Amanda Pritchard speech to NHS Confed Expo conference, 14 June 2023

Thank you very much.

And wow, George is a tough act to follow, isn’t he?

A bona fide star of stage, screen, the written word, and, of course as we saw, the Strictly dancefloor.

George, we’re so privileged to have you with us here today, and to hear your powerful message.

Let’s all show again our appreciation for George.

We all wish, of course, that more of our colleagues could have been here today to hear George’s message, as well as to contribute to the important discussions that are planned across the programme.

On behalf of my NHS England colleagues who can’t make it, Steve Powis, Ruth May, David Sloman, Vin Diwakar and many others, I want to give my apologies for the unavoidable disruption to the schedule.

And speaking personally, I wish that I could stay longer but sadly, I need to go straight back to the office, having already done incident management calls remotely this morning.

And of course, I know that you understand that as valuable as this time is to connect and share and learn together, we must prioritise the management of what is a serious business continuity incident, and therefore a serious risk to patient safety.

So once again we are heading into this period of industrial action against a backdrop of rising pressures.

So as regrettable as it is that so many colleagues won’t be able to be here this week, let’s also just show our appreciation for those who are once again working tirelessly to maintain vital services.

However you feel about the rights and wrongs of industrial action in the NHS, our number one priority must be patient care and patient safety, both in the immediate window of action, and in the longer term, too.

Because as much as we learn from managing each action, every time it happens it creates risk, it creates upheaval and distracts from our priorities, particularly elective recovery.

As you know, over half a million appointments have already had to be rescheduled.

Many of those people will have been waiting months.

It’s likely we’ll see tens of thousands more affected this week.

So while the NHS will of course expertly manage the incident to the best of our ability, I know we all hope for a resolution soon.

I would also just like to say a special thank you to the ambulance crews and other NHS and emergency services staff who responded to the appalling tragedy in Nottingham yesterday.

Our thoughts and sympathies are with those killed and injured, along with their friends and loved ones.

This terrible incident was just another reminder of the bravery of paramedics and other ‘blue light’ staff who can never know what they will be confronted with when they leave their home, leave their loved ones, and clock on for their shift.

As I’ve said, unfortunately I can’t stay for long at the conference this year but I know it’s part of my job to try and fire you up for the 30 or so hours ahead because you also have important work to do here.

Every part of this programme, every idea you pick up or share, every connection you make, has the potential to lead to improvements in care and services for patients.

And that’s why we’re all here, so let’s get to work.

As you know, we are approaching the 75th anniversary of the NHS.

And big anniversaries always give us cause to look back and reflect on milestones past.

Yesterday I visited Trafford General Hospital, literally just a few miles from here, to do just that.

Now many of you will know why that site holds such a special place in NHS history.

For those who don’t, it was the hospital where Nye Bevan launched the new National Health Service on the 5th of July, 1948.

At the time, Park Hospital Davyhulme, as it was called then, was the most modern hospital in the area.

But it hadn’t just opened that day.

Of course it had its own history, going back to the 20s and even for 13-year old Sylvia Beckenham, the girl in the pictures with Bevan, presented as the very first NHS patient, while no doubt a day she would remember for the rest of her life, in truth, in terms of her medical care at least, it was no different to the previous days that she had been in that same bed being treated for acute liver disease.

I know many of you will be looking forward to hearing from Aneira Thomas later today.

I had the pleasure of meeting her a couple of weeks ago in London.

She has a great story about how she came to be the first baby to be born in the NHS in Wales and I won’t ruin that story now.

But even for Aneira and her mum, Edna, aside from the added significance of that birth that everyone involved felt, largely their medical treatment will have been the same as a baby born in that same hospital a day, a week, or a year before.

So while it was a momentous occasion, as Bevan said to Sylvia, a milestone in history, the most civilised step any country had ever taken.

We would be wrong to say that on the stroke of midnight on the 5th July 1948, the standard of healthcare in our country was suddenly transformed.

There were still huge challenges to overcome.

There were just 10,000 doctors and 60,000 nurses working in English hospitals, serving a population of around 40 million.

GPs were in many cases working out of the front room of their houses.

And of course, the pent-up need for care was huge.

All massive challenges, and many more besides.

But the wheels were turning.

They were turning and they have continued turning for the last 75 years.

And at any point in that 75 years, if you’d have stood still and looked, if you’d taken a snapshot, you’d be forgiven for not having seen that momentum.

But look back over the arc of time and the picture becomes clearer.

Milestone after milestone.

Achievement after achievement.

In many cases, not just leading the world in equity of access, but in game-changing innovations too.

The first modern hip replacement.

The first CT scan.

The first combined heart and lung transplant.

The first baby born after IVF – just 10 miles from here at Royal Oldham.

The first heart surgery carried out by a remote controlled robot.

And, of course, the world’s first Covid vaccine delivered outside a trial.

An amazing history, but never a static one.

And if I look back just over the course of my own adult life, the story is the same.

In the 1990s, we had wards full of patients with HIV and AIDS, and deaths climbing towards 2,000 a year.

Now we have the prospect of being the first country in the world to end new HIV transmissions.

Back then, Hep C infections were still on the rise.

Now, again, there’s a real opportunity for is thanks to a ground-breaking find and cure partnership with industry and charities, to have a real shot at being the first country to eliminate the virus as a public health concern.

Infant mortality has halved.

So have death rates from heart and circulatory diseases, thanks in part to effective identification and cheap treatment.

Breast screening, in its infancy then, now saves 1,300 lives a year.

And thanks to being one of the first countries in the world to deliver mass HPV vaccinations, combined with our screening programme, we can also see a path to eradicating cervical cancer, which still killed scores of young women every year at the turn of the century.

In the 1990s, it was taking teams of hundreds of scientists across the globe months and years to put together fragments of a genetic sequence.

Now the NHS can provide whole genome sequencing to every infant in intensive care, giving clinicians the ability to check for over 6,000 rare diseases in days, so they can deliver the right treatment fast.

Surgery was a major life event for most, meaning days in hospital, extensive scarring and long recovery times.

Now up to 75% is carried out through day surgery, and we increasingly use robots and other techniques to deliver safer and more effective procedures.

Home computers were still for the few, the internet was home to less than 10,000 websites, and mobile phones – if you had one – were the size of handbags.

Now the NHS App allows patients to access their medical records, order prescriptions, make appointments, and seek personalised health information and support, with many more developments in the works.

Look, you get my point.

But as we have consistently seen, as challenges subside or are beaten back by advances in practice or science, new ones emerge.

In some cases, it is precisely that success which creates new pressures.

Nowhere is that more evident than in our ageing population.

Life expectancy has increased by well over 13 years since the NHS was formed.

That’s real, meaningful progress.

But what it means of course also is more people needing medical care, often for multiple conditions at the same time.

It also means more people needing social care, and we’re all well-versed by now in how capacity in social care has a direct impact on people’s lives, as well as on the NHS.

So just like in 1948, just like in any year you’d care to choose in the last 75, we know the NHS faces challenges now.

They’re different challenges, but they are challenges nonetheless.

I talked about many of them at this conference last year, you may remember my four Rs.

But even looking back just over the last year, a mere sliver of the history of the NHS, we see important progress.

I talked about the need to see recovery of key services because of the inevitable impact of Covid.

And you delivered.

In elective care we have seen the number of people waiting for 78 weeks or longer fall by 90% from its peak by March, despite the severe winter pressures we experienced and the disruption from industrial action.

On diagnostics, you have delivered a million and a half more scans and tests over the last 12 months, helped by our growing number of Community Diagnostic Centres, which have now contributed more than 4 million additional scans and tests in total.

In cancer services, the number of people seen for urgent checks continues to break records, now double what they were a decade ago.

And that means we are catching more cancers at Stage one and Stage two, when they are easier to treat, than ever before, and cancer deaths are 10% lower than just five years ago.

In urgent and emergency care, ambulance response times have improved across every measure, and we saw very promising improvements in A&E performance after we published our recovery plan, although I know in recent days there have been real pressure on systems not least the heat and demand from industrial action as well. many teams have been under real pressure from big increases in demand.

In primary care, so far in 2023 GP teams have delivered around two million more appointments a month than last year, with seven out of 10 of them being face to face, and still more than half of them being same- or next-day.

In community services, you delivered our target for 2-hour urgent community response teams early, with more than four in five patients referred benefiting from a fast response to assessing and meeting their needs.

In mental health, you have supported record numbers of children and young people, rolling out school based teams ahead of time.

Record numbers of adults with serious mental illness are being treated, too, and record numbers of new mums, as our perinatal mental health teams continue to go from strength to strength.

And in learning disabilities, you have supported more people to live well in the community, with discharges from hospital up 6% year on year, and a significant increase in annual health checks.

When I spoke of my second R, the need to reform for the future, I spoke of the immediate opportunity in front of us to grasp the benefits of integration.

And you delivered.

Locally, ICSs are not just words in a statute book, they have become a way of working.

They have been central to some of that progress I just described, the rapid deployment of system control centres to better manage winter pressures a case in point.

Nationally, we have brought together NHS England, NHS Digital and Health Education England to create a new organisation, one that is better able to support the wider NHS in a coherent, coordinated way.

And crucially, we have co-created our new Operating Framework, bringing shared understanding to how we all work together.

That framework will of course continue to be iterated, particularly thinking now about how we take forward the recommendations from the Hewitt review.

I talked about the need to harness the potential of technology and data, and you have delivered.

Every ICS now has a shared care record in place, we’re within touching distance of nine out of 10 trusts having electronic patient records in place, and we have supported more than half of all adult social care settings to adopt digital social care records.

And I spoke of the need to continue to work with innovators, researchers and the life sciences sector, to support the development of new technologies, and crucially to ensure NHS patients are at the front of the global queue to benefit from those which are effective.

Here too, you have delivered.

The NHS Genomic Medicine Service has continued to expand the number of tests available.

The NHS Galleri trial has exceeded patient recruitment targets, and is showing real promise in being able to spot the early signs of dozens of cancers.

Our Be Part of Research partnership has recruited an additional 150,000 potential participants, including 108,000 who have registered via the NHS App.

And our Clinical Entrepreneurs Programme has surpassed 1,000 innovators, being supported to develop and spread promising new products.

All of that without mentioning the dozens of new treatment options now available to patients that weren’t last year, thanks in no small part to our ability to get the best deals for taxpayers.

My third R, many of you might remember, was resilience, ensuring the NHS can meet future pressures.

Central to that, I talked about the need to boost workforce numbers.

And again you have delivered.

The latest provisional figures for March show 20,000 more clinicians in our hospitals and community services compared with the same month last year, topping 671,000 for the first time.

And in primary care we have surpassed our target to recruit 26,000 additional roles a year early.

On the other side of the coin, I talked about the need to right-size physical capacity, too.

And you delivered, with over two and a half thousand more general and acute beds open at the end of March this year compared to last, supplemented by a huge increase in virtual ward capacity, now supporting thousands of patients at home every week.

And my final R, no less important – Respect.

Firstly, respect for our staff.

I won’t gloss over the really challenging findings of the staff survey, or how industrial action is straining relationships locally.

But we are taking action, and we are delivering results.

Since we launched the national retention programme in April last year, leaver rates have improved across the board.

But in the 23 exemplar sites the improvement has been double the average for staff, including nurses, giving us a solid foundation of learning we can now spread across the country.

Our continued focus on improving the representation of colleagues from ethnic minority backgrounds is also paying off.

Windrush 75 is a reminder the NHS has always benefited from the skill and dedication of colleagues from overseas, something that historically hasn’t been reflected in the senior positions across the health service.

But we are improving.

The latest reports show more nurses from ethnic minority backgrounds are progressing from band five into more senior roles, including chief nurses and midwives.

And now over a quarter of our clinical directors and a fifth of our medical directors are from an ethnic minority.

Of course, it’s not enough that people stay in the NHS, we need them to stay well, too.

We learnt a lot about addressing health and wellbeing during the pandemic, but we need to move to prevention, rather than just helping people when they need it.

More than 200 Wellbeing Guardians are now in place in local trusts, and in July we launched ‘Growing occupational health and wellbeing together’ which is our new five-year programme supporting employers to develop proactive support offers.

I also talked about respect for patients.

Specifically, the need to roll back visiting restrictions put in place to save lives over the pandemic, so that people could move to being able to see their loved ones, which makes such a massive difference both to experience and quality of care.

You delivered that, too.

And finally, I talked about respect for the public’s investment in the NHS.

And once again, you delivered, with the NHS in England living within its means, despite the real pressure on budgets caused by inflation, and in doing so delivering more than five billion pounds of efficiencies.

All achievements we could be proud of in the best of times.

To achieve them in the toughest of times shows just what the NHS and its staff are capable of.

To paraphrase Nye Bevan, speaking during the Third Reading of the National Health Service Bill in 1946:

We may discuss these things here, but we do so in the knowledge that it is people outside this room, people including you, who make them a living reality, who give them meaning, for those who they need to mean something to.

So a thank you for your sustained effort, and for making a real difference for patients.

None of us would say the job is done in any of the areas I’ve just touched on.

We all know there is still lots more work to do, and that work is really hard.

But we are moving forwards.

The wheels are turning.

And there’s nothing inevitable about that, it’s because of your hard work.

History tells us that our path has always been an uphill one.

Our course has always had an element of uncertainty.

And the ground has always been uneven.

Because of that, progress has sometimes been faster, and sometimes slower.

So our role, just as it was the case for those who came before us, can’t be limited to providing the force to maintain momentum, although we have shown time and again how effective we are at doing that, particularly when the going is toughest.

It must also be in providing the vision, in surveying the landscape, in identifying the ditches and the divots that threaten our progress, and equally, the tools and techniques at our disposal, so we can steer the best course.

Sometimes, that horizon has to be two months, two weeks, maybe even two days ahead, as we did during the height of the pandemic.

Lots of times the horizon might be one, two, three years in the future, and that’s where we’ve been recently in addressing the recovery challenge.

But the greatest gains come from looking beyond, to a further horizon.

When you do that the picture is less clear, the breadth of the horizon is larger.

So surveying and sense-making is best done collectively.

And thanks to the NHS Assembly, that’s what you have been doing.

Over the last couple of months their call for views has gathered hundreds of individual submissions, taken in feedback gathered by scores of local leaders, and delivered in-depth engagement with patients, carers and clinicians.

All told, the voices and experiences of hundreds of thousands of people have been brought to bear, and I want to thank everyone who responded to the Assembly’s call, and all those who have given their time to lead it.

So it felt fitting yesterday, as I was reliving our shared past at Trafford General, to hear from members of the Assembly about what they’d learned from you.

It was no surprise that, just like public surveys consistently find, you have great pride in what the NHS stands for and the things colleagues have achieved, not just in the past, but every day.

And importantly, despite the significant challenges we have faced together over the last few years, you are optimistic about the future, and the opportunities that exist to improve care and outcomes.

But you are also mindful of the fact that, if we are going to take those opportunities, if we are going to build a bridge to that future, we need to ensure the foundations that bridge sits upon are as strong as they can be.

That strikes a real chord with me, and echoes conversations we have been having, and work we have been doing, nationally.

So I want to just focus in on a few of those now, innovation, improving quality, prevention, and of course our workforce.

Taking innovation first.

As I described earlier, a key part of the history of the NHS.

Innovation has to be central to our future, too.

The sheer scale and pace of possibility means we have to take a deliberate approach, focusing on those things that will deliver the biggest impact, and making sure we have got the right foundations to be able to seize those opportunities.

So look, if we take technology and data, getting the foundations in place means completing the work to roll out EPRs, and making sure we have the right data architecture, which we’re doing because we are in the process now of doing the procurement for the Federated Data Platform.

If we can do that right then we can put ourselves in the best possible position to benefit from innovations like artificial intelligence.

Benefits we are already beginning to see.

In stroke care, AI is already in use in more than four out of five stroke networks, helping clinicians to reduce the time to deliver effective treatment by an hour, tripling the number of stroke patients recovering with no or only slight disability from one in six, to just under half.

And in cancer, we are rolling out AI teledermatology capability, which can predict with 99.7% accuracy whether a skin lesion is likely to be cancerous or not, speeding up diagnosis and treatment for patients.

Far more applications are on the horizon.

Applications that have the potential to free up clinicians’ time, give them faster access to test results, and provide new forms of support for many patients.

And as a national health service we are in prime position to be able to make this technology available quickly.

And our national commercial powers make us well-placed to get the best deal for taxpayers.

I think it’s a similar story when we think about life sciences.

I’ve spoken already about our proud history of incubating and making available new tests and treatments, a history that we continued during the pandemic with the discovery of the benefits of dexamethasone, and one that we still continue now.

So for every four treatments available in Europe, there is an additional one available in England, including medicines for rare and complex conditions.

A review of 222 new medicines showed the UK was 3rd globally in the number of medicines commercialised within a year of their first approval, and a more recent industry review placed us third in the G20 for access to new treatments.

Do we demand a fair price for taxpayers? Yes, we do.

But do we deliver for patients? Yes, we do.

And we want to continue doing that, in a spirit of partnership with the Life Sciences industry.

The kind of partnership that has given patients access to the Galleri trial I mentioned earlier.

And the kind of partnership we are entering into on Cancer Vaccines, a shared quest to realise the potential of mRNA technology to teach our own bodies to fight cancers and other killer diseases.

We know there will be other potentially game-changing tests and treatments coming down the line.

And we want to make sure the NHS is in a prime position to take the opportunities they bring.

That’s why earlier this year I asked Roland Sinker to lead an action-focussed piece of work, together with industry, academia, the NHS and patient groups, to ensure that we can prioritise the biggest improvements to improve care, help develop them, and ensure as many patients as possible benefit.

That’s the work that will enable us to continue to be a world leader, continue to make the kind of difference that I heard about recently when I met Reuben Tanaka and his parents.

Reuben was seriously unwell from birth.

At just five days old, he was vomiting.

His mum, Eleanor, was unable to feed him.

His family had to travel from Cheltenham to Bristol so he could receive intensive care, obviously an incredibly worrying time for the family.

Initial investigations found high levels of ammonia in his blood, but couldn’t pinpoint a cause.

But thanks to the fact that the NHS provides Whole Genome Sequencing, his care team were able to narrow it down, meaning they could give him the right treatment to save his life, without the need for a dangerous liver biopsy.

And now, thanks to that treatment, he has been able to have a liver transplant which means, all being well, he has many healthy years ahead of him.

Making more stories like Reuben’s, for patients at all stages of their lives, is why we have to set ourselves up to take the opportunities that science and technology will present.

Of course, it’s not always about innovation.

Most often, improving outcomes is about iteration, and it’s about improvement.

That’s true in everything the NHS does, but it’s most important when we think about the quality of care.

It’s a question we ask every day: how can we do this better for patients?

Because as good as our care is in historical terms, even at best, it can always be better.

We know that’s true in maternity services.

Most women continue to have good experiences and safe births.

But for as long as some don’t, we have work to do to improve, and particularly in those Trusts where we know the most significant challenges lie.

So a priority for our new Chief Midwifery Officer, Kate Brintworth, will be leading – with Ruth May and others – further intensive work, with families, clinicians and local leaders, to support our maternity workforce to deliver the best possible care for women and babies.

But we are equally determined to do our best in every area, whether locally that means tackling waiting lists, bringing down ambulance waits, or increasing access to primary care.

That’s why, earlier this year, we launched NHS Improving Patient Care Together, or NHS Impact for short.

By creating a new, single, shared NHS improvement approach, one that is built on the best evidence and practice from what you are already doing, we are working to drive the delivery and continuous improvement of care for everyone.

And to lead this work we are launching a National Improvement Board, bringing together executives, directors, clinical leaders and improvement experts, to support local leaders to shift and improve care for their local populations.

I know from the conversations we have had with ICB and trust leaders just how much enthusiasm there is for this work, so I am really looking forward to working with you all on it.

Another thing that came through strongly in your response to the Assembly’s call was the opportunity to give people greater opportunity to improve their own health, and hopefully therefore avoid the onset or progression of disease. that’s absolutely the right ambition.

It’s what we said in the Long Term Plan.

And the NHS has played a key role over the decades in creating a healthier country, in particular through our vaccination programmes.

But here too, we can continue to build on those strong foundations.

There are lots of things we can do, and need to make sure we are doing.

Last Summer, I asked Steve Powis and Chris Whitty to work with local systems and clinical experts, to promote those interventions where we know the NHS can make the biggest impact.

Interventions like identifying and controlling hypertension, cholesterol and atrial fibrillation, driving uptake of the NHS Health Check, or giving people help to lose weight, stop smoking or reduce their alcohol intake.

The NHS delivers around two million patient contacts every day.

So there is a real opportunity to make every contact count, to offer more people the chance of a healthier future, and to help make the NHS more sustainable.

And to do that we need to forge the right partnerships and pathways between NHS services, to make those offers joined up and patient-centred.

But as I mentioned earlier, when some challenges subside, others emerge.

Smoking is a great example.

In 1948 more than eight out of 10 men smoked.

Now it’s more like one in eight.

For the most part, a success of wider public policy.

And also, particularly over the last few years, a success of innovation, with the advent of e-cigarettes encouraging and supporting many former smokers to switch.

But with that innovation has come a new challenge, the availability and attractiveness of e-cigarettes to our young people.

The report last week from the Royal College of Paediatrics and Child Health, of children presenting to hospital with conditions that can be linked to vaping, was really worrying.

And that is coming through in the figures.

Last year there were 40 admissions of under-20’s for vaping-related disorders, up from 11 two years previously.

So the Royal College of Paediatrics and Child Health (RCPCH) are right to call for action, and the Government are right to be taking those calls seriously, and I’m sure we’ll be seeing further steps put forward when its call for evidence on this issue concludes.

Of course that’s just one example of an area of concern.

There are more and bigger ones – particularly obesity, and particularly among children.

We all know obesity can lead to a string of serious illnesses such as cancer and diabetes.

A terrible human cost, but also a real pressure on the NHS.

So doing nothing now is not an option.

Today we are announcing ten more specialist clinics for children and young people suffering complications from obesity, doubling the ambition set out in the NHS Long Term Plan just four years ago.

These new clinics will bring together a range of experts in one place, providing intensive – but sensitive – physical and mental health support for thousands of young people and their families, helping them lose and keep off weight, and therefore reducing their chances of developing more serious conditions.

Both of these issues are vivid examples of how the NHS can’t create a healthier county on its own.

The vast majority of what determines someone’s health happens way beyond the reach and remit of the health service.

So it’s right that colleagues also see a real opportunity in integrated care systems and integrated care partnerships for the NHS to help drive collective action on the wider determinants of health, working with colleagues in local authority public health and social care teams, as well as schools, housing associations, employers, the voluntary sector, and many others besides.

Because it is only that kind of partnership working, locally and nationally, that will deliver what we all want to see, which is people living longer, healthier and happier lives, spending more time at home and less in hospitals.

Lastly, the strongest theme that came through in the Assembly’s engagement was the need, and the opportunity, to support and grow our workforce so it is fit for the future.

Doing that is so fundamental to everything I’ve just talked about, everything the NHS does.

Its first, medium and last in our priorities.

I’m hopeful that the Long Term Workforce Plan will be published very soon to address that feedback.

We all know the headlines will be about training places, and about new roles and routes into professions, because they already are, before the plan is even published.

And make no mistake, those things are absolutely crucial.

A few weeks ago, I had the great pleasure to return to my old secondary school, Durham Johnston Comprehensive, thanks to the NHS75 Speakers for Schools partnership.

Aside from just how smart and articulate the pupils of today are, and I say that as a mother of three, the thing that struck me most was just how many of them were already interested in a career in the NHS.

Kids as young as 11, 12, 13, already with at least an inkling that they want to join us in helping those who need it.

We can’t afford for that wave of enthusiasm to crash against the closed door of insufficient places on medical or nursing courses.

Neither can we afford for it to crash against a cliff face of high academic requirements, if we can provide an alternative channel into professions for people with the talent and the drive to do those roles.

After my visit to my old school, I went to University Hospital of North Durham.

There I met Zoe, Jo, Sophie and Hollie, all of whom were progressing through apprenticeships in both clinical and non-clinical roles.

The traditional ways into the NHS didn’t work for them for a number of reasons.

But with guidance and time and experience, they are being supported to build a career, build a life for themselves, and build the future of the NHS.

It was so inspiring to meet them, because every step of that progression clearly meant so much to them, and they were so excited for where their new careers could take them.

So yes, we want to expand training places.

And yes, we want to bring talented people in through other routes, too, including degree-level apprenticeships.

Our plan will set out how we will do both those things.

It will also set out how we want to keep people at the end of their career engaged in ways that work for them.

The experience of the pandemic showed the enormous value of returners in supporting the current workforce.

And we have continued to bring staff back through the NHS Reservists Programme, to respond to surges in demand or emergency situations when they arise.

We want to continue to provide routes to return for staff with the skills we need.

So as part of that I can announce today that, from this autumn, newly-retired doctors will be offered the chance to keep caring, and to continue tackling the elective backlog.

A new digital platform will allow them to sign up to deliver outpatient appointments – either virtually or in person.

Local NHS trusts will be able to upload details of the patients that need to be seen, and they will be matched with doctors, based on their availability and area of expertise.

Creating this new route back has the potential to help us see patients quicker, give regular doctors more time to spend on the most complex cases, and give Trusts an alternative to using expensive agency staff.

But just as importantly it gives out most experienced specialists the ability to keep on contributing to the NHS, but in a way that fits far better around their lives.

But again, it’s important we get the foundations in place.

We can’t invest in training and additional routes to bring more people into the health service, if when they get here they find the conditions aren’t right and they leave.

Retention and everything that contributes to it, environment and culture, flexibility and work/life balance, development and career progression, must remain a core part of how we grow our workforce.

I know I’m not saying anything new.

It’s what I was talking about last year when I talked about respect for our staff.

It’s a key driver behind our Equality, diversity and inclusion (EDI) plan, published last week, which made clear that we all bear responsibility for creating a working environment in which all our colleagues want to stay and want to give their best work.

And it’s a key outcome for the work we are doing to support managers and leaders at every level, building on the findings of the review from Gordon Messenger and Linda Pollard, who reinforced the key role leaders play in creating a positive culture for staff, and thereby improving care for patients.

So that underpinning work, that work on leadership will be central to our workforce plan, that work on retention, and how we take it forward, those are some of the themes from your response to the Assembly’s call for views, and my reflections on them.

There are more, and I’m looking forward to seeing their full report soon.

But to close today, I want to go back to the beginning.

When Bevan brought forward his National Health Service Bill, he did so despite challenge from several quarters.

Many doctors didn’t want to be employees of the state. Many organisations – including charities, churches and councils – didn’t want to lose control of hospitals.

Many politicians and commentators, despite the widespread support for the Beveridge Report years earlier, argued their case against on grounds of principle or precedent.

But he drove a path through Parliament, because he believed in the idea, and the value it would bring to individuals and to communities.

He passed the Bill, and he launched the NHS.

But that wasn’t the end of the matter.

By the end of 1948, he felt compelled to send an official memo to his Cabinet colleagues.

Demand for the new NHS was significantly higher than had first been expected.

People were coming forward in their droves, bringing health issues that had previously gone unseen and unaddressed.

And there were accusations of excessive administration costs, which just like now, amounted to just 2p in the pound, far lower than our international counterparts.

But he persisted.

He helped to keep the wheels turning.

Determined, of course, to ensure costs didn’t jeopardise the new social contract.

But stressing in his memo “the truly vast benefits to the population as a whole it has involved”, and how it had given the people “a new freedom from the anxiety in sickness”.

Just six months later he had to make the case again.

There was disquiet over growing waiting lists.

Indeed, much of the rest of his tenure as Minister for Health was typified not by the success of the service he helped to create, but responding to the challenge that success brought.

My point is, the history of the NHS is one of challenge.

It was there on day one.

It’s here today, on day 27,374.

It will be here tomorrow, next year, and on the 85th birthday, too.

But what successes, too.

What life-changing, in many cases world-changing, successes.

Not just creating health, but creating health for everyone.

Truly, the most civilised thing a country can do.

So if we accept that challenge is part of the job, which we must, we must also accept that part of the job is make sure those successes are not just for the history books, but there to be bettered, to be built upon, and to benefit as many people as possible.

There are so many opportunities ahead of us.

And we all have the power, not just to take those opportunities, but to create even more.

So just like all those who came before us, let’s keep the wheels turning, let’s stay the course, and together let’s drive those improvements in health and care that we all want to see.

Thank you, and have a great conference.

Watch and listen to Amanda’s keynote speech: