Lord Victor Adebowale’s speech to NHS Confed Conference

Welcome and introductions

Good morning.

On behalf of the board of trustees and staff of the NHS Confederation, I would like to welcome you to day two of our annual conference.

For those of you that don’t know me, my name is Victor Adebowale and I have the pleasure of being the chair of the NHS Confederation.

As Matthew Taylor did yesterday, I also want to take the opportunity to thank our commercial partners. In particular, our main conference partner, Palantir Technologies UK. More generally, I want to thank all our sponsors and exhibitors.

I also need to run through some quick logistics.

You can view all sessions on the agenda and can bookmark any to add to your personal agenda over the three days of the conference.

Confederation members have access to exclusive sessions in our Member Zone.

Do try to visit the Partners and Exhibition pages and the Solutions Library, where you can interact and find products, services and solutions.

This event is being hosted on Swapcard, which is great for networking and booking in one-to-one or group meetings with colleagues.

Hopefully you are used to it now, but for hints and tips on how to get the most out of networking on Swapcard, visit the helpdesk where we have short videos to guide you.

Finally, some sessions will be available to watch back on demand an hour after they have finished. All Zoom sessions will be available to watch back on demand from later today.

Business of the General Meeting vote

Apologies to anyone who is not a member of the Confederation, but I do have a short piece of business to conduct on behalf of the board of trustees before I get into the substance of my talk.  

This is to ask our members to vote on resolutions that will enable the adoption of our new articles and byelaws.

Placed-based and system working are increasingly important to you and we will support our members in their role in local systems

This is an important part of the Confederation’s new strategy, which as Matthew said yesterday is now up and running. I want to thank my fellow trustees and the staff at the Confederation who have led this significant change programme within the organisation, culminating in our new membership strategy and brand which has been rolled out this week.

Our renewed focus is on supporting healthcare organisations to improve population health. We know that placed-based and system working are increasingly important to you and we will support our members in their role in local systems.

Alongside this, we will continue to support you and your teams with a range of networks and activities dedicated to your sector. In the last 18 months, we have launched new membership networks for integrated care systems, primary care networks and primary care federations and acute providers. This is on top of the support we are already providing to providers and commissioners across the system, in England, Wales and Northern Ireland.

We will be doing some exciting things in the weeks to come that Matthew will be telling you more about, including ramping up our support to systems on digital and launching a new series focused on the local health and care systems that are transforming care. We’ll be highlighting best practice and giving you the opportunities to learn from each other. As they say, watch this space…

Turning to the resolution that our members are voting on in a few minutes, this will enable new NHS organisations like primary care networks and integrated care systems to be represented on our board. It is the logical next step in the Confederation’s development but requires formal ratification by our members.

So, without further ado, can I ask our members to vote via Slido – you will see that my colleague Leanne has added a link to the chat box for those who are eligible to vote.

While you are doing that, I want to thank all our members who have already sent in proxy votes.

Next phase in the development of the health and care system

Now onto the meat of what I want to say today. I am going to focus on two things: population health and system leadership. For me, they hold the key to healthier, happier and more productive local communities.

To keep our families safe you have sacrificed precious time with your own families. We are grateful to you and for everything you do for the country

But before I do that, I also want to thank our members who have delivered under extreme circumstances in the last year. As Sir Simon Stevens and Matthew both said yesterday, the NHS’s response to the pandemic shows that when you are given the support, tools and backing, you can do and achieve incredible things.

Senior leaders rarely get the respect they deserve, but we know that moral harm affects you, and that all of you have made sacrifices in support of the wider health and care system. I know that to keep our families safe you have sacrificed precious time with your own families. We are grateful to you and for everything you do for the country.

Population health management

As Matthew said yesterday, we are meeting at a pivotal time for the health and care system and we have an opportunity and a duty.

I am going to talk about the opportunity that we must grasp from putting population health approaches at the heart of our strategies.

Population health is much talked about, but less understood. Many of you understand it, but many of you are also facing day-to-day challenges that make population health look like a future issue rather than a today issue.

What we do isn’t about us and our organisations – it’s about patients and citizens and placing them at the heart of our service delivery and design

I understand that, but I am clear that none of us will be able to get away with this mindset.

The reason that it’s so important is because it’s the ultimate test of a health and care system, how we work with our partners across all parts of society, and what we deliver for our local communities.  

Ultimately, what we do isn’t about us and our organisations – it’s about patients and citizens and placing them at the heart of our service delivery and design. 

Population health’s time has come as we prepare to make a fundamental shift in the way the health and care system is organised. I believe that population health can be the unifying issue for place-based partnerships and each integrated care system. 

Our members have talked about how COVID-19 was the single issue that unified them, and how tackling health inequalities can be the single item that brings them together with their partners at ICS, place and neighbourhood level as we build a new health and care system on the back of all we have learned from the pandemic.

The end result of population health is that care comes to the patient rather than the other way round

I recently came across a report by the Royal College of Physicians, Academy of Medical Sciences and the Royal Academy of Engineering which perfectly encapsulated what a population health management approach can deliver. I am going to steal with pride here as I think it’s a brilliant portrait of how the system often falls down.

They give an example of Mrs G, a frail 80-year-old woman who lives alone, suffers a fall and experiences poor care from a disjointed system. After calling an ambulance and being transferred to hospital, Mrs G tells the A&E staff that she has diabetes, pulmonary disease, heart failure and kidney problems. The A&E staff are not sufficiently confident to send her home because they cannot establish the cause of her falls, access her GP record of treatment or enable extra support or assessment in her home for the next morning. Mrs G is therefore admitted and it takes days for the hospital to investigate the reasons for her fall.

After lying in bed for this time she loses all confidence to move unaided. Transfer to an intermediate care facility is advised and four days later she is moved, still not confident to get out of bed alone. Mrs G is worried she will end up in a nursing home and so are her family who live far away.

Because of inadequate planning and a lack of system-wide design and poor implementation, the ‘system’ does not meet Mrs G’s needs. But it could be very different, and the report posits an alternative scenario based on a systems approach that places a clear understanding of the individual at its heart.

In this scenario, Mrs G experiences the same fall but starts by calling a number given to her by her community support group. A community nurse attends, checks Mrs G’s blood sugar level as she seems confused, and makes her something to eat. The nurse checks the care plan with the community-based team and rings Mrs G’s daughter to update her on the situation.

Next day a speciality frailty nurse calls at Mrs G’s home to reassess her abilities, as this was her second fall in two weeks. The nurse arranges extra short-term care and discusses with Mrs G the possibility of moving into assisted living. The nurse arranges for her to visit a nearby facility with her daughter, updates her care plan and shares it with the GP and multi-professional team at the hospital. Mrs G is happy with the outcome and her family are reassured that plans are in place to deal with any future problems.

If you want to know what population health is, then this is it. This is what should happen when we understand our populations. The end result of population health is that care comes to the patient rather than the other way round. But we know it doesn’t happen enough.

I can already see our members trying to take this approach with the elective backlog. It is early days still, but never before have we seen such a focus on patients’ backgrounds, their postcodes, jobs, families and livelihoods. Looking at people’s co-morbidities and making nuanced and more informed decisions to minimise harm to patients, by condition and by postcode, however imperfectly – all of which we have rarely seen before.  

We must hold our nerve and build back in ways that ensure we do not exacerbate the health inequalities that have been so painfully exposed during the pandemic

We are not just banging through waiting lists, but we know that pressure will build politically for these lists to be addressed, not least before we get to the next general election.

The warning signs are already there with recent IpsosMori polling showing us that the public care primarily about reducing the time people wait for treatment, rather than in reducing inequality.

But we must hold our nerve and build back in ways that ensure we do not exacerbate the health inequalities that have been so painfully exposed during the pandemic. I am clear that if we want to solve the elective care problem then we need to solve population health.

We have the most centralised health system in the world – that needs to change

I see a determination to change this and long may it continue. But the key will be whether we can make reducing inequalities as important as every other statutory obligation that we have, be that financial balance, meeting waiting time or other performance targets.

All of this will be helped if we can ensure that the upcoming NHS Bill cedes power to where this matters the most. As I said in my response to the Queen’s Speech in the Lords, we have the most centralised health system in the world. That needs to change.

System leadership 

But we can’t do population health unless we have system leadership. And this is the second issue that I want to touch on briefly.

This is another phrase that we use, but don’t necessarily understand the full implications. I think Dame Jackie Daniel captured it brilliantly in her session yesterday when she said: “system leadership results in making your organisational boundaries sticky.”

System leadership is about being responsible for conducting power to where it matters most

In other words, your job is to make the conditions necessary to create a culture which is ‘and and’; not ‘either or’. That means you have to ask yourself questions about what kind of leader you will be, and what kind of questions you need to ask of your organisation, and of the other organisations in your system on behalf of the Mrs Gs of this world. 

System leadership is therefore not about having more power, or more individual power. It’s about being responsible for conducting power to where it matters most. And that’s in the delivery of better outcomes for the public and patients.

As Sir Simon Stevens said in his speech yesterday, it’s about beginning with the end in mind and reverse engineering from there. Or, as I would put it, it’s about being clear with your intention and ensuring the processes you use match the intention. It’s the opposite of fetishising about structures. 

Many of you have already started this journey and with a huge degree of humility and learning from the pandemic. This has led to the extraordinary delivery and outcomes that have been achieved during one of the worst crises since the second world war. I think it’s safe to say – to paraphrase Matthew – that the NHS is pulling the country through the crisis because of the leadership that you are giving.

The job of the Confed will be to support you in making these changes and in embedding population health approaches that place the NHS on a more sustainable and equal footing. With the support of the Race and Health Observatory we will help you to lead all the people, all the time, everywhere. And we will continue to work closely with all our partners, including NHS Providers where we will work together to support our respective members on this journey.

And, finally, a thank you to Sir Simon Stevens

I don’t want to close without personally thanking Sir Simon.

I have always respected his integrity and his razor-sharp analysis – he has a brilliant mind and will be sorely missed

He is a remarkable public servant and we owe him a debt of gratitude for his leadership of the NHS through what have been some very, very turbulent times.

Simon and I haven’t always agreed about everything, but I have always respected his integrity and his razor-sharp analysis. He has a brilliant mind and will be sorely missed.  

On 7 July, I will be introducing Simon into the House of Lords and I know his influence over the future of the health and care system won’t end when he leaves Skipton House.