Members

• Richard Meddings, Chair
• 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
• Professor Dame Helen Stokes-Lampard, Non-Executive Director
• Jeremy Townsend, Non-Executive Director
• 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

• Dr Jayne Chidgey-Clark, National Guardian for the NHS
• Navina Evans, Chief Workforce Officer
• David Fitzgerald, Director of Policy and Strategy
• Annelise Hillyer-Thake, FTSU Guardian
• Chris Hopson, Chief Strategy Officer
• Prof Peter Johnson, National Clinical Director for Cancer
• Dorota Mason, FTSU Guardian
• Dr Habib Naqvi MBE, Chief Executive – NHS Race and Health Observatory
• Katie Neumann, Assistant Director of Secretariat
• Bola Owolabi, Director of Healthcare Inequalities
• Steve Russell, Chief Delivery Officer / National Director of Vaccinations and Screening

1. Welcome

1.1 The Chair welcomed everyone to the meeting.

Apologies for absence

1.2 Apologies for absence were received from Mark Bailie (Non-Executive Director), Sir David Behan (Non-Executive Director), Vin Diwakar (interim National Director of Transformation), Wol Kolade (Deputy Chair) and Sarah-Jane Marsh (National Director of Urgent and Emergency Care (UEC) / Deputy Chief Operating Officer).

Declarations of interest

1.3 No declarations of interest were made over and above those already on record, and no interests were declared in relation to the items on the agenda.

Minutes from the Board meeting held on 16 May 2024 (BM/24/26(Pu))

1.4 The minutes from the public Board meeting held on 16 May 2024 were approved as a correct record.

2. Chair’s update

2.1 The Chair highlighted the recent Synnovis cyber incident and the CrowdStrike-Microsoft outage and the work underway across the NHS to manage this.

2.2 The Chair noted that Sir David Behan would leave the Board on 31 August 2024 and thanked him for his substantial contributions and dedication as Non-Executive Director for NHS England and previously as Chair of Health Education England. It was also noted that Professor Dame Helen Stokes-Lampard was leaving the Board in the coming months and Members thanked her for her support and contribution to the NHS and as a NHS England NED.

2.3 The breadth of business considered by NHS England’s board committees since the previous meeting, and the work underway to review and refresh the role and responsibilities of the Quality Committee were noted.

2.4 The Chair summarised his engagements with the healthcare sector and partner organisations, including visits to Nottingham University Hospitals NHS Trust, St George’s University Hospitals NHS Foundation Trust, Shrewsbury and Telford Hospital NHS Trust and a primary Care visit in Hackney. The progress and innovations demonstrated across these visits and plans to drive further improvements were discussed. The Chair had also met with the Dean of the Royal College of Psychiatrists, attended a strategy session with Genomics England, and engaged with the Nuffield Trust on communication challenges across the NHS and research into primary care.

2.5 The Chair highlighted the challenged financial position across the NHS, as reflected in the National Audit Office’s NHS financial management and sustainability 2024 report. The drivers of these continuing challenges and actions being taken to address this were considered.

2.6 The position on operational performance and continuing pressures on NHS staff and the actions being taken to drive improvements were considered. In the context of this challenged performance, the Board expressed its support for Lord Ara Darzi’s independent review of NHS performance.

3. Chief executive update (verbal)

3.1 The Chief Executive Officer (CEO) welcomed Duncan Burton to the Board as the new Chief Nursing Officer, replacing Dame Ruth May.

3.2 The CEO updated the Board on the progress made, emerging risks and key achievements since the May Board meeting, including

• The positive engagement with the new government and ministers on the direction of travel and strategy for the NHS. The CEO expressed NHS England’s strong support for the three shifts underpinning the government’s mission for health, to move care out of hospital into community and primary care, to move from an analogue to a digital way of working, and shifting from treatment to prevention, to improve patient and public experience and health outcomes were highlighted.
• The focus with government on implementation of the planned step up of elective activity and, recognising the criticality of the NHS workforce to deliver day to day activity and support transformation and improvement across the NHS, the initiatives in place to support the NHS staff in the context of continuing industrial action (IA) and rising demand and pressure across NHS services.
• On IA, the recommendations of the NHS Pay Review Body (PRB) and Senior Salaries Review Body (SSRB) were anticipated in the coming months and will inform any changes required in the pay award for NHS staff, supported by robust assessments of affordability.
• Ongoing work on winter planning, building on the urgent and emergency care (UEC) recovery plan. The focus on patient safety and experience at both trust and system level as part of this work to ensure patients are getting the best care possible when they need it and that staff are supported to do this was emphasised.
• The continued iteration of the NHS England operating model following the conclusion of the New NHS England Programme and establishment of integrated care boards (ICBs) as statutory organisations, to best support and enable delivery and strategic change and transformation across the NHS.

4. Performance update (BM/24/27(Pu))

Operational performance update

4.1 The Chief Operating Officer (COO) presented the latest operational performance across the NHS in England. Robust engagement had been carried out with systems on their plans for 2024/25 and Members commended the high quality and level of ambition reflected in system returns. The continuing impact of IA on operational delivery and activity levels across the NHS and the actions being taken to manage this were considered.

4.2 Challenges remain around financial, quality and operational performance ahead of winter, with work focusing on balancing UEC and elective delivery, and patient flow as part of winter preparations. It was discussed that additional funding had been provided to establish additional beds last winter and providers would be required to maintain this capacity this winter without the additional funding previously provided. The work underway to increase support and guidance to the NHS to support local adoption and adaption of improvement initiatives and good practice to improve resilience ahead of winter was discussed.

4.3 On UEC, Members discussed that plans are in place and being developed to manage potential high temperatures across England in Summer, ongoing IA, increases in emergency department attendances and category 1 and 2 ambulance calls. Performance against the 4- hour and 12-hour standards and the actions being taken to improve this were considered.

4.4 The Board discussed the position on elective care and considered the composition of the total waiting list, including variations in complexity across the list and the challenges in some specialties which require a multidisciplinary response.

4.5 The improvements delivered across the cancer Faster Diagnosis Standard and across cancer services more widely were highlighted, noting the further work needed on 62-day referrals.

4.6 Members considered the increasing pressure across mental health services, in particular in the mental health UEC pathway. The work underway to establish aligned standards for mental health as exist for elective services was also considered. A discussion took place on the actions being taken to address long waits (>116 weeks) for adult community services, noting the impact of these waits on people seeking support for neurodevelopmental conditions in particular.

4.7 The Board acknowledged the pressures across primary care services and discussed the extent to which the Pharmacy First service had offset rising demand and helped improve access to primary care services, particularly for more complex cases. It was noted that the NHS was in year one of the Delivery plan for recovering access to primary care, which focused on streamlining access to care and advice, and consideration was given to the next steps for this work.

4.8 Members considered the plans in place across the NHS to support delivery of the World Health Organisation’s ambition to eliminate cervical cancer by 2040. The Chief Delivery Officer / National Director for Vaccinations and Screening (CDO / NDVS) updated the Board on the progress made against the NHS aims to achieve a 90% vaccination rate for Human papillomavirus (HPV), 80% coverage under the NHS Cervical Screening Programme, and 90% treatment rate for cervical cancer.

Financial performance update

4.9 The Chief Financial Officer (CFO) summarised the latest position on 2024/25 planning and the month 2 (M2) financial position for the NHS.

4.10 The Board discussed that funding remained broadly flat in real terms despite substantial unprecedented financial and operational pressures across the NHS. Spend at M2 reflected a circa £300m adverse variance from plan, which presents a material risk to NHS finances, and the CFO emphasised the responsibility of NHS boards and executive teams to deliver their agreed financial and operational plans to achieve a balanced position across the NHS. The substantial progress made and further work underway to reduce temporary staffing costs across the NHS was considered. Members endorsed the planned intervention and additional support that will be provided to the ten most challenged systems to recover their position.

4.11 The CFO clarified that the position set out in the report did not reflect any potential increases in pay costs based on recommendations from the NHS PRB and SSRB, which would be agreed with government, or associated with any potential pay deals that may be agreed to resolve IA.

4.12 The ongoing discussions with government on the status of the £3.4 billion funding allocated in the spring budget to boost NHS Productivity were noted.

5. Autumn/Winter 2024 seasonal vaccination (BM/24/28(Pu))

5.1 The CDO / NDVS introduced the report on the Autum/Winter 2024 Seasonal Vaccination Strategy.

5.2 The Board noted the planned later start to the flu vaccination programme based on the Joint Committee on Vaccination and Immunisation’s advice, with advice still awaited on covid-19 vaccination. Members also noted the plans in place for Respiratory syncytial virus (RSV) vaccination.

5.3 A discussion took place on the recent measles and whooping cough outbreaks, both of which were preventable through vaccination. The further work planned to improve the rate of measles, mumps, and rubella (MMR) vaccination, and, working with the Nursing directorate, to increase uptake of the pertussis (whooping cough) vaccination was considered.

5.4 Members considered the shift in approach to vaccination this year to adopt a more people-centred approach to vaccination and integrate vaccine delivery into primary and secondary services to maximise uptake. Under this approach, pregnant women would be offered four vaccines through maternity services, flu, covid-19, RSV and pertussis, with flu, covid-19 and RSV also offered to people over 75 years old. Assurance was provided that delivery of these programmes would be aligned, and vaccinations co-administered wherever possible and appropriate. The contribution required from the voluntary and community sector and local government to support this was emphasised.

5.5 Consideration was given to the approach to communications for the programme to build public confidence and trust. The importance for this to include communication and education through local education and community institutions was highlighted. The drivers of poor vaccine uptake and the extent to which these will be addressed through this public engagement were considered

5.6 The Chair requested further information on how the NHS App was used to support vaccinations.

Action: Steve Russell

6. Cancer – diagnosis and treatment (BM/24/29(Pu))

6.1 The National Clinical Director for Cancer introduced the report, which provided an overview of the progress made on cancer diagnosis and treatment. The Board emphasised the benefits of shifting care out of hospital and improving local access to services demonstrated through this work.

6.2 The next steps for this work to address ongoing challenges and drive further improvement were considered. The plans in place for breast, cervical and colon cancer screening, including Faecal Immunochemical Testing, were considered. The proportion of diagnostic capacity used for cancer diagnostics and the anticipated increase in demand and activity in the coming years were considered.

6.3 Members discussed the key challenge around the delay between referral to receiving a diagnosis, and the further challenge in time to initiate treatment. The criticality of timely investigations and investment to increase diagnostic capacity and capacity to delivery surgical interventions to address these challenges were considered.

6.4 Members queried the delivery of personalised cancer vaccines and discussed that these are aimed at people who have had cancer and have a risk of recurrence, with the vaccine targeting that specific recurrence risk.

6.5 The Board discussed the progress made to improve digital pathology and the innovations being developed to support this, including developing work on the use of artificial intelligence to support diagnosis. The focus on system interoperability and scalability to enable testing to be carried out at any diagnostic centre and for these results to be analysed through a central facility, supported by AI, to maximise capacity was considered. The work underway to clarify the investment and workforce required to support both the implementation and ongoing operation of digital pathology services in the context of competing digital priorities were considered.

7. Freedom to Speak Up

National Guardian’s Office update and priorities for 2024/25 (BM/24/30Pu))

7.1. The Board welcomed Dr Jayne Chidgey-Clarke, National Guardian for the NHS, to present the National Guardian’s Office’s (NGO’s) annual report on the progress made in the past year and the priorities for 2024/25 to improve the speaking up culture of the healthcare sector. The National Medical Director (NMD) and Senior Responsible Officer (SRO) for internal Freedom to Speak Up (FTSU) informed the Board that the NGO is jointly funded by NHS England and the Care Quality Commission.

7.2. Members emphasised the role of NHS leaders to create a culture where people feel able and safe to speak up. The role of FTSU Guardians to support people speaking up alongside this was also considered. It was discussed that the NGO had published a refreshed strategy for 2024 on 18 July and the Board considered the goals set out in this strategy to drive further change and improvement across the NHS in the next three to five years

7.3. Consideration was given to the data and analysis provided in the report on FTSU activity across the NHS and the work planned to address identified challenges and opportunities for improvement, noting the following:

7.3.1 The latest data reflects a 27% increase in FTSU cases, however the NHS Staff Survey results show a decline in ‘safety to speak up about clinical concerns’ which requires further review. The potential need to strengthen local HR processes to ensure that wherever possible and appropriate issues are resolved through local HR teams rather than being raised through the FTSU process was also considered.

7.3.2 Reviews were underway of culture across ambulance services, concerns around FTSU arrangements for overseas trade workers, and escalation routes for serious matters of concern.

7.3.3 Work continues to improve diversity across FTSU Guardians to ensure this was representative of the workforce within their organisation.

7.4 The learnings identified in the report for NHS England were discussed and further work proposed as follows:

7.4.1 Reporting on workforce and culture, including FTSU data, should be integrated into business as usual performance reporting;

7.4.2  The role and responsibilities of ICBs in speaking up should be clarified; and

7.4.3 Clarification was also required of the need for independent providers that deliver NHS services to establish FTSU arrangements and appoint a Guardian(s) within their organisation

Action: Steve Russell, Steve Powis

NHS England internal FTSU annual report (BM/24/32(Pu))

7.5 The NMD and SRO for internal FTSU introduced the report and summarised the work carried out by NHS E in the past year and next steps for internal FTSU, highlighting the focus on culture development within NHS England.

7.6 The Board welcomed Annelise Hillyer-Thake and Dorota Mason, NHS England FTSU Guardians, and considered their reflections on the themes identified in FTSU cases, including the increased complexity of cases and the further work needed around maintaining confidentiality in the FTSU process. The Guardians thanked the Non-Executive and Executive Directors for their support and contribution to FTSU across NHS England.

7.7 Members discussed the work planned to produce a comprehensive grievance policy and procedure for NHS England, agree clear timeframes for the FTSU process, strengthen reporting on outcomes, and improve oversight of implementation of FTSU recommendations. The emphasis of this work on the timely resolution of FTSU cases balanced with thorough investigation was considered.

7.8 The Board discussed the learnings for NHS England on adopting a more humanistic approach to FTSU, ensuring that FTSU and HR policies and procedures enable NHS England to take action where necessary and appropriate, and equipping line managers and staff with the skills to have difficult conversations to support the early identification and resolution of issues. The actions being taken and further work needed on these were considered.

8. Annual report on NHS England’s work on healthcare inequalities and the NHS Race and Health Observatory (BM/24/31(Pu))

8.1 The Chief Strategy Officer introduced the annual report on NHS England’s Healthcare Inequalities Improvement Programme and the work of the NHS Race and Health Observatory (RHO). The Board received examples of the work carried out and improvements delivered by the RHO and by NHS England through the NHS England Health Inequalities Improvement Programme in the previous year. The benefits delivered through the anti-racism work, the targeted lung health check, dental and sickle cell disorder initiatives, the high intensity use service work with UEC team, and the health innovation collaboration with the Accelerated Access Collaborative were highlighted.

8.2 The Board expressed its support for the move from input to impact measures to drive progress and support NHS England and the NHS more broadly to demonstrate measurable progress in reducing health inequalities. The importance for this work to feed into Lord Darzi’s independent investigation of NHS performance was discussed. The ambitions for the coming year to evidence the impact of these initiatives on a larger scale and drive improvements across all Core20PLUS5 areas were supported.

8.3 Governance of the Programme was considered and Members proposed that:

8.3.1 The Programme should report to the Quality Committee on a regular basis to support the Board’s oversight of this area and complement the existing executive engagement and reporting arrangements; and

Action: Secretariat

8.3.2   the indicators and metrics established in the Programme should be integrated into BAU performance reporting at executive and Board level.

Action: Steve Russell, Performance and Delivery Unit

9. Directions and mandatory requests for information (BM/24/33(Pu))

9.1 The Board noted the following Directions and Mandatory Requests for Information that had been issued to NHS England:

9.1.1 Electronic Prescribing and Medicine Administration (ePMA) Directions 2024 issued to NHS England by the Secretary of State for Health and Social Care in May 2024.

9.1.2 Healthcare Operational Data Flows Directions 2024 issued to NHS England by the Secretary of State for Health and Social Care in May 2024.

9.1.3 NHS login for health services supplied by third party Apps in Wales Request 2024 issued to NHS England by the Digital Health Care Wales in May 2024

10. Any other business

10.1 There was no other business.

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