NHS Confederation Integrated Care System Leaders conference

Thank you very much Matthew and thanks for inviting me and thank you for everything that you do. You might be able to tell from the background that I’m joining you from Glasgow, from COP26 where there was also a very important health announcement yesterday – I’m sure none of you missed it.

But let me just start my remarks by just saying that we have all got such affection for the NHS because, ultimately, it’s about all of us.

It’s a truly national health service for NHS patients and NHS colleagues – including leaders like you – because we are all two sides of the same coin. We’re all cast together by the values that underpin the NHS. That we all share a responsibility for the health of each other. I think that’s never been truer than the past couple of years. We all have another difficult winter ahead. But we face it in a stronger position because of the leadership of everyone in this virtual room.

The way you’ve performed through the pandemic has undoubtedly saved countless lives. You can be very proud of what you have all achieved and I’m certainly proud of you. While we’re all still navigating the difficult days ahead, we must also look to the vital work beyond the pandemic. In many ways, Amanda and I, who you have just heard from earlier, are the new kids on the block. I took up my post in June, and Amanda in August. But of course, we’re not that new!

This is the sixth department I’ve led – and Amanda’s distinguished NHS career spans three decades. But we do have new ideas for what is unquestionably a new era. My priorities which I have talked about a lot in this job are Covid, recovery and reform. Covid – getting us, and keeping us, out of the pandemic. Recovery – tackling the huge backlog of appointments it has caused. And reform of our health and social care systems for the long-term. Three words, covid, recovery and reform. But a tremendous amount for us to do. So I’m really grateful for this first opportunity to address you: the leaders of our Integrated Care Systems.

There are two big reasons why we’re at an inflection point for our ICSs. The first, because this is a new era for ICS leaders after the Bill. And second, because the pandemic has made sure that health and care in this country will not — and cannot — ever be the same again. But I believe it can be better – and it can be more integrated.

But to achieve that, we must learn from the pandemic. What went wrong? Of course. But equally important is what went right. For a start, we’ve never been more integrated. The way, for example, we’ve worked across traditional barriers to vaccinate the country against Covid-19. The way that we’ve got data pumping through the arteries of our healthcare system. And the way we’ve simplified so many staff processes – from registering overseas doctors to streamlining appraisals.

For our NHS leaders, the pandemic has been like sending elite air force pilots into space. Your knowledge, discipline and experience have helped you thrive in extreme new circumstances. It’s proof – if proof were still needed – that integration must continue to be our watchword and Integrated Care Systems are the right way forward. Because joint working has always been our greatest weapon against this virus. We’ve been pulled ever-closer together by a shared enemy. Now we must stay together, to combat other challenges: like health disparities.

Passing the peak of the pandemic has been like a receding tide, revealing the underlying health of our nation. We can see that the health disparities in our society — whether regional, racial or socioeconomic disparities — have only deepened. Men in England’s most deprived areas can expect to live nearly ten years less than those in the least. Black women are five times more likely to die from complications during childbirth than white women. Black, Asian, and minority ethnic groups make up less than a seventh of our population but they represented a third of the critical care admissions from Covid.

It’s time to level up on health. That’s going to take partnership. And it’s going to take a new kind of leadership – from me and from all of you. After all, the NHS didn’t become the institution we all love today by standing still. Nearly 40 years ago, when Roy Griffiths reported to Mrs Thatcher on NHS Management, he famously said, and I quote:

“If Florence Nightingale were carrying her lamp through the corridors of the NHS today she would almost certainly be searching for the people in charge”.

Well, if Florence Nightingale carried her lamp through the Nightingale Hospitals, ICUs and A&Es last winter she would have found the people in charge and she would have found an NHS management that is innovative, integrated and open. And the Leadership Review, led by General Sir Gordon Messenger and Dame Linda Pollard is about taking the very best of what you’re doing and doing even more of it and turning it onto those great challenges of the future.

Because the future of health in this country is not just about people like me in Whitehall but about people like you – working in partnership with everyone who can make a difference. We’re not just giving you the investment to reform, we’re also giving you the freedom to innovate so that ICSs can take on an ever-greater role as hubs of innovation and show the way forward for other parts of the country.

I am determined to do all that I can to help you achieve this. To be innovative, to be even more integrated and have an even more open future. We put in historic levels of funding at the spending review. In fact – on capital expenditure – I think I am right in saying that we put in a £1 billion more than even the NHS Confederation asked for! It does help, of course, if you know a few of the tricks of the Treasury. We’re also laying legislative building blocks. Like the Health and Care Bill, which provides the architecture for our statutory ICSs.

And soon, I’ll be bringing forward a White Paper on Integration, with our proposals for how health and care can work better as one. It will see us embrace new ways of sharing records and delivering digital services together, for example. It will also see us embrace new approaches to the workforce. Not only helping staff move from sector to sector but also to promote more joint roles across health and social care. Aside from the structures, we want, quite simply, more people working across health and social care and we’re bringing in even more talented colleagues to join you.

Since last August, we’ve recruited almost 5,500 more doctors, almost 10,000 more nurses and there are almost 39,400 more staff in hospital and community health services in total. More colleagues who – under your leadership – can embody not only the kindness, compassion and resilience that sets the NHS apart but your spirit of innovation, integration and openness too.

But to lead this change, we’re going to have to make a big psychological leap. We have to step out of our shoes and experience health and care through the eyes of the people we serve. If you’re recovering from a serious operation, you don’t care which structures sit where. You only care about the quality of care you are going to receive. My objective, above all others, is to stop people bouncing around the system. It sounds simple – but I know it’s hard. If it were easy, we’d have already done it.

But with this shift in perspective – and a shift in professional culture too – I think we can achieve it by thinking as one, planning as one, and working as one – across our ICSs. The Prime Minister and I have high expectations but given everything we’ve achieved already, I have every confidence we’ll get there. But in addition to all of this, there’s one more ingredient that’s so important to me: and that is respect.

I’ve been appalled to hear of incidences of violence and abuse in the NHS.

Let me say this: I am going to have a zero-tolerance approach. Everyone in the NHS deserves to work with respect and dignity. They have a right to expect a workplace free from violence and abuse. And I’ll keep working with leaders like you to promote those positive cultures we need to see.

Some of you may know that when I was Home Secretary, I made protecting staff in emergency services a priority and I’m determined to do the same in the NHS. And to help us realise this, I want us to have an NHS Covenant – just like we have for the Armed Forces and the Police. It can bring together so much of the work we’re already doing from the People Promise, to action against violence and abuse. I want to consult widely on it. Both across the NHS and the general public to get it right, so we have a Covenant that makes a lasting difference to people’s lives.

Covenants are a promise. They’re a mark of respect to those who’ve served. And they are a thank you from a grateful nation. And it only remains for me to add my own thanks. Thank you for everything you’ve done throughout this pandemic. I want to thank you for your leadership. And I want to thank you for everything that you are planning to do in the future. Together, I know this new era will be one of the most consequential in the NHS’s proud history.

Let’s make it count. Thank you very much.