Amanda Pritchard speech to NHS ConfedExpo conference, 12 June 2024


Thank you, Victor.

It’s great to be with you all again.

As it’s great once again to be working in partnership with the NHS Confederation.

And we do so on many key priorities to bring together a programme full of interesting speakers and brilliant examples of what can be achieved for patients.

Thank you, to you Victor, to Matthew, and to the teams in both our organisations, for all the hard work that goes into making this week happen and indeed for the work we do together the whole year, to support colleagues in health and care.

Things look a little different to when we began planning the agenda.

We knew this would be a year in which politics and the NHS would be more intertwined than most.

In truth, there’s never a year where they aren’t.

I was reminded of that a few weeks ago joining hundreds of NHS colleagues for a special performance of Nye, a play which gives a glimpse into what drove Aneurin Bevan in his battle to bring the health service into being.

Bevan – many of you will know – was a very quotable character. And I want to share one of them with you today. It’s not featured in the play, so I’m not giving away any spoilers.

It’s one told to Peter Hennessy by Barbara Castle, herself a future Health Secretary.

Talking in 1948 about the gargantuan task of building the new welfare state, Bevan told her: “Barbara, if you want to know what all this is for, look in the perambulators”

For those of us who were not born in the Victorian age: that’s prams.

That simple advice will resonate with many of us here today.

Those of us driven by a mission.

Wanting to make the world – even just a small part of it – a better place for others.

What better reminder of the importance of that mission than looking into the face of the children – the generation – who will inherit it from us?

And it’s a mission that, on so many fronts, we can say we’re achieving as the NHS.

Many of the services we now offer, unthinkable in 1948.

The NHS has constantly adapted to the changing needs of patients and the opportunities afforded by science and technology.

Just a few days ago we had cause to be proud once again.

The first trial jab delivered through the NHS cancer vaccines launch pad.

A programme that could change the future for the better, for millions of people.

And one that the NHS is uniquely able to deliver thanks to our scale and make-up.

But it’s not always easy. And it never has been.

Bevan’s advice, rooted in his own experience. And 76 years on, many of us will still need to heed it, metaphorically, at least.

Because it is hard. Missions motivate, especially when they’re as crucial as ours.

But they can also weigh heavy, especially when we feel we aren’t achieving them.

And it would be easy to feel that.

For all the great things we will hear about today and tomorrow, all the milestones we can point to, we all know we could still do far more, far better, for our patients.

And when you’re in it every day, staying over the end of your shift, having to explain to patients why things aren’t the way they, or you, would like.

That is hard.

And when that’s your working life, and outside work you hear of examples where the NHS has fallen short, that can be hard, too.

The recent report from the Infected Blood Inquiry was a case in point.

A tragedy for those infected, and affected.

And one for which I want to again, on behalf of the health service, say sorry to all those touched by it, as inadequate as that word feels weighed against the scale of their suffering and loss.

Since we last met, we’ve also seen further concerns about safety and experience in maternity and mental health services – including here in Manchester.

More stories, too, of staff subjected to unacceptable behaviour, violence, and sexual assault at work.

And there was the important – and hard-hitting – story of Martha Mills, whose mother Merope will be joining us tomorrow.

All of them, different. Different places, different services, different times.

Nonetheless, all of them telling – at least in part – stories of where the NHS has failed to listen.

Failed to listen to patients and families.

To our own colleagues.

To the data, and other warning signs.

All of them, requiring us to ask how we stop them happening again, how we foster a culture in which staff and patients can speak up and be heard, but also, particularly for our colleagues, to be part of the solution.

That’s the kind of NHS our colleagues want, and our patients want, and all of us here will share a determination to get there.

That’s why, among other things, we’ve worked with Merope to start rolling out Martha’s Rule.

Why safety culture and speaking up is central to our Maternity and Neonatal Action Plan.

And why it is central to the work we have already done, and will be doing over the coming months, on improving working lives and bolstering management and leadership.

It’s important to recognise where we need to do better for patients.

But it’s also important that we don’t collude with defeatism.

Yes, the post-COVID NHS is damaged but it is not destroyed.

It is struggling but it is still doing incredible things, every day.

You only have to look at progress over the past year.

Record numbers of people supported by mental health services and continued roll-out of new services such as mental health teams in schools.

Millions more GP appointments, the launch of Pharmacy First and a funded plan for tackling dental deserts.

Around a million more elective treatments, and long waits dramatically reduced, supported by surgical hubs, and greater use of the independent sector, now delivering one in ten of every treatments.

Almost two million more diagnostic tests supported by our growing network of Community Diagnostic Centres.

Another record-breaking year for urgent cancer checks and achievement of the faster diagnosis standard.

Supported by innovations such as lung scanning trucks, direct referrals from community pharmacy, FIT testing and cytosponges.

And a corner turned on urgent and emergency care, 999 and A&E performance improving thanks to your work to put more ambulances on the road, open more core beds, and extend out of hospital care.

All of that despite industrial action, the spectre of which looms over us once again.

Far, far more to do, on everything.

But going in the right direction.

Reasons for pride, reasons for hope, but no room for complacency.

So, the important question is “where do we go next?”

Partly, that’s a question is for future government.

But the challenges of the coming years are clear.

And here’s where we return to the occupants of Bevan’s perambulators in 1948.

Over the next 15 years, they’ll be part of a 55% growth in the number of people aged 85 or over.

Now that’s great.

But it means we need to be ready.

Seven in eight people aged 85 or older live with at least one long term health condition.

And in fact, at that age, you’re more than twice as likely to be living with three or more health problems, than you are to have none.

The total number of people living with major illness is projected to increase by 2.4 million by 2040, and that’s around three times the population of Manchester and Salford combined.

And over 4 million more people will be living with anxiety or depression, around the size of the population of Croatia.

Now, we know this won’t be felt equally.

The older population is likely to be concentrated in coastal and rural communities and disparities in health among those of working age will likely grow.

For the NHS, more illness means more demand, requiring more capacity.

More people, more places, more equipment, more drugs.

And all those things add up to more costs.

But we also know we’re going to have a smaller working age population paying the taxes that meet those costs.

So yes, the NHS will need to grow.

But we can’t afford for the NHS just to grow.

We’ll need to re-imagine, to do things differently.

And we’ll start with primary care.

Primary care is the bedrock of the NHS.

Delivering more appointments than ever before, on average, six per year for every man, woman and child in the country.

But not enough to meet demand.

Not enough consistency in what you can get, and how long you wait for it.

We are making progress.

More GPs in the pipeline, more clinical staff working in surgeries to manage new demands from society.

Mental health therapists, clinical pharmacists, physios, and recently, the first ever primary care dementia nurse.

It’s clear the GP workforce will need to grow in some parts of the country, faster than others.

But again that can’t be the only solution.

We need a modern vision for primary care.

And two years ago, Claire Fuller gave us one.

Streamlined access to urgent care or advice.

Proactive, personalised care for patients with long term needs.

And helping people to stay well for longer.

It’s a vision we could all get behind.

That’s why the first pilots are now exploring the big questions around how can we deliver it for everyone.

Like how we make it easier for practices to meet urgent demand, alongside continuity of care and preventative work and crucially, in a way that takes patients with us.

How we make the best use the skills of colleagues to deliver those three offers with GPs as the leaders of multi-disciplinary teams.

And how we make sure we’re consistently using tech to deliver a 21st century service for patients, and for staff.

Now, I know there is no shortage of ambition among GPs and their teams.

I saw that here in Manchester in January at the Ancoats Primary Care Centre.

I heard there from an incredible practice manager, about how they were delivering responsive urgent care to a large population.

But I also saw the work they were doing to prevent need developing.

So their data showed that homeless women faced the most serious health inequalities and just weren’t coming into the surgery.

So, they bought a van.

They kitted it out.

And they worked with homeless charities to offer sexual health services where those communities were – where they are, using the opportunity to identify people who then needed more help.

There are countless examples like that across the country.

We want the ambition they show to be the norm and it can be, if we give primary care the tools they need.

So, what happens in those pilots is going to be integral to the future of the NHS.

But it’s not all of it.

We need the same ambition for community care.

Already delivering around 300,000 patient contacts per day.

Already innovating, too.

Urgent Community Response teams, now responding to over 4,000 2-hour referrals a day, up 77% in a year, and fast approaching a million in total.

Single Points of Access, providing simple routes to get people the support they need quickly, and in a coordinated way.

And Community Frailty Services, proactively helping people most at risk of needing hospital care to stay well at home, complementing the Acute Frailty Services that we’re rolling out in major A&Es, helping people get the right checks and return home with the right support, whether that’s ongoing care through virtual wards, or drop-ins from community teams.

Again, we don’t have to go far from here to see that ambition in action.

Back in January I also met the Bury Integrated Neighbourhood Team based at the Heathlands Village in Prestwich, supporting all parts of the community, but particularly older residents, working with other health and care teams to actively manage their care.

Again, ambition I know will be, I know is matched in many other places.

But questions to answer if we want it to be the norm.

If we want community teams to work seamlessly with other services.

If we want an ambulance, A&E attendance or admission to really be the last resort.

If we want people to only be in hospital for as long as they need acute medical care.

Then we’ll need to get serious about how we achieve it.

In part, having enough people with the right skills, deployed in the right way.

In part, again, using tech and data to make best use of their time and put people in the driving seat for their own health and care.

But we’ll also need to put our money where our mouth is, and where our patients are.

We know incentives work.

We see it in the Elective Recovery Fund, driving extra activity.

But we’ve also seen it improve outcomes through things like Best Practice Tariffs, rewarding not just doing stuff, but doing the right stuff, at the right time.

On hip fractures, for example, the incentive to hit key clinical standards, such as surgery within 36 hours, saw 7,600 extra lives saved over six years.

They also drove a big increase in day case procedures delivering a better experience for patients, and better use of hospital beds.

So can we go further?

Can we incentivise the right care in the right place, rewarding all the providers involved in someone’s care for heading off acute need for making best uses of resources and for improving quality.

Just last week I met with our clinical leads on palliative care and end of life care.

They told me that around a third of all bed days are accounted for by the tiny proportion of our population, around 1% who are in their last year of life.

Now, if we can shift that by just 10%, by better caring for those people at home and in the community, then as well as giving them, and their families, a better experience, nationally we’d deliver the same effect as building three large new hospitals.

And if we can do that for other people, too – including equivalent models in mental health, there’s a strong case that we can both improve outcomes and experience for people who need these services, as well as relieve pressure on hospitals and deliver more for taxpayers’ money.

The time is therefore right to do the work on how we can change our contracts and incentives to support this model, and we have started to do just that.

Some of you will be thinking: we’ve heard this before.

We tried it, it didn’t stick.

And do you know what?

You were right.

But we now have opportunities we’ve never had before, thanks to the work of people in this room, and beyond.

Opportunity number one: we now have a credible Long Term Workforce Plan, for the first time in our history.

Our workforce is already at a record level.

39,000 more clinicians in secondary care than a year ago.

The focus for this year must be ensuring they are in the right places, and that we’re using this growth to reduce agency bills.

But the Long Term Workforce Plan gives us a blueprint for the future.

Training thousands more clinicians.

Doing more to keep the staff we’ve trained and invested in.

But also reform:

  • more routes into professions
  • more flexible use of skills
  • more time for clinicians to do what they do best.

And I want to be clear.

This is a three-legged stool – recruit, retain AND reform.

We can’t pick and choose. And decide we only want to do one or two of the three.

Associates, for example – a small part of the plan, but an important one.

So we must work with clinicians, with royal colleges, the GMC, to ensure their roles are clearly understood, that they are well deployed, well supervised, well regulated and crucially, well supported as colleagues.

Now a lot of you, and a lot of your colleagues, worked incredibly hard over many years to get this Plan over the line, and it’s now all our jobs to deliver it.

Opportunity number two: we now have the technology that can support our ambition.

We now have an app that’s in the pocket of 34 million people, over 75% of the population, twice the subscribers of Netflix.

It’s putting more information and options at people’s fingertips.

In April, people viewed or changed 7.7 million secondary care appointments, through the app they ordered 3.9 million repeat prescriptions and accessed 1.6 million online consultations, all at the touch of a button.

We’re also modernising systems that support staff.

Over 90% of hospitals now have modern electronic patient record systems.

GP practices now have cloud-based telephony systems.

Every hyper acute stroke unit in England now uses artificial intelligence to speed up care.

And now, by rolling out the NHS Federated Data Platform, with 43 Trusts already using it, we have a credible path to being able to connect the hundreds of disparate IT systems over the next few years, putting powerful tools in the hands of clinicians.

Tools that have already increased theatre use by in Croydon by 12% and reduced long stays in North Tees and Hartlepool by 36%.

And more on the way, like AI-generated discharge summaries being trialled at Chelsea and Westminster and shared elective lists, helping trusts work together to reduce waits.

Some say the NHS is stuck in an analogue past and look sure, some bits still are.

But we are already building the foundations that make better care possible.

And the planning we’re doing now to deploy extra funding next year will help us put rocket-boosters under that progress, getting the basic building blocks right, so that we can take full advantage of the data and AI revolution.

Opportunity number three: you.

Or more accurately, the relationships you are building.

Not just between different NHS organisations but also with the independent and voluntary sectors, local authorities, and other public services.

That’s been really clear from the planning meetings I’ve been having over the last month with every ICB.

In some cases, honestly a startling change.

From sitting in the room with ICBs and trust leaders and witnessing sometimes adversarial relationships, to unity of purpose, and trust.

From shunting risk and cost – and people – from one service to another, to an understanding that both patients and taxpayers are best served when everyone is doing their bit.

And when that ‘badges off’ approach gets put into practice, you really do see special results.

A few weeks ago, in Taunton I visited the Arc Veterans Project, which is an incredible, supportive community for former members of the Armed Forces who find themselves homeless and struggling.

A man I met there – let’s call him John – years after leaving service, had lost everything through depression and addiction.

Now, on the road to recovery and a new life through a combination of therapy and social support.

It was almost impossible to know who was NHS, who was voluntary sector.

And it didn’t matter.

What mattered is that they were all contributing, and they were making a massive difference for John, and for people like him.

So I’m under no illusions.

Some places still aren’t there.

So, through the NHS Oversight Framework we need to, and will, make it much clearer who is responsible and accountable for what.

Because that is the basis for mature relationships and fundamentally it is the strength of those relationships within a system that will make integration work for patients.

So, real opportunities.

But also, real tasks that we need to get to grips with, if we’re going to seize them.

So task number one: management and leadership.

The NHS has some brilliant leaders, in many cases, world class.

Not my words, those of General Sir Gordon Messenger.

Most leaders and managers that he talked to were not professional managers they were clinicians.

Others, technical experts, in disciplines like finance, estates and logistics.

Promoted because they’re good at what they’ve been trained for, but often left to learn management on the job.

Now it really shouldn’t be controversial to say that the NHS needs well-trained, well-supported managers, at every level.

That’s what makes well-performing teams.

It’s fundamental to getting back to our pre-pandemic productivity growth, driving the best possible use of taxpayers’ investment and clinicians’ time.

Fundamental to fostering the kind of culture in which staff and patients can speak up, and be listened to.

And fundamental to every other challenge or priority the NHS faces.

So, if we want a well-run NHS, we must support those who run it.

If we want leaders to be accountable – which we do then we must give them the tools they need to do their jobs well.

So, we’re taking forward the excellent work of Messenger and Kark and we’ll shortly begin developing a new, multi-disciplinary NHS Management and Leadership Framework.

Bringing together expertise from inside and outside the NHS, learning from places like Royal Berkshire who already do this well, and working with the Chartered Management Institute and others, we’ll create a new Code of Practice for all managers and leaders, with clear standards and competencies, from entry level, to middle tier, to board, and a curriculum for the training and skills people will need.

Having developed those managers and leaders, we’ll need to do more to keep them, and to encourage the best to take on the toughest jobs, where they can make the biggest difference, including giving them the space, the time, the teams and the resources to turn things around.

Task number two: giving people the tools and information they need to improve.

Improvement isn’t accidental.

It takes work.

Many of you are here today because you’ve done that – and that is brilliant.

But we can’t rely on pockets of improvement driven by brilliant people.

Our ambition is to be the fastest improving health system in the world, so improvement has to be everyone’s business.

Consistent improvement needs a consistent approach.

And we’ve seen the impact of GIRFT in reducing variation in hospital care and processes.

We’ve seen the impact of using CORE20 PLUS5 to identify and bear down on health inequalities in our communities.

But we must go further.

So, we’re doubling down on our work through NHS IMPACT to support delivery of clinical and operational excellence, with a clear focus on our biggest challenges, supporting both better care and productivity.

And learning from the successes of the Modernisation Agency, we want to ensure that you have the tools to make a difference.

So we’ll be setting up improvement collaboratives and networks, allowing you to better share practical data and evidence-based techniques, so that the successful approaches we’ve seen in Trusts like Leeds, and North East London, become how we do business everywhere.

But if a whole organisation is going to improve, we need to support those leading them, too.

Effective boards depend on having the right information, at the right time, used in the right way, and whether that’s up-to-the-minute operational data from within the organisation or bench-marking and best practice from outside.

That’s crucial if as leaders we’re going to respond quickly to problems and even head them off.

Lots of organisations do that brilliantly already.

But we need it to be true everywhere.

So, over the last few months, again learning from the successes of the past like the Intelligent Board guides, and from those organisations which are already doing this, we’ve been working with many of you to pull together the best practice, evidence and ideas to shape how all organisations, including NHS England, use the information we have to better deliver for patients, communities, and staff, and we’ll be sharing that with you soon.

So the third task, making it easier than ever to innovate.

Sometimes, improvement will only take you so far.

Sometimes, really taking opportunities, particularly with technology and with data, means doing things totally differently.

Again, no shortage of innovators in the NHS, or indeed in this hall.

I mentioned the Cancer Vaccine Launch Pad earlier.

I’ve talked about the primary care pilots.

The NHS Genomic Service, another great example, now expanding into trials of screening newborn babies for rare diseases, so the right treatment can start quicker.

We can already see the scale of ambition you have.

In London, examples like the remote eye A&E run by Moorfields and the REACH initiative by Royal London and the London Ambulance Service.

Technology-enabled care, already safely helping to avoid thousands of unnecessary hospital visits, and further plans shaping up which could make London the first city in the world to offer a digital-first urgent and emergency care service.

So as we finalise the plans for additional tech investment from April, we’ll be calling on you to come forward to test how connected systems, AI and automation can not just improve care, but transform it.

We are at a tipping point when it comes to tech.

We have a unique opportunity to build on what we already have, and truly revolutionise our patient offer, giving the public greater control over their health than ever before, and making it as easy to access support as it is to order your weekly shop.

As the NHS, we must always think at an individual level, to ensure we don’t leave people behind.

And as the current cyber incident in South East London shows we also need to be vigilant to the global threats of an internet age.

But the time to think big, and to be radical, is now, and if you do that, you will have our backing.

Three key tasks.

Not an exhaustive list.

But things that we should do, and can do.

But there are other key choices that an incoming Government is going to have to make, that we can’t.

They’re well-rehearsed by now.

It’s capital and estates.

It’s public health and prevention.

And of course, it’s how we boost capacity and quality in social care, a question to which we still need an answer, vital, obviously, to the generation in Bevan’s perambulators, but also to the things everybody wants the NHS to achieve, whether that’s shorter waiting lists or faster A&E care.

But if we look further ahead, more questions appear.

Let’s take Bevan’s advice again.

If we go out now onto the streets of Manchester, and we look into the first pram we find, what is the future we want for that child?

How can we reimagine the NHS for them?

I’ve set out some of the things we can do, and are doing.

There are others, responding to changing needs, like our ADHD’s taskforce, established to work out how we best respond to the growing number of referrals.

Mental health teams in schools.

Combating vaccine fatigue and misinformation.

But their health – our health – is about more than what the NHS can do.

It’s about everything from our upbringing and education, our environment, our work, and our support networks.

So, we must ask ourselves uncomfortable questions.

Just to pick out two examples:

In 1948, when Bevan was looking in his perambulators, we still had rationing.

Now the number of under-40s at risk of type 2 diabetes, a disease driven by junk food and obesity, has risen by a quarter in just 12 months, part of a wider growth of over half a million people.

Last year, I announced the NHS would open 10 new specialist clinics to support severely obese children, taking the total to 30 across the country.

One part of a growing raft of NHS initiatives to tackle obesity, which now also include working on how we can integrate new weight loss drugs.

Yes, the NHS can help – will help.

But we can’t solve this alone.

So as society we need to ask, are we fine, for example, with the fact it’s far easier and cheaper for those children to buy calorie and fat-laden food on their way home from school, than it is to find healthy snacks, particularly in the most-deprived areas?

Another example: in 1948, betting shops were still illegal.

Fast-forward to earlier this year.

The NHS opened the 15th specialist centre for gambling addiction, responding to a real and growing social need.

Again, the NHS can help – will help.

But again, we can’t solve this alone.

So as a society we need to ask: are we OK to just continue picking up the pieces while the methods employed to keep people hooked get ever-more sophisticated, and ever-more opportunities spring up for younger people to get addicted to gambling, including, as I heard from staff when I visited the national problem gambling clinic, earlier this year, on unregulated cryptocurrency markets.

These questions, and more, speak to the kind of society we want, that we want for our children, and by extension, to what we want the NHS to do with finite resources.

Nettles we must grasp: will we tackle problems at source, or do we accept the NHS becomes an expensive safety net?

That kind of service is what the NHS was born as.

But it shouldn’t be our ambition now.

Those babies in Bevan’s perambulators, over the course of the last 75 years, have brought us incredible advances.

They are the generation that harnessed the “white heat of the technological revolution”, delivering things which have changed the face of medicine, and society, forever.

So, while we have a responsibility to plan for how we meet their needs in older age, alongside the needs of the generations since we shouldn’t forget to draw inspiration from their achievements, and use that to be ambitious about what we can do.

If it feels hard, that’s because it is.

But we are doing it already.

We are recovering from Covid.

We are strengthening our foundations.

We are reforming for the future.

And we are clear where to go next, and how to get there.

We have the vision to reimagine the NHS for needs of tomorrow, more resilient and responsive primary care, more integrated services delivered in the community.

We have the opportunity, in our workforce plan, our technological foundations and scale, and in the relationships you have forged.

We have the ability, to do what we need to do, supporting better leadership and management, becoming the fastest improving health service in the world, and backing innovation.

So, whatever your version of Bevan’s perambulators might be, keep it in mind.

Because we can be the generation who saw the challenges of the future.

And we can be the generation who took the opportunities of the present to meet them head on, so that the generations that follow inherit an NHS they can be proud of. One that delivers health and high-quality care for all.

Thank you.