Healthcare, economics and society – unlocking NHS collaboration

Will NHS leaders, as part of an Integrated Care System (ICS), make conscious decisions to drive economic and social change?

What social and economic value do ICSs offer the wider population they serve? How will industry support ICSs to deliver population-based health and social benefits?

Prof Phil Richardson (Chair and Chief Innovation Officer, Mtech Access) is joined by Michael Wood (Head of Health Economic Partnerships, NHS Confed) for a far-reaching discussion around system integration, population health management, and the NHS’s social and economic potential.

In December (2022), Michael Wood authored a report exploring one of the four key purposes of an ICS: to help the NHS support broader social and economic development. Michael’s NHS Confed report looked at the economics of healthcare and where broader strategic partnership working might lead system thinking in the NHS.

Phil Richardson was one of several experienced ICS, local authority, university and professional experts that Michael invited to share their perspectives in the report.

We were delighted to bring Michael and Phil together in this webinar to discuss these topics, particularly in light of what these new leadership purposes mean for the NHS’s relationship with the Pharmaceutical and wider Life Science industries.

In the webinar, Phil and Michael discuss:

• NHS Confed and the links between the health sector and the economy
• The need for ICS leaders to focus on broader social and economic development
• How Pharma and Medical Device companies can add value to support this key ICS purpose
• Why health and economic development is key to tackling health inequalities
• The important role the NHS plays as an anchor institution that links better health with economic and social development
• What health and economic development could mean for funding at different levels of an integrated system – e.g. place based commissioning
• Opportunities for industry to step up and support the NHS with economic and social development

Learn more about this webinar here

Learn more about our work with the NHS

This episode was first broadcast as a live webinar in January 2023

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Transcript

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- [Narrator] Welcome to this Mtech Access webinar. At Mtech Access, we provide health economic and outcomes research and market access services from strategy through to implementation. Our unique NHS relationships guide and validate everything we do in the UK. We work with over 80 NHS Associates to bring our Pharmaceutical and Medtech clients authentic insights into the NHS. We can help you answer key questions related to the NHS, from how to communicate with Integrated Care Systems, Places, and Primary Care Networks, to how to capture pathways of care. Get in touch today to discuss your market access goals. First, though, I hope you enjoy the webinar.- Hello, everyone. And welcome to this NHS Whispers webinar. I'm Phil Richardson. I'm going to be your host today, and I'd like to welcome you to this webinar on "Healthcare, Economics and Society, Unlocking NHS Collaboration." We have a great mix of audience today with industry in both Pharma and Medtech here, and we've got a number of people from the NHS and I'd particularly like to welcome our NHS Associates who play a key role in the specialist work we do. For those that don't know Mtech Access well, we're specialist health economics outcomes and market access consultancy, with a track record in expert delivery. And we provide specialist support to Pharmaceutical Medtech clients. And we work as a collaboration partner with the NHS. Today, the focus of our webinar is on health economics, and specifically the role Integrated Care Systems can provide in the key purpose to provide broader economic and social development. And I'm delighted to welcome our speaker, Michael Wood, from NHS Confed. Hot on the heels of Michael having published some key work in December. So we're delighted to have Michael here and delighted to be able to talk to Michael and share his work. So welcome, Michael to the webinar. Thank you for joining us.- Thanks, Phil. Good to be here.- Great, thanks. Could perhaps you start by introducing yourself and explain your role at NHS Confed?- Yeah, yeah. And good afternoon, everyone. So I work for the NHS Confederation for those that are not aware, that's a national membership body for the range of NHS organisations. And my role is one that's quite, I suppose it's quite specialised for NHS, which is I focus on the links from the NHS and local economy. So, and that's a job I've cultivated and crafted myself, actually over a number of years. And that takes me to some fascinating conversations. I like to think, Phil, that what links the NHS and local economy, it's everything. It's what we buy, it's the staff we recruit, it's the buildings we work in, it's our partnerships. So I have some weird and wonderful conversations and I also, it's worth saying part-time, I support and advise NHS London on their anchor strategy, which again, is how the NHS in London can play a part in London's economic and social future. So my link is the NHS and local economy, and it's really about supporting, advising, just leading that concept, Phil, and making it feel real on the ground.- That's fantastic. And of course, we know Michael, there's no such thing as a part-time NHS role, so, you know, very impressive that you are able to do, to make that active contribution, but also to really help people lift their heads up and think about the broader picture and think about how we can influence and support change on a much broader basis. I mentioned the reports that you published in December, and I'd like to go on in a moment to explore that in a bit more detail, but I'm really interested to understand your motivation that took you to that point, that one that you felt you needed to do something as key as that, as writing that.- Yeah, well, and it's interesting, Phil, so it goes back, it probably goes back, you know, seven or eight years, where I was observing a dissonance between economic development and between NHS leadership. And I would go around the country knocking on doors and saying, "The NHS is 10% of the economics, 10% of GDP, where is it around your tables?" You know, this is at the time where the evolution was taking hold, Phil, local economic planning, you know, the huge disparities in productivity across the country. So I was just trying to bring two worlds together. And I think what we've seen since then, we've seen a growing awareness from the NHS that yes, it is more than just a service provider. It was a huge part of local economy. And, you know, given the fractured economy, given of course the pandemic, you know, we've also seen that growing awareness from our economic leaders from industry, actually, you know, the public sector has a key role, an anchoring role almost in many economies. And so I've long looked at how to bring these two together. I've supported different aspects of policy. And partly because of that, what was fantastic for me, in 2020 when NHS England published one of their first strategic papers, Phil, about, you know, what Integrated Care Systems will look like and will focus on, one of those points there was related to helping NHS support socioeconomic development. So for me, that was a wonderful marker of the journey. It was almost like a key litmus test about whether this matters going forward. And so, you know, I really wanted to try and fill that gap, Phil, and just try and help systems understand something, which, as you know, with your experience to it, it's not intrinsically, it doesn't come naturally, to an NHS leader to understand what goes on outside those four walls, hospital walls, and what the impact is and where our sphere of influence meets our partners' sphere of influence.- Yeah, it's interesting. Well, you paid a fantastic vision of you being the journeyman walking rounds with your key papers and key points and banging on doors. And I think lots of our audience who maybe started out as a medical rep or advisor equivalent would really be able to identify the awesome and enormous task it is to get some airtime, to get a conversation going and importantly to get people on board to participate. And you've done a absolutely fantastic job in doing that. And I think interesting about policy and guidance too. So I remember the five year forward view coming out at the end of 2014 when we were starting to work in Dorset and the continual flow of guidance, which was massively amplified obviously during Covid. And I think one day in April, we had some like 149 separate pieces of guidance arrive on the same day. But your lens on all of this is fascinating and I think if you were to take what you've seen, you've mentioned the 2020 guidance coming out, but what other guidance could you point to or do you see that ICS leaders would have access to? Right now, what exists? What help is that?- It's really interesting, Phil, you are right about the reams of guidance coming down and actually, and I give NHS England credit here because they stated that one of only four core purposes, so Integrated Care Systems have four, there's only four core purposes. And so this is one of four. And, when they, so it was, you know, I really supported its inclusion. But what pleased me was they didn't then rush to define it because by definition, this is a world outside that direct sphere of NHS understanding. So I think it would've been a mistake to rush to try and define what this is. And so that enabled us, NHE England actually commissioned me and the confederation just to take a bit of time to bring partners together to start understanding what lies outside of our, you know, our sector. But where our impact can be found positively and negatively. Because if we are placed blind in our decision making, we do not know what we are, the impact of our decisions, the better or for worse. So I was really pleased NHS England almost took that pause. Now there's a danger there, of course, Phil, as you know, in NHS thinking that if you pause on something, if you don't define something, it becomes something which is a nice to do, not a must to do. So what I wanted to do was to come out with the first real published literature almost, about the issue, you know, what is social economic development and why it matters to the NHS and vice versa, how you might go about doing it, and where next, which is really interesting. So it's that 'what','why','how' and 'where next'. And for me that that's there, but it's, you know, we have to continually stretch our thinking and understanding of this. And I'm sure this will come out as we go through the conversation today, Phil. So this isn't a sort of publish and be damned, this is a look, this is here to help you. And what I would say, the last thing I'll say in that question, Phil, is, you know, I sometimes I read the reams of guidance, that comes out from the centre for local partners. And I think...what are they going to do with this? And for me, this issue more than any other, if we were to travel across the country and look at the nuance in local economic development, the different understanding of how social development's planning and the different places we have, we would soon realise that you can't just mandate a sort of a to-do list from the centre for this. So what I wanted to do was publish guidance, which isn't to be rigidly followed, but it's more to provoke new thinking, to I think to expand our horizons and push us to be curious and to get us working in partnership with others, about those shared outcomes. So it's not to follow rigidly, it's there to provoke and ask new questions, Phil, and that is so important.- I think it's really interesting. I think the role of catalyst is critical. It's critical here as we talk about the economic and social development. It's key in innovation, it's key in digital, it's key in clinical practice, it's key in partnerships with industry. And that is a, and here you're now playing an essential role in helping bring it to life for people who want to get engaged in the conversation. And you did remind me of the must dos, do you remember the nine must dos. We went through that phase at one point, and eight of them were very specific must dos. And the ninth one was create a sustainability and transformation plan. And that almost became a focus on the document rather than where we are today, which is a focus on delivering integrated care in place. And I think it's quite interesting because this feels a similar journey in that we're at least need to get people focused on something needs to be done and we need to have a sensible conversation about it, but we need to be orientated to action. And I think in a second, when we explore a little bit about what the work is that you've done, I think the piece here is you are empowered by the brave decision nationally that was taken not to provide a whole load of detail or a spreadsheet or a checklist or an assurance process. And that empowerment really, I think you're trying to enthuse all of us to be part of the crowds that brings its wisdom together to make change. And it's quite a challenge and you are very skilled at doing this. Now I'd love you to share a little bit more about how did you manage to bring, what felt like quite a diverse audience together? It's not the usual suspects by any stretch. Could you share a bit more about how you managed to do that?- Yeah and, I mean, partly it's about having a very extensive little black book from going up and down the country, knocking on doors, Phil, you know, as you know and building that trust. What was fascinating, we had a series of engagement pieces. We had people there who'd just been appointed into ICB or ICS or ICP positions. We had people who were from within the NHS. We had people who were partners of the NHS and people who actually weren't partners of the NHS, but who wanted the NHS to be more active and more aware of what's happening locally, which is really, really important. So there were voices there I think we know about, but we were challenging them to come into our space and there were voices there that actually were new to us. And it's just worth, I think taking a moment, and some comments I think, Phil, which reflected and you know, and Phil, you came and you gave a fantastic example from Dorset, which just, I think lit the touch paper, on some of our discussions. And I was talking afterwards to an ICB chair, Phil, you know, after one of our engagement sessions. And she's chair in a northern ICS, very mature. And she said, "I was a bit,... when we started I was thinking my place is so radically different to Dorset, I'm not entirely sure what I'm going to learn from this." But you started talking about some fantastic work with universities. You started talking about a really quality relationship with industry. You started talking about the turning the USP of its place on its head. And she said how much that resonated with her And I think actually all our conversations really stretched our long thinking, huge support from my chief exec, Matthew Taylor, who instinctively gets this agenda. And there's some messages which came up, and this is what I've tried building in the report, but what I'm trying to challenge NHS and particularly the NHS leadership about. So when we asked the non-NHS partners what it was, their perceptions of the NHS, what they wanted from us? One quote that sticks in my mind was,"The NHS isn't curious enough." So NHS leaders don't ask why things are how they are. And I thought, how fascinating, that's because we traditionally look up not outwards, but if we're not asking our partners why things are as they are, we're certainly not in a spot, in a place where we can come up with the right solutions for that. Another quote from a, I think a third sector colleague was,"For the NHS, the answer to every question is a service, and it'll be the one that provides it." And actually, you know, so for me, how can we move from being service leaders to civic leaders, leaders of place? And I think this is where some of the people on the call will come in, Phil, and they'll say,"I'm an industry leader, but I'm a civic leader too." If I'm in a place, I'm a leader of that place and my decisions are there to make my place more productive, more prosperous, more healthy. And I think what's fascinating throughout the journey of writing this report, and certainly now when I'm talking to local colleagues, they're starting to see the true difference in being a service leader and a system leader. And I think some of us that might have been obvious, but I think if you've been, you know, within the NHS for a generation almost, you know, that can be really challenging. And just to quote, have a last quote from an ICB chief exec who was involved in the conversations and she said,"When you think, when you unpick this one purpose, it reignites the very reason I came into public service all those years ago." And I thought, wow, so actually this, by going through that process and by challenging themselves, and realising you're right, the empowerment, but also the broad responsibility that come and the ability to truly impact on local communities in ways that often actually we don't, the power of this purpose, Phil, really shone through. So that gives us a platform to build on, that we have to maintain and keep working, you know, arm in arm with our systems and challenging the centre to do the right thing to support systems'cause a really interesting but challenging place. But going through that process, Phil, really challenged all our thinking and it made us, I think, understand better the difference between a service leader and a system leader.- Yeah, I think it's fantastic, and I like the language of using civic leader even more than system leader.- Mm.- Because the tendency in a system leader is to think my role is to make the system work. And actually it isn't that at all, is it? It's just an enabling function. And I-- Yeah.- I was in one conversation on a similar topic and it's this bringing the civic leader together, provocatively said, "Actually, this is all just about me, my family, my friends, and my neighbours." And we should stop talking in the abstract about the patient who was somebody else, or the citizen who was somebody else.'Cause if we all thought about our friends and our family and our neighbours, that's really who we're doing it for. We're doing it for collectively, for ourselves. What kind of responses do you get, though, in using what is a very different language to the traditional NHS, you know, way of communicating?- Yeah, so, I think two points I make there. One point in the report, we actually try and define, as far as we can, social and economic development. So that our systems have that upfront. And there is a definition, but actually some systems have said to me, they see it as simply creating the conditions for good life. I mean that's fantastic. If they're going to, can you imagine, Phil, if it going back five years, a health related strategy that have that in its strap line, that at its heart, and I think through this purpose, we have the potential to see integrated care strategies, particularly with a strong ICP having in the very opening paragraph,"Our job is to create the conditions for a good life." And so I think that's really important. And the second challenge around, I get excited by that civic leadership thought, Phil, and what I do think is we can make this real for people. So, you know, so a challenge I was working, speaking to chief people officers recently, in a civic leadership box, I was saying, you know,"What are you going to do if a big private employer is about to leave your town?" It will detrimentally affect you, it will affect directly and to its detriment, the health and wealth of your population. Now, if your prevention plan does not have as a huge risk, a big employer leaving, it's not a real plan, is it? It's not a real strategy. So we can make it real. I've done lots of work, Phil, looking at health on the high street. And so, you know, the way I would train, we all have a high street, we all depend on that high street. We all know if that high street fails, our place is in a death spiral. So for me, sometimes, it's about getting our leaders to think about their citizen hat, you know, and say,"Do you want to live in a prosperous, successful place?" Well actually, you know, that's no difference there to your professional hats, you know, your professional hat is to do this. So what we have to do, Phil, is we have to keep making it real and but keep being supportive and say, "Actually this isn't you. You have a role in this." And I think it's really interesting, isn't it? You know, the last point I make actually on this point, is I expect systems to be involved in place campaigning going forward. Investment is finite, isn't it? So you know, if I live within a system, I want that system leader to be telling people why my place is good for investment, is good for housing, is good for families, and why it deserves, you know, organisations to come and people to work in it. And that's just, I find that maybe it's just me. I find that truly exciting and I think that's what unlocks something in our leaders, Phil, and maybe the way they've been, you know, we've not gone out of them over years. And I think if we can, you know, reinvigorate that thinking, it's really positive.- I think it's really inspirational and I think it will absolutely give a worthwhile topic to engage with. And while I think we're seeing already, aren't we, some of the, some people, early movers, who are really embracing this. If I referred to the work that you published, if you were able to bring out some of the key findings from it so we could just better understand, almost the sign posting of the thing, of the richness that we could later discover for those who've not yet read it, what would be some of the key things that you'd like to highlight?- Yeah, so I think first of all, a really important point, and I say this to, if we had a room full of system leaders here, Phil, and they're saying to me, "How do I go about doing this?" I say, my first point is, you know, social and economic development, is as old as the places in which we live. You know this isn't, it might be new to those of us, who come from an NHS background who have an official Integrated Care Board or system role. It's not new. You know, and actually, you know, to deliver on this purpose, it's more often than not, you'll be joining existing conversations rather than starting new ones. And actually that brings into that civic leadership of knowing when to lead or when to hold back, doesn't it, Phil? And it challenges that notion that the answer to every question is a service because it's not. And so I think for me, there's something really important there, right at the outset. If we look at the report and there's some recommendations for the national, for the government and for NHS England to support and sustain this, at its heart is really interesting. It's almost, you don't have to follow this, but there's, I've set out a model process, or framing tool, by how a system might actually undertake and go through this. And I'm happy to talk about that in more detail, Phil. I think that occupies a core part of the report. We're trying to change mindset, skillset, tool set. So we're trying to change the mindset and we've used the report to show, I think, why health occupies such a pivotal role in the economy and vice versa. It's not a one-way street, it's a two-way relationship. We've used it to help guide systems through a court, a process that might work for them. And we focused on the skills that system leaders need and which the national NHS needs to articulate and support to really change the weather on this. But in its heart, Phil, in its heart, is we've got a huge potential and I don't think we've scratched the surface of how the NHS can really narrow inequalities and make our places more prosperous. And I think it is in all our advantage and benefit if we support systems to, you know, to see this as the big ticket stuff, which will lead us to a, you know, which will solve some of the operational challenges we face.- So if we, so I'm sitting nodding, so I'm thinking, "Yeah, I get that." And I can see that's absolutely what we should collectively focus on. And I'd have a few ideas about what I might do. But if we think about it from a who's listening to this, who is listening to this story, and if we think about leaders, I'd like to think more broadly about leaders, as you've talked about it. Say there are system leaders who have a role. We've got industry leaders who have a role too. And I think, could you just help us navigate now, some of the practicalities? So I buy the idea and I'd love to now do something to make it happen. Where can I go or who can I talk to? How could I get involved? And I'm thinking about, I'd like to not learn more, I want to be part of it. How could I get involved?- So I mean, the starting point is, this is one of only four core purposes. I'll repeat that because in talking to ICS leaders, they, you know, they feel like they've got permission now to stretch where they are. So actually what I see, and what was interesting was, often our non-NHS partners saw how we approach this ICS purpose is almost a key test of an ICS more broadly. You know, whether will the NHS really be interested in anything other than the current operational firefighting. This purpose will be the test of just how serious systems and leaders take it. So whether I'm in NHS, whether I'm an industry partner, whether I'm a university vice chancellor, I'd like work in a further education college, this almost is a meeting point. And this should be the heart of, so every system will develop an integrated care strategy. So if you think about that question about making a condition to a good life, what does that strategy say? I'm not expecting a strategy so far to be that well developed and thought through, there shouldn't be because there've only been statutory since July, but we're in a place to stretch thinking. And I think what interests me, Phil, in this, is there's so many touchpoints between the NHS and economic and social development. So many touchpoints. So it could be, so we can come at this conceptually and you know, and I speak to groups about the idea conceptually, but I was speaking, as I say, to Chief People Officers the other week and I was focusing on workforce. So things like health and work, things like a labour market, which is in disarray quite frankly, isn't it? You know, how are you going to, where are you going to recruit your staff from? You know, how you're going to attract them or retain them, how you're going to grow and develop them. And actually there is a huge shared agenda on workforce with everyone. Everyone on this call will have a focus, an urgent need to develop a fit and healthy and productive workforce. And you might need, you know, they want a healthy workforce too. So how can we focus on, what I would say is a place priority and take and stretch the ICS's thinking on this. And if you look at the guide, Phil, the step two of the guide focuses on reframing some of the questions that Integrated Care Systems asked. So what I'm trying, what I said to the Chief People Officers,"If you are asking how can I recruit 500 nurses? Well that's not really a question that's going to bind your local partners to your journey. In fact, actually our partners might see that's about to skew the labour market." You know, we're competing for staff. If you were to say to partners and maybe putting a strategic question about how do we make our place more productive? How do we support over 50 year olds who have manual careers, you know, back into the labour market? Actually, what a fantastic starting point, for a renewed conversation where everyone on this call would have an interest, probably something to offer too. So I'm not trying to get systems to operationalise this, Phil. I'm trying to get systems to ask different questions, which should all fall out of their strategy and that will then lead them through different operational processes. So how can we challenge our system thinking to come into new spaces? How can we support the non-executives of our systems to make sure that leadership is focused on this? How can we develop and ask and offer locally across a place? Because I don't think our relationships. Our relationships too often are transactional. So think about those priority areas, workforce, prevention, population health, estate, maybe financing. What are the touchpoints where we might develop? But reframe the question and develop a bit of a shared outcome because I think we could truly, truly, you know, close the gap on some of these if we were to look on that basis. And I think the spatial plans give us the ability to make things real in a way which national plans often arn't.- No, that's brilliant. Thanks, Michael. And I think the, yeah, as you talk about, I hear curiosity in much of what you frame your thinking around, which is fantastic. I completely agree with you asking the right question could change the paradigm in a good way. If we think about the different groups of people who are looking at this, I quite like the intersection because I think there is almost a moment where people may walk past each other inadvertently without thinking about it. And I think your timing is perfect where the ICS and NHS are clearly focusing on operational issues, as you've said, but they're also looking at the strategic play, wider partners round the table, local authorities, police, fire, other public service organisations. Third sector charities are starting to engage in the discussion, including groups in the population, which I think is really powerful. And industry and academia rather two other almost cohorts of people who are also thinking about it and traditionally struggled because of the disconnect with thinking and the disconnect with language. Now we're in this space, what advice would you give to industry leaders about what they could do and how they could help?- It such an important partner and what, you know, I'm thinking now about place, not product, you know, and I think there's something really important here isn't there, Phil? Before we go into, I think sometimes we've been transactional, you know, we go into a partnership, focus on a specific product, the best we can achieve is that specific product. I think if we go into a partnership focusing on a place, on a geography or a given population, that opens up the doors, just so you know. And we're seeing that and that loops in academia too. So I sit on the advisory board for the civic university network, you know, and I think it's about 75-80% of universities in the UK are committed to civic programmes. So spatial decision making is now absolutely paramount. I mean we've got half the country has a metro mayor, you know, half the country has a combined authority. This is the way we're going. So for me, place not product, is absolutely key ask. And the second one, going back to those touch points, inequalities now matters for everyone, doesn't it? Inequalities is absolutely, the CBI have a health team now, Phil, I mean what a statement that is and it's health inequalities and the impact of the labour markets, which has driven their members to demand that. So we are, if you think I used to look at it as a Venn diagram with economic development and you know, and NHS is two entirely separate circles, and that shaded area's grown. I get industry saying,"I want to understand how I can contribute to a more sustainable, healthy area." And I get the NHS saying,"I've realised that actually we're one of the real main reasons industry wants to locate to where we are." You know, so this purpose almost gives you, this purpose gives you a tool to wrap around that. And actually how interesting if we can start measuring that impact. So how interesting if we can actually get an ICS measuring its impact on startups, its impact on how much money it attracts, its impact on workforce but not the workforce we employ, the workforce we support, lots of opportunities. Health and work, you know, I was in a conversation last week, Phil, about health and work with industry leads. It's just a core challenge, a core issue. And actually one which we should have been working for decades on this, shouldn't we? As close as we can, you know, the physical and mental health impacts of employment and the labour market. And I just think now, it's a much easier jump now, to find the links in conversations than it was perhaps five years ago. So we need to build on that. But I would encourage people on the call to be bold, and to start asking and to use this fourth purpose is almost that way in, look, I know you've got to do something which contributes to social and economic development. Now actually we've got our CSR plans or we're about to expand our, you know, our site, or we're looking for shared workforce or we're trying to support voluntary sectors. You know, there's a whole lot of things we can do under that civic banner, isn't there, Phil?- Yeah, well yeah, absolutely. And net zero springs to mind-- Yeah.- Too, the whole sustainability.- Huge opportunities and you're right, Phil, and net zero is a brilliant example where, you know, the NHS is, I think the first national health system to have a net zero plan, which is a fantastic statement, but we can't do that by ourself. And if you travel around the country, of course, your journey will depend on the economy you are in. And actually how can we support a transition to a net zero economy, which, you know, minimises huge inequalities, which offers up opportunities. And I think being that place partner, Phil, in other people's plans is a space I don't think we've occupied enough in our thinking.- You know, I think it's interesting, that the piece where you are tying, what essentially is a traditional paradigm to a future opportunity and the come back to the catalyst earlier really, to help people just figure some level of confidence that they can engage in it'cause I think that's part of it. And certainly the conversations I'm having with industry more broadly at the moment is that the keenness to be part of a journey with an ICS, engage with the leadership team, engage with working on solving some of these bigger challenges. But internally, organisations grappling with the drug tariff, the reduction in cost, what's happening with specialised commissioning, what's happening across the transactional landscape as you've described, and a huge amount of work and effort put into market access and comparative donor, individual products, and interventions. But it sounds like the two conversations really need to come together and that's certainly some of the advice that I've been giving people I've talked to. And it sounds like you would give the same advice but almost at a level, which is, let's just be who you are, in the place you live, because that's where the magic can happen. That's what I think I'm hearing. Is that really where you are? Is that the sweet spot, almost?- I'm often struck as I go around having local conversations, Phil, about how little we know about each other. You know, even between, and it's fascinating if you look at since 2010, the NHS has had more money, less power, local governments had more power, less money. The two closest partners in a place, and that's driven us apart rather than united us. So you know, too often, we are not understanding what success looks like for local partners, what challenges they face and where the interactions are. And it's only by learning that, that we can start to understand and challenge what's been before. And so if we don't, so my challenge to everyone on the call is, you know, what we've ultimately, I think I truly think through this, and we can talk about this, I think we can get to a different place of looking at shared outcomes, locally, different systems, and a message that we we're giving to NHS England is to, yes to set general expectations for this purpose, but to let systems understand where they can make the most progress. And I think that's really important that level of autonomy. Autonomy, Phil, is really important. And I think, so colleagues on the call, there's a question about what does decentralisation mean? You know, it really it's not an end, it's a means to an end, it means showing what you can do better locally than it can be done nationally. And we've got to fight for this, aren't we? We've got to understand the local context, understands what it is we want to do and understand how to do that. And I think there's a challenge for all of us in this, which is let's make the new system and that increased level of autonomy work because we know what the alternative is, it is great decentralisation, you know? So I think, you know, we've got to fight for each other and the civic, and the reason I use civic leadership as an example is that's understanding when a partner's in trouble. You know, so we've seen during austerity, aren't we at local authorities retreating from certain properties or investments or services, and when that happens, are we going to stand there if a leisure centre shuts, so we are going to stand there and you know, if a library shuts and not do anything, or are we going to lead in and say, "What can we do?" And that's what I would ask industry colleagues on the call just to think about. What does, you know, the to and the fro of the local economy, when do I need to lean in and when do I need to stand back? You know, and that's a constant question for us all, Phil, isn't it through good times and bad?- Yes, but I think what I mean, what I hear, Michael is that it's almost looking through a different lens to understand what success looks like.- Hmm.- And I hear completely the piece around engagement. I hear the civic leadership piece, but we've also got transitioning part of this too, don't we? So there's the bit which is, we buy into the concept as you talked about earlier. You are helping us by putting a proposed tool set together, which helps us move forward with it. There are people I imagine will be a growing band of people who want to engage in this. So there's that type of transformation and transformative thinking and strategic thinking, I think is an element part of that. But there's a translation transition piece as well because we're in a world of, well, who's going to do the commissioning? And where the resource is going to be allocated? And where's the workforce? And I wondered, should we be reframing the lens through into a health economics and value based view of the world as opposed to our more traditional, as you've talked about several times, transactional, you know, how many, how long, how heavy type model. Should we be thinking, could we be using industry who think like this more frequently around, let's have a look at from the health economics of a place rather than the health economics of a pathway. And I just wonder, I'd be interested in your thoughts on that.- It's really important and often I think that the reason the NHS is so cost focused sometimes, is because we are simply having a debate within itself. You know, so we have a global budget, and it is passed down through a hugely complex system and we are taking decisions which are partially blind, aren't we, Phil? That they are decisions being made within a cost window set by someone in Westminster. And at the heart of this purpose and at the heart of an ICS is spatial health and care planning. And what's interesting, the more we are exposed to new conversations, so the more we are exposed to conversations with industry, which are about a place, not a product, the more we are exposed to conversations with our metro mayor or our elected leadership about transport, of our infrastructure, about planning, about housing, the more we realise that actually we are but part of the world, not the world in itself. And actually we then start to see, you know, what is the value of the NHS pound locally. You know, and I published the report in October, for which looked at in GVA terms what investing a pound meant in, you know, for the economy, and of course that difference up and down the country depending on your economy. So it's really interesting. So we need to challenge siloed NHS thinking. We need to next, interestingly, really next step in this conversation, Phil, is yes, it is no good, it's not good enough just us saying,"The NHS is an investment." We've got to behave like an investment to show that. And so for me, that we've got to challenge our own resource allocations. We talk a good game on prevention and yet actually how much have we shifted money and resources into prevention? So the more we expose the impacts of our decision making, the more we see the limits of taking a cost focus and you know, and if our partners can reflect back the value that maybe buying things in a different way or working in a different way, partners, or looking beyond 12 months, you know, the more our partners reflect back that, and the more we talk about social value as being a core part of what we do. I think the more we're realising that, you know, chasing a quick, you know, a quick decision in the long run, we know it's the wrong thing to do, and yet the system has sort of pushed us down that road. So we're trying to expose leaders here, Phil, and the next test will be when we challenge systems on resource allocation, you know, nothing will change until we really truly empower prevention. And actually to do that, we need the voices from industry and from local government, of academia challenging us, I think. And that's for me, that's where a system works best, where you've got that challenge across the board table.- Yeah, I think that's really important. And also, that challenge brings the diversity of experience and thinking together. And if I take it back to the broad theme about economic and social development, we need to understand what the sum of the parts is and what matters. And I had a conversation this was with somebody to try and illustrate what this might look like. I exaggerated slightly, but said,"You know, we're sitting in a room talking about a CT scanner and it's return on investment over many years, and we're talking about making a slight tweak in a pathway, but I think we'd be better off investing in a better bus service because 40% of a number of diseases are determined socially and that might be better." And that's a real exaggerated example, but it sort of plays into the challenging questions that you're raising, doesn't it?- Yeah and what's interesting on that piece, Phil, is actually that could be a deliverable under this purpose. So for the first time, a system could be measured on how it's supported new bus routes, how it's maybe campaigned for cross route, you know, for HS2 to come across to its city. So actually, I think previously, we might have encouraged these behaviours previously. The system didn't measure, then the system didn't set, then system didn't reward them. So if it's an explicit purpose of an ICS, that means a system should be incentivizing and rewarding these behaviours, Phil. So hopefully that just again raises that confidence. You used the word confidence, that's a key word.- Yeah. Yeah, no, that's really good. And just played a bit further into that behaviours change, language is critical in this, isn't it? And do we collectively need to learn a new language and a new way of talking and will that change the kind of conversations that we might have?- Yeah, I mean in, you know, in the NHS, we design a huge and complex system. We use a range of acronyms, you know, it sometimes I think we're doing it on purpose to shut others out of our decision making space. But the trouble is, you know, we're led down a silo, and one of the difficulties, Phil, is you can get to be incredibly senior in NHS and yet not have been exposed to different conversations in different sectors. So actually I think the more we learn about what really lies, that curiosity question, Phil, you know, what if I go meet a local trust leader, I will look at the window at a new building, I said, "Do you know what's been built there by whom? For what reason, with what funding?" And often the answer is,"No, we haven't asked the question." I think if we start understanding our pinch points, if we understand our impacts more, we start being dragged into different conversations where actually why aren't we talking about productivity? And I don't mean the productivity in terms of how much are...are acute activity. I mean our productivity in terms of what we're doing for the economy and how we're narrowing, you know, that regional divide, and how we're supporting communities and prosperity. So I think we have to relearn what makes a good place and we're going to have to relearn what our role in that is. And that takes bravely and humble leadership too.- Yes, I can completely see that. And you need to step up to that space, wouldn't you really? It's not going to come naturally and it's likely to need to be people who've not had experience in working that way. So, but there's a need for support, a supportive environment really. And I wonder whether ICPs particularly, have an opportunity to set the language, set the environment around it. And as they're playing a key role in setting the system strategy, I'd be interested to get your reflections looking from the outside in, which is one of the benefits for working NHS Confederation. You can be a critical friend in a true sense of that phrase. But have you got a sense what the engagement level is on this fourth objective for ICPs particularly? And what your hints would be to them, to help them nudge them forward if they're perhaps not making a meaningful headway at this point?- Yeah, I mean the ICP is really the key voice within a system, isn't it? To look at that future long-term vision. This issue really gets ICP leaders excited. And we all benefit from a strong ICP, which has the leverage to support and to push and to challenge its ICB down the path it wants. So I would absolutely look to the ICP, in its integrated care strategy, to be setting out why this purpose matters. And fundamentally, now this is the journey. This is the journey, Phil, of a course over years, and I'll just give a quick shout out for Cathy Elliott, who's a chair of West Yorkshire ICB. And she actually, in the report, she's actually written a maturity framework which tries guiding a system, you know, by, you know, in the first two years what you might do, and the next five years, what you might do, what looks like in a decade. And she's done that because she fully understands immediate operational pressures of what determined newspaper, you know, pages, what the sector of state responds to. Of course we're in very difficult times. So she's trying to show people this is a long-term vision and ICPs are trying to do that, and we need to support them. And that's one of a key job for the Confed. We bring ICP leaders together, we bring ICB leaders together, we bring all the different partners together. They instinctively know this is the right thing to do. And it's about supporting them to get to a point where they feel they can solve today's problems in a way that makes tomorrow easier. So it's not just firefighting what's going on today, because tomorrow never comes. It's choosing issues to start on which affect today. So we know the workforce is a core issue. We know estate, you know, is a core issue. It might be something to do with transport, whatever, you know what, there are enough core priorities, which are absolutely key operational pressures that we can start mapping out a different way of working, bringing in our university, bringing local combined authority, bringing an industry, et cetera. And the other point I make is devolution is happening. And you know, I mentioned half the country has or will have a combined authority in a metro mayor. The ICPs are absolutely understanding this. And the ICPs will be the area where they're just almost testing out with the metro mayor, the combined authority. What does macro level decision making look like, you know, and what does accountability for a place look like? These are big ticket issues, aren't they, Phil? Which, you know, which we can't expect to be solved immediately, but the ICP should be in a place having strategic conversations that perhaps before this latest reform, weren't really going on. And that's a huge positive.- It is really positive. And I think the opportunity with places taking a responsibility for themselves and then working collectively together with them to work at scale for things, I think is going to be key. One of the challenges though, as we talk, and I'm sure it's replicated in ICPs, ICBs, and within industry conversations at a leadership sense, is that you can get a bit lost in the mechanism and organisation, and roles and responsibilities, and language and things. And one of the things that we have on the front cover of every organisation here, whether you are industry or academia or NHS or providing some level of support or analysis, we all have the patient is the most important thing, we're here to do for the patient. What does this mean, that this conversation mean, from a patient's point of view? What's the story for the patient?- I think we can stretch a patient to citizen, Phil, too, actually.- Yeah, yeah.- I think it's really, and if I was looking at before and after strategy, I think before we talk about patient, I actually hope we're going to start talking about the citizen, Phil. And I think that and that's really interesting'cause that's what buys in our partners and takes us and drags us into a different space, doesn't it? By looking at that. And what I would say is that, so I've advised something out of country on local anchor strategies and what's really interesting and the feedback I get from trust and this is one of the very few health policies which is bottom up. So actually, you know, many health policies, if I can speak frankly or, you know, are sort of catching things from the top down and trying to mould them into a strategy and it'll go on a shelf and it'll gather dust, and it'll look very pretty but not actually mean anything. The anchor policy is really about what is your direct impact on the communities in which you serve. And in fact, you know, that stretches us to realise we don't actually understand our communities. You know, so actually I think this has the ability to be real to people in our populations, in a way that some top down NHS strategy never will be, quite frankly. You know, and one of the key challenges for any statutory organisation is community engagement. You know, we don't do it well in the NHS. We think the communities are the people that come to us. Well they're not, you know, and that widens inequalities and you've got the inverse care law, et cetera. I actually think this purpose and seeing people as citizens and working with other partners locally is, you know, is a brilliant example of finding out who is in a better place to serve populations that you know, who are your community anchors, you know, who else, you know, what are the assets on the ground that actually that communities might benefit from being connected to, whether to receive health services or whether just to connect with other issues. And I think that's what, so for me, I want to build on the spirit of the anchor policy, which is bottom up and real, and challenge systems to actually start understanding their communities more.'Cause if we don't understand our communities, we're always going to be coming up with the wrong solutions.- Yeah, no, that's really clear. Thanks, Michael. And I think if I fast forward this conversation to 6 or 12 months out from now, and if we think about service development, and pathways and treatments on the ground, the frontline as it's typically talked about, and I think there's a frontline in industry too, which mirrors this. So there are people, you know, under real pressure on a day-to-day basis. What would it feel like to them as this conversation matures and people start to make it real? What do you think that would look like?- So we've got to work at lots of different levels. One, the challenges in the NHS is right. You're going to do that at that level, we're going to do that at that level. Well, that ignores the messiness of life, you know, so there's got to be in all of this, there's got to be a constant, in London, I'll like to call it an echo between the London, you know, the mayor and the local, the back streets of Southwark. You know, we've all got to be challenging each other. I would hope that, I think on this purpose, we will have made progress. And what would be interesting, it'll be hugely varied progress. I think some parts of the country will have done some fascinating things about supporting people into labour markets. I think some parts of the country will have developed new science parks or new grand strategies for, you know, for healthy innovation and aspects. I think some parts of the country might have taken over high street and put health services and businesses, you know, at the heart of the place. That's really interesting because for me, what I want is this to be real in our staff's mind and real in our partner's mind and real in the minds of our communities. You know, so how can we, how can staff sort of see that their citizen hats and their professional hats, you know, are one and the same, and they can come up with ideas. How can systems start realising that? To answer that question, how to create a conditions for good life. I'm going to be doing something different in Cumbria than I am in South London. And that's fine. And the system set and the centre that says,"I completely understand that and I support that." You know, so I think in the coming year, we're going to see an impact on the autonomy of systems and the learning from when the centre just can stand back. That's a system learning. I think we're going to see some real delivery on the ground where the health, where the NHS impact is actually measured in that. And what I hope is we're going to an ambition and an appetite. When people go through this process and they do something, Phil, and you realise actually how much better it is for our populations and how much we share in common with our partners, and how social policy, economic policy and health policy actually aren't three different policies. I think we're going to see a real heightened ambition. So what I want to do, I want to look at integrated care strategy in a year. And I would hope it's far more advanced and ambitious than it has been at the moment.- Yeah, I think, Michael, you have really just brought it all together very nicely that in fact there is just one plan and the plan is around the person. And the sooner everybody gets to grips with that and sees the value in doing that, the massive difference that can be made. I want to pull the conversation together now to just to say thank you. The hour has zipped by and talking to you is always highly energising, really motivating, and there's lots of really positive takeaways to come from today. So really want to thank you for that. We will share a copy of your report and some of the related things with everybody afterwards, so they've got an opportunity just to immerse themselves a bit more. But you've been an absolutely fantastic guest today. Really enjoyed talking with you. And I'd love to keep in touch and maybe we could connect back again and, you know, how is it going, and you know, just to see how things are developing. But I just want to say thank you very much for today. I want to thank the audience for giving up the time and joining us'cause we had a really good turnout for today'cause this was such a key topic and people were keen to hear you talk about it. So thank you very much for that. And I'd just like to wrap up by saying I'm here to keep going with you. So I'm still with you on this journey. You've really just reinforced it for me today. So thank you very much.- And Phil, I'll just thank you for your constant challenge on this and you know, it's really important, and people on the call, I think, you know, just keep me updated on what it looks and feels like locally. I think that's, you know, whatever we discuss, Phil, you know, economies and communities are nuanced, and I think we're just really interested in your progress going forward. So thank you for the opportunity. It's been fantastic to speak to you.- Yeah, brilliant. Okay, yeah, thanks, Michael. And thanks, everyone. Thank you. Bye-bye.- [Narrator] Thank you for watching. If you'd like to find out more about our work with the NHS or how we could support your market access goals, please email info@mtechaccess.co.uk or visit our website at mtechaccess.co.uk.