22-24

For 20 years now, at roughly this point in the calendar, I have written some version of the same damned article.

As a healthcare journalist, you cannot avoid it. This is the month the NHS Confed Expo happens, and my profession is duty-bound to produce an opinion on the gathering of the tribes, the exhibition of the hopeful, and the tournament of ideas in which the winners ride off to NHS glory.

It triggers the usual frenzy of top-ten takeaways, trend pieces and templates for the future. I have contributed to that racket often enough myself, and to such an extent that I now occasionally wonder whether the AIs trawling the web for conference wisdom have already pinched my numbers three and five.

The event also works as a morale barometer. This year the needle sat a little to the buoyant side, though that may reflect the larger delegate turnout generated by the partnership with the NHS Alliance.

It also sharpens the question PharmaTimes readers always ask of their one giant, baffling, indispensable and frequently maddening customer: what, exactly, does the NHS want from us?

So let us get the ceremonial takeaways out of the way. I am sparing you the full ten. Life is short. Here are five, followed by the part that actually interested me.

1. The 10-year plan hovered over everything
A year on from the 10-year health plan, every conversation eventually circled back to it. At the top level, the language stayed full of digital creativity, reform, neighbourhood care and doing things differently.

On the floor, the mood felt more earthbound. People are already stretched by backlog clearance and waiting-list pressure. The much-invoked three Streeting shifts floated over the conference like a mission statement still waiting for a realistic operating manual. Financing remains foggy. Delivery remains foggier.

2. James Murray delivered a holding-pattern speech
The set-piece address came from the new Health Secretary, James Murray. Given the churn in public life, parts of the audience may have been forgiven for wondering whether Wes Streeting might reappear before the next full moon.

Murray’s core message was continuity of purpose. Leaders should carry on building, keep steady, stay the course. The tone felt managerial, provisional and rich in motoring metaphors. I do not think, for what it is worth, this man will ever get his own Spitting Image puppet.

3. Prevention remains conference catnip
The ambition to make the NHS the world’s most AI-enabled health system, and to use that shift to drag the service towards prevention, showed up everywhere.

So did the industry’s roll-call of enabling technologies and future gains: genomics, cancer vaccines, obesity medicines, predictive analytics, earlier diagnosis, tighter stratification.

The appetite for this agenda is obvious. So is the difficulty. A service under permanent acute pressure does not easily generate spare capacity for long-horizon prevention work.

4. Workforce flexibility has become a survival issue
Professor Sir Stephen Powis, now chair of NHS Professionals, returned to the case for a more flexible workforce and away from the absurd levels of agency spend that have haunted the system for years.

The £795 million saving figure landed because it captured a truth everyone recognises. Huge sums leak away through staffing models that are expensive, reactive and entrenched.

5. AI has graduated from hype to framework
There was plenty of talk about AI implementation, particularly in screening and diagnostics. The language has become more sober and operational: people, process, culture, tools, tech.

That at least suggests a maturing conversation. Whether the NHS has genuinely escaped pilot-itis, or simply become more fluent in describing it, remains open.

The brochure themes are familiar enough. The more revealing story sits underneath them.

After 20 years of reporting on these events, I have stopped expecting revelation and started paying attention to recurrence.

The same tensions reappear every summer in fresh lanyards. The same frustrations wander from fringe session to keynote and back again. The same aspirations receive vigorous applause. Then the delegates go home and the system resumes its argument with itself.

The NHS does this a lot. It still struggles to speak coherently across its own boundaries. Sectors remain siloed. Calendars remain packed with meetings about silos.

Everybody agrees care should move closer to home. Agreement then evaporates the moment the conversation reaches delivery, incentives, ownership, budgets and institutional loss. Somebody always stands to lose from change, and those somebodies usually possess meetings, spreadsheets and objections.

There is also a familiar wobble around evidence. Care closer to home has acquired the status of revealed truth, despite a patchier economic case than enthusiasts sometimes admit.

At Confed, as ever, one heard conviction in abundance and operational clarity in shorter supply.

The workforce arguments follow a similar script. More staff, yes. More staff of the right kind, in the right places, with the right flexibility, yes again.

GPs need more power. GPs already carry too much. ICBs are meant to think strategically. ICBs spend their lives handling tactical problems because nobody else is positioned to catch them.

The contradictions are not occasional irritants but part of the furniture. Health inequalities, meanwhile, continue their long reign as the silver thread of every serious presentation in British healthcare.

One end of the Jubilee line gets a longer life than the other. Everybody in the room knows the slide. Everybody has seen the figures. Everybody can recite the moral.

The problem stays put. Frail older people are told technology will help them remain independent and out of hospital. Frail older people often remain the least likely to embrace the technology designed to rescue them.

Nobody at Confed seemed shocked by that. Nobody ever is.

All of which brings us to the part of the conversation that matters most for this readership: the NHS-industry interface.

If I had a pound for every time someone in or around the NHS said ‘sell us outcomes, not products’, I could have hired a decent stand of my own by now.
The line survives because the underlying grievance survives. Pharma hears it every year because the NHS keeps finding reasons to repeat it.

That does not mean the sector is deaf. Plenty of companies understand the wider environment far better than they used to. Plenty now speak confidently about pathways, service redesign, patient support, diagnostics, adherence, prevention and population impact.

Even so, the gap remains. The NHS still wants industry to grasp the full shape of the burden facing providers and systems.

A therapy sits inside a pathway. A pathway sits inside a workforce crisis. A workforce crisis sits inside budget pressure, political pressure, capacity pressure, inequalities pressure and social care pressure.

That is the true purchasing environment.

Viewed from that angle, ‘outcomes’ multiply at alarming speed. Mortality and morbidity remain there, naturally.

So do referral patterns, pathway shortening, bed days, theatre time, recovery, rehabilitation, patient experience, equity, access, staff time, carer burden, out-of-hospital management, local productivity, pressure on social care and the wider economic footprint of keeping people well for longer.

It is a formidable list. It is also the list that increasingly governs the terms of serious engagement.

One could argue that NICE ought to print the whole thing on a laminated card and hand it out to anyone attempting market access in England.

The deeper issue comes back to understanding the NHS as it actually exists, rather than as it appears in global strategy decks.

It is uniquely centralised and unruly at the same time. It can sound highly strategic in London and deeply improvised in local delivery. It can move glacially and suddenly.

It can frustrate the life out of anyone trying to work with it, then reward the patient and perceptive partner with opportunities few health systems can match.

This is why some companies make real headway while others keep wondering why apparently sound propositions slide into treacle.

That is why one of the most interesting examples at this year’s event came from respiratory.

There were some strong sessions on pharma-NHS collaboration, and full marks to the Respiratory Transformation Partnership and to my friends at AstraZeneca, Chiesi, GSK and Sanofi.

One NHS speaker produced the driest line of the conference when the speaker observed that once certification and compliance appear, industry can move every bit as slowly as the service itself.

‘You’re as bad as us.’

A fair cop.

The respiratory example matters because it offers a concrete model of progress. Cross-company collaboration happened. NHS engagement happened. Shared goals happened. Real delivery work happened.

The lazy alibi that such partnerships are simply too hard to organise looked weaker by the minute.

That only makes the next set of questions more pressing. Why respiratory? What conditions made that partnership viable? Clinical urgency? Commercial balance? The right personalities? The right governance? A therapy area broad enough for companies to collaborate without feeling they were disarming in front of competitors? A policy moment that made the stars align for once?

More to the point, what travels? Could the same kind of arrangement work in cardiovascular disease, obesity, mental health, vaccines or oncology supportive care? Which therapy areas are ripe for the same model? Which are structurally hostile to it? Where does the next transformation partnership come from?

Then we hit the old NHS riddle that no conference has managed to solve. When something works, how does it spread? Why is local brilliance so often trapped in local geography? Why do good ideas acquire pilots, awards, applause and case studies, yet still struggle to become system habit?

That is what Confed Expo keeps surfacing, year after year. A health service full of ideas, full of decent people, full of pockets of ingenuity, full of presentations that describe the future in loving detail – and still chronically vulnerable to friction, fragmentation and patchy scale.

So yes, the Confed remains two things at once: an energy pool for visionaries and a tragicomic circus whose performers know the script by heart and still miss their cues.

As for pharma, the message remains gloriously repetitive. Bring the product, certainly. Bring the evidence. Bring the health economics.

Then bring patience, pathway literacy, stamina, a tolerance for institutional absurdity and a serious answer to the question of what changes for the NHS once your product enters the room.

Otherwise, I will be back here next year, writing the same damned article again.

‘You’re as bad as us.’

A fair cop.

The respiratory example matters because it offers a concrete model of progress. Cross-company collaboration happened. NHS engagement happened. Shared goals happened. Real delivery work happened.

The lazy alibi that such partnerships are simply too hard to organise looked weaker by the minute.

That only makes the next set of questions more pressing. Why respiratory? What conditions made that partnership viable? Clinical urgency? Commercial balance? The right personalities? The right governance? A therapy area broad enough for companies to collaborate without feeling they were disarming in front of competitors? A policy moment that made the stars align for once?

More to the point, what travels? Could the same kind of arrangement work in cardiovascular disease, obesity, mental health, vaccines or oncology supportive care? Which therapy areas are ripe for the same model? Which are structurally hostile to it? Where does the next transformation partnership come from?

Then we hit the old NHS riddle that no conference has managed to solve. When something works, how does it spread? Why is local brilliance so often trapped in local geography? Why do good ideas acquire pilots, awards, applause and case studies, yet still struggle to become system habit?

That is what Confed Expo keeps surfacing, year after year. A health service full of ideas, full of decent people, full of pockets of ingenuity, full of presentations that describe the future in loving detail – and still chronically vulnerable to friction, fragmentation and patchy scale.

So yes, the Confed remains two things at once: an energy pool for visionaries and a tragicomic circus whose performers know the script by heart and still miss their cues.

As for pharma, the message remains gloriously repetitive. Bring the product, certainly. Bring the evidence. Bring the health economics.

Then bring patience, pathway literacy, stamina, a tolerance for institutional absurdity and a serious answer to the question of what changes for the NHS once your product enters the room.

Otherwise, I will be back here next year, writing the same damned article again.

Straight stuff first

Here is where it got interesting

The so what bit