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

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, Public Health England 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 off long-term 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 to ensure in today’s world there will always be 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 an SOS, is to say ‘Bevan was wrong’, NHS diodes not have to seem inadequate for patients or staff: this time can be different. Today’s tech, unlike previous tech, allows us to do more at lower cost, which I don't think has ever been true in NHS history. Have been innovations: heart transplant, chemo: good but more expensive. Power of modern tech allow improve outcomes and improve quality. Radiology in the cloud.

While tech on its own solves little, tech that clinicians want to use, that is 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 a platform, not a series of silos.

Staff do more of what came into medicine to do. Do all we can to remove or impede the grind of routine processes.

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

The concept of ‘better healthcare cooked up by the centre’ has been tested to destruction

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

And it requires trust. This is about culture. Trust in clinicians, local systems, all in NHS to seek and make improvements - and in patients to play their own part in their own health

This is how it 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: aim to increase healthy life expectancy. 5 more healthy life years by 2030 – add 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 we need to look after it with dignity and respect, treat me as person and individual. Public confidence is not the same as public satisfaction. How you’re treated at reception,;is it clean and tidy; do people explain to you and keep you updated? Not strictly clinical, but matters. Service’s bills and wages are paid by public, and so it matters.

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 it is 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 thruough best and worst. Keeps public support. As PM says, like whole nation round your bed when sick, make you aware.

NHS is 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. For example, my sister had a very serious accident, amazing lifesaving support at Southmead Hospital, when went back to GP to get approval for driving licence, her GP who she’d known her all life had no idea she’d been in an acccident. That sort of thing is happening every day.

National has another aspect, highlighted by Marmot. Look at life expectancy. Wokingham 72 years of heathy life, Nottingham 54. Blackpool 1 in 4 women smoke when pregnant; in Westminster , it’s1 in 50

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

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

We need one architecture. Announced over Christmas, one of most popular things, NHS login national ID assurance platform. Minutes to log in to many diff systems, best IT thing was a ‘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 they want us 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, when we 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 based in acute care – rest is down to genetics, environment and lifestyle. As system, good track record on conditions amenable to healthcare. Our smoking rates have halved to one of lowest in Europe; management of diabetes is 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 how 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 have statutory change giving you powers of direction over NHS?

Don't think designing system improvements from Whitehall big bang how improve service delivery. By empowering incremental delivery and listening to them about improvements to be made.

Any health bill’s aim must be to reduce burdensome bureaucracy of previous reports. Primary and community services are not allowed to communicate and empower ICS principle of population health.

Many parts of ICSs work very well, but I don't want to say that every one of them is 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 NHS England?

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 the 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? Govt’s immigration policy says they’re not.


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

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

Q: Surely it’s unlikely your rules are going 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.