He articulated clearly that the only way to turn things around in the ailing health service is by working collaboratively. We saw none of the previous language of “blockers and checkers” or implication that the health service was anti reform. In fact the opposite.

He gave a flavour of what’s to come in the forthcoming 10 year health plan - and in many ways it’s back to the 2000s (but without the money): a greater role for NHS regional tier, Foundation Trusts, financial incentives.

The diagnosis that sits behind this is that bureaucracy and top down control are at the heart of the NHS’s problems. There is no doubt that looking upwards and numerous onerous reporting requirements have not always served the NHS and its patients well.

But there is little evidence that simply changing structures leads to better health outcomes. This will be something to watch when the 10YP is finally published. Are structural solutions expected to do the heavy lifting for what is essentially a huge cultural shift in how the health service works?

Also interesting remarks from Streeting in the Q&A about how he has worked to improve relations between the DHSC, NHS and HMT. Tensions between these Depts have undoubtedly had a big impact in the past as the excellent @markgdayan.bsky.social has argued www.nuffieldtrust.org.uk/news-item/nh...

It will be an interesting few months. And thanks to @danielreynolds.bsky.social @confedmatt.bsky.social and the wider Confed team for a v impressive conference.

It will be interesting to see if this more collaborative and friendly tone from SofS sticks when the rubber hits the road in the face of continued financial pressures. Will the language of blockers and reactionaries return when difficult things are revealed to be difficult?

So…. Welcome recognition of how hard it is and good that he sees that the NHS is up for change - much more realism - but a bit too much of a love affair with FTs - but let’s see …

6) Fewer targets, focus on health disparities - to be welcomed - no mention of the health mission….

5) says this is not a top down re organisation - get the point but wouldn’t feel like that in an ICB or NHSE

4) recognises the money is not going to be enough without reform. @nuffieldtrust.org.uk would add the need to make difficult choices ….

3) Organisational form can be flexible to place - GPs leading, GPs run by acutes -maybe a bit too much on structures - not enough on relationships & trust

2) the return of the Foundation Trust as a driver of change & entrepreneurship - hmmm - evidence mixed as to whether it was FTs drove big improvements or the £ at that time

Completely agree