Conference call

I’ve been going to the NHS Confederation’s annual conference – or as it’s more snazzily called these days, #NHSConfedExpo – for precisely 18 years.

It’s the biggest conference in the NHS, bringing together all its managers, system leads, Trust CEOs, movers, shakers and clinicians with missions.

Pharma is always on the exhibition floor in big numbers, schmoozing and lanyard-swiping for dear life. It’s sociable and it’s fun.

I operated a robot surgeon in practice mode and got 61 out of 100, which is apparently promising for a beginner.

I spent six minutes in the latest chrome NHS staff vibrating microsleep pod, emerging back into the conference hall like a refreshed Jetson. Furthermore, I enjoyed free-flowing coffee, mints and conversation.

My first confed was in 2006, back when Patricia Hewitt was Health Secretary, and the big topics du jour were the smoking ban (that’s how old I am) and Sir Nigel Crisp’s controversial “universal roll-out” of practice-based commissioning. Jeopardy, eh?

These were tamer times, when the word ‘crisis’ was heard rather less and optimism (or complacency?) was generally rather widespread.

We’ve been on quite a journey since then, haven’t we? Here’re the things I learned while I was there.

Because of the election the conference this year did not feature the Health Secretary, and the big keynote speech was delivered by NHSE CEO Amanda Pritchard.

Generally the reception of Pritchard’s speech was that it “was better than last year’s”, involving a fair amount of head-on acceptance of the scale of the challenges ahead, and the need to radically reimagine how healthcare could be done, as opposed to last year’s turd-polishing.

For me, as summary speeches go it was perfunctory. Two big requests to government: for more money and for more of a focus on prevention. Three big asks to the service: build capacity, continue the recovery and constantly innovate.

And three big opportunities: properly empowered and motivated workforce, better use of tech and relationship-building between different parts of the system. Fair enough.

But there aren’t really many better ways to sum up the NHS to its own leadership than how my colleague at HSJ Julian Patterson puts it; that ultimately, “there are nearly 8 million people on the waiting list, almost every part of the NHS is in deficit and the entire workforce is in the shitter”.

Takehome: Whoever takes over after the election has much more work to do than they did in 2006, that’s for sure.

So onto the miniature theatres that dotted the exhibition floor, all dedicated to on-trend themes; population health management, innovation, digital, best practice, transforming care pathways, improving outcomes.

I spent a lot of time in the ABPI-sponsored In Conversation with… stand where I heard a very interesting session on NHS-Industry collaboration.

It turns out that, according to an industry survey, only 8 per cent of NHS leaders could see value in pharma partnerships (compared with 28 per cent for partnerships with medtech. Why is medtech so special? Or why is pharma so mistrusted?).

The panel was keen to stress how the rules of the Code and the new joint working guidelines that allow collaboration for the benefit of systems, not just patients, should make this kind of thing transparent, rational and with clear win win wins.

Takehome: Pharma still has a job to do to convince the NHS that its partnership offers value.

Everyone is agreed – Labour, Tories and the NHS – that investment in primary, community and prevention is the way forward – to manage demand in the first place to make the NHS literally financially sustainable.

To reduce the dependence on expensive DGHs; and to keep patients closer to home with less ping-ponging and a more streamlined experience with the prospect of better outcomes.

There’s widespread agreement on the need for change here. So what will the new government do to meet those asks?

The system is still set up to incentivise secondary care activity. In order to do anything about this you’d need something similar for primary care. More patients seen, more work done, more money.

Amanda Pritchard mentioned this need in passing without elaboration. But sure enough, HSJ followed this up and there is indeed a plan afoot for a primary care activity incentive.

There’re still some big question marks on how this will be done. Changing financial flows and contracts is something that has been avoided in the last few years.

It raises a whole lot of questions about how hospital finance will be balanced. It’s not straightforward. And Pritchard’s comments come slightly out of the blue.

Takehome: Primary care IS going to become a bigger player with more clout in the NHS in the next few years. It will have more investment, more power, more responsibility and patients will increasingly spend more of their pathway time here, whatever the clinical condition.

The successful legacy projects, the useful real-world evidence and the best outcomes are going to come from locally driven, bottom-up, grassroots initiatives.

In the space uncovered by the slow withdrawal of centralised commissioning and planning, the best areas have been working away in programmes, setting up pilot projects and using ICS autonomy to come up with innovative solutions.

Takehome: Local system knowledge, uncovered, fed back and monitored by field reps, will be crucial to tap the potential of the NHS market.

My own company Wilmington Healthcare has been involved in healthcare equity projects for some time and it does feature heavily in our messaging.

If I was worried we were over-egging this pudding though, I needn’t have.

The theme was all over the conference; it had its own workstream running through the breakout rooms; a sponsored exhibition theatre, and found its way into several other conversation stations.

There’s every sign it will be as important as ever under a future Labour government, and is one of those few happy crossover points between naked capitalism and altruism.

Better access to medicines for the deprived groups – such as BAME, disabled or older people, or patients in poorer areas – that would most benefit from them.

How to achieve that? Well if you’re not yet sure of what equity project an NHS-pharma partnership might cover, the Confed was full of ideas. Earlier lung checks for those at greatest risk.

Boosting community ownership of a disease area as a long-term improvement approach. Redesigning pathways to improve access, support integration and help achieve innovation.

Patient-centred weight management. Tailored education to engage underserved communities. Digital first patient empowerment. Improving cancer screening rates in hard-to-reach groups.

Takehome: In the next few years any pharma worth its salt is going to be all over improving diagnosis, medicines access, and medicines adherence for deprived, forgotten and hard-to-reach patients.

Oli Hudson is Content Director at Wilmington Healthcare.
Go to wilmingtonhealthcare.com