Lord Carter of Coles opened the second day of our annual conference and exhibition. Health secretary Jeremy Hunt gave a keynote address, and afternoon plenary speakers included NHS England chief executive Simon Stevens and CQC chief executive David Behan.

A summary of the keynote session is available below, and notes from all sessions will be on the website shortly. 

Lord Carter of Coles

Lord Carter gave his latest views on the productivity work he is carrying out with trusts, including the areas where he thinks there have been improvements and others that still require more work.

He noted that the NHS had much to be proud of already in terms of the efficiency savings they have generated, mentioning that CiP attainment of £3.2bn over the course of the last year, and highlighted the Getting It Right First Time programme has saved approximately £50m.

He stated that while the NHS has been and is good at driving savings whilst maintaining quality, what it needs to get better at is doing this at greater pace. As an example, he cited that while many trusts have brought e rostering software, many are still not using it properly and to its full potential. If done properly he noted that e rosters can generate 6% more efficient use of staff, and delays on getting this working is “disappointing”.  Similarly he said better job planning is required for clinicians.

Further, he added that there is also still too much unwarranted variation in corporate back office cost, for example in cost per pay slip varying between £2 and £6 in similar trusts. He said the lesson here is that attention to detail about these small costs, in a systematic and line by line manner is absolutely key to driving down overheads and making the sector more efficient. To help this, he referenced the model hospital work that his work programme has developed, which will allow directors within trusts to easily examine productivity performance against their peers.

On the approach that is needed to be taken by the centre to ensuring trusts are performing he said that an approach that is not too top down, but also holds trusts to account is required. For example, he noted that in due course league tables of trust productivity will be developed and published, but at the same time NHSI has to be “tactful” and recognise the individual contexts in which different providers have to operate. He also noted the role the centre has to play in sharing good practice to help the pace of change that is required.

As a final point, Lord Carter announced that he would be rolling this work out to community and mental health providers, starting work with a cohort of these trusts form January next year. He said that there would be an initial report with recommendations for these providers in the Autumn of 2017.

See Twitter highlights from the session.

Rt Hon Jeremy Hunt MP

The secretary of state, Rt Hon Jeremy Hunt MP, praised the extraordinary workforce of the NHS and their role in patients and the public believing their care has never been safer, more personal or delivered with more dignity and respect. The focus of his speech was on the strategic workforce planning challenges facing the NHS and set out his answer in to three key issues: how do we attract more people into leadership positions, how do we support and improve morale, how to we respond to changing work-life patterns.

Looking at NHS leadership, he emphasised how difficult the it is and the multiple lines of accountability that trusts manage. He was also struck, though, by how few leaders had a clinical background, as well as how the skills of women and those from BME backgrounds were not being used to their full potential. He made a number of announcements intended to attract more clinicians into management, including reviewing regulatory policy, creating a fast track development programme, building in clinical leadership training, increasing places on the NHS graduate management scheme, and offering an NHS MBA.

With clinical engagement directly linked to morale, Hunt highlighted a number of measures already taken to support staff. These included extending whistleblowing protection to junior doctors, and ensuring better management of rotations and training. He also announced a review of the assessment appraisal process, £10m funding to improve support for doctors returning to work and a training pilot to support mentoring and the effectiveness of medial teams. A skills escalator will also be developed so that staff can progress from entry level apprenticeships to a nursing degree level.  Nursing associates will also be regulated, and there will be a clearer progression path for nurses to reach advanced level practice.

Finally, in exploring ways to support flexible working, Hunt highlighted the value of e-rostering. By the end of next year, he wants all trusts to make use of it, and announced funding for a new best practice sharing initiative where those trusts which are meeting the NHS Improvement e-rostering standard can share their knowledge with other trusts. He also announced a £1m fund to help GPs nearing retirement stay in practice by increasing the flexibility, variety and choice of work available.

See Twitter highlights from the session.

Simon Stevens

Simon began his session by reflecting on the broader national conversation on the NHS and the importance the NHS given the role it plays in our national life at a time where divisions in society are being revealed both in the UK and across the globe. He reflected that divisions are just as visible within health given the continued rise in health inequalities, particularly in some urban areas across the country. This is against a backdrop where the financial challenges in the country are self-evident and public spending is expected to fall by £19bn in real terms by 2020/21.

Overall, Simon's view on the national context is: continued public support and shared appreciation for the NHS; fantastic staff in the NHS, including managers who are playing an incredible role; as well as rising quality of care - including rising cancer survival rates and improving stroke mortality.

Simon then shared his thoughts on the three practical things the sector needs to deliver over the next 18-24 months.

Firstly, the NHS needs to demonstrate and bring about continued improvement on big health conditions, including cancer and mental health. This will make it clear that money spent on the NHS is money well spent. Simon shared the clear goals now on cancer and mental health that will be supported by national leaders drawn from the within the sector, including chief executives and medical directors from NHS Providers' member trusts.

Secondly, the NHS has to continue progress and make improvements in the  efficiency agenda. He commented particularly on the need to make progress in unaffordable medical agency costs, as has been achieved in nursing agency spend. He also highlighted the potential efficiency opportunities in reducing clinical practice variation.

Thirdly, use the sustainability and transformation plan process to get serious about service redesign in the NHS. While Simon recognised that STPs are going against 25 years worth of ingrained processes in the NHS, including funding flows, he commented that there are less statutory barriers in the NHS to making this happen than in other health systems across the world. He also commented that the 'P' in 'STPs' stands for three things depending on the area of the country: proposals, plans, and governance partnerships with the pooling of sovereignty and moving towards population health systems.

The main task for the NHS  over next 90 days is to sort out 17/18 and 18/19 financial plans and intensify engagement with frontline staff and local authorities on STPs. Simon confirmed that following the submission of STPs and two operational plans from the sector, the centre will assess the capital ask across the NHS and before the end of the financial year will distill the priorities for the next two years, aligned with the three areas above, which will make it clear what practical changes the NHS is mobilising behind.

Simon made two announcements in his address:

A public consultation will be launched shortly which proposes to close the last of the long stay learning disability hospitals in the country A big upgrade in HIV prevention will be launched with Public Health England later this week

Simon's closing remarks were to reiterate that this is a moment to hold our nerve, focus on what really matters, mobilise around the three concrete sets of actions above.

See Twitter highlights of the session.

David Behan

David Behan, in conversation with conference chair Cathy Newman, argued that the golden thread of his career history has been a commitment to social justice and highlighted his proudest moment in charge as the journey of the regulator in terms of driving improvements and becoming fit for purpose. 

The State of care report, launched in October, was a significant report based on the comprehensive model of inspections that CQC has been rolling out in recent year. The baseline which the CQC now has built through its inspections is unparalleled anywhere in the world. The report also made the case for allocating additional funding to social care. 

The CQC will be launching a consultation over how its regulatory model will evolve following the publication of its five year strategy earlier this year. David acknowledged the need for further progress on efficiency and also the challenge around consistency that the CQC still needs to address. 

In response to a question on how standards can be maintained during a challenging financial environment, David argued that quality and safety do not represent a binary choice and acknowledged that board members are working hard to strike the balance between finance and quality. He pointed out that there is a direct relationship between trusts being rated outstanding on quality of care and financial stability. 

David characterised the relationship between the CQC and NHS Improvement as growing and developing. He stressed a commitment to achieve a shared understanding of 'well led' domain and also on the assessment of use of resources between the two regulators. 

Speaking about some of the common frustrations that providers experience, the CQC is looking at restructuring how it publishes reports following the inspections it carries out to address concerns about the factual accuracy of reports. This is likely to see shorter reports from the CQC on the performance of providers, with evidence captured in the appendix. 

See Twitter highlights of the session.

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