This meeting was held at Wellington House, 133-155 Waterloo Road, London SE1 8UG.

Members

• Richard Meddings, Chair
• Sir David Behan, Non-Executive Director
• Mike Coupe, Non-Executive Director
• Rakesh Kapoor, Non-Executive Director
• Julian Kelly, Chief Financial Officer
• Dame Ruth May, Chief Nursing Officer
• Sarah Jane Marsh, Deputy Chief Operating Officer / National Director of Urgent and Emergency Care (deputising for Sir David Sloman, Chief Operating Officer)
• Sir Andrew Morris, Deputy Chair
• Professor Sir Munir Pirmohamed, Non-Executive Director
• Professor Sir Stephen Powis, National Medical Director
• Amanda Pritchard, Chief Executive Officer
• Jeremy Townsend, Non-Executive Director
• Laura Wade-Gery, Non-Executive Director
• Professor the Baroness Watkins, Non-Executive Director

Attendees

• Dr Jayne Chidgey-Clarke, National Guardian for Freedom to Speak up in the NHS
• Dr Neil Churchill OBE, Director for Experience, Participation and Equalities
• Amanda Doyle National, Director for Primary Care and Community Services
• Navina Evans, Chief Workforce Officer
• Dr Tim Ferris, National Director of Transformation
• Chris Hopson, Chief Strategy Officer
• Katie Neumann, Head of Board Governance
• Clare Perry, Office of the Chair and CEO
• Jacqui Rock, Chief Commercial Officer
• Steve Russell, Chief Delivery Officer / National Director of Vaccinations and Screening (until item 8)

Welcome

1.1 The Chair noted that this was Laura Wade-Gery’s last Board meeting and thanked her for her dedication and contributions to NHS Digital, as Chair prior to the merger with NHS England (NHSE), to NHSE and the wider NHS.

Apologies for absence

1.2 Apologies for absence were received from Rakesh Kapoor (Non-Executive Director, Susan Kilsby (Non-Executive Director), Wol Kolade (Deputy Chair), Sir David Sloman (Chief Operating Officer), Professor Sir Mark Walport (Non-Executive Director), Laura Wade-Gery (Non-Executive Director) and Professor Sir Simon Wessely (Non-Executive Director).

Declarations of interest

1.3 No declarations of interest were raised over and above those held on record and no direct conflicts of interest were raised in respect of business covered by the agenda.

Minutes from the Board meeting held on 30 March 2023 (BM/23/16(Pu))

1.4 The minutes from the Board meeting held on 30 March 2023 were approved.

2. Chair update

2.1 The Chair updated that the next Board meeting on 27 July 2023 would take place in Birmingham, followed by a programme of visits across the Birmingham and Solihull Health and Care System on 28 July 2023.

2.2 The publication of the urgent and emergency care (UEC), primary care access and maternity recovery plans, which had been considered at previous meetings, and the anticipated publication of the Long Term Workforce Plan (LTWP) were noted and the Board commended the executive on this work.

2.3 The Chair highlighted the ongoing work to increase the Board’s focus on the strategic priorities for NHS England (NHSE) and the NHS, noting the item scheduled for the meeting on technology and innovation in the NHS.

2.4 The Chair provided an overview of the engagement carried out with NHS stakeholders through roundtable sessions to bring together expertise from the health and social care sector and the broader community to discuss key topics and challenges facing the NHS, such as prevention and primary care, and improve information sharing and collaboration to drive improvements in care.

3. Chief executive update

3.1 The Chief Executive updated the Board on the status of the New NHSE Programme. The Board’s decision to extend the timeline for delivery of the Programme to the end of March 2024, noting that nine out of ten staff will know their status before Christmas, to facilitate a robust consultation and change process was noted. The scale and complexity of the Programme was emphasised and the Chair commended the NHS Executive for their leadership of the Programme and their, and all staff members’, support and engagement with the Programme and continued delivery of business as usual activity.

3.2 Consideration was given to the continuing operational pressures resulting from industrial action (IA), by NHS staff. It was discussed that the Royal College of Nursing had rejected the Government’s pay offer and that engagement was ongoing with the British Medical Association’s (BMA’s) Junior Doctors Committee and the BMA’s Consultants Committee on potential IA, recognising that consultant action would be a new challenge for the NHS.

3.3 An update was provided on Covid-19, with fewer patients currently in hospital than at any time since June 2021 and continued focus on delivery of the Covid-19 Vaccination Programme. The NHS was currently in the recovery phase from the incident, which was anticipated to persist for some time.

3.4 The Chief Executive highlighted delivery of the first milestone in the Elective Recovery Plan in July with the virtual elimination of two year waits and updated the Board that focus was now on eliminating 18 month waits and strengthening action to address 65 week waits. Members emphasised that the number of people waiting to receive treatment had reduced by over 90% and thanked colleagues across NHSE and the wider NHS for the substantial work that had gone into delivering these improvements.

3.5 The preparations underway for the NHS’s 75^th birthday on 5 July 2023 were noted.

3.6 The Chief Executive announced the roll out of a new combination therapy to treat advanced endometrial cancer in between 500 and 750 women each year. The Board was also informed of NHS England’s partnership with NHS Blood and Transplant to roll out a new genetic blood-matching test for people living with sickle-cell disease or thalassemia to more accurately match those in need of transfusions to donated blood. The importance of innovation and technology in driving clinical improvements and transforming patient care was emphasised.

4. Performance update (BM/23/17(Pu))

Operational Performance Update

4.1 The Deputy Chief Operating Officer (COO) / National Director for Urgent and Emergency Care introduced the operational performance update, highlighting the reported improvements in operational delivery across urgent and emergency care services, the reduction in length of stay (LoS) over 14 days, and the focus on sustaining improvements delivered and further reducing the 62-day cancer backlog.

4.2 The progress made on UEC recovery and the early action being taken with systems to develop plans for winter, guided by the Delivery plan for recovering urgent and emergency care services, were considered. The Board also discussed the improvements delivered in elective care, with 1.4 million of 7.22 million patients waiting for inpatient treatment and the remainder waiting for outpatient or diagnostics treatment, the latter of which would be the focus for NHSE support and action. The need for robust networks to identify and share learnings on effective approaches to address the patient backlog and support the adoption of these methods across the NHS was highlighted.

4.3 Consideration was given to the increase in primary care appointments delivered across the NHS and the progress made on cancer referrals, emphasising that the majority of people who receive a cancer referral do not have cancer. The progress made on learning disability services was also noted, with further work planned to improve health checks for people with a learning disability.

Financial performance update

4.4 The Chief Financial Officer (CFO) provided an overview of the draft month 12 2022/23 financial position and the ongoing work with integrated care boards (ICBs) to review and finalise 2023/24 plans. The core aims to balance financial, operational and quality delivery and retain focus on the spend commitments announced to date were noted. The CFO also highlighted the real terms increase in investment in education and training in 2023/24, which represented a step towards delivery of the LTWP.

4.5 Members commended the team on their continued hard work, and to NHS staff for their contributions and dedication to maintaining delivery in the current pressured operating context. It was discussed that the financial constraints for the coming and future years in the context of rising demand and the limited latitude to reallocate funding were central to system planning.

4.6 The Board noted the approval of NHSE’s 2023/24 Business Plan which would be published in due course.

5. Primary Care Access Recovery Plan (BM/23/18(Pu))

5.1 The National Director for Primary Care and Community Services provided an overview of the scope and content of the recently published Primary Care Access Recovery Plan. A marked drop had been reported in peoples’ satisfaction with their ability to access primary care services, but not in the quality of the care they receive, which drove the sole focus of the Plan on improving access.

5.2 Demand for primary care services varied materially across different age groups, with patients over 65 years old having five times as many appointments per year as younger adults due to multimorbidity and complex care needs, and the Board discussed that the Plan aims to address these in four main ways: i) enabling patients to access care through the NHS App; ii) streamlining referral to community services where possible and appropriate; iii) scaling up community pharmacy to expand its role in clinical service delivery; and iv) moving to a digitally-enabled way of managing incoming demand. The Board commended the integration of digital and technology into all aspects of the plan.

5.3 The positive reception to the plan from primary care staff and community pharmacists was highlighted and assurance provided that a National Institute for Health Research study will be run on the increase in clinical service delivery through community pharmacy to ensure this does not increase the risk of antimicrobial resistance.

5.4. The Board discussed that in spite of increases in demand and pressures on the workforce, progress had been made to improve access which would be furthered through implementation of the Plan. Consideration was given to the ongoing work with regional teams and ICBs, with support from Transformation and Commercial directorate colleagues, to develop local implementation plans. It was discussed that the Plan articulates practical steps to drive change and improvements and provides the building blocks for wider primary care reform.

5.5 It was noted that 2023/24 was the fifth year of the five year GP contract and additional roles scheme and that additional funding was being allocated to support this work. Further consideration was also being given to the approach to funding allocations and budget flexibility at local level as part of the strategic review of the 2024/25 GP contract. The potential impact of the funding approach on the interface and interoperability between primary and secondary care was emphasised. Members also discussed ongoing work to consider the future approach to the Quality and Outcomes Framework to ensure this appropriately incentivised the use of specific evidence-based interventions to improve patient outcomes was noted.

6. Technology and Innovation in the NHS (BM/23/19(Pu))

6.1 The National Director of Transformation introduced the report, which focused on the use of technology and innovation to transform the delivery of care. While progress had been made through biologic and data sciences to increase diagnostics capacity and provide additional tools to manage demand, the infrastructure on which these developments were being rolled out required substantial updating to ensure it is fit for purpose to deliver a digitally enabled health and care service. The Board discussed that technology is a critical element of transforming services and is essential to reduce the transactional friction that occurs when people interact with the healthcare service and to streamline clinical pathways and deliver operational and financial efficiencies.

6.2 An overview was provided on the progress made against the Digitise, Connect and Transform strategy for technology in health and care, including on frontline digitisation, increasing Electronic Patient Record (EPR) coverage (with EPRs in place at 88% of organisations), and implementing electronic bed management systems (digitise); establishing shared care records (SCRs) across integrated care systems and work planned to align data standards to ensure interoperability across these SCRs, migrating the NHS Spine Platform to the cloud, and procurement of the Federated Data Platform (connect); and on pathway-specific transformation, noting in particular the use of medical photography in dermatology, technological innovations for delivering echocardiograms, the use of AI tools in radiology and stroke diagnostics and of digital health therapeutics for musculoskeletal disease and mental health (transform).

6.3 Consideration was given to the opportunities to improve access, release capacity, and streamline service provision through expanding the NHS App and introducing ambient documentation. Members discussed the challenge in prioritising pathway-specific transformation and considered that prioritisation would be determined based on the innovations and changes that will deliver the most benefit for the NHS. In line with this, the Board supported the planned publication of the list of potential innovations prioritised according to impact. The commercial complexities associated with this work were also considered, noting the change in commercial approach for true innovations where something is singular and brand new and when they become a commodity.

6.4 Assurance was provided that active consideration was being given to digital exclusion in this work, noting the benefits this would deliver in increasing capacity to deliver services in person or over the phone, and in increasing data utilisation to better understand who is not accessing digital services and identify individuals who may be digitally excluded.

7. National Guardian’s Office update and priorities 2023/24 (BM/23/20(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 NHSE 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. Specific Equality Duties: NHS England review report 2022/23; the future report 2023/24 & 2024/25; and the engagement report (BM/23/21(Pu))

8.1 The CNO introduced the reports on NHSE’s compliance with its statutory requirements under the Equality Act 2010’s Public Sector Equality Duty (PSED) and the associated Specific Equality Duties (SED).

8.2 Members considered the impact of the Creating the New NHSE Programme on diversity across the organisation and discussed that this would be assessed ahead of a review of NHSE’s equality objectives. The Board emphasised the core aim for NHSE and NHS organisations to reflect the communities they serve and the benefits that can be realised through a diverse and engaged workforce were discussed.

Resolved:

• The Board resolved to approve:

1. the inclusion of employment data for NHSE as at 31 December 2022;
2. the content of the Review Report and the Engagement Report for 2022/23;
3. the design principles for NHSE’s equality objectives and targets and rationale for adopting equality objectives and targets for two years;
4. the eight equality objectives and targets for 2023/24 and 2024/25; and
5. the proposed approach for moving forward.

Any other business

• There was no other business.

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