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Editorial Thursday 27 February 2020: Matt Hancock speech to Nuffield Trust Summit

Publish Date/Time: 
02/27/2020 - 16:40

Rough text of Matt Hancock speech to Nuffield Trust Summit. Uncorrected. Will contain typos.

Government’s vision for the NHS and social care – Matt Hancock

We’re doing all we reasonably can that’s possible to keep the public safe from Coronavirus.

Praise exemplary response from officials, PHE and DH. Brilliant work of CMO Prof Chris Whitty. Plan driven by science and guided by expert advice marshalled by Chris Whitty. Tackling this is overwhelming and currently taking most of my time.

But must not take eye of LT challenges need to make to health system to make best can possibly be

Delivering manifesto commitments 50,000 new nurses and 40 new hospitals.

Big long-term Q how ensure in today’s world always confidence in NHS. In speech to nurses 1948, Nye Bevan said “we shall never have all we need. expectations must exceed capacity. My argument, hard for SOS, say Bevan was wrong, NHS not have to seem inadequate for patients staff this time can be diff. today’s tech unlike previous tech allows to do more at lower cost, don't think ever true in NHS history. Have been heart transplant chemo good but more excessive. Power of modern tech allow improve outcomes and improve quality. Radiology in the cloud

While tech on own solves little, tech that clinicians want to use, done with them not to them has game changing potential. Known as can see across every other part of tech and in some parts of the NHS. Get this right and by end of decade, NHS can be platform not series of silos.

Staff do more of what came into medicine to do. Do as removed or imped grind of routine processes.

To do have to change how we think of change in the NHS. Policymakers love idea change something do with top-down transformation and big bang reforms. Decade littered with EGs

Better healthcare cooked up by centre tested to destruction

I millions of incremental improvements, small tweak to process that improves patient flow. These transform the NHS. Don't happen on own. Require strong accountability, right data, resources, including record £33.9bn will be enshrined in law

And it requires rust. This a=is about culture. Trust in clinicians, local systems, all in NHS to seek and make improvements and in patients play own par in own health

This how happens, but marginal improvements requires people to have common mission. My changes must free people up to innovate, and where works, that is driven by a common goal.

Can achieve that in NHS.

Two big-picture goals for NHS system in broadest sense, not just front-line

One clinical, other of user experience. Equally important and reinforce each other

Clinical: increase healthy life expectancy. 5 more healthy by 2030 – years to life and life to years.

Not enough alone, people go to work in NHS to serve.

2nd goal is to increase public confidence in NHS – that will always be there and need look after with dignity and respect, treat me as person and individual. Pub confidence not same as satisfaction. How treated at reception, is it clean tidy, do people explain and keep you updated? Not strictly clinical but matter as paid by public and matter

Parallel with CV19. Seen approach

Q2 2019 NHS received 50,000 complaints – largest part were communications

So setting NHS challenge to be as good at process and admin as at medicine. Not carry ring binder of notes. Not ask stress journey into acute for home possible test.

NHS must be a national health service and a service for the nation’s health

National – why NHs so important – part of national identity, love always there for us unconditionally thru best and worst. Keeps public support. As PM says, like whole nation round your bed when sick, make you

NHS not one single command and control Biskmarckian monolith – more like the Holy Roman Empire, no national back office, each locality has own teams with massive duplication of effort, no national data architecture, my sister had a very serious accident, amazing lifesaving support at Southmead Hospital, when went back to GP to get approval for driving licence, GP known her all life had no idea. That is everyday

National has another aspect, highlighted by Marmot. Look at fie expectancy. Wokingham 72 years of heathy life, Nottingham 54. Blackpool 1 in 4 women smoke pregnant. Westminster 1 in 50

In 2020s must put national back in to NHS, levelling up ending postcode inequalities access to GP, national standards. Want local variation where local variations in conditions. Local systems

Why should some parts offer three IVF cycles, others none? Absurd and unacceptable in a national system.

One architecture. Announced over Christmas, one of most popular things, NHS login national ID assurance platform. Minutes to log I to many diff systems, bets thing was NHS login once announcement. New infrastructure, all bits require you to prove who you are. Have to do that simply and once. Most impactful clinical can create is national database for patient experience, clinicians, and data. creating an architecture systems can talk to each other. Shared care records peak to each other with common standards.

Just published new draft technology standards on interoperability, requires tech suppliers to do if we want to buy.

Other tech announcements on what good looks like, get involved interested or not, should not be left to us at the centre. Will never be big bang moments say switch pulled and problem solved. Must be iterative and based in evidence of what works: that is strong and growing. Bringing tech into C21 works, ignoring tech and data is just wrong.

Get this right, and we can do incredibly powerful things

Health – only 25% of longer lives in acute – rest genetics, environment and lifestyle. As system, good track record on amenable to healthcare. Smoking rates halved, one of lowest in Europe, manage diabetes world-leading, CHD deaths halved. Some of best public health in the world, for which we're grateful.

Most of 70 years, single acute illnesses and money into acute providers. As enter 8th decade, lifespan increase started to slow. Have to focus on healthspan – this is for the NHS and wider system too. Prediction and prevention mission critical to extra 5 years of healthy life. Part smarter NHS use, like dedicated alcohol teams in acutes, support to quit smoking, radically improve screening progs and more resources in primary and community, and ask our army of pharmacists to do more. This approach about recognising not all answers in NHS, air pollution, properly designed homes, insulation, transport, walking.

Discussed since 50s why now?

Lots more info on smartphones, Fitbits, 5 million genomes sequencing. All data helping up fill in big gaps, in knowledge about what works and for whom. Topol and Stork work on top 10 US drugs by gross sales, 75% of patients did not have desired result of benefit. NNT question. Until can safely use all data hold on individua patients, goes, on. NIHR cancer trail show not know which benefit from prostate cancer. Bring NNT closer to one, save NHS and patients cost and pain of unnecessary treatment.

Already have AI and tech to produce outcomes. MIT found new antibiotics. So new £250M NHS lab for this. By end of decade docs need all relevant info on patients, and if want to volunteer genomic and genetic data. Need the tech to process. Being done in pats. Turn NHS from national hospital service to health service, focused on patients

Service – deliberate focus on service distinct from health. Barts solved for chronic kidney patients, data sharing agreement with 160 GP services, so can see patients’ records. Own reviews and notes on Barts system, few how need creatine-related review seen, rest not. OP referral was 64 days, now less than a week. Too early to say if improved clinical outcomes, but not the point -point to improve service. Virtual clinic improves access, removes transport waiting rooms. Not only did patients consent, amazed not happening already. Many areas can make service better, medical advances amazing but service advances far to slow. Patients should be able to access medical records. Can be life-saving. Southampton real time PSA data access for patients, which has been incredibly popular and shown how people want to manage their own care. Wherever possible, healthcare should come to you before you go to healthcare. Some scoff. 30 years ago, had to go to doctor for pregnancy test. Now of curse.

Capex prog not just those 40 new hospitals about getting the right service, hospital clean, staff motivated, food good and crucially know what’s going on. Have to matter to all in the room and to all staff. Then NHS is a service r it is nothing, GOSH note child’s fav food and football team, to help staff make connection.

NHS service underline, that explicit public goal of confidence in NHS. Overall hugely exciting agenda. About ow incentivise and support and train, happy with staff survey in right direction, to see 8,000 new nurses, infrastructure, fixing roofs, using tech to fix historic problems of NHS and bring into C21st.

Can’t stand still must reshape NHS to use resources and deliver NHS of which we can be proud.

Q: No plans to statutory change giving you powers of direction?

Don't think designing system improvements from Whitehall big bang how improve service delivery. By empower increment delivery and listen to them about improvements to be bale. Bill aim is to reduce burdensome bureaucrat of previous reports., primary and community not allowed to communicate and empower ICS principle of population health. Many parts ICS work v well, but don't; want to say everyone working very well. ICS principle exactly where we are going, got to get powers right, must be bottom-up going with grain and improving powers

Q: Does SOS need more powers over NHSE

Qs have been raised about this. Merger between NHSE and NHSI which were set up to counterbalance each other, but primary goal is to remove burdens and barriers impeding improvement and causing incremental problems on way

Q: Prevention got mentioned, but councils don't know their public health grant for the coming year – where is the beef?

In v broad agenda of which Ph grant small piece. Increasing this year get exact allocation out f soon, but v broad, reducing are polluting not through Ph ground or housing. Improving designs to be more pro heath and MH. Of course important but a small part of overall agenda.

Q: Are care workers skilled workers


Q: How come in Home Secretary’s plans, they won't be allowed in?

Proposals allow for points-based health system, important thing , consequence of leaving U, UK government able to set.

Q: Unlikely to allow for that class of worker.

Talked about the NHS visa. Priti Patel and I have ongoing dialogue about how this will work for social care

Q: PM promised to fix social care once and for all. Where is the plan?

“We’re on it”

Q: Dilnot reform on statute book. Start there?

Parliamentary debate – failure not delivery, but have plan. Three parts. 1. Seek cross-party consensus in 100 days 2. put in more £ (1.5 bn next year) 3. Ensure have system don't; have to sell home to pay for care.