An NHS we love to work for

Secretary of State for Health and Social Care Matt Hancock's speech to staff at Southmead Hospital, Bristol

It is the greatest fear anyone can face. The fear of losing a loved one. A child. A sibling.

Everyone here. Everyone who works in this great hospital. Everyone who works in the NHS, from the cleaner, to the consultants, to the chief exec.

You save people from their greatest fears. You do it every day. And you’ve done it for me. And I just want, from the bottom of my heart, to say thank you. To the Great Western Air Ambulance and everyone at Southmead.

Thank you for saving Emily’s life and putting her on the road to recovery.

I will never forget my time here. Not just today – it was wonderful to be able to thank Jas and the whole ICU team who we never got the chance to thank properly. But I’ll never forget the week we spent here, on the edge of the abyss. When Emily was falling into the jaws of death, you caught her and held her and brought her back to life and cared for her. And it’s not the first time or the only time the NHS has done this for me. You do it for everyone.

And I don’t care if you’re a porter or a receptionist or the finest surgeon in the land. A manager or midwife or pharmacist or physician. Every single person contributes to saving lives and improving lives every single day.

And the reason the NHS is so loved by so many is because you do this according to need, for everyone.

And for me, it’s deeply, deeply personal. And now it’s my great honour to be the guardian of health and care within government as Secretary of State.

Today I want to talk about you. The workforce of the NHS, and the social care workforce across the country.


A few weeks ago, in my first speech in this job, I set out my early priorities, and what I want to do to engage with the 3 million people who dedicate their working lives to caring for others.

It’s another reason it’s so great to be here at Bristol Southmead, in a hospital that I know takes staff engagement so seriously. As a man known for my fondness for apps, I was particularly pleased you’ve a staff engagement app, which I had a demonstration of earlier.

I’ve been lucky enough in the past few weeks to spend some of my time shadowing people working on the frontline across the country.

And I’ve just come from one of the St Monica Trust care villages, and seen just what a difference the care workers there make to the lives of their residents. They’re dedicated. They’re skilled. And they bring light to the lives of the people they care for. It hasn’t taken long for me to see for myself the pressure that the health and care workforce are under, and how hard you work every day. And I’ve also seen that you feel undervalued, and that your voices haven’t been heard. I’m determined to turn that around.

Everyone knows the work you do is a vocation. But let’s be completely frank. Most people in the NHS love their work despite the system. They love their work not their jobs. Mission-driven jobs – yes. But sometimes very frustrating jobs too. I want to make health and care jobs the best jobs there can be.

A conversation

And I need your help. I need to know direct from you the changes you want to see. Today I want to start a new form of engagement. Like the best organisations, I want to start an open-ended, 2-way, frank conversation.

Today marks the start of that dialogue. A real conversation. And, like a true conversation, it will evolve based on what you say, what you think, and on the changing world of health and care. I want us to be realistic yet ambitious in what we can change for the better. And I want this exercise to reflect the real-time concerns and ambitions of the workforce, rather than take a snapshot of how you feel at one point in time.

The platform

As you may know I’m passionate about technology and, for me, technology isn’t just important in delivering better health and care, but can be a powerful tool for engagement. So we’re launching our new platform, TalkHealthandCare.

Government has never engaged with health and care staff in this way before.

This is about giving you a voice in the day-to-day creation of policy in government, and giving you somewhere to go with your ideas and questions, somewhere for you to challenge us and, equally, for us to ask something of you. Because, if the culture in health and care is really going to change, it will take all of us, working together, to make it happen.

That’s why this new engagement platform – or website, to you and me – will start by launching 5 challenges.

We’ll be exploring each of these in depth – inviting you to share your stories and ideas, and sharing our own ideas in the meantime, in the form of blogs, videos and more.

Then we’ll read what you’ve said and feed back to you. We’ll set out what we’ve learned from you and what we’re going to do about it. And – in case you’re interested – we’ll let you know what I’ve been up to, and I’ll share some of my personal reflections on the process.

And this isn’t the only new form of engagement I’m interested in. We’re also launching a brand new Workforce Panel, which I’ll meet with, physically and virtually, to hear, first hand, what’s happening in care homes, hospitals, board rooms, surgeries, ambulances, hospices and labs across the country. This is a personal sounding-board, intended to compliment and build on the excellent work of the Social Partnership Forum.

The challenges

Now before I touch on the first 5 challenges that I want your help with, I want to say this.

You can’t spend even 2 months in this job without realising one of the biggest things, if not the biggest thing, impacting on the morale are rota gaps and unfilled vacancies.

We have proposed, from next year, to increase the NHS budget by £20 billion a year, alongside a long-term plan for how we guarantee the NHS for the long term. And we will publish our green paper on the future of adult social care, with a strategy for its workforce, later this year.

I want the response to these challenges to feed into those plans.

The challenges are about empowerment, safety, development, respect and getting the basics right.

I hope you will allow me a minute to go through each one.

Challenge 1 is about making sure staff in health and care feel empowered at work. It’s about spotting a better way of doing things, of innovating, in a way that improves the experience for both those we care for and those who care.

This is about organisations in health and care working with staff to develop a shared vision about what they’re trying to achieve, it’s about staff feeling empowered to innovate, and learn from the innovation of others, and it’s about all of us developing a culture of continuous learning and testing, and strengthening the pride you have in your job.

And while we are talking about pride, I also wanted to thank you for all those who care unpaid. Those who volunteer in our hospitals and to the millions who selflessly give up their time to care for their friends and family. I’m delighted we are formally working with HealthForce and urge everyone to harness its potential.

Challenge 2 will ask about working in an environment in which you feel safe and secure. An environment without fear of bullying and discrimination, and where victims of violence are taken seriously and supported. Health and social care jobs are fundamentally about caring for people and it’s unacceptable that there are still a worryingly high number of reports of bullying and harassment.

The Social Partnership Forum – made up of NHS employers and staff representatives – is developing proposals on how we can prevent and reduce violence against NHS staff and how we can support staff who experience violence. I’m clear that this partnership will bring real sustainable changes to issues like violence, bullying and harassment, which are too often put in the ‘too difficult’ pile and accepted as the way things have to be. Not so. It’s not acceptable and we will stop it.

I want to know about your experiences of bullying, discrimination and violence, and about good examples of what’s being done to tackle them.

Challenge 3 is about development – making sure staff have access to the training, development and support they need.

Staff at all levels should feel they are supported to access training that supports them to provide high-quality care and to progress in their career. Learning is a lifelong pursuit for everyone, but we know that staff don’t always feel able to access the development they need.

I want there to be a ladder of opportunity up which everybody can climb. So that someone who starts as a porter or a cleaner, and works hard, can climb that ladder and end up 30 years later as a consultant or chief executive.

This can be done. Peter Homa, for example, Chair of the Leadership Academy, started his service in the NHS in 1979 as a porter. We have added rungs to that ladder with nurse associates. Now I want every rung in place, and I want that ladder in social care too. I know that, just like in health, it can feel like there is never enough time, and not enough money, to prioritise training, but we know that the best social care providers with the most engaged staff recognise that this investment is worth it.

We need more people to feel they have had the support that allows them to get to the point where they can take on the critical registered manager roles.

I am so proud that in my first ministerial job, as Skills Minister, we introduced nursing apprenticeships. I think it is fantastic that we now have a complete pathway from entry-level healthcare support worker to nursing associate, registered nurse and onto postgraduate advanced clinical practice in nursing – all through the apprenticeship route.

That ladder must keep being built and I am so pleased that my fantastic colleague and the Minister of State for Care – Caroline Dinenage – is working to expand the number of nursing associates in social care. I believe there are more opportunities like this, and I want to hear what you think about them.

Challenge 4 is about belonging to an organisation that respects and values everyone’s contribution. All staff in health and care must feel included, valued and respected.

This challenge is all about people feeling trusted – belonging to a team, a group, an organisation who they identify with, feeling engaged by their employer, no matter where they come from.

It is about equal pay for equal work across all roles. It is about ending the gender pay gap and tackling bullying wherever it is found.

But it is also about doing what we can to ensure that the roles that you are asked to do are realistic and reflect 21st century working lives.

There must be more opportunities for flexible working and flexibility in training throughout your career. Medical training for doctors must be designed in a way that recognises that junior doctors have lives and commitments outside work. Why do you have to move trust every 6 months even if you could get the breadth of training in the trust you are in? Why don’t we have training that fits the need of the trainee?

We shouldn’t duck the issue of how to provide more stability and certainty when it comes to training placements. I am encouraged by the changes already made to accommodate the preferences of trainees with special circumstances and to minimise unnecessary movement for others, but there is much more to do.

And finally, challenge 5 is about getting the basics right – what should we do to make sure staff are equipped to do their job? We know that staff need their basic physical and emotional needs to be looked after before anything else can happen.

This challenge is all about staff having access to healthy food, places to rest and to emotional support. It’s ensuring you feel able to remain fit and healthy, or able to recover from illness or injury. And it’s about having access to equipment that helps you do your job and helps managers run their organisations as effectively as possible. And of course pay matters too. I’m glad we have agreed a long-term settlement for AFC staff, and I want to work with the doctors to do the same for them for the future.


The key to getting all of this right, of course, is great leadership and ensuring that leaders of different functions or organisations work together in a united way, around a clear vision.

I want to do more to get great leaders and future leaders into health and care. The NHS graduate management scheme is already one of the most competitive grad programmes in the country. It is expanding, with a bigger intake of 200 graduates this year, rising to 500 next year.

In the past year, we’ve also taken the important step of bringing that together with the corresponding scheme in social care. There are now elements of shared training so that future leaders across health and social care have a better understanding of the challenges faced by each other.

And we want to nurture leadership talent too. In social care, Skills for Care continues to grow its registered manager network to offer support and guidance to those in this role that is so critical to the quality of care provided.

I’m going to put rocket boosters under the NHS Leadership Academy, which is going to do far, far more now than develop and deploy talent – both clinical and non-clinical. And the NHS Digital Academy is going to grow.

I want a more porous border between clinicians and management, and a more porous border between the NHS and elsewhere. It is really striking when you look at the pool of potential NHS leaders just how few have a clinical background or come from outside. Only a third of chief executives are clinicians. Nor do we tap into the skills of women and those from BME backgrounds: only 47% of chief executives or directors are female compared to 75% of the workforce as a whole, while a mere 2% of chief executives are from BME backgrounds compared to 17% of the workforce as a whole. And far, far too few managers in the NHS bring skills and experience from outside.

Change management is hard. Let’s get the best wherever they come from.

Summing up

So there we are – 5 challenges to kick off with. And these are challenges to all of us – everyone who makes a life of working in health and care. We want to know what’s working and where it’s working – what’s important to you? What has the most impact on your lives, and what are we missing?

And it won’t stop there. I want to keep talking, and keep listening. I want you to innovate, and I want the department to innovate too. Part of that means trying new things, learning as we go, and improving where possible. That’s no different for this platform.

Working in the NHS is not just a job – it’s a mission. I want to harness that passion.

I know that, if not for the people at this hospital, my sister might not be here today. I also know that our story isn’t unique, and that everyone in this country has been touched, at one point or another, by the incredible skill and compassion of our health and care workforce. And that’s why I’m launching TalkHealthandCare today. Because it’s time to hear what you have to say about the jobs that are at the very heart of this country.

Department of Health and Social Care
The Rt Hon Matt Hancock MP