NHS Confed Expo 2022 - Back together but forward thinking

Back together, back in person, but the NHS is looking forward not back following NHS Confed Expo 2022 - but what is next?

Its hard to think that the last time there was a NHS Expo or Confed Expo, they were separate and way back in 2019. It has been announced that the events would be combined going forward, and that was met with much acclaim from NHS leaders, other attendees and those having exhibition stands. This brave new world was heralded for 2020, and 2 years later, following the Covid-19 pandemic we were finally able to have an in person event, in the new location of Liverpool (replacing Manchester Central).

In some ways it felt fitting, this 'new dawn' comes within weeks of a big change in the way the NHS is run formally beginning. Whilst in some areas STPs and merged CCGs have been acting as de-facto ICSs for some time, from 1 July 2022 the whole of England will be run by ICSs as legal entities. How much actual change this will herald is up for debate, but, at least from the leaders within NHSE and DHSC it is hoped it will be substantial (I received much more mixed messages when speaking privately with trust leaders and those providing into the NHS). Richard Headings (Chair NHSE) described them as a truly important and revolutionary strategic change for the NHS

A warm welcome for Amanda Pritchard, and for the ICS

The show gave many people their first chance to hear Amanda Pritchard (NHS Chief Executive) speak in person, since she was appointed successor to the long term predecessor Sir Simon Stevens last year. Setting out her stall as Chief Executive as an opening gambit of the whole conference (whilst many still queued outside) worked well (albeit a late change to the schedule). There was a clear mantra for her leadership, her call to arms of 'Its because we are the NHS' was warmly received every time she said it, and it tied together a speech which worked its way from Covid-19 and into the future well.

Its clear that the NHS is going through a time of unprecedented change and challenge. Finances are more stretched than ever before with real terms savings of 2.2% from the budget required this year even before the rise in inflation and energy prices which (in the words of one Chief Executive) are 'crippling' trusts. The value of this was put at an additional £1.5bn, but that seems to be a conservative estimate. There is also a clear desire to make further savings so as that money can be invested in the future, rather than just the fire fighting of the last 2 years (and arguably a lot longer). Notable in its absence however was any mention of '40 New hospitals' or the governments supposed investment in estates, a probable sign that this pledge which is already looking shaky at best, will be dropped in the Autumn Statement. More notably, later in the day there was also no mention of this from Sajid Javid, and a NHS leader I spoke to who has seed funding for their plans was similarly downbeat about the chances of funding happening within the decade. Very much a missed opportunity for true investment in the future of the health service.

The enthusiasm shown by Amanda Pritchard towards ICSs is clear, she is a believer in the opportunity they bring to complete one of her 4 Rs (Recovery, Reform, Resilience & Respect) as they bring the opportunity for 'ever deeper collaboration' and the opportunity to better use data across all parts of the NHS to improve service delivery, and also reduce cost. The time, we were told, was for the NHS to properly utilise its purchasing clout. The NHS, she continued, was not always delivering best value for the public purse, and it was essential that the NHS did better.

However the speech was far from doom and gloom, it was full of hope, of pride, and the 'its because we are the NHS' mantra ensured that even the negatives were delivered with a shot of energy. The ever enthusiastic Lord Victor Adebowale asked if the NHS, and the front line had the energy and enthusiasm to deliver what was needed after the last 2 years and its clear that whilst the answer from Amanda was resounding, further conversations indicated that the answer was yes, but not quite so enthusiastically!

So what for the future? - The answer is in the data, and working together

The overwhelming theme from across the 2 days was the importance of data, and the sharing of that data. Data to improve patient care and choices, data to better map demand, services and delivery. Data to predict needs and place staff, data to make better decisions around procurement and improve finances. There is an ever increasing need I was told, for the NHS to use digital as an enabler, and for digital to be at the heart of every NHS organisation. One conversation, admittingly with an ambitious Chief Digital Officer, was that every NHS organisation should have a seat for Digital on the board. Whilst this is not a new thing (I remember having the same conversation with a Digital Transformation Director who was already on the board at her trust, a few weeks before the pandemic) it did show that in the last 2 years little progress ahs been made on this front, and that, despite the NHS knowing it needs to do more, there are still many that are resistant to this change.

The mindset change that will be needed to show that data does not just belong to data professionals will be significant, any change in mindset always takes a significant investment in winning over 'hearts and minds' to change from the 'its always been done this way and worked' mentality. This may be something where ICSs coming is as 'new' organisations may have an advantage over some trusts. I say some, as many have embraced digital, and there is an every increasing divide between the organisations with the most agile, forward thinking and progressive leaders, and those with (as one delegate described them to me) Dinosaur leaders. I should make it clear that some of the most progressive leaders have been in roles for a long time and the Dinosaur comment is about mentality rather than age!

There seemed to be a reluctance, across the board to speak about the pandemic 'hangover' - not to ignore it, its importance, nor the fact that many were describing it as currently strangling the overall service, but moreover that this is a issue now, but one that is being worked through, and that actually to focus on it would be to not be focussing on the overall problems, those that were there in 2019 and maybe, in some cases have been ignored or at least put in the background for 2 years.

There are further issues and not just around workforce (over 100,000 vacancies across the NHS) but also in terms of access to care, in getting services where people need them most and at the right times. There was an admission that this could not be fulfilled by the NHS alone and there would be, as is part of the remit of the ICSs, and ever increasing and continued partnership with local authorities, the third sector and also private companies developing solutions to care (be that virtual GPs, secure virtual appointments or apps which tie together the NHS and patients, especially within mental health, thus reducing requirements on A&E and crisis centres). More needs to be done, and with less!

The NHS 5 Year plan, and more recently the 10 points for 2022 pointed at the need for better efficiencies, collaboration and system working. These are going to be the key pillars of Pritchard's NHS, and are things which were done well in her tenure at Guy's. Whilst many called her the 'continuity' option when she succeeded Sir Simon, she is in fact a veteran of the front line, well respected by the trusts and has a different kind of gravitas, which she leans on to good effect. Less a 'continuity' of the past, but a next logical step forward. A pupil of the past, but with a lived in experience which shines through and delivers the message, in my opinion at least, in a more landed way. And because we are the NHS, its this sort of change, more in progression than 180 turn which is best received and best delivered.

Sajid Javid (The Secretary of State) went further, with the reform of social care being pin pointed as the biggest requirement for the NHS to solve its 'current' issues (looking more at the immediate term than the medium and long term with this statement) and that is true. People are not getting Ambulances because the Ambulances are parked at A&E in queues. They are in A&E in queues because A&E is full, A&E is full because the hospital is full, hospitals are full (partly because the NHS has had to decrease its bed base to the smallest of any comparable nation, something Amanda Pritchard is wanting to reverse) because patients can't be discharged because there isn't adequate social care. And the circle is completed as without the adequate resources outside of hospital settings, there is a reliance on ambulances and 999.

Obviously the integration and partnership working which ICSs are designed to deliver should help in this, and where those ICSs are already established and matured we are already seeing improvements. But again it looks like this may lead to a postcode lottery. Those with less established organisations will fall further behind - in some areas mergers are still likely, and many of the areas with the 'weakest' ICSs on day one are the areas which need them the most. Its going to take a lot of effort to bring these up to standard, and some of that leadership is going to have to come from the centre and from NHSE itself - and a time where as an organisation it too is undergoing change in incorporating Health Education England and to a lesser extent NHS Digital.

The other big incorporation into NHSE has been the long overdue incorporation of NHS Supply Chain into the brand. For too long a slightly awkward step brother, the incorporation should allow a better delivery of shared objectives, and should aid the 2.2% savings requirement through better purchasing decisions, and the ability for the NHS to show its clout more. Obviously there is a long way to go, and in a session with NHSSC there was a undertone of scepticism of NHSSC as a whole, there was an appetite and energy for the NHS on a local level to try and embrace the change and the potential solution to challenges which may come from it. Like much of the NHS, there was an understanding, and acceptance from NHSSC that things need to improve, but an energy and enthusiasm to deliver it.

So - overall what is the plan, will it work, and how were people feeling about it?

Its safe to say that the biggest take away was that people were pleased to be back, pleased to be able to see each other face to face again and pleased to, as a whole, be looking forward rather than backward. Its true too that everyone is prepared to give ICS working a chance, and wants it to work, however the enthusiasm does differ across different people, but more in line with how their local system is working rather than as a reflection on the idea or the desire for success.

Its true too that there is a renewed energy among NHS suppliers and contractors to deliver better for the NHS, for health as a whole, and to support the NHS as it continues through its digital transformation. Hardly a stand I passed was not emphasising their digital credentials - albeit there was an overall shortage of a 'green' and 'carbon neutral' stance which I for one was expecting. This energy is going to be important. It was noted by almost everyone I spoke to, that the digital (and non digital) development would come primarily from the private sector, and its the job of the private sector to show the NHS the efficiencies it can bring, to highlight the savings (be it physical £s or man hours).

But there are scars. The last 2 years have been hard, on everyone, but especially on those working in the NHS. I possibly hadn't quite understood quite how much of that had been burdened on NHS leaders - the focus has (understandably) been on the front line doctors nurses etc. and not on the generals, but the impact has been huge - and did not even need to be vocalised to be understood. Again this is where NHS suppliers need to support, by providing the answers to those problems keeping them up at night. Be it workforce, be it costs, be it access to care, be it bed numbers or backlog - whatever it is we need to deliver more and we need to do better.