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It would be hard to reflect on the two days of The King’s Fund’s annual conference without mentioning a certain special guest. Sir Keir Starmer was a surprise addition to the conference agenda, joining us on the second day to deliver his first health and care speech since taking office following the publication of the Darzi review.  

The content of the review had already been a topic of conversation throughout the conference, but delegates were now able to hear from the Prime Minister himself about Darzi’s ‘raw and honest’ assessment of the state of the NHS. Although the NHS was the focus of his speech, it was reassuring to hear the Prime Minister confirm that the adult social care sector will feature in the government’s forthcoming 10-year health plan. 

There probably aren’t many conferences where a Prime Minister could come and describe the sector that attendees work in as ‘broken’ and be met with such broad agreement. But as the Prime Minister said, ‘the challenge is clear before us’ – a theme definitely shared by the speakers, with Ben Allen, a GP from Sheffield, reading his poem about working conditions in general practice, where ‘the floodgates are open, we're weary and tired’. Kiara McElroy, a nurse and midwife, talked about patients losing trust in the system as they are moved around A&E departments to support the meeting of performance targets while their needs go unmet. 

Conference attendees were also asked what name should be given to winter pressures that happen all year round.  

After sharing his stark analysis of the issues, which were clearly well known to The King’s Fund’s audience, the Prime Minister talked about the three big shifts that his government’s 10-year health plan would be built around: moving from an analogue to a digital NHS; shifting more care from hospitals to communities; and moving from sickness to prevention. How the sector will deliver these shifts when previous New Labour levels of investment have been ruled out was a question left unanswered. But the sector’s ‘shared passion and determination to make the NHS better for our patients’, as highlighted in Lord Darzi’s review, meant that these shifts met with broad agreement from the audience. Reflecting on what we heard over the two days, though, how easy will it be for the government to realise these ambitions? 

What clearly emerged from the conference was that when sharing his vision of a more preventive model, the Prime Minister is preaching to the converted. When he declared his willingness to be bold on prevention, even in the face of ‘loud opposition’, the energy was palpable but so too was the ambition from the sector. Chris van Tulleken’s presentation closing out day 1 of the conference showed the PM where he could direct this boldness – tackling the ‘commerciogenic’ factors that influence our health. Dr Van Tulleken argued that this means not just regulating salt or banning the advertisement of junk food but going further to tackle the conflicts of interest between the food industry and the bodies responsible for safeguarding our health from harmful foods. There was clear appetite from the audience to make best use of ICS partnership working to drive this forward, helping to shape people’s health by looking beyond what the NHS can do alone. 

On moving from an analogue NHS to a digital one, Steve Russell from NHS England, articulated the challenges presented by ‘the estate and technology that we [NHS England] are asking people to use’, which often makes the job more difficult, not less. This outlines the realities of technology in the NHS and the importance of digital in enabling service transformation as a theme for the 10-year health plan. But also, how far there is to go until this ambition is achieved.  

The Prime Minister talked about cutting-edge innovation in his speech, such as non-invasive knifeless surgery for kidney cancer, but it is essential to get the basics right first. As The King’s Fund has argued, there is a need to avoid over-emphasising technology without also developing an environment in which staff are given the right skills, training and capacity to use it effectively.  

When it came to the Prime Minister’s third shift, there was widespread agreement, in theory, from our delegates on the need to shift care from hospitals into the community, as highlighted by both Lord Darzi and The King’s Fund. In practice, though, this ambition has been more difficult to realise, with hospitals exerting a gravitational pull-on resources, staff and focus. Much of our health care system is built around hospitals so making the shift to a more community-focused service will be complicated, but it can be done, and is already being done in pockets. Nicci Briggs, Chief Finance Officer at NHS Cambridgeshire and Peterborough Integrated Care Board, shared how she has used financial levers to break away from the Carr-Hill formula of general practice funding so that practices and providers could be freed up to develop a new approach to using NHS funds that better meets patient need. This change involved sharing resources across the system, with the local acute hospitals contributing financially, redressing the focus on hospitals that the Darzi review called out. The result of this was that one practice had the funding to employ a Bangladeshi nurse, mirroring the community the practice served, helping increase screening rates from 20% to 70%. 

From my two days spent at The King’s Fund annual conference, what became clear to me is that we are moving from an agreement that reform of the NHS is needed – the stark findings of the Darzi review are a testament to that – into the knotty phase of how to make it happen. 

Dame Una O’Brien, former permanent secretary at the Department of Health, remarked how it would be easy to let the urgency of the challenges ‘crowd out the important’ long-term change. But if the mood and content of the conference was anything to go by, then the sector, and most importantly the people working in it, are ready for the long-term change and eager to realise a hopeful vision for the future of the NHS. In some cases, they are already doing the work to realise these important shifts.  

I left inspired by the hope each speaker offered in sharing their experiences and look forward to hearing at next year’s annual conference how the changes the Prime Minster described are being realised.