Saffron Cordery delivers her opening speech for this year's NHS Providers annual conference and exhibition 2022. You can read the full-transcript below.
Welcome
Welcome to the NHS Providers annual conference and exhibition. This is always a big moment for us, never more so than now because of the interruptions caused by COVID-19. So let me say, with added feeling, thank you for coming. It's good to see you. This event couldn't happen without our event partners and I'd particularly like to thank Hempsons, Newton and BD for their support.
I also want to encourage you to support all our commercial partners and spend as much time as possible in our exhibition space, and do look out for some really good sessions delivered by our partners.
Resilience
Since we last came together in person like at our conference three years ago, the NHS has been tested as never before. In that time we've seen the extraordinary sacrifice and commitment of staff, and the dedication and resourcefulness of leaders, innovating, problem solving, and working in new ways. Your leadership from across the provider sector – in hospitals, mental health, community or ambulance services – represents the best there is.
What COVID-19 has shown us is that the underlying pressures haven't gone away. In fact they have intensified as demand for care has grown, waiting lists of all kinds have lengthened, and staff vacancies increased. Social care is in crisis, and funding for health and care, and indeed the whole public sector, is severely stretched. These are very real challenges for the NHS.
It may sound trite to say in the face of this, that we need to pull together. But it's true, isn't it? As colleagues and as leaders, as representatives and partners in collaboratives, in places, systems and regions, with national colleagues and our local communities – we need to work towards creating a strong and sustainable service fit to withstand the shocks, turbulence and challenges of 21st century Britain. We need, quite simply, to be resilient.
Now, we know that some think using the 'R' word – resilience – as the theme for our conference is controversial. So let me be clear. This isn't about encouraging people to power on through exhaustion, forever putting on a brave front whatever problems they face, depleting their personal resources in seeking to tackle unending challenges.
I'm talking about the resilience that systems – of every kind, with a big 'S' and a small 's' – can engender. A resilient health and care system that is properly resourced, evidence and data driven, adaptable in meeting local needs and challenges, values-based to deliver quality, compassion, offering a fair deal to staff and patients, and an end to the structures that perpetuate discrimination.
This is the kind of resilience where leadership matters, behaviours matter, innovation can flourish, and equity is hardwired into everything we do.
So we're in Liverpool. It's fair to say Liverpool has lived through its share of turbulence and knows a thing or two about resilience and creativity. And it's now home, finally, to a new hospital – the Royal – which some of our leadership team visited yesterday. Through so many setbacks successive leaders have worked towards realising their vision of a modern, well-designed state-of-the-art facility, an investment which will help staff to deliver the quality of care the people here deserve.
That word, investment. It goes hand in hand with resilience. The headlines that decry the NHS as a bottomless money pit infuriate and exasperate me in equal measure. Of course, the health service must be efficient and effective. It must work to improve productivity. And it must be held to account for what it spends – which as trust and system leaders you are, every day.
But, let's be clear, resilience will be significantly undermined, if on Thursday the chancellor and the health secretary agree that it's acceptable to balance the NHS books by, yet again, raiding the hard won capital budget. Surely they know, as do you, that efficiency and transformation go hand in hand.
After all, what is efficient about the mental health trust which has to spend hundreds of thousands every year in repairs to keep an outdated building going?
What is efficient about the big teaching trust scheme which is 'shovel ready' as part of the new hospital programme but just can't get the go ahead, and the cost of the build is going up by the month?
What is efficient about the backlog maintenance bill having reached £10bn rendering buildings unsafe or unusable, putting operating theatres out of action and forcing patients to be treated in substandard conditions
And finally, what is efficient about not investing in the means to digitise the NHS frontline?
I don't want to fire shots at politicians. After all, it's not an easy job. But I would make one plea to them – every now and then just inject some long termism into your thinking. A truly resilient NHS will not be built by short term decisions – the kind that take us from now to the next general election. Patching, propping and stop gap measures are not lasting solutions.
Resilient systems are led by the evidence. That evidence tells us that the NHS is an investable proposition. Be it for buildings or equipment, research and development, strengthening the workforce, tackling inequalities, supporting mental health, or increasing employment – carefully planned, effectively delivered investment in health and care brings benefits that both improve the bottom line and also go way beyond it – building social, intellectual as well as economic capital and nurturing aspiration.
The case must be made and re-made for the NHS. You don't need me to tell you it is under attack from every angle – whether it's the questioning of the founding principles of the NHS or the increased calls for yet another NHS overhaul or the manager bashing.
These attacks are misplaced. The health service, and the values behind it, are something the public hold dear even as services have come under intolerable strain. They rightly want to see improvements but they don't want to see it gone. As the voice of trusts working in systems we have been and will remain champions and defenders of the NHS. Not out of dogma or self interest. Certainly not out of resistance to change – the NHS is no stranger to reform. We will continue to make the case for an NHS free at the point of use, regardless of ability to pay; and highlight the challenges, the solutions and what the NHS needs.
And this is our focus in the two key publications we are publishing during conference. Our State of the provider sector report, out today, based on a survey, sets out your concerns about the pressures you and your partners face in the lead up to winter, and the next in our Providers Deliver series shares learning from trusts operating successfully in systems – making a difference for patients and their communities. Building resilience in turbulent times.
Performance and progress
And what times! Three prime ministers this year, four chancellors, health secretaries coming and going. Political upheaval and economic turmoil, with society in shock from the ravages of a pandemic and cost-of-living pressures, all of which have devastating consequences. And now the real prospect of industrial action.
We'll be talking a lot about leadership and the challenges you face across your organisations, systems and communities. You also need support from our national leaders, politicians and the government. Here too we expect leadership based on experience, compassion and integrity, a willingness to act on evidence, to listen and to learn. This conference is the place to pose questions to those leaders.
It's very early days for our new secretary of state, Steve Barclay. Our politics and economy have been in flux but that doesn't make the task in hand go away. From him we need focus, strategic direction, a sense of shared endeavour and acknowledgement that the NHS does and can transform with the right support.
Despite the great work that you are doing, the NHS – too often – is coming up short for patients, staff and the public.
Response times for the most urgent ambulance calls have reached record levels. Four-hour performance in A&E is at an all-time low. 12 hour waits for admission have risen by 6000% since the start of the pandemic. And we see growing pressures right across health and care – in the numbers in contact with mental health services now at an all time high of 1.8 million, in delays for community services – paediatric diagnoses, audiology, speech and language therapy, the list goes on. The longstanding neglect of social care – its staff and infrastructure – is neither good for those who need the care nor for the NHS. Last month on average more than 60% of patients fit to be discharged were delayed – and that's only the figure for hospitals.
These statistics have human consequences. At NHS Providers we take care to be measured, accurate and evidence based. We call it as we see it. Right now we need to maintain investment across finance and capital, performance and workforce, health and race inequalities, COVID-19, the cost of living and social care.
Money is tight, with inflation on track to wipe out at least £7bn from next year's NHS budget. To say there is no slack in the system would be a gross understatement. Hence the recent warnings from NHS England that future investment in key services including cancer, mental health and primary care will have to be 'completely revisited'.
What gives in a service that's already overstretched? A £1bn reduction in funding for frontline services could mean around 700,000 fewer planned operations and procedures for patients next year. What would these cuts mean for quality and safety? What choices need to be made about the viability of smaller paediatric units and emergency departments, for much needed improvements to maternity care or services for long COVID? That's why protection for the NHS budgets in Thursday's autumn statement will be essential.
And, I don't want us to overlook the challenges for those services that are not always centre stage. Mental health and learning disability services are struggling as never before facing increased demand, the severity of cases coming through their doors are greater than ever before, lengths of stay longer than ever before, and the wait for services expanding.
Community services tell us they have a list of well over a million, including many children awaiting treatment vital for their development. We are now dealing with the new burden of long COVID, and ambulance services are most publicly visible at the sharp end in the emergency care pathway, handling the consequences of increased patient risk caused by overstretch across systems.
None of this is an excuse for poor performance, for breaches in quality and safety, but they are the context in which you operate. There are important lessons from Edenfield, from the Kirkup report and from other examples of abuse, neglect or poor care that have been exposed in recent months. As NHS leaders you aim high to provide the very best, often in difficult circumstances which make it harder to sustain a positive and caring culture.
Honesty, integrity, a willingness to learn, and an appetite for improvement are the cornerstones of resilience, but you need time and space as leaders, system partners, and colleagues to embed that.
You told us in our recent cost of living survey that many staff have now reached a tipping point. Nurses are skipping meals to feed and clothe their children. Staff are struggling to make the journey to work. It's getting harder to recruit and retain staff for lower paid roles. These money worries are impacting on the physical and mental health of staff, exacerbating the conditions patients present with if they're living in a cold home or going hungry, chipping away at their resilience, which it is our job – with others – to underpin. Let's be clear – as leaders you're stepping up – providing support and care for your staff with food backs, uniform banks, hardship funds, free meals. But really, this shouldn't need to happen.
So against this backdrop where are we now? Every year through our State of the provider sector report we check how you're feeling. The findings, published today, are stark. Overwhelmingly, you are more worried about the coming months than any previous winter in your careers. Less than one in 10 of you are confident you can meet demand for services. More than nine in 10 fear staff burnout. Finances are getting tighter, with most of you expecting the situation to worsen in the coming year. Fewer than half of you say you're on course to meet end of year backlogs and cancer targets. Confidence in levels of investment in social care is close to zero.
And, as we have seen for a number of years now, workforce is your biggest concern. Little wonder with vacancies topping 130,000, with experienced staff leaving, those on lower pay lured to retail and hospitality and senior staff stymied by pension rules. And industrial action is on the horizon.
This makes the failure by the government, still, to deliver a fully costed and funded workforce plan that defines and commits to meeting future workforce needs all the more frustrating.
But what also comes through is that determination to adapt, to do the best you can for patients, staff and your communities. You tell us that provider collaboratives are starting to improve outcomes and deliver greater value for money. There is hope.
Our survey shows that more of you are now prioritising health and race inequalities. Let's be clear these must be central pillars of everyone's work not a nice to have if we are to deliver equity and justice, and relieve the growing pressures on health and care services.
Staff from ethnic minorities make up a significant proportion of our workforce – 22% overall, with 25% of nurses and 45% of doctors from minority groups. We know the facts and figures only too well and we also know their experiences are so much worse than those of their white colleagues. These experiences are a reliable barometer of the climate of respect and the culture in an organisation, which also impact directly on patients.
And let's not forgot the connection between race, health inequalities and health outcomes. COVID-19 shone the brightest possible light on that. 63% of health workers who died were from an ethnic minority.
A decade ago deprivation related inequalities cost the NHS nearly £5bn a year. Let's imagine the cost now. Not tackling health inequalities not only undermines the financial sustainability of the NHS and resilience, it also diminishes its contribution to building resilience in our communities and society. It's estimated that health inequalities lead to productivity losses of £31-33bn a year. So, tackling race and health inequalities are not just morally right or an additional burden, they are, of course, part of solving the problem.
In the midst of so many challenges perhaps what is most striking and remarkable is the way you have not only kept services going, but also stepped up activity, helping more patients, often by working smarter, by coming together, supporting each other. No one should under-estimate the achievement of virtually eradicating two year waits even as Omicron diverted resources and increased staff absences.
Trusts in systems
For so many of the problems and challenges you and your boards face, systems and your role in them will be a big part of the solution. Through your developing partnerships and collaboration, working in different forms, footprints and configurations you are making integration a reality while expanding your role and remit into new areas. We're seeing fresh thinking.
Systems at their best harness the strengths of collective endeavour, adding up to far more than the sum of their parts. Yet this cannot dilute board accountability for overseeing care nor can it undermine the importance of good governance.
At NHS Providers we've made important interventions to shape the new architecture and have championed the role and integrity of the unitary board model, and we've helped you navigate this new, complex, landscape.
And it's vital in our approach to system work that we keep sight of the original intent behind integrated care systems. Improving outcomes, tackling inequalities, enhancing productivity, and supporting social and economic development. We need to give systems a chance to do what we need them to do – including their support for primary, social and community care, and ambulance and mental health services as they work to move activity upstream preventing the cycle of crises and admissions. Trusts in systems are at the heart of this work. As the place of delivery, they – you – are central to finding a way through and building resilience.
Solutions
This weekend the chancellor said there are no rabbits to pull out of the hat. We're not asking for him to be a magician. We're asking that he follows through on commitments made and investments planned.
While much of the provider sector's resilience will and should come from your own agency and actions, you need a framework of support from government and the centre to underpin this.
Resilience comes from decisions made for the long term: not raiding the capital budget to prop up revenue; finally committing to a long term costed and funded workforce plan rather than half measures and work arounds.
Resilience comes from understanding the dependencies and connections: reform social care, create a sustainable funding model which will support social and domiciliary care. The NHS – as well as local government – needs this to get through this challenging winter and beyond.
Resilience comes from sensible short term steps: changes to the pension rules to retain our senior staff; getting round the table to avert industrial action; changing the arcane Treasury rules on capital spending.
And resilience comes from the centre sometimes letting go rather than tightening its grip: don't haul in trusts when targets haven't been met, don't plan time consuming inspections that divert staff for the most pressured time of year, don't ask for returns that reassure you but don't shift the performance dial. And... whatever the circumstances don't ask for double sign off for expenditure as low as £50,000. Who knows where that will end.
You are playing your part as trust leaders to protect and improve services in these difficult days. We are playing ours.
You tell us how much you value our work in the media, in government and across health and care, the insight and analysis in our reports, briefings and bulletins. Your satisfaction with all our development programmes and events is truly exceptional. I commend to you our new development brochure which summarises our enhanced support programme.
I am proud to have led an organisation which is true to its values, respectful, inclusive, collaborative and effective. That is making concrete strides in becoming an anti-racist organisation, tackle race inequality and supporting you to do the same.
It's been my privilege to open this conference. NHS Providers new chief executive, Julian Hartley – known to many of you – will close the conference tomorrow afternoon. I'm sure you will give him a warm welcome.
This speech has been mostly about resilience. I want to finish by paying tribute to the team at NHS Providers, who, during the whole of COVID-19 and in more recent months have worked with genuine dedication to deliver services to you, our members, and have each played their part in making us the adaptable, creative and resilient bunch that we are. Thank you, team!
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