The next 15 years start here… Professor Ian Cumming, Chief Executive

Our purpose ‘Health is all about people. Beyond the glittering surface of modern technology, the core space of every health care system is occupied by the unique encounter between one set of people who need services and another who have been entrusted to deliver them.’ Health professionals for a new century [first published in the Lancet], 2010

Some NHS facts and figures 1.3 million staff – one of largest employers in world £115 billion annual budget - £2k annually for every citizen Over one million patients treated every 36 hours 15 million hospital admissions per year 88 million outpatient attendances £12 billion spent on medicines 1000+ different employers across public, private, voluntary sector 350 different roles – nurses largest, circa 30%

Looking to the future ‘Computers in the future will weigh no more than 1.5 tons’ (popular mechanics 1949) ‘We don’t like their sound and guitar music is on the way out’ (Decca recording company re: The Beatles 1962) ‘Heavier than air flying machines are impossible’ (Lord Kelvin 1895) ‘Louis Pasteur’s theory of germs is ridiculous fiction’ (Prof Pierre Pachet, Prof of Physiology 1872) Brexit? 4

Planning for an uncertain future Many predictions, e.g. Nuffield in 1999 have only partially come to pass: Greater concentration of specialist expertise and equipment Growing importance of self-diagnosis & treatment More common conditions treated by telemedicine Capacity for screening widespread Reductions in length of stay

Why a 15 year strategic framework? Circa 13 years to train a consultant / 3 years for a nurse We invest £4.8b in education and training, making expensive assumptions about future health care models If we are wrong, under-supply could result in unmet need; over-supply means an unemployed workforce & wasted resources If we make wrong decisions we risk locking the service into outdated models of care We need a strategic framework to guide our investments in the future

The best predictor of the future is the past…

Changes in projected demand Consultants Adult acute nursing In 2015/16 trusts reported increased demand for nurses for the fourth consecutive year. The cumulative total increase in established posts is 25,131fte in adult hospital settings alone (14.3%) Staff in post has increased significantly since trusts started trying to expand in 2012 by 12,199fte The outpacing of demand v supply growth was forecast to result in over 12,000 additional vacancies Consultant vacancies appear to have been historically stable at 3.0% to 3.5% Only excess vacancies pre 2014 were 2008/9 which appears to have been due to higher level of posts created that year (2,050- 6.2%) 2013/14 and 2014/15 both appear to have been periods of very high establishment of new posts, 5,909 - 15% in two years (as reported by trusts) Supply did increase above the ‘norm’ in response but not enough to match increased demand Excess vacancies of a level previously unseen have therefore been created Unclear if extra posts are sustainably funded Concern that historically vacancies have been hidden if no prospect of filling them

How can state funded healthcare respond to economic challenges?

Demographics

Informatics 43% using internet to access health information New ways of predicting, preventing, diagnosing and treating some conditions How can we ensure our staff have the skills to respond to and adopt new research, technology and innovation, so that patients can reap the benefits?

Patients will be more informed, active and engaged, and with higher expectations Health app downloads predicted to triple to 142m in 2016 One of the main topics of google searches is health Patients are likely to become members of communities of health 91% of cancer patients want to be involved in care decisions But the capacity to be engaged is not distributed equally across society Expectations of quality are increasing all the time How can we educate and train our staff so that they can respond to the full spectrum of needs in society, able to treat the whole person and not just one disease or specialty?

Genomics

The Genomic Revolution Improving diagnosis of infectious disease, cancer, and rare diseases Individualising clinical care: ‘Precision Medicine’ Better predicting drug effects Understanding disease and tracking epidemics Developing novel therapies Refine diagnoses and understand disease (eg Deciphering Developmental Disorders project) Individualise clinical care (eg cancers) Better predict drug effects Diagnose infections and track epidemics (eg MRSA outbreaks) Develop new therapies (eg Cystic Fibrosis)

Five Year Forward View Health gap Quality gap Finance gap Three areas of action Health gap Quality gap Finance gap *They will know about the FYFV, our issue is what workforce is doing to support it – i.e. WAB* so I wouldn’t really talk about this slide beyond saying: Workforce, our people, is where the majority of our spend is, around 70%. To meet the health gap, the quality gap and the finance gap our workforce needs to be at the centre of the discussions and the answers. It can’t just be about more pay restraint and fewer people, it has be to about working differently in different settings and that means changing the workforce of the future through the education and training we commission, but it also means making change now and supporting staff through that change.

The future workforce So what kind of workforce will be required if we are to respond to the drivers of change and meet the predicted need of future patients?

Mind the (generational) gap ‘Baby Boomers’ ‘Generation X’ ‘Generation Y’ ‘Generation Z’ 1946-1964 1965-1980 1981-1994 1995-2010 Motivated and hard working; define self-worth by work and accomplishments. Practical self-starters, but work-life balance important. Ambitious, with high career expectations; need mentorship and reassurance. Highly innovative, but will expect to be informed. Personal freedom is essential. 25% of the NHS workforce 40% of the NHS workforce 35% of the NHS workforce <5% of the NHS workforce Jones K, Warren A, Davies A. 2015. Mind the Gap: Exploring the needs of early career nurses and midwives in the workplace. Summary report from Birmingham and Solihull Local Education and Training Council.

We must be bold and brave… “We always overestimate the change that will occur in the next two years and underestimate the change that will occur in the next ten. Don’t let yourself be pulled into inaction.” Bill Gates