NHS England » Minutes of a public meeting of the NHS England Board held on Thursday 16 May 2024

Members

Richard Meddings, Chair
Mark Bailie, Non-Executive Director
Mike Coupe, Non-Executive Director
Jane Ellison, Non-Executive Director
Julian Kelly, Chief Financial Officer and Deputy CEO
Dame Emily Lawson, Chief Operating Officer
Professor Sir Robert Lechler, Non-Executive Director
Dame Ruth May, Chief Nursing Officer
Sir Andrew Morris, Non-Executive Director
Professor Sir Stephen Powis, National Medical Director
Amanda Pritchard, Chief Executive Officer
Suresh Viswanathan, Associate Non-Executive Director
Professor Sir Mark Walport, Non-Executive Director
Professor the Baroness Watkins, Non-Executive Director
Professor Sir Simon Wessely, Non-Executive Director

Attendees

Duncan Burton, Deputy Chief Nursing Officer
Neil Churchill, Director for People and Communities
Dr Vin Diwakar, Interim National Director of Transformation
Adam Doyle, National Director for System Development
Navina Evans, Chief Workforce Officer
Chris Hopson, Chief Strategy Officer
May Li, Director of Efficiency
Sarah-Jane Marsh, Director of UEC/Deputy COO
Kelly Phizacklea, Neonatal Service User Voice Representative, Maternity and Neonatal Programme
Donald Peebles, National Clinical Director for Maternity
Steve Russell, Chief Delivery Officer / National Director of Vaccinations and Screening

1. Welcome

1.1 The Chair welcomed everyone to the NHS England (NHSE) public Board meeting.

Apologies for absence

1.2 Apologies for absence were received from Sir David Behan (Non-Executive Director), Tanuj Kapilashrami (Associate Non-Executive Director), Wol Kolade (Deputy Chair), Jacqui Rock (Chief Commercial Officer), Helen Stokes-Lampard (Non-Executive Director) and Jeremy Townsend (Non-Executive Director).

Declarations of interest

1.3 No conflicts of interest were declared over and above those already on record and none were raised in respect of the business covered on the agenda.

Minutes from the Board meeting held on 28 March 2024 (BM/24/16(Pu))

1.4 The minutes from the Board meeting held on 28 March 2024 were approved as a correct record.

2. Chair’s Update

2.1 The Chair informed the Board of the planned further Non-Executive Director (NED) recruitment to be undertaken considering upcoming departures from the NHSE Board, and the appointment of Dr Brian (Jamie) Saunders as Chair of the Cyber Security and Risk Committee and Non-Executive Committee Member of the Data, Digital and Technology Committee, replacing John Noble whose term ends on 31 July 2024.

2.2 The Chair provided an overview of his engagements with the healthcare sector and partner organisations since the March 2024 Board meeting, focusing on healthcare strategy, primary care, transformation, and innovation.

2.3 The Chair highlighted the improvements and innovations delivered across the NHS, including the 23% increase in GP appointments, expansion of NHS virtual wards, and improvements in functionality and use of the NHS App. Record levels of healthcare are being provided and the Board commended the substantial contributions from NHS staff to deliver this activity. The continuing challenge to manage rising demand and ongoing pressures across the NHS was noted.

2.4 The Chair noted the closure of the New NHSE Programme (discussed under item 9) and both the Chair and Chief Executive thanked Wol Kolade, Deputy Chair, the Chief Delivery Officer / National Director for Vaccinations and Screening, as Senior Responsible Officer of the Programme, and the NHS Executive for their leadership of this work. The impact of the change process on staff was acknowledged and the Board thanked staff for their continued commitment and delivery despite this disruption.

3. Chief Executive Update

3.1 The Chief Executive Officer (CEO) updated the Board on the progress made, emerging risks and key achievements since the March Board meeting, including:

planning is underway for 2024/25 focusing on continued improvement on recovery, delivery of the NHS Long Term Workforce Plan, and transforming services for the future. Meetings are taking place with each integrated care board (ICB) and providers on their plans and the strength of engagement through these sessions was highlighted
on industrial action (IA), the government and the British Medical Association (BMA) Junior Doctors Committee are taking forward independently mediated talks on JD pay. However, in parallel the BMA General Practitioners Committee is balloting GP contract-holders on a form of collective action
work continues to develop the Productivity Plan, taking account of the additional funding allocated through the Spring Budget
following discussion at the public Board meeting in March, the Attention Deficit Hyperactivity Disorder (ADHD) cross-sector task force has been established to better understand and inform action to address demand and capacity challenges associated with ADHD. The Board noted that the taskforce will be co-chaired by Professor Anita Thapar and Joanna Killian
the letter that had been sent to the NHS on improving the working lives of doctors in training. The actions set out in the letter were summarised, including on health and wellbeing and psychological support
the All-Party Parliamentary Group (APPG) had published its Birth Trauma Report. The alignment of the recommendations with the Maternity and Neonatal Three Year Delivery Plan was noted. Further work is needed to address continuing challenges across maternity and neonatal services and the support from the Chief Executive and the Secretary of State for Health and Social Care for the development of a cross-government strategy to drive this work was highlighted
congratulations were offered to the Greener NHS team on the support provided to NHS organisations on the Public Sector Decarbonisation Scheme (PSDS). An additional £200 million had been allocated to 20 trusts to support energy and cost-saving efforts, taking the total investment awarded to the NHS through the PSDS to over £1 billion across over 100 projects

4. Operational Performance update (BM/24/17(Pu))

4.1 The Chief Operating Officer (COO) provided an update on NHS operational performance, noting in particular:

elective: A marginal decrease was reported in the waiting list position, with the total waiting list currently at 7.54m. Improvements had been reported in 65, 78 and 104 week waits, alongside a slight deterioration in 52 week waits
cancer: The additional capacity and new ways of working had delivered improvement on the 28-day faster diagnosis standard, which had been achieved by all seven regions in February and March 2024. Improvement had also been reported on the 62-day referral to treatment target; however, significant variation remained between the top and bottom decile of trusts against this metric. Deliverability of the ambitions for cancer services in the planning guidance was considered
mental health: Systems continue to deliver high levels of activity. The dementia diagnosis rate had steadily improved since January 2023 and will remain an area of focus for the coming year
urgent and Emergency Care (UEC): Emergency department attendances and calls to ambulance services had increased by 9% and 3% respectively in April 2023. Performance against the four-hour standard had improved, but remained below the same month in 2023, and category 2 performance had also improved. A slight deterioration was reported in 12-hour delays and Members discussed the need for increased focus and active reporting to the Board on the position

4.2 A discussion took place on the progress made on prevention and long-term conditions, in particular through the NHS Diabetes Prevention Programme. The strength of the independent evaluation embedded in this Programme was highlighted. It was discussed that obesity is a contributory factor for diabetes and increases the risk of cancer and the Board noted the work requested to develop an obesity strategy, working with government.

4.3 Members discussed the links between diagnostics, prevention and addressing health inequalities and considered the need to build-in additional investment in prevention to manage demand and capacity in the long term.

Urgent and Emergency Care Year 2 Plan

4.4 The National Director for UEC / Deputy COO summarised the content of the UEC Recovery Plan Year 2 and the three priorities for delivery in the coming year: i) maintaining capacity expansion; ii) increasing productivity across acute and non-acute services; and iii) continuing to drive the shift from acute to out of hospital settings where appropriate. Assurance was provided that the learnings around delivery support, tiering and improvement initiatives from Year 1 of the Plan had been fed into these priorities and actions. The earlier release of the detail on the capital incentive scheme to promote engagement with and drive further improvements through additional capital investment was noted.

4.5 The Board commended the team and the wider NHS on the progress on UEC recovery to date. The value delivered by working with and through systems on the development and delivery of this and other recovery plans, including the criticality of clinical and operational leadership at system and organisation level, was emphasised.

5. Financial Performance Update (BM/24/18(Pu))

5.1 The Chief Financial Officer (CFO) presented the NHS’s financial performance for month 12 of the 2023/24 fiscal year, noting that the NHS had delivered financial balance in aggregate through a real terms reduction in spend while delivering substantial operational and transformational improvements across the NHS.

5.2 A discussion took place on the reprioritisation of spend in-year to achieve this financial position, in particular the reduction in the overall planned investment in digital infrastructure and technology. It was considered that, while the overall level of investment had reduced, progress continued to be made on NHSE’s long term ambitions for data and digital transformation, including through the Federated Data Platform, NHS App and clinical innovations to improve care quality and outcomes. The additional £3.4 billion allocated in the Spring Budget for the Productivity Plan, which will be available from 2025/26, was also noted.

5.3 The investment in the physical and digital NHS estate to deliver service improvements and improve care quality and experience were considered.

6. NHS Productivity (BM/24/19(Pu))

6.1 The CFO introduced the report on NHS Productivity, noting the decline in productivity during the Covid-19 pandemic, reflecting increased costs and the disruption to services, the progress made to date and further work required to recover the position. The challenges in measuring productivity and the work underway with the Office for National Statistics on this were considered.

6.2 Members discussed that the developing Productivity Plan will focus on programmes of continuous improvement, value-based healthcare, identifying and reducing waste and removing barriers to enable people to do the best job that they can. The support that will be provided to leaders, managers and staff across the NHS to equip them to identify opportunities and deliver productivity improvements was considered. The relationship between this work and NHS IMPACT and the Getting It Right First Time (GIRFT) Programme was considered.

6.3 The Board considered the rate of productivity growth across different public services and the impact of this on the NHS, such as the potential impact of low productivity across social care on length of stay in the NHS. The work underway with local authorities to manage this where possible and appropriate was considered.

6.4 A discussion took place on the criticality of technology investment to deliver the required productivity growth across the NHS, as demonstrated by the productivity improvements realised through digital and technology initiatives such as electronic patient records and the repeat prescription function in the NHS App.

7. An update on delivery of the first year of the Maternity and Neonatal Three-Year Delivery plan and next steps (BM/24/20(Pu))

7.1 The Chief Nursing Officer (CNO) introduced the report highlighting the progress made on the Maternity and Neonatal Three Year Delivery Plan. The Board welcomed Kelly Phizacklea, Neonatal Service User Voice Representative, Maternity and Neonatal Programme who provided an overview of her experience of maternity and neonatal services and the new initiatives being implemented to strengthen service user voice, including the roll out of Maternity and Neonatal Voice Partnerships.

7.2 Consideration was given to the next steps for this work and deliverability of this alongside the actions and recommendations from other reviews of maternity and neonatal services, including the Ockenden review of maternity services and the APPG Birth Trauma Report. Assurance was provided that the Plan aligns with and consolidates these actions.

7.3. The Board discussed the balance of national and local action to deliver the required improvements, including through the Maternity Safety Support Programme, noting the ongoing work with trusts and systems to target support and develop local skills and capability to deliver sustainable improvement. Members also discussed the actions being taken around retention, education and training, including on preceptorships.

7.4. The importance of this work and the value of increasing service user input on the Programme were emphasised.

8. Research in the NHS (BM/24/21(Pu))

8.1 The Interim National Director of Transformation introduced the report on the current approach to research in the NHS and the potential next steps to embed research into everyday NHS care.

8.2 The Board discussed the clinical and operational benefits that can be realised through both operational and biomedical research, including on prevention, efficiency and productivity, and patient outcomes. The challenges associated with the prioritisation of research alongside other competing priorities were considered. The potential to strengthen collaboration with universities and the life sciences industry to drive progress through strategic partnerships was discussed.

8.3 Members emphasised the criticality of research to enable the NHS to respond to changes in disease and prevalence. The support provided to the NHS workforce to enable them to undertake research, and the guidance provided to NHS finance directors on funding for research were considered. Members discussed the need for more active consideration of the approach to clinical research careers as part of this work. The approach to data collection and processing for research and the safeguards in place to ensure that patients can safely and confidentially share their data for this purpose were considered.

9. Report on the completion of the New NHS England Programme (BM/24/22(Pu))

9.1 The Chief Delivery Officer / National Director for Vaccinations and Screening (CDO/NDVS), as Senior Responsible Officer (SRO) for the New NHSE Programme, introduced the report summarising the outcomes delivered through the New NHSE Programme and next steps for ongoing areas of work, in particular on culture and organisational development (OD) for the new NHSE.

9.2. The Board reflected on the scale of the change delivered across the organisation and the continuous review of the balance and prioritisation between fairness for staff and pace of change. The robust lessons learned review that had been carried out and the approach to implementation of these recommendations were considered, noting the potential to apply these learnings to other large scale change programmes.

9.3. The breadth of business discharged through the single new organisation, including through the NHSE Board and its committees, was considered. The focus on continuous improvement going forward was emphasised.

Resolved:

9.4. The Board resolved to:

approve closure of the New NHSE Committee following its meeting on 2 May 2024
support the retention of a small programme team, reporting to CDO, to deliver ongoing areas of work
agree that the NHS Executive will assume accountability for areas of ongoing work, with board committee oversight as required, including but not limited to the OD & Culture programme and establishing an internal improvement team
note the planned internal and external comms on the closure of the programme, learning and next steps

10. Specific Equality Duties: 2024 SED Review Report (BM/24/23(Pu))

10.1 The CNO introduced the 2024 SED Review Report which demonstrated NHSE’s delivery of its statutory requirements under the Equality Act 2010’s Public Sector Equality Duty (PSED) and the associated Specific Equality Duties (SEDs). The Director for People and Communities summarised the areas of focus in the report, highlighting the progress made despite pressures across the service.

10.2. Consideration was given to the proposed extension of the existing objectives for 2024/25. Members discussed that a further detailed review will be carried out to inform NHSE’s objectives for 2025/26 beyond, in line with the Equality and Human Rights Commission’s requirement for objectives to be reviewed at least once every four years.

Resolved:

10.3 The Board resolved to:

approve the extension of the current equality objectives and targets to 2025/26
approve and accept the SED Review Report and the revised equality targets

11. Update on the review of the approach to NHS oversight and assessment (BM/24/24(Pu))

11.1 The CDO/NDVS summarised the three pillars of work underway, the approach to oversight and accountability for the NHS, Developing our leadership, and Delivering improvement. An overview was also provided of the proposed updates to the NHS Oversight and Assessment Framework, which fell under pillar one of this work, and the proposal to introduce whole-system assessment against key priorities set by NHSE. On non-NHS providers, it was clarified that they are overseen through the contracts that they hold with their commissioners, including in primary care and dentistry.

11.2. The Board confirmed its support for the proposed changes and welcomed the additional clarity this offered on the role of all parts of the NHS system. Members discussed that a short period of public consultation will commence from 20 May ahead of launching the Framework in July, subject to the Board’s approval. The intention to publish this alongside the Insightful Board series, which will set out (across three separate documents) the information that high-performing and well-governed provider and ICB boards and the NHSE Board should receive and scrutinise was noted. It was proposed that the document should be updated to clarify that reference to the NHS Executive includes both National and Regional Directors who are members of the NHS Executive.

Action: SR

11.3 Consideration was given to the balance of metrics that will be monitored under the Framework, including on quality of care and research, and the proposed approach to annual ICB capability assessments. Members expressed their support for the work that had been commissioned from the Medical Director of Primary Care and the Deputy Chief Nursing Officer on the proposed measures to ensure these are clinically and operationally relevant. The intention to continue to review and evolve the Framework in the coming years and the progress made on this improvement journey through the revised Framework were considered.

12. Directions and Mandatory Requests for Information (BM/24/25(Pu))

12.1 The Board noted the Outcomes and Registries Directions 2024 issued to NHS England by the Secretary of State for Health and Social Care in March 2024.

13. Any Other Business

13.1 There was no other business.

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