Members

• Penny Dash, Chair
• Mark Bailie, Non-Executive Director
• Duncan Burton, Chief Nursing Officer
• Mike Coupe, Non-Executive Director
• Jane Ellison, Non-Executive Director
• Claire Fuller, Co-Medical Director – Primary Care
• Tom Kibasi, Executive Director of Strategy
• Professor Sir Robert Lechler, Non-Executive Director
• Sir Jim Mackey, Chief Executive Officer
• Sarah-Jane Marsh, Urgent and Emergency Care and Operations Director
• Sir Andrew Morris, Deputy Chair
• Elizabeth O’Mahony, Chief Financial Officer
• David Probert, Deputy Chief Executive Officer
• Jeremy Townsend, Non-Executive Director
• Suresh Viswanathan, Associate Non-Executive Director
• Professor the Baroness Watkins, Non-Executive Director
• Professor Sir Simon Wessely, Non-Executive Director (to item 6, from item 8)

Attendees

• Glen Burley, Financial Reset and Accountability Director
• Bethany Carter, National Lead Guardian Support and Policy
• Rob Checketts, Strategic Adviser (excluding item 10)
• Mark Cubbon, Elective Care, Cancer and Diagnostics Director
• Dr Vin Diwakar, Interim National Director of Transformation
• Amanda Doyle, National Director for Primary Care and Community Services (until item 4.7)
• Tom Grimes, Deputy Director, FTSU & Organisational Health
• John Lester, Director of Corporate Governance
• Katie Neumann, Assistant Director of Secretariat

1. Welcome and apologies

1.1 The Chair welcomed everyone to the meeting.

Apologies

1.2 Apologies for absence were received from Meghana Pandit (Co-Medical Director – Secondary Care) and Mark Walport (Non-Executive Director).

Declarations of interest

1.3 The Chair noted a change to the declarations of interest to reflect that Jeremy Townsend was no longer a director of Ocado Retail Ltd. Further changes were required to the Chair’s declarations which would be address outside of the meeting and update on NHS England’s (NHSE’s) website.

1.4 No other declarations of interest were raised 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 29 May 2025 (BM/25/23(Pu))

1.5 The minutes from the public Board meeting held on 29 May 2025 were approved as a correct record.

2. Board Committee updates (BM/25/24(Pu))

People and Remuneration Committee (PRC)

2.1 Jane Ellison, Chair of PRC, reported that the Committee held two productive meetings, with continued focus on strengthening the non-executive director (NED) and chair pipeline across the NHS. Efforts are underway to adapt performance training to current organisational changes, with a sustained emphasis on management excellence and setting minimum standards for line managers.

Audit and Risk Assurance Committee (ARAC)

2.2 Jeremy Townsend, Chair of ARAC, highlighted the constructive discussion on the risk registers and the subsequent input from the NHSE Chair, noting that these were scheduled for discussion later on the agenda. A key priority is managing risks linked to organisational transition, particularly the impact on internal controls. The Committee is working with NHSE’s Internal Auditors and liaising with the Department of Health and Social Care (DHSC) to ensure coordinated oversight and avoid duplication.

Quality Committee (ARAC)

2.3 Professor Sir Robert Lechler, Chair of QC, outlined ongoing discussions to integrate the National Quality Board (NQB) with the NHSE QC. The Committee is aligning its work with the 10 Year Plan and addressing migration-related risks. It was reported that the Quality Strategy is under development jointly by the QC and NQB. Patient voice representation remains strong, with discussions on going around extending this to the NQB

Data, Digital and Technology Committee (DDaTC)

2.4 Mark Bailie, Chair of DDaTC, provided a summary of the Committee’s work, noting key themes around the need for consistency in digital delivery, particularly in relation to the NHS App and electronic patient records. Cybersecurity remains a significant concern within and beyond the NHS, and the Committee is actively engaged in this area. Discussions also focused on the optimal operating model to balance local delivery with national standards, noting that discussions with DHSC are progressing, with a meeting scheduled in the coming weeks to refine transition options for critical national systems. A preferred direction is expected to be identified within the next month.

3. Chief Executive Officer update (verbal)

3.1 The Chief Executive Officer (CEO) reported strong progress against the 100-day plan agreed with DHSC, confirming that the majority of commitments had been delivered. These included ICB changes, the model ICB, the NHS Oversight Framework (NHSOF), segmentation, transparency, urgent and emergency care (UEC) delivery, Spending Review contribution, and the publication of the 10-Year Health Plan (10YHP).

3.2 The 10YHP had been positively received across the service, public, and stakeholders. A recent chief executives’ session marked the transition to delivery, with preparatory work underway for autumn planning. This included development of Integrated Health Organisations, the NHS foundation trust pipeline, and neighbourhood care models in collaboration with system partners.

3.3 Operational performance remained mixed, though elective recovery showed improvement, with two consecutive months of waiting list reductions. Transparency also improved, with plans in place to distribute routine performance data directly to NHS colleagues to support local decision-making.

3.4 Winter planning was reported to be ahead of previous years, and financial performance had improved, led by the CFO and Finance team. Engagement across professional groups had increased, supporting alignment and collaboration across the system.

3.5 On industrial action, the CEO acknowledged the right to strike but noted the significant impact on service delivery and public confidence. Preparations, led by the UEC and Operations Director, had been strengthened, with a revised approach placing greater responsibility on local leadership for safety. The CFO confirmed that junior doctor strikes had incurred direct costs of £1.5 billion, excluding wider productivity losses. The Board agreed that future action would require a more cost-effective and risk-aware approach.

3.6 Members supported a shift away from the previous national safety framework, recognising the broader and longer-term impacts of disruption. The CEO committed to accelerating work to address longstanding non-pay concerns among junior doctors, including training placements, working conditions, and system responsiveness.

3.7 There was consensus on the importance of improving junior doctors’ sense of belonging, continuity of care, and professional value to prevent long-term disengagement. The Board requested further work to explore how staff wellbeing and working environment could be better reflected in performance metrics.

Action: DP

4. Performance and delivery update (BM/25/25 (Pu))

Integrated performance report

4.1 The Deputy CEO presented the latest operational performance across the NHS in England, structured around the NHSOF domains and sub-domains. Key highlights included:

1. Quality and safety: The Summary Hospital-Level Mortality Indicator reached a two-year low, and Care Quality Commission ratings for ‘good’ and ‘outstanding’ increased, though inspection volumes remained low. Plans were in place to publish provider league tables and expand access to quality data via the NHS App.
2. UEC: Despite sustained high demand, including heat-related pressures in June, performance held at approximately 76%, with improvements in ambulance handovers and patient flow.
3. Elective care: Record treatment volumes were achieved in May (75,000 per day), exceeding pre-pandemic levels. Efforts continued to reduce 52-week waits and meet the 65% Referral to Treatment target.
4. Cancer services: Treatment volumes and speed improved, particularly against the Faster Diagnosis Standard and 62-day Standard. While further progress was needed to meet newly set ambitions, the Board acknowledged the significant strides made by cancer services.
5. Mental health services: Access for children and young people improved, including faster crisis response and reduced length of stay. Further work was needed to strengthen community provision

4.2 On productivity, the CFO confirmed the establishment of a national productivity group and the upcoming launch of a dashboard providing cost and productivity data at Health Resource Group level, including mental health providers. This tool, developed with provider input, would support local improvement rather than act as a league table. The Board welcomed this development and noted the importance of aligning productivity metrics with sector needs.

4.3 Members noted gaps in reporting, including primary care, maternity, community services, cardiovascular disease, diabetes, and prevention. The Executive confirmed relevant data existed and would be better reflected in future reports. A design session in August, linked to the Neighbourhood Health Programme, would explore population outcome metrics.

Action: DP, CF

4.4 The Board agreed on the need for a coherent and consistent set of metrics across quality, performance, and oversight. It was proposed that the National Quality Board and Quality Committee lead on quality metrics (including prevention and vaccination), while the Finance and Performance Committee focus on broader system performance. Alignment across internal reporting, the NHSOF, and ministerial briefings was targeted by year-end.

Action: RL, MP, CF, EOM, DP

4.5 Members requested that metrics to monitor implementation of the 10YHP, including outpatient redesign, be integrated into future reporting to support alignment between strategy and delivery.

Action: DP

4.6 The Board discussed the disconnect between national satisfaction data and more positive GP-level feedback. It was agreed that a more balanced narrative was needed. The latest National Cancer Patient Experience Survey, published that morning, showed the highest rating in four years (8.94/10), highlighting strong teamwork and patient involvement. The Board welcomed this as a learning opportunity for wider service areas.

Financial Performance report

4.7. The CFO provided an update on the financial position and outlook, including the conclusion of phase two of the 2025 Spending Review. Revenue budgets were confirmed through 2028/29 and capital budgets through 2029/30, supporting medium-term planning. Indicative budgets for future years would also be shared to aid local planning.

4.8. At month 2, following £2.2bn in deficit support, all 42 systems submitted break-even plans. The year-to-date overspend stood at £51m (0.2% of allocation), with £110m concentrated in four systems. By quarter 1, the system-level deficit had reduced to £78m, with improved run-rate and 75% of providers on plan. Efficiency shortfalls remained (£159m), but were partially offset. Provider pay was flat, and headcount had decreased by 1.4% since month 12.

4.9 The Board welcomed the strong early performance and engagement across the system, noting the positive impact of transparency, peer learning, and productivity packs. A “finance amnesty” approach had encouraged openness and support-seeking, with systems increasingly using data to identify variation and request help. The revised NHS Oversight Framework was seen as a key enabler of behavioural change and improvement.

4.10 The Board acknowledged the financial risks posed by potential IA, with a £1.5bn impact from previous IA requiring difficult trade-offs. It was requested that any such decisions be brought back to the Board for discussion. Members also noted the need for a more detailed review of capital, particularly in relation to the emerging neighbourhood health model. While early estimates had been included in the Spending Review, most premises were expected to require modification rather than new builds, with existing Community Diagnostic Centres offering potential solutions.

4.11 Concerns were raised about newly qualified nurses and midwives facing employment challenges due to financial constraints. The Executive confirmed efforts were underway to support placements, including engagement with social care and the independent sector. Improved retention rates were also contributing to reduced vacancies. The Board emphasised the need to communicate clearly with graduates about geographical flexibility and employment expectations.

4.12 Members stressed the importance of early planning for future cost improvement programmes, recommending boards begin work over the summer. The CFO confirmed that updated productivity packs would be issued in autumn, with improved data quality and additional themes. There was interest in analysing costs per 100,000 population and exploring unexplained variations in activity and spend. The Board also discussed the need to capture uncounted productivity linked to emerging care models.

4.13 The Board requested enhancements to financial reporting, including presenting system overspends as a percentage of total budget and distinguishing between ICB and provider performance. It was suggested that financial data be linked to quality indicators, such as emergency admissions and condition-specific outcomes, to better understand drivers of financial pressure.

Action: EOM

4.14 The Board recognised the strong start to the year but acknowledged that challenges would emerge. Continued transparency, engagement, and responsiveness were seen as critical to maintaining momentum.

5. Risk Management (BM/25/26(Pu))

5.1 The Board received NHSE’s revised Strategic and Operational Risk Registers, presented publicly for the first time, alongside a refreshed Risk Management Framework for approval.

5.2 The Strategic Risk Register highlighted:

1. A new risk on aligning strategies and delivery plans, including the 10YHP and statutory duties.
2. A revised risk on the scale of change required to deliver the 10YHP.
3. Ongoing high risks in digital, data, and technology, including cyber threats and innovation uptake.

5.3 The Operational Risk Register focused on short-term risks, including IA, IT system delivery for the primary care performance list, and delivery of the year-end financial position.

5.4 The Board welcomed the progress and transparency, and emphasised that the registers must be dynamic and actionable, not static. Risks should directly inform delivery planning, with clear mitigation actions, timelines, and ownership. It was agreed that:

Each strategic risk should be mapped to a relevant board committee and executive lead.

1. Mitigation plans should be tracked, with progress reviewed regularly.
2. Target risk scores should include expected delivery dates by quarter.
3. Risks should be triangulated with the 10-Year Plan workstreams and delivery plans.

5.5 The Board endorsed the proposal that committees, not ARAC, should own and manage specific risks, with ARAC overseeing the overall process. This would ensure risks are actively managed within the appropriate governance structures. Members stressed the importance of addressing behavioural and cultural barriers, particularly in digital transformation.

5.6 Looking ahead, the Board requested that future planning cycles integrate risk mitigation and resource requirements to support prioritisation and alignment across strategy, finance, and delivery.

Action: DP, EOM

5.7 The Board noted that while the current position was strong, risks would evolve, and the framework must remain responsive. The next ARAC meeting would review progress on implementation.

Resolved

5.8. The Board resolved to approve the Risk Management Framework.

6. Winter planning and preparedness (BM/25/27(Pu))

6.1 The Board received an update on winter preparedness, emphasising that UEC planning is a year-round priority. The approach builds on the 2025/26 UEC delivery plan, with close tracking of key metrics including Category 2 response times, 4-hour and 12-hour performance, and ambulance handover delays.

6.2 The UEC and Operations Director reported that winter planning is being co-designed with system leaders, supported by board assurance statements for ICBs and trusts. Regionally-led stress-testing exercises in September will assess resilience against three winter scenarios – moderate, severe, and extreme – focusing on both capacity and responsiveness. Members considered that the assurance process is designed to prompt meaningful board-level conversations rather than rely on documentation alone.

6.3 The Board welcomed the inclusion of elective and cancer care within winter plans, noting that many systems are proactively scheduling activity during more stable months. Discharge planning was identified as a critical enabler of flow, with emphasis on consistent standards, especially at weekends, and coordination across acute, community, and social care services. The Board requested that the approach to and status of seven-day service availability was reviewed to identify opportunities for improvement and drive progress across all parts of the country.

Action: MP

6.4 Use of shared data platforms, particularly the Federated Data Platform (FDP), was highlighted as a key driver of operational improvement. Evidence from early adopters shows significant reductions in long-stay patients. The Board discussed the potential correlation between FDP maturity and operational performance.

6.5 A “top 12 actions” list, based on best practice from high-performing trusts is being used by the Emergency Care Improvement Team to support challenged organisations. The Board agreed that adoption of these actions should be expected, with follow-up from NHSE leadership where necessary. A report on adoption rates will be brought to the next Board meeting, aligned with performance data.

Action: SJM

6.6 The Board welcomed the co-designed approach, noting strong engagement from chief executives and GP leaders. The process has helped elevate winter planning as a strategic priority and fostered cross-system collaboration.

Resolved

6.7 The Board endorsed the proposed approach to testing winter plans through regionally-led exercises in September, and the proposed roles and responsibilities of ICBs in planning for and overseeing winter operations.

7. Pandemic Preparedness and Exercise Pegasus (BM/25/28(Pu))

7.1 The UEC and Operations Director informed the Board of NHSE’s role in the government’s pandemic preparedness programme, led by DHSC. The first scenario, focused on respiratory pandemics, aligns with early findings from the COVID-19 Inquiry and remains a high-priority risk on the government’s Risk Register.

7.2 NHS England will participate in Exercise Pegasus, a Tier 1 cross-government simulation running from September to November, involving ministerial engagement and COBRA activation. A warm-up exercise (Alkarab) has already provided valuable insights into system resilience. Members discussed that NHSE’s participation will focus on testing internal response capabilities, with lessons to be shared with the Board post-exercise.

7.3 Key points raised included:

1. Paediatric and workforce capacity: The Board stressed the need to test scenarios involving children and young people, particularly PICU capacity and workforce resilience.
2. Infrastructure readiness: The preservation and scalability of vaccine manufacturing and testing infrastructure post-COVID are under review with DHSC.
3. Data systems: The importance of robust data infrastructure was highlighted, including tools developed during COVID to manage vaccine supply chains. The Board requested assurance that data requirements will be tested during the exercise.
4. Cyber resilience: The Board recommended a similar Tier 1 exercise focused on cyber threats, involving NHSE, ministers, and third-party partners. A ransomware simulation recently conducted in the South East region will inform future planning and feed into risk mitigation strategies.
5. Routine care impact: Members emphasised the need to assess the broader impact on routine care, noting the NHS’s high cancellation rate during COVID. The exercise will consider societal responses and indirect effects, including school closures and public behaviour.
6. Planning capacity: The Board acknowledged the pressure on the emergency preparedness team, which is also managing industrial action. Despite resource constraints, pandemic preparedness remains a top priority.

7.4 The Board agreed that future exercises must go beyond COVID-specific lessons and consider emerging global threats. International best practice, including models from countries like South Korea, should inform planning. A follow-up report will be brought to the Board after Exercise Pegasus, summarising lessons learned and implications for future preparedness.

Action: SJM, MP

8. 10 Year Health Plan update (verbal)

8.1 The Board received a verbal update on delivery progress following the publication of the 10YHP. NHSE and DHSC are working under a joint governance model, with nine workstreams split between the organisations.

8.2 Key highlights included:

1. Neighbourhood Health: The Neighbourhood Health Implementation Programme was launched this week, with strong engagement from the service. The programme will focus on multi-morbidity and integration across acute, community, and mental health services. A detailed delivery plan is expected by early September.
2. Mental Health: The first 24/7 mental health crisis centre opened in Tower Hamlets, part of six national pilots. These hubs integrate physical and mental health with wider support (e.g. employment, debt). The Mental Health Modern Service Framework, led by the Medical Director for Mental Health and Neurodiversity, will focus on serious mental illness and has been well received by clinical communities.
3. Financial Foundations: A new three-year planning framework will be published in October. Work is underway on block contract reform, neighbourhood tariffs, and modelling the financial impact of the government’s shift from hospital to community based health and care, including implications for acute trusts and future NHS foundation trust applications under a new authorization scheme.
4. Digital and Data: Priorities include NHS App development, single patient record, and procurement planning for 2026. The FDP will support shared visibility across care pathways.
5. Quality: Includes revamping the National Quality Board, developing a new strategy, and modern service frameworks for CVD, mental health, sepsis, and cancer. Maternity Outcomes Signal System is being rolled out.
6. Oversight and Organisational Models: Performance segmentation, public league tables, and a revised FT licensing model are in development. Early scoping of Integrated Health Organisation models is underway.
7. Workforce: A new 10 Year workforce plan is in development, alongside nursing and midwifery strategies. Focus areas include improving staff and trainee experience and aligning workforce, service, and financial planning.
8. Life Sciences and Innovation: The government’s Life Sciences Sector Plan was published this week, aligned with the 10YHP. It includes commitments to improve research, accelerate innovation adoption, and streamline regulation

8.3 Over 150 expressions of interest have been received from system leaders to support delivery planning, reflecting strong service-wide engagement. The Board welcomed the collaborative, devolved approach and noted the shift in focus from hospital-based activity to community and preventative care, particularly for vulnerable groups.

9. Speaking up

NHS England Internal Freedom to Speak Up annual report (BM/25/29(Pu))

9.1 The Board received an update on NHS England’s internal Freedom to Speak Up service, launched over a year ago. While usage has increased, only 40% of those who spoke up said they would do so again, citing inconsistent organisational responses and lack of resolution.

9.2 Key concerns included:

1. Guardians are valued, but staff often feel unsupported by leadership and unclear about outcomes.
2. Leadership behaviours and management capability are frequently part of the problem, particularly at first-line management level.
3. The burden on guardians is significant, especially during organisational change, and support for their wellbeing is essential.
4. Improvement actions underway:
5. Strengthening resolution processes and early engagement with senior leaders.
6. Enhancing feedback loops to demonstrate learning and encourage future speaking up.
7. Rolling out compulsory management development training, with adjustments to reflect current organisational pressures

9.3 The Board discussed broader cultural challenges, noting persistent issues with appraisal coverage and feedback practices. Annual appraisals are not consistently delivered, and regular, in-the-moment feedback is lacking. Members agreed that guaranteed annual appraisals should be a minimum standard and emphasised the need for clearer behavioural expectations, starting from induction. The Board also noted wider HR process weaknesses and recommended internal audit involvement to support cultural and operational improvements. PRC will continue to monitor progress, including appraisal data and feedback from guardians.

9.4 PRC has reviewed span of control and highlighted the need to ensure managers are appointed based on capability, not seniority. The integration process presents an opportunity to reset culture, streamline management structures, and embed consistent leadership standards.

9.5 PRC has reviewed span of control and highlighted the need to ensure managers are appointed based on capability, not seniority. The integration process presents an opportunity to reset culture, streamline management structures, and embed consistent leadership standards.

9.6 The Board also noted wider HR process weaknesses, including leavers procedures, and recommended internal audit involvement to support cultural and operational improvements. PRC will continue to monitor progress, including appraisal data and feedback from guardians.

National Guardian’s Office update and priorities for 2025/26 (BM/25/30(Pu))

9.7 The Board welcomed the update on the National Guardian’s Office (NGO), including transition planning following the publication of the 10YHP and the Dash Review. NHSE expected to be substantially integrated by Q1 2026/27. Key considerations include staffing, communications, legal arrangements, and continuity of guardian roles across the NHS.

9.8 Highlights from the NGO report included:

1. Over 1,400 trained and registered Freedom to Speak Up guardians.
2. In 2023/24, the most reported themes were inappropriate behaviours and worker safety/wellbeing.
3. Nearly 80% of staff who spoke up said they would do so again, though confidence in action being taken remains lower than confidence in raising concerns.
4. A recent Speak Up review into overseas-trained workers has led to the formation of a steering group to oversee implementation of recommendations.
5. Work continues to embed guardians more consistently across ICBs and primary care.

9.9. Looking ahead, the NGO will continue supporting guardians through CPD, training, and compliance monitoring. A new review into the experience of temporary workers is planned for summer.

9.10. The Board acknowledged the NGO’s contribution over the past decade and emphasised the importance of maintaining and delivering its functions effectively within NHS England. Members stressed the need for clear escalation routes, particularly in cases involving senior leadership, and agreed to revisit unfinished work with CQC and NGO to clarify pathways for raising concerns safely.

9.11. It was noted that regional teams often manage complex cases informally, and this should be recognised and formalised within the new operating model. The Board also highlighted the importance of active listening, early resolution, and clearly defining what a good outcome looks like.

9.12. The integration presents an opportunity to reset internal processes and strengthen leadership accountability. The Board agreed to monitor progress and ensure the transition supports a robust and trusted Freedom to Speak Up culture across the system.

10. Update on NHS Oversight Framework 2025/26 (BM/25/31(Pu)))

10.1. The Board received a summary of feedback from the NHSOF consultation. The revised framework introduces a more focused set of indicators, aligned with strategic priorities and the 10YHP. While the framework will guide national oversight, boards are expected to continue reviewing a broader range of metrics.

10.2 The framework is dynamic and rules-based, linking freedoms, incentives, and improvement offers to performance. Provisional Q1 data has been shared with systems, with formal publication and public-facing league tables due in August. The Board welcomed the positive response and agreed to revisit the indicator set annually to ensure relevance and robustness.

11. Any other business

11.1 The Chair noted upcoming changes to NEDs and board committee structures in the autumn. Further details will be shared in due course. The Board expressed appreciation for the continued commitment and contributions of NEDs and executive colleagues during a period of significant change.

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