Members

• Richard Meddings, Chair
• Sir David Behan, Non-Executive Director
• Mike Coupe, Non-Executive Director
• Julian Kelly, Chief Financial Officer
• Wol Kolade, Non-Executive Director
• Dame Emily Lawson, Interim Chief Operating Officer
• Dame Ruth May, Chief Nursing Officer
• Sir Andrew Morris, Deputy Chair
• Professor Sir Stephen Powis, National Medical Director
• Amanda Pritchard, Chief Executive Officer
• Professor Sir Mark Walport, Non-Executive Director
• Professor the Baroness Watkins, Non-Executive Director
• Professor Sir Simon Wessely, Non-Executive Director

Attendees

• Tracy Bleakley, Chief Executive, NHS Norfolk and Waveney Integrated Care Board
• Helen Clifton, Director of Product and Platforms
• Dr Vin Diwakar, Interim National Director of Transformation
• Amanda Doyle, National Director for Primary Care and Community Services
• Thomas Dunn, Office of the Chair and Chief Executive Officer
• Liz Durrant, Deputy Director of Mental Health, Learning Disability and Autism Quality
• Navina Evans, Chief Workforce Officer
• Ellen Graham, Director of the Office of the Chair and Chief Executive Officer
• Joe Harrsion, National Director of Digital Channels
• Chris Hopson, Chief Strategy Officer
• Nick Hulme, Chief Executive Officer, Norfolk and Norwich University Hospitals NHS Foundation Trust
• Sarah-Jane Marsh, Director of Urgent and Emergency Care/Deputy Chief Operating Officer
• Claire Murdoch, National Director for Mental Health
• Katie Neumann, Head of Board Governance
• Clare Perry, Office of the Chair and Chief Executive Officer
• Jacqui Rock, Chief Commercial Officer
• Steve Russell, Chief Delivery Officer/National Director of Vaccinations and Screening
• John Stewart, National Director of Specialised Commissioning
• David Webb, Chief Pharmaceutical Officer

1. Welcome

1.1 The Chair welcomed colleagues to the NHS England Board meeting, which was being held in Norwich.

Apologies for absence

1.2 Apologies for absence were received from Jeremy Townsend (Non-Executive Director).

Declarations of interest

1.3 Professor the Baroness Watkins declared her appointment as a member of the House of Lords’ inquiry into the prevention and consequences of preterm births.

1.4 No direct conflicts of interest were raised in respect of business covered by the agenda.

Minutes from the Board meeting held on 7 December 2023 (BM/24/01(Pu))

• The minutes from the Board meeting held on 7 December 2023 were approved.

2. Chair update

2.1 The Chair provided an update on the progress made to maintain and improve performance across the NHS during the winter period, which was significantly better than the same period last year.

2.2 The launch of the national NHS Jewish BRCA Testing Programme to identify cancer risk early in people with Jewish ancestry who are more likely to carry a genetic abnormality was highlighted. It was noted that the programme formed part of the NHS’s major drive to catch tumours early when they are easier to treat.

2.3  The Chair updated the Board on the recent primary care event with colleagues from across the NHS, focussing on the primary care estate, GP retention, the interface between primary and secondary care, and patient safety in primary care. An overview was also provided of his visits across the NHS since the previous Board, the engagement carried out on the Life Sciences Vision, and the integrated care board (ICB) and trust chair event planned for 28 February.

2.4 The Chair informed the Board that he had joined the NHS Genomics Board, which supported the coordination and progress of the genomics strategy for the NHS. The progress made on this work, including genome sequencing, was considered.

3. Chief Executive Update

3.1 The Chief Executive set out the position on industrial action (IA), noting the impact of the actions taken to maintain urgent and emergency care (UEC) services and the actions being taken to manage planned care. It was discussed that Category 1 and 2 response times are 50% lower than in 2022 against a backdrop of materially higher demand. The actions being taken to improve care for patients with poor mental health or experiencing a mental health episode in the UEC pathway were also noted.

3.2 The launch of Pharmacy First on 31 January 2024, which reflected a positive and important step in delivering the vision for pharmacy and community services, was highlighted.

3.3 The Board were informed of the recent spike in measles infections and the actions being taken by NHS England to manage this as part of the UK Health Security Agency-led response.

3.4 The Chief Executive highlighted the issues identified at Nottinghamshire Healthcare NHS Foundation Trust and Greater Manchester Mental Health Trust in the context of the continuing challenges around access, funding, prevention and quality of care across inpatient mental health services. Assurance was provided on the comprehensive programme of work underway to address this and transform inpatient services to ensure people who need care can access it in a way that is safe, effective and compassionate to both the individual and their families.

3.5 An update was provided on the status of the New NHS England Programme and the status of the Filling of Posts Implementation process. The Board noted the change in policy on hybrid working for NHS England.

3.6 The Board noted the work underway to strengthen the non-executive director and chair talent pipeline across the NHS.

4. Performance update (BM/24/02(Pu))

Operational performance update 

4.1 The interim Chief Operating Officer introduced the operational performance update, highlighting the continuing pressure on NHS services due to high demand and ongoing IA. It was emphasised that, despite these pressures, the NHS has continued to maintain and, in some areas, improve performance; however, the strain on capacity and the NHS workforce is increasingly evident.

4.2 Improvements had been delivered in UEC performance against the same period in the previous year and consideration was given to the potential drivers of this. On elective, the Board discussed the waiting list position, which was reported as 7.6 million in November across the total list, and the ongoing work to manage this. The increase in urgent suspected cancer referrals to almost 128% above pre-pandemic levels was considered, noting the significant spike in attendance for melanoma screening following the announcement of the Duchess of York’s melanoma diagnosis. Members strongly encouraged everyone to engage with their GP if they have any concerns. The focus on the 62-day cancer backlog, delivery of the faster diagnosis standard for the coming months and maintaining the improvements delivered in access to cancer screening, particularly in deprived communities, was emphasised.

4.3 An update was provided on the progress made on implementing capacity plans across the NHS and the investment in capital schemes to improve operational performance and delivery, in particular the delivery of additional virtual ward beds ahead of plan.

4.4 The substantial work and time invested in preparations for IA and the positive impact of this on the continued delivery of NHS services during IA were emphasised.

4.5 A discussion took place on the increasing pressure on paediatric services resulting from the recent spike in measles infections. The expansion of vaccinations activity, targeting 6 to 11-year-olds and up to 25 year olds, and the communications planned for integrated care boards to increase vaccine uptake in areas with the highest infection rates were noted.

4.6 The Board reflected on the rate of growth in demand across all NHS services and commended the continued efforts and progress delivered from all NHS staff to increase the scale of provision to manage this.

Financial performance update

 4.7 The Chief Financial Officer provided an overview of the month 9 2023/24 financial position, highlighting the impact of prolonged IA and inflation on the current position. Assurance was provided that NHS England will deliver within its mandate in 2023/24, noting the ongoing discussions on the 2024/25 financial settlement and planning process. Consideration was given to the position across the most challenged integrated care boards and the support in place to recover the position and improve financial grip and control.

4.8 The Board discussed the savings delivered across the NHS through a circa 12% reduction in temporary staffing costs. It was noted that this reduction corresponds with an increase in the substantive workforce, which will help drive improvements in quality of care. The increased focus needed for reducing the use of bank staff was highlighted.

4.9 Members were informed that approximately £300 million had been saved on a recurrent basis in 2023/24, which is anticipated to equate to over £600 million full year effect. Assurance was provided that this saving has been reinvested to support frontline services, including both maintenance of capacity and investment to drive the improvement and transformation of services. It was also noted that an additional circa £200m has been saved through the consolidation of services at integrated care board level.

4.10 A discussion took place on the funding and spend position against other OECD countries. Consideration was also given to the levels of productivity achieved in previous years and the need for continued focus on this for 2024/25 and beyond.

5. Update on winter planning and delivery (BM/24/03(Pu))

5.1 The National Director of UEC/Deputy Chief Operating Officer introduced the report on winter planning and delivery. The positive progress made in performance across the service and the extent to which this is attributable to the strong collaboration and effective partnership working evidenced between systems and providers were considered. The learnings from this year’s winter period which will be carried into preparations for winter in 2025, including on maintaining capacity, patient flow and productivity as well as extending preparations beyond the acute setting were discussed.

5.2 The Board welcomed Tracey Bleakley, CEO of NHS Norfolk and Waveney (N&W) Integrated Care Board and Nick Hulme, interim CEO of Norfolk and Norwich University Hospitals NHS Foundation Trust (NNUHFT) who offered their views from a system and provider perspective on the significant challenges experienced and the actions taken, working with NHS England, to deliver the significant improvements reported to date. The particular focus on culture change and collaboration to drive and sustain this improvement was emphasised. The system and infrastructure changes being implemented to achieve the longer-term transformation of services were noted.

5.3 The Board discussed the substantial improvements delivered in NNUHFT’s UEC performance in the previous year, in particular the reduction in ambulance response times and handover delays. It was recognised that the actions taken to deliver this improvement have shifted clinical risk from people’s homes to hospitals, which creates additional pressure for the hospital and staff but is the safest and most appropriate approach for the community. To sustain this improvement up to and during the next winter period, Members discussed how the culture change and shift in focus across the trust from improving ambulance turnaround times to improving patient care and clinical quality will support this; however, to ensure this is embedded, further work is needed to combat long-standing ways of working and behaviours.

5.4 The integrated care board’s role in enabling this improvement and providing support during periods of significant pressure were discussed. The Board considered the reliance of the wider approach to admission avoidance and referrals outside of the acute pathway based on clinical risk on effective coordination from the integrated care board to ensure collaboration and engagement across all system partners. The role of all NHS leaders to drive collaboration and foster compassionate care across their organisations and systems was emphasised.

6. Update on the Pharmacy First Service (BM/24/04(Pu))

6.1 The National Director of Primary Care and Community Services updated the Board on the launch of Pharmacy First, in line with the commitment set out in the Primary care access recovery plan. Pharmacy First adds to the existing NHS Community Pharmacist Consultation Service and enables community pharmacies to complete episodes of care for 7 common conditions following defined clinical pathways, alongside an expanded contraceptive and prescription service.

6.2 The ambitions of this work as part of the wider Primary care access recovery plan around integration, inclusion (improving access to pharmacies in areas of higher deprivation), and impact (ensuring everyone can access the care they need when they need it) were considered. Assurance was provided on the work undertaken with clinicians to ensure that the risks of extending the prescription of antibiotics into pharmacies in relation to antimicrobial resistance have been appropriately considered and managed in the pathway design.

6.3 The impact of this on NHS 111 and UEC services was discussed, and it was clarified that Pharmacy First covers GP-provided services across the 7 conditions and will redirect demand for out of hours GP services where possible and appropriate. Patients from NHS 111 will be directed to Pharmacy First when appropriate, with more patients anticipated to go directly to their pharmacy as awareness increases and the service becomes embedded. The Board discussed that reporting through Pharmacy First will be fully integrated, with information on consultations through Pharmacy First flowing directly into the workflow in the GP’s clinical system. Roll out of this integrated reporting infrastructure will be completed in the next few weeks.

6.4 The metrics that will be used to measure the success of Pharmacy First were considered. The importance for this to account for the feedback and experience of the highly skilled pharmacy workforce was highlighted.

7. Mental Health, Learning Disability and Autism Quality Transformation Programme (BM/24/05(Pu))

7.1 The National Director for Mental Health and Learning Disability and Autism introduced the report on the Inpatient Quality Transformation Programme. The Board noted that an additional £57 million will be invested, on a recurrent basis, to support the programme and that plans have been requested from integrated care boards on their approach to improving and transforming mental health and learning disability and autism pathways across their system.

7.2 Consideration was given to the systemic issues and risks that were being addressed through this work, including the issues identified at Nottinghamshire Healthcare NHS Foundation Trust and Greater Manchester Mental Health Trust. Members discussed the potential risks to delivery given challenges around workforce growth and recruitment and retention, and the actions being taken to address these. The work carried out to date and further work planned to improve the mental health and learning disability and autism estate was also considered.

7.3 The culture change required to realise sustained improvement across these services was discussed. Members considered that the programme seeks to develop organisational capacity and capability to strengthen clinical oversight from ward to board level, which will inform and drive action to deliver sustainable change and improvement across these services.  

7.4 The Board considered the pace of delivery and emphasised the need for rapid action to address immediate concerns around patient safety and quality of care where possible and appropriate, alongside more medium to long-term action to transform services.

8. Transformation and Innovation delivery update (BM/24/06(Pu))

8.1 The interim National Director of Transformation highlighted the transformation and innovations delivered across the NHS to date, noting the ongoing discussions on the level of ambition and funding available to drive further progress in 2024/25.

8.2 The National Director of Digital Channels summarised the progress made to date in revolutionising how patients and the public manage their health and access services through the NHS App, including the integration of NHS 111 and Pharmacy First into the App. The next steps for the expansion of the NHS App and the ambition for one third of all health interactions to be digital first in the next 5 years were considered.

8.3 Recognising the power of data and technology in improving health, the Board considered the planned development of a digital workforce plan for the NHS to ensure that staff are equipped with the skills and experience necessary to manage this.

8.4 A discussion also took place on the approach to managing variation in digital literacy across the user base and the actions being taken to ensure the App is as user friendly as possible for everyone who uses it. The engagement underway with the National Institute of Health Research to improve the user experience for individuals signing up to participate in research through the App was considered. It was also discussed that individuals must ask their GP to make their medical record available if they want to access this through the App. Assurance was provided that work is underway to develop the native environment for the App which will improve the scalability and security of the App and support the evolution and improvement of functionality.

8.5 The potential challenges associated with accessing and coordinating care through the App where the underpinning systems and services are not interoperable or aligned were considered.

9. Dementia Programme and Alzheimer’s disease modifying treatments briefing (BM/24/07(Pu))

9.1 The National Director of Specialised Commissioning introduced the report on the wider Dementia Programme, highlighting the positive impact of the actions taken to improve dementia diagnosis since the covid pandemic and the work underway to improve access to disease modifying treatments (DMTs) for Alzheimer’s disease.

9.2 The prevalence of dementia across the population and the risks to and experiences of people with dementia were considered. Members discussed the work underway to fundamentally improve the care model for patients with dementia, taking account of the demand on acute services driven by patients with dementia and the need to establish clearer mechanisms to avoid admission.

9.3 The Board discussed the current pipeline of 28 potentially disease modifying treatments for Alzheimer’s disease in late-stage trials, in particular Eisai/Biogen’s lecanemab (brand name, Leqembi®) and Eli Lilly’s donanemab (brand name Kisunla®) which are currently subject to UK licensing applications with the Medicines and Healthcare Regulatory Authority (MHRA) and technology appraisal from the National Institute for Health and Care Excellence (NICE). Members discussed the modest clinical benefits, safety concerns and intensiveness of the treatment regime evidenced through the trials to date and the anticipated costs of roll out across the NHS, which are estimated between £500 million to £1 billion across drug and service costs. The plans developed to support implementation across the NHS should these DMTs be approved and licenced by NICE and MHRA were considered. The potential for the introduction of these treatments to drive an increase in diagnosis rates was discussed.

9.4 Consideration was given to the NICE appraisal process and NHS England’s obligation to fund medicine for all eligible patients if NICE approval is obtained, except where a funding variation is agreed as part of this approval. The limitations associated with the current approach to assessing and trialling new medicines and the potential to adopt more robust population-scale trial processes to better identify and understand the clinical benefits and risks of new treatments were discussed.

10. Any other business

10.1 The Chair thanked Board members and the Executive for their continued contributions and support to NHS England and the wider NHS.

11. Close