome and it’s good to see tangible steps to address the state of mental health facilities, we know that the dialogue around mental health is still unequal and there are still significant challenges facing this sector.
- The future of the NHS: collaboration and regulation
The future strategic direction of the health service was also a central theme across the three days.
Our plenary session with senior leaders from Care Quality Commission (CQC) Ian Trenholm, chief executive, and Professor Ted Baker, chief Inspector of hospitals, discussed CQC’s forthcoming strategy, Smarter regulation for a safer future, and outlined the transitional approach they have started to adopt. They placed a strong onus on having a supportive approach that is less intrusive and matches today’s challenges.
Our director of policy and strategy Miriam Deakin chaired a session on exploring provider collaboration within the system by default model. The discussion showed how providers are at the heart of collaboration across systems.
In our recent survey of trust leaders, 92% said that the experience of COVID-19 had accelerated better partnership working across systems, and this is reflected in collaborative efforts to restore services. These relationships will be vital in how the sector will manage the risk it is carrying over the next six months.
- Restoring services and the coming winter
Trusts and frontline staff are working flat out to restore those services which were necessarily interrupted to cope with the first peak of the pandemic. Chris spoke in his opening address about how it’s been frustrating and disappointing to hear the NHS described as providing a COVID only service over the last nine months.
The NHS never provided a COVID-only service. While the NHS did have to prioritise patients on the basis of clinical need, as it always does, to cope with the first COVID-19 surge and some treatments were delayed, when the impact of the virus on the NHS was at its peak, mental health, community and ambulance services carried on providing broadly the same full range of services to their patients and service users throughout the pandemic. The restoration of services is down to the energy and commitment of frontline staff.
We spoke in a number of sessions throughout the week about restoring services that were paused during the first peak of the virus and how hard trusts are working to ensure this happens. The second edition of our Restoring services: NHS activity tracker, published on day three of our conference, highlighted the great work that’s going on in this area. However, we look set for a difficult winter, and with cases of COVID-19 rising, local lockdowns, new restrictions, and concerns from trust leaders around a burnt-out workforce, we know there are concerns this could be a ‘perfect storm’ for the service.
- Clarity on funding
Funding is always a key concern for the NHS and an important theme at our conference. This year in Chris’ keynote speech, he warned that worrying gaps in health spending must be addressed in the forthcoming comprehensive spending review.
Reflecting on the way politicians have neglected social care over many years, Chris pointed out that the NHS could face a similar fate where funding failed to keep up with demand, pushing it into crisis.
The warning drew widespread national media coverage which was sustained throughout the week, highlighting the importance of this annual event, and the platform it provides to those who take part.
I would like to thank everyone who contributed to the success of our conference and exhibition, and hope the lessons shared will stand us all in good stead in the difficult months ahead.