Lord Victor Adebowale's opening address at NHS ConfedExpo 2024

Good morning.  

On behalf of the board of trustees and staff of the NHS Confederation, I would like to welcome you to NHSConfedExpo 2024 – our joint annual conference with NHS England. For those who don’t know me, I’m Victor Adebowale, chair of NHS Confederation, and it’s my pleasure to host you all for the next two days.   

It’s great to be back here in Manchester, and to welcome partners from across the health and care system - from local government, social care, housing associations, and from the voluntary, community and social enterprise sector. I want to thank our sponsors, Google Health and Novartis for supporting us to make this happen.  

I am so pleased that so many of you have come, and I really mean that. I know that it’s not easy, and I know that you may have weighed up whether you should be here or not, but can I say thank you for coming to invest in yourselves -  we will do our utmost over the next two days to make sure that you feel it has been worth it. I really want to focus on how I hope you will feel at the end of these two days.  I hope you leave feeling you have had the opportunity to invest in your own development, that you will leave feeling a greater sense of optimism. If you are privileged and lucky enough to be in this room I think you are far too lucky to feel pessimistic.

I hope that you leave feeling more prepared for what you will face in your work, and hopefully more proud of what the NHS and our partners are achieving together in the most challenging of times. I also hope that you will feel more capable of adding value to the citizens that we serve.

I recognise that we are also here in a time of increased uncertainty with the upcoming General Election, and I understand how that sense of the unknown can sometimes hang over the day-to-day work of you and your teams.

Before I go on, there are other health and care providers around the world that are working in some of the most challenging front lines - Israel and Gaza, Yemen, Ukraine – working desperately hard to save lives. I think it’s worth us remembering that we are actually all part of that wider community.

Working on you behalf

Since we last met, we at the NHS Confederation have been working hard on your behalf to secure the wins that are needed for the health and social care sector. As you would expect, lots of that influence will continue after the election, but in the meantime we work hard to keep health and social care at the top of the agenda where it should be. And right now it’s the number one issue for voters. We continue to listen to your concerns and highlight those to policymakers, as we did recently with our finance survey. But here’s just a flavour of what we have been delivering for you and with you:

• Matthew will say more about this, but we have increased our improvement support for members, including our interface improvement programme across primary and secondary care; our learning and improvement across systems programme in partnership with the Health Foundation and Q Community; and our improvement support programme for leaders around action on health inequality and inequity.
  
• Together with the Local Trust, we announced an exciting new partnership that will promote and test community-led approaches to health and wellbeing in some of England’s most deprived neighbourhoods.
  
• Over 1,000 leaders across health and care signed our inclusive leadership pledge, which outlines nine behaviours that leaders and aspiring leaders can publicly commit to doing within their organisations to work towards creating psychologically safe working environments for all staff.
  
• We showed the importance of out-of-hospital care by publishing new research with Carnall Farrar that showed that for every £1 invested in community and/or primary care, there is up to a £14 return to the economy. This was showcased at a sell-out conference exploring health beyond the hospital.
  
• Our learning platform of resources that support systems with their work around social and economic development – one of the four core purposes of integrated care systems – has been widely accessed and used.
  
• Our report, Maximising the Potential of Digital Mental Health, identified common principles, key themes and further ideas for exploration in digital mental health. The findings and recommendations have been built into our own work, including examples of digital  services across places.
  
• In collaboration with NHS Providers, our Community Services Week united the community services sector and raised national awareness to the wider health and social care sector of the importance of community services.
  
• We published a practical guide for system leaders that will help to inform future spending on health inequalities and health inequity, and support implementation of high-impact changes within integrated care boards so that we can address health inequity and health inequalities. 
  
• We hosted a webinar for well over 300 leaders, supporting them to embed anti-racist leadership behaviours within their organisations and recognise personal accountability at a system, place and neighbourhood level. Supported by my colleagues at the Race and Health Observatory.

Thank you

As ever, I must say thank you for all that you are doing. ‘Thank you’ sometimes feels inadequate to recognise the lengths you are going to, to keep the show on the road. I wish there was something bigger that I could say, but thank you, nevertheless. It’s your sheer diligence, like Matthew Gleadall I met Matthew when I went to Doncaster, he's the operational director of estates and facilities at Doncaster Royal infirmary.

I was so impressed with Matthew – given the state of the hospital building. He literally walks round the entire building daily, including over the holiday period, checking for any dangerous wiring, of which there are many, checking for faults which could cause harm to patients and staff. He shouldn't have to, I’m sure there are many other things he needs to be doing but that’s a number one priority given the age and state of the building. He has to do it to keep people safe. and it just underlined for me the issue of what you have to do to keep the hospitals safe. The visit brought into sharp focus for me the issue of capital spending, and for me, that's one of the issues that we are pushing on your behalf around capital spend. It’s essential that that message is heard.

The public just don’t see what it takes to keep things going, do they? And let’s remember, and we know this, you know this. When we hear talk of just blithely getting rid of 5,000 managers, frankly I wish there were 5,500 managers to get rid of. We know that the NHS is under-managed compared to international health systems and other parts of the UK workforce. As I've said finding 5,500 managers to get rid of might be the first task.  But so many of you go to such lengths in the name of providing the best you can for your patients. 

Leadership

Friends, I think I can call you friends, I do want to talk about leadership and the kind of leadership I think we need in our health and care services today.

It’s a kind of leadership that I refer to as ‘systemic’, and what I mean by that is leading on behalf of the whole health and care system from where you are, not simply your organisation.  I also don’t mean just ICS leaders, I mean all leaders in health and care systems. We all have to have a system focus if we are going to make real change. 

I recently met John Turner, who's the ICB CEO in Lincolnshire. His style of leadership really impressed me – he brought everyone together in the room, no egos, and it was just what was needed. It's easier said than done but it's essential. Or the leadership that Sam Allen has shown through chairing our Women Leaders network as well as her system in North East North Cumbria.  

System leadership isn’t just about repeating the words ‘system leadership’, in fact I'm often fond of saying that the way in which the NHS avoids change is to learn the language but not change the behaviour.  It’s about being able to work across boundaries, through differences, with many different groups of people, patients, citizens and staff. It’s about really taking people with you on the journey, not just bundling them in the back of the car.

Nor is it enough to use the right language, it’s a form of leadership that demonstrates the right behaviours of partnership, collaboration, compromise and flexibility, so that we succeed or fail together. We don't need systems to fail. And I know that sometimes people get cynical about  them, and let’s be about honest, we all do from time to time. We know it’s the right direction of travel, so let’s keep going. 

It’s why we as an organisation are investing more and more in helping you with your leadership development, by running bespoke courses for ICS leaders, programmes for primary care leaders, for equality, diversity and inclusion directors, support programmes around health inequality and inequity, support for clinical leaders and first-time chief executives. This is where we want to be going forward because we know that when we invest together in leadership, the results speak for themselves.

Here is a quote I really like that focuses on the nature of leadership in three ‘I’s, and it’s from the Canadian writer Robin S Sharma, and he says:

“Leadership is not about a title or a designation. It’s about impact, influence and inspiration. Impact involves getting results, influence is about spreading the passion you have for your work, and how you inspire teammates and patients and citizens.”

So friends, let’s think about our own impact, let's take responsibility for our influence and our ability to inspire. 

Realities not aspirations

We know the reality of the health and care service today. We must deal in realities, not just aspirations. The reality is that unfortunately most people I meet have a story about where the NHS hasn’t delivered. We may have experienced it ourselves, I know I have, as patients or with family members.

There are issues that are hard for us to process, that show where the health service has failed and where we have huge lessons to learn. It’s a moment to reflect on the people impacted by those issues and the recent reports and inquiries that have highlighted how people have been let down in the past as well as recent times.

Tomorrow we will hear from one person deeply impacted by a situation where the NHS did not meet their needs - Merope Mills. She'll be talking about the treatment her daughter Martha received, and her successful campaign for Martha’s Rule. I am very pleased that 143 hospitals have signed up to the scheme to ensure patients and their families can seek a second opinion. I want the rest to sign up too. But it shouldn’t have taken the death of a young girl with her whole life ahead of her. That is an example of learning in action. Let’s be the leaders that listen, with empathy and understanding, to our staff, our patients and their families.

Culture and leadership

And that leads me back to the theme of leadership, because it’s not just the type of leaders we are, it’s the culture that we create, that we are responsible for. Whatever culture we as leaders are presiding over is of our own making - we are responsible for it. Take a moment to ask yourself an honest question – what culture am I responsible for creating?

We need leaders that are open to critique and challenge, that are encouraging. And if we expect our teams to live out our organisational values, we need to own them and live them ourselves first.

Let’s keep the realism people, and we must be realistic with the public about what’s going to be possible in the future. 

Matthew will talk later about what we at Confed, having listened to you, think about the future of our health and care service. It’s not just our thoughts, it’s what you as our members, have told us you want to see. And we will continue to speak truth to power on your behalf.  

So friends, let’s have a chat. Let's have a bit of a laugh, and you are allowed to laugh, although there's been no jokes in my speech. Let’s be challenged, let’s be inspired. If you see me around, do say hello, and I hope you get the most out of your NHS ConfedExpo 24. Not just for you, but as important as you all are, this isn't about you. It's about the people who aren't in this auditorium, who aren't in the space. The people out there, the people for whom we all care, for whom we all work, and whose lives we have to improve.

Thank you.