NHS England » Minutes of a public meeting of the NHS England Board held on Thursday 28 March 2024

Members

Richard Meddings, Chair
Mark Bailie, Non-Executive Director
Sir David Behan, Non-Executive Director
Mike Coupe, Non-Executive Director
Julian Kelly, Chief Financial Officer
Wol Kolade, Non-Executive Director
Jane Ellison, Non-Executive Director
Dame Emily Lawson, Chief Operating Officer
Dame Ruth May, Chief Nursing Officer
Professor Sir Stephen Powis, National Medical Director
Professor Dame Helen Stokes-Lampard, Non-Executive Director
Amanda Pritchard, Chief Executive Officer
Professor Sir Mark Walport, Non-Executive Director
Professor Sir Simon Wessely, Non-Executive Director

Attendees

Dr Vin Diwakar, Interim National Director of Transformation
Navina Evans, Chief Workforce Officer
Professor Clare Fuller, National Medical Director for Primary Care (item 6)
Catherine Hinwood, Attention Deficit Hyperactivity Disorder (ADHD0 Programme Director (item 6)
Chris Hopson, Chief Strategy Officer
Jennifer Nabwogi, Secretariat Lead
Clare Perry, Office of the Chair and CEO
Jacqui Rock, Chief Commercial Officer
Steve Russell, Chief Delivery Officer/National Director of Vaccinations and Screening

1. Welcome

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

Apologies for absence

1.2 Apologies for absence were received from Jeremy Townsend (Non-Executive Director), Andrew Morris (Deputy Chair) and Professor the Baroness Watkins (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 1 February 2024 (BM/24/08(Pu))

1.4 The minutes from the Board meeting held on 1 February 2024 were approved as a correct record.

2. Chair’s Update

2.1 The Chair provided an overview of his engagements with the healthcare sector and partner organisations since the February 2024 board meeting. He also noted the Spring budget allocation of £3.4 billion to the NHS for transformation activity. The Chair reported that he had participated in various meetings and visits, including with NHS Providers, London Ambulance Service NHS Trust, Leeds Teaching Hospitals NHS Trust, University of Yorkshire, CMR Surgical Robotics in Cambridge, a supplier forum in Leeds, Royal College of Psychiatrists, and the NHS Assembly.

2.2 The Chair further noted the Board committees and groups that had convened since the last board meeting.

2.3 Board members were informed of the 2023 British Social Attitudes survey that had been published, which had revealed a decline in public confidence in the NHS. The Chair acknowledged the low confidence but emphasised the notable improvements delivered across the NHS in the face of significant financial and operational pressures, such as improved access to GP appointments and innovations and improvements to the NHS app.

2.4 Other updates were provided on issues such as industrial action, which had negatively impacted patient treatment and efforts to address long waiting times. Lastly, an announcement was made that 2 new associate non-executive directors, Tanuj Kapilashrami and Suresh Viswanathan, had formally joined the NHS England Board.

3. Chief Executive update

3.1 The Chief Executive Officer (CEO) emphasised the significance of the £3.4 billion allocated to the NHS in the Spring budget, highlighting its potential to bring transformation for both patients and staff. She referenced the recently published planning guidance, underscoring its role in articulating NHS ambitions and supporting sustained focus and improvement across the service. Despite facing increased demand, industrial action, and ongoing covid pressures over the past year, the NHS had successfully delivered on its commitments, a feat for which she commended NHS staff.

3.2 Acknowledging the update provided by the Chair on the 2023 British Social Attitudes survey, the CEO added that the findings reflected the sustained pressure on the NHS and the substantial work being delivered to maintain activity and drive service improvement.

3.3 The CEO expressed empathy for the Princess of Wales’ cancer diagnosis and noted the subsequent increase in visits to the NHS cancer web page.

3.4 The CEO highlighted achievements of the past year, including the opening of 5000 core general and acute beds; an increase in gambling clinics; and improvements in A&E performance, mental health services, cancer diagnosis and treatment, and reductions in long waits for elective care. Despite facing significant challenges, the NHS was steadfast in delivering on its plans, a testament to the dedication of its staff.

4. Performance update

Operational performance update (BM/24/09(Pu))

4.1 The Chief Operating Officer (COO) provided an update on NHS operational performance to the end of January 2024. Demand remained high across urgent and emergency care, February 2024 had seen record levels of A&E attendance, and pressures remained across ambulance, mental health and cancer services. The progress delivered in spite of this, as referenced by the CEO, was emphasised.

4.2 On the waiting list position, the Board was informed that the total waiting list had reduced for a fourth consecutive month, with targeted support in place for the most challenged trusts and clinical areas. On long waits, assurance was provided that although the numbers may appear consistent, patients were continually joining and leaving the list.

4.3 Clarity was sought on the plans for next winter and the COO explained that different implementation approaches for winter plans had been adopted in the last year, with focus now on sharing learnings across systems and the planned earlier commencement of winter planning for this year. The Board discussed the variable reporting on 65-week waits and requested further work to review the inconsistent reporting.

Action: COO

4.4 The Board commended the achievements made amidst the challenges in NHS operations.

Financial performance update (BM/24/09(Pu))

4.5 The Chief Financial Officer presented the NHS’s financial performance for month 10 of the 2023/24 fiscal year, forecasting a system deficit of just over £1 billion. The drivers of continuing financial pressures, including industrial action and inflation and the ongoing engagement with government and NHS organisations to manage this were considered. The savings delivered through the New NHS England Programme, totalling approximately £300 million for this year, were highlighted. Members noted the £32 million underspend forecast against capital budgets.

5. Planning guidance and budget for 2024/25 (BM/24/10(Pu))

5.1 The Chief Financial Officer provided an overview of the 2024/25 planning guidance which had been published the previous day and stressed that recovery of NHS core services remained the overall priority in delivering for patients. Among key performance goals were the improvement of mental health services and enhancing access in primary care.

5.2 On productivity, members noted the reported changes in substantive and agency staffing numbers reported in 2023/24 and considered the further work required on this in 2024/25.

5.3 On the allocation of the £3.4 billion capital funding in the Spring budget, the Interim National Director of Transformation reported that it would be divided into 4 key areas: improving basic infrastructure such as broadband; the NHS App; investing in data structures like the Federated Data Platform; and providing artificial intelligence tools for clinicians. Detailed plans for the allocation would be developed for next year.

5.4 The Board commended the team for managing the budget effectively despite challenges.

6. Attention deficit hyperactivity disorder (BM/24/11(Pu))

6.1 The Chief Delivery Officer presented the report addressing attention deficit hyperactivity disorder (ADHD) service provision within the NHS, highlighting the profound impact of ADHD on people’s lives and the need for broader support beyond the NHS. The increased awareness of ADHD and the corresponding demand across NHS services which had prompted the review of the service model was discussed. A clinical reference group (CRG) had been set up to explore key areas, including the approach to and balance of medication and therapeutic treatments and variations in access, experience and outcomes for different populations.

6.2 The CRG had concluded that combating ADHD requires a coordinated effort with the NHS, justice system and other key partners. It was reported that a task force was due to be set up that would engage communities, while NHS England would utilise the CRG findings to shape ADHD services, including the role of independent sector providers.

6.3 The Board discussed ADHD’s prevalence and challenges, including lengthy waiting lists and the current lack of multidisciplinary assessments. The need for improved cross-sector collaboration to address long waits and ensure patients can access services when and where they need them within the NHS was emphasised.

6.4 The CEO expressed gratitude to those who had contributed to the understanding of ADHD, including the ADHD team, Healthwatch, and youth ambassadors of the Children and Young People Programme.

7. Specialised commissioning – update on specialised services for delegation (BM/24/12(Pu))

7.1 The Chief Financial Officer (CFO) presented the report setting out the recommendations in relation to the specialised services that were deemed to be suitable but not yet ready for full delegation from April 2024. 25 services were recommended for delegation from 1 April 2025 and 32 were to be retained by NHS England. The rationale for delegation and alignment of the approach with the NHS Operating Framework were discussed. The previous decisions taken by the Board in February and December 2023 on the delegation of specialised services were also noted.

7.2 The Board queried how NHS England would manage accountability for the delegated services and the CFO provided assurance that NHSE has mechanisms for maintaining oversight of quality and performance.

Resolved

7.3. The Board approved the list of services that should be delegated, and which should be retained by NHS England from April 2025 as set out in annex A of the report.

8. Directions and mandatory requests for information (BM/24/13(Pu))

8.1 The Board noted the Community Services Data Set Amendment Directions 2024 and the Cancer Programme Pilots Evaluation Directions 2024 issued to NHS England by the Secretary of State for Health and Social Care in March and February 2024 respectively.

9. Report on the use of the NHS England Seal (BM/24/14(Pu))

9.1 The Board noted the documents that had been authorised and sealed with the NHS England seal between 11 October 2023 and 7 March 2024.

10. Annual emergency preparedness, resilience and response assurance report (BM/24/15(Pu))

10.1 The Chief Operating Officer (COO) explained NHS England’s responsibility to deliver and report on emergency preparedness, resilience and response (EPRR) as a core function and a statutory requirement of the Civil Contingencies Act 2004, and to respond to emergencies in line with the NHS Act 2006 and the Health and Care Act 2022. The report provided assurance that NHS England and the NHS in England is prepared to respond to an emergency and is resilient to provide continued safe patient care. The report highlighted the key activities in 2023/24, including responding to industrial action, and plans in place for 2024/25. It was noted that although the formal covid incident had been stepped down on 18 May 2023, learning from covid continues.

10.2 Given the large number of incidents responded to in the previous year, it was requested that the capacity of the NHS Resilience team should be reviewed to ensure this is sufficient to effectively deliver its duties.