Members

• Richard Meddings, Chair
• Duncan Burton, Chief Nursing Officer
• Mike Coupe, Non-Executive Director
• Jane Ellison, Non-Executive Director
• Julian Kelly, Chief Financial Officer
• Wol Kolade, Non-Executive Director
• Dame Emily Lawson, Interim Chief Operating Officer
• Professor Sir Robert Lechler, Non-Executive Director
• Sir Andrew Morris, Deputy Chair
• Professor Sir Stephen Powis, National Medical Director
• Amanda Pritchard, Chief Executive Officer
• Jeremy Townsend, Non-Executive Director
• Professor the Baroness Watkins, Non-Executive Director

Attendees

• Dr Vin Diwakar, Interim National Director of Transformation
• Navina Evans, Chief Workforce, Training and Education Officer
• Sarah Jane Marsh, National Director of Urgent and Emergency Care / Deputy Chief Operating Officer
• Adam Memon, Director of Demand Insights
• Katie Neumann, Assistant Director of Secretariat
• Jacqui Rock, Chief Commercial Officer
• Steve Russell, Chief Delivery Officer / National Director of Vaccinations and Screening
• John Stewart, National Director of Specialised Commissioning
• Jan Thomas, National Director of Intensive Support and Recovery Support Programme / Chief Executive Officer of Cambridge and Peterborough (until item 4.7)

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), Chris Hopson (Chief Strategy Officer), Suresh Viswanathan (Associate Non-Executive Director), Professor Sir Mark Walport (Non-Executive Director) and Professor Sir Simon Wessely (Non-Executive Director).

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 30 March 2023 (BM/24/40(Pu))

1.4 The minutes from the public Board meeting held on 3 October 2024 were approved as a correct record.

2. Chair’s Update (verbal)

2.1 The Chair noted his intention to step down from the NHS England Board at the end of March 2025, and offered his reflections on the progress made and future priorities for the NHS and NHS England (NHSE). The Chief Executive Officer (CEO) thanked the Chair for his commitment to and advocacy for the NHS, and his level of passion and commitment to transforming the NHS to ensure it is fit for the future. 

2.2 The Board was informed that recruitment for the new NHS England Chair will commence shortly, alongside a recruitment process for new Non-Executive Directors given recent and impending departures. The criticality of these recruitment processes to support the continued operation of the Board and the board committees was emphasised. 

2.3 The Chair noted that this was Jacqui Rock’s, Chief Commercial Officer (CCO), last meeting. Members thanked Jacqui for her hard work contributions to the NHS and NHS England, noting in particular the reform of the commercial profession and function across the NHS and improvements in NHS procurement.

2.4 An overview was provided of the engagement to date on the 10 Year Health Plan, including through the working groups and the deliberative events that had commenced across the regions. 

2.5 The Chair discussed that the Autumn Budget 2024 had been delivered on 30 October 2024. The Chair welcomed, on behalf of the Board, the increase in capital funding for the NHS and noted the ongoing discussions with government on the final budget position and priorities for the coming year. The need for clear and stringent prioritisation in the coming year to manage within the constrained resources available was emphasised. 

2.6 The Chair provided an update on his engagements with the healthcare sector and partner organisations since the last board meeting in October 2024, including with the Department of Health and Social Care (DHSC), Genomics England, Nuffield Health, NHS Providers, The King’s Fund, Nexis group and the Health and Wellbeing Service. The Chair also informed the Board of his recent visits to NHS services in York and Cornwall.

3. Chief Executive Update (verbal)

3.1 Noting the planned departure of the Chair and CCO, the CEO also welcomed Louise Shepherd as NHS North West Regional Director. 

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

3.2.1   The ongoing discussions with government to finalise the NHS budget for 2025/26 and the implications of the anticipated funding levels for NHS England and wider NHS activity.

3.2.2   The Institute for Fiscal Studies (IFS) published its analysis on NHS hospital productivity on 12 November, which reflected the increase in productivity over the last year. The further work required and actions being taken on this, as considered under item 5, were acknowledged.

3.2.3   The government had announced its commitment to reduce waiting times, which was shared by NHS England. Noting the recent press activity on this, the CEO highlighted the progress made and improvements that had been delivered across the NHS in the last year, in the context of industrial action and rising demand.

3.2.4   Winter preparedness and resilience remains a key priority for NHS England and the CEO noted the publication of the first weekly winter situation report. The pressures facing the NHS as we enter winter as reflected in this data, including a 350% increase in flu and 86% increase in norovirus against the previous year, and the likelihood that demand and acuity will continue to rise were considered. The focus on vaccination and discharge activity to support performance was noted.

4. Performance update (BM/24/41(Pu))

Operational Performance Update

4.1 The Chief Operating Officer (COO) presented the latest operational performance across the NHS in England. The Board recognised the continuous improvement delivered across the service in the context of rising demand and the material challenges that are facing the NHS during and beyond winter.

4.2 Key highlights included: 

4.2.1   Urgent and emergency care (UEC) and winter: The latest reported data reflects the increased pressure across emergency departments driven by increased attendance rates and emergency admissions, including higher rates of flu admissions. The Board emphasised the criticality of the flu, covid and respiratory syncytial virus vaccination programmes and encouraged all eligible individuals to get vaccinated as soon as possible. Performance against key constitutional standards and the UEC recovery plan ambitions was also considered, with 1 million more people treated within 4 hours this year than in the previous year and increasing focus on improving 12 hour and 72 hour performance. The Board commended the hard work and dedication from NHS staff to maintain quality and access during this challenging period.

4.2.2   Elective: Improvements had been delivered across most waiting lists. The ambition to virtually eliminate 65 week waits by the end of September had not been delivered (with the list sitting at 22,903 at the end of the month), however the NHS was now working to ensure that fewer than 10,000 people remain on this list by the end of December. The COO noted the work underway with government on the 18 week referral to treatment standard and the planned publication of the elective reform plan.

4.2.3   Cancer: Levels of urgent suspected cancer referrals are down from the previous year, and while none of the waiting time standards were met in September they had all improved against the previous year.

4.2.4   Diagnostics: The waiting list position had improved as a result of additional diagnostics capacity and subsequent higher levels of activity month on month across the NHS. The focus on collating and sharing best practice to drive further improvements was highlighted.

4.2.5   Mental Health: Performance had improved across mental health services, in particular perinatal mental health and maternal mental health services. Challenges remain around access and the national and regional team are working with systems and providers to address these through the identification and sharing of learnings. The improvements delivered across children and young people’s mental health services, talking therapies, and physical health checks for people with severe mental illness were also noted.

4.2.6   Primary care: Primary care access continues to improve, with just over 50% of appointments taking place on the same day of contact and 90% within 14 days of contact. The communications approach to build awareness of this improvement was considered. 

Update on the Recovery Support Programme 

4.3 The Board welcomed the update on the Recovery Support Programme (RSP), covering the current and proposed revised, matured approach to oversight and intensive support for the most challenged organisations (currently including 20 providers and 3 integrated care boards (ICBs)). Assurance was provided of the alignment of this work with the development of the operating model, NHS Oversight and Assessment Framework and Performance, Improvement and Regulation Framework. 

4.4 The progress made through RSP to date and the further work needed to facilitate sustainable improvement and turnaround was considered. NHS England’s role in supporting and guiding colleagues who lead the turnaround of these challenged organisations, including Improvement Directors, and to establish the appropriate infrastructure to support this process was considered. The work underway with the Workforce, Training and Education directorate to develop the leadership capacity and capability across the NHS to drive turnaround and sustain good performance as part of this was noted. 

4.5 A discussion took place on the importance of accurate and robust diagnostics to inform the improvement ambitions under RSP and to measure delivery throughout an organisation or system’s turnaround journey. Members noted the adoption of the quadrant approach under the RSP to ensure a clear understanding of and appropriately balance risk across finance, quality and operational performance. The need to consider the drivers of poor performance, drawing on data and analysis and learnings from other organisations, to enable sustainable improvement was emphasised. Members discussed that sustainable improvement takes time and considered how this is accounted for in the turnaround plan for each organisation and system. 

4.6 The Board considered the work underway with regional teams on the early warning indicators that could be used to support the early identification of a deterioration in performance and prevent entry into RSP. 

Financial performance update 

4.7 The Chief Financial Officer (CFO) summarised the M7 financial position for the NHS, which reflected an £851 million adverse variance to plan. The drivers of this position and the actions being taken to manage this, including targeted support for the most challenged systems, were discussed. 

4.8 The position for 2025/26 and the constraints this will place on NHS budgets were considered, noting that these constraints will be worsened if systems do not deliver their plans in 2024/25. The following points were raised in relation to the coming year: 

4.8.1   Work is ongoing with DHSC to agree actions to manage budgetary pressures, including pay, inflation, medicines prices and elective costs amongst others, and to deliver the ambitions set out by government. It was noted that the additional £22.6 billion funding agreed for the NHS was broadly committed to manage the above referenced pressures.

4.8.2   There is no new funding for new activity or initiatives within NHS England or across the NHS, so this will have to be funded through productivity gains or the reprioritisation of existing resources.

4.8.3   In the context of the above, financial grip and control at organisation level will be essential, and the NHS will be required to deliver a higher level of productivity than in previous years to manage the position.

4.8.4   Focus remains on reducing temporary staffing costs, highlighting the benefits this drives in relation to continuity of care and patient outcomes. 

4.9      The consistency of the challenge across all government departments in managing the financial challenge was noted.

5. NHS Productivity (BM/24/42(Pu))

5.1 The CFO introduced the report and provided an overview of current productivity levels across the NHS, noting the 14% increase in the number of patients seen across the service and, as raised by the CEO, the IFS publication which reflected the improvement in productivity across the acute sector. 

5.2 The Board considered the productivity challenge for 2025/26 and beyond and discussed the need to focus on both acute and non-acute productivity, particularly across community and mental health services, and reducing variation across the whole NHS to maximise value for taxpayers and improve outcomes for patients across the service. Consideration was given to the work planned to scale up a national improvement programme (building on NHS IMPACT) to upskill clinical and operational staff across the NHS to improve patient flow (reducing avoidable admissions and optimising length of stay) and to improve physical and people asset utilisation (including in relation to theatre utilisation and outpatient activity, back office functions and job planning). The continuing focus on technology and frontline digitisation was discussed, including the roll out of Electronic Patient Records, NHS App and the Federated Data Platform. The productivity gains realised through establishing cervical hubs was also noted. 

5.3 Members noted the work underway to develop and share in early 2025 trust-level data and analysis on their productivity levels, including data on workforce growth across the NHS which has exceeded plans, to inform local action. A discussion took place on the level of investment planned to support this in 2025/26 and the ongoing investment required to improve productivity year-on-year, particularly around investment in technology. The engagement required with government on this, which will also cover the balance between capital and revenue funding, was noted.

6. Health, Work and Prevention (BM/24/43(Pu))

6.1 The Board welcomed the Director of Demand Insights  who summarised the work underway with partner organisations and government on health, work and prevention, which aimed to realise the economic and fiscal opportunity to the Exchequer in tackling ill health and helping keep people with health conditions in work or bringing them back into work if they left employment due to ill health from higher tax revenue and lower welfare spending. 

6.2 A discussion took place on the Health and Growth Accelerators, which were planned to launch in April 2025. It was discussed that the Accelerators will test the extent to which integrated care systems provided an effective vehicle for deploying identified, evidence-based tools and interventions to reduce health-related labour market activity. Members raised the following for consideration through this first wave of three integrated care systems: 

6.2.1   Noting that early life is not specifically covered in the Accelerators currently, consideration should be given in future waves to how school-age children are supported to stay in education.

6.2.2   The work will focus on individuals on the edges of the labour market (that is people who have recently left or are on the cusp of leaving employment) and Members supported the analysis underway of the potential correlation between labour force and waiting list data.

6.2.3   The analysis produced through this work should inform the NHS Productivity programme and the Long Term Workforce Plan refresh, in addition to informing content in the 10 Year Health Plan and to ongoing prioritisation and planning discussions.

6.3 The intention to carry out with the National Institute for Health Research as close to real-time evaluation as possible in 2025/26 to evaluate the effectiveness of this approach through the Accelerators and to run a more comprehensive evaluation in three to five years was considered.

7. Quality Strategy (BM/24/43(Pu))

7.1 The Board welcomed Dr Jayne Chidgey-Clarke, National Guardian for Freedom to Speak Up (FTSU) in the NHS, who set out the work carried out by the National Guardian’s Office (NGO) on FTSU over the past year and the priorities for 2023/24. The Board joined Dr Chidgey-Clarke in thanking the Chief Nursing Officer (CNO) for her work on international nurse recruitment and the support provided to black and minority ethnic nurses to enable them to speak up. 

7.2 Members discussed the important role of local boards and leaders in establishing and maintaining a speaking up culture within their organisations, noting the reported deterioration in speaking up based on the 2022 NHS Staff Survey results. The support and guidance provided to the NHS on this, including with the Care Quality Commission through the well-led framework, and the further action that could be taken were considered.

7.3 Consideration was also given to the governance in place to enable people to speak up and raise concerns relating to externally-contracted NHS services. The Board noted that while the NHS contract articulates that any organisation providing NHS services must have a FTSU Guardian, further work is underway between the NGO and NHS England to provide guidance to ICBs on how this should be managed and overseen by local boards.

7.4 The work underway with the Workforce, Training and Education Directorate on training for FTSU guardians was also noted, linking to the NHS equality, diversity and inclusion (EDI) improvement plan and strengthening relationships with FTSU Guardians.

8. Commissioning Integration: Delegation of Specialised Services to Integrated Care Boards 2025/26 (BM/24/44(Pu))

8.1 The National Director for Specialised Commissioning provided an overview of the recommendations for the delegation of specialised commissioning to ICBs in April 2025, noting that around 100 services will be retained by NHS England. 

8.2 The discussions underway to develop the approach to assuring and overseeing the effective and appropriate discharge of delegated functions, including performance reporting through the Board and governance and assurance through the Audit and Risk Assurance Committee, were considered. Assurance was provided that NHS England remains accountable for delegated services, will continue to have the ability to set the standard for each service nationally, and has established a central team to manage any concerns raised. 

8.3 The format and scope of the delegation agreement (DA) was considered, noting this had been developed in consultation with regions and systems. 

RESOLVED:

8.4      The Board resolved to: 

8.4.1   Approve the delegation of commissioning responsibility for the 70 specialised services that were suitable and ready for delegation to all ICBs in the North East and Yorkshire, London, South East and South West regions from April 2025 (and the additional 11 services to those ICBs in the Midlands, North West and East of England regions that took on full delegated commissioning responsibilities this year); 

8.4.2   Agree the application of a consistent condition on delegation to all ICBs falling within segments 3 and 4 of the NHS Oversight Framework that requires any decision that impacts on the overall spend of the specialised service allocation to have NHS England Regional approval before the commissioning change is made or any change process is begun. 

8.4.3   Approve the template DA for signature ahead of 2025/26; and 

8.4.4   Delegate authority to Regional Directors to sign the final DAs on behalf of NHS England.

9. Directions and Mandatory Requests for Information (BM/24/45(Pu))

9.1 The Board noted the Summary of National Major Trauma Registry (NMTR) for NHS Wales Request 2024 issued to NHS England by the Digital Health Care Wales in October 2024.

10. Any other business

10.1 There was no other business.

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