Members

• Penny Dash, Chair
• Louise Ansari, Non-Executive Director
• Mark Bailie, Non-Executive Director
• Duncan Burton, Chief Nursing Officer
• Paul Corrigan, Non-Executive Director
• Sam Everington, Non-Executive Director
• Claire Fuller, Co-Medical Director – Primary Care
• Ravi Gurumurthy, Non-Executive Director
• Tom Kibasi, Executive Director of Strategy
• Robert Lechler, Non-Executive Director
• Jim Mackey, Chief Executive Officer
• Sarah-Jane Marsh, Urgent and Emergency Care and Operations Director
• Andrew Morris, Deputy Chair
• Elizabeth O’Mahony, Chief Financial Officer
• Meghana Pandit, Medical Director – Secondary Care
• David Probert, Deputy Chief Executive Officer
• Jeremy Townsend, Non-Executive Director
• Suresh Viswanathan, Associate Non-Executive Director

Attendees

• Dianne Addei, Director, Healthcare Inequalities Improvement Programme
• Glen Burley, Financial Reset and Accountability Director
• Tom Cahill, National Director of Learning Disability and Autism
• Rob Checketts, Strategic Adviser
• Alex Churchill, Deputy Director Clinical Trials, DHSC
• Mark Cubbon, Elective Care, Cancer and Diagnostics Director
• Chris Gormley, Chief Sustainability Officer
• Lauren Hughes, Chief of Staff
• Lindsey Hughes, Director of Research
• Iram Khan, Secretariat Manager
• Jo Lenaghan, Interim Chief Workforce, Training and Education Officer
• Carolyn May, Director of Leadership, Talent and Management Development
• Habib Naqvi, Chief Executive, NHS Race and Health Observatory
• Ming Tang, Interim Chief Digital and Information Officer

1. Welcome and apologies

1.1 The Chair welcomed all to the meeting noting that this is the first meeting for Louise Ansari, David Bennett, Paul Corrigan and Ravi Gurumurthy, who had recently joined the NHS England (NHSE) Board as Non-Executive Directors.

1.2 The Chair thanked Suresh Viswanathan as this was his last meeting and thanked him for all his contributions.

Apologies

1.3 Apologies for absence were received from Amanda Doyle, National Director for Primary Care and Community Services and Vin Diwakar Clinical Transformation Director.

Declarations of Interest

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 17 July 2025 (BM/25/32(Pu))

1.5 The minutes from the public Board meeting held on 17 July 2025 were approved as a correct record.

2. Board Committee updates (verbal)

Audit and Risk Assurance Committee (ARAC)

2.1 Jeremy Townsend, Chair of ARAC, reported good progress on the risk registers. Work is underway with the Department of Health and Social Care (DHSC) to ensure alignment between the risk registers and the Internal Audit Plan.

The Committee had received an update on Primary Care Support Services, which highlighted several risks. A detailed report will be presented to the Executive to support the development of a robust transition plan over the next couple of years.

2.2. The ISFE2 Accounting System is scheduled to go live on 1 October, following extensive preparation involving 42 integrated care boards (ICBs), commissioning support units, and NHSE. Financial control teams have made significant contributions to support the implementation.

Data, Digital and Technology Committee (DDaTC)

2.3. Mark Bailie, Chair of DDaTC, provided a summary of the Committee’s work, noting progress in key areas including cyber security, the single patient record prototype, NHS App user engagement, and the integration of technology into care pathways.

2.4 The single patient record project prototype is expected to be delivered by the end of the year. The team is focusing on identifying high impact use cases with clinical sponsorship for further development.

2.5. The NHS App continues to demonstrate strong adoption and usage, with 35,000 users regularly engaged in feature testing and feedback. Work is ongoing to integrate data from wearables and external devices.

2.6 The Board proposed further discussion, through DDaTC, on the embedding of technology into care pathways, including debate of the benefits and limitations of a push versus pull model. The need to leverage the modern service frameworks for pathway redesign and ensuring operational ownership to support adoption and deliver productivity gains were emphasised.

Action: JH

3. Chief Executive Officer update (verbal)

3.1. The Chief Executive Officer (CEO) reported strong progress in the Operating Model, NHS Oversight Framework and ICB Cluster arrangements, including appointments of ICB chairs, with CEO appointments expected soon.

3.2. Ongoing discussions are taking place with HM Treasury regarding the voluntary redundancy scheme, with resolution anticipated in the coming weeks. A contingency plan is in place with ICB colleagues should it be required.

3.3. The CEO noted good progress on delivery of the 10 Year Health Plan (10YHP), with a focus on maintaining balance between short-term delivery priorities and longer-term financial and operational imperatives.

3.4. Significant progress has been made in sustaining activity levels despite recent challenges, including periods of industrial action.

3.5. Work is underway with system leaders to address challenges relating to digital and technology, and to support improvements in pathways, outpatient services, and emergency department service models.

3.6. The CEO highlighted strong enthusiasm and motivation across the system, particularly among Chief Executives and GP leaders, with collective support for key priorities including delivery of the 10YHP, outpatient redesign, integrated health organisations, and neighbourhood health and care.

4. Performance and Delivery Update (BM/25/34 (Pu))

Integrated Performance report

4.1.  The Deputy CEO presented the latest operational performance across the NHS in England, structured around six priority areas:

1. Improving health and reducing inequalities
2. Effectiveness and experience of care
3. Patient safety
4. People and workforce
5. Access to services
6. Finance and productivity

4.2 Members noted the particular focus on maternity, community services, cardiovascular health, diabetes and prevention. Further work was underway to enhance future reports by drawing out key themes and trends.

4.3 The Board noted several areas of improvement including:

a) Breast cancer screening coverage following the impact on the service after the COVID Pandemic.

b) A reduction in the number of inpatients with autism or a learning disability.

c) Improved access to primary care and Urgent and Emergency Care (notably Category 2 ambulance response times).

d) Continued progress in children and young people’s access to mental health services.

e) Increased community mental health access rates for adults.

4.4 Ongoing challenges were highlighted, including long waits for community services, delays in autism assessments, and the use of out-of-area mental health placements. Targeted initiatives are underway to address these issues.

4.5 The Board recognised opportunities to improve patient experience, particularly in referral efficiency, the complaints process, and access to information. The Quality Committee was asked to review additional patient experience metrics for future reporting.

Action: DBu

4.6 The Board discussed variations in performance across key metrics and emphasised the importance of addressing inequalities through different perspectives and approaches.

4.7 The Board stressed the importance of oversight on maternity performance data and agreed to review system-level data on a quarterly basis and welcomed the introduction of deep dive sessions at Board meetings, beginning with maternity.

Action: DP / DBu

4.8 With the continued shift from hospital based to community-based care, the Board noted the importance of maintaining visibility of quality measures within community services.

4.9 The Board noted the stagnation in four-hour emergency performance. Contributing factors include inconsistent use of Urgent Treatment Centres, variable internal processes, and the need for standardisation of data definitions and care pathways. Technical and leadership interventions are ongoing to address these challenges.

4.10 All regions have now completed winter planning exercises, focusing on scenario planning, escalation triggers, and cross-service coordination. Preparations are reported to be at a higher level compared to previous years.

4.11 The Board requested a report on the medium-term Urgent and Emergency Care strategy.

Action: SJM

4.11 It is noted that the vaccination reporting will be available from 1 October with a request for data on flu and COVID-19 vaccination uptake to be provided at a future meeting.

Action: DP

Financial performance update

4.13 The Chief Financial Officer (CFO) provided an update on the financial position noting a small aggregate overspend, continued pressures relating to efficiency targets, pay costs, the upcoming mid-year review and capital allocation processes.

4.14 At Month 4, the position remains broadly on plan with a £57 million aggregate overspend, representing a significant improvement compared with the previous year. Six systems account for half of the overspend, while 16 systems are currently reporting on plan.

4.15 The mid-year review will focus on ensuring credible plans are in place for the remainder of the year. A planned exercise at Month 6 will assess whether financial pressures are constraining elective recovery activity and will support greater transparency in both commissioning and delivery.

4.16 Capital spend currently stands at 13% of the annual budget, with a forecast £240 million underspend. Early identification of underspend will enable reallocation of funding, whereas late notification may lead to lost investment opportunities.

4.17 Key risks were highlighted, including unfunded redundancy costs, pressures within specialised commissioning, the use of high-cost devices, and the potential for further industrial action. Engagement with the pharmaceutical industry continues regarding the Voluntary Scheme for Branded Medicines Pricing, Access and Growth (VPAG).

4.18 In line with ongoing work on efficiency savings, the Board emphasised the importance of ensuring quality impact assessments and close collaboration with clinical colleagues. This will support triangulation across a range of quality indicators to safeguard patient care while delivering financial efficiencies.

4.19 The Board discussed the importance of clearly defining and demonstrating how resources are allocated to maximise population health, including understanding where money is being spent to improve health outcomes, how each ICB represents this allocation. This should be reflected in future reports, ensuring clarity on the proportion of spending across areas such as hospitals and other services and assessing unit cost performance to inform analysis of service efficiency.

Action: EOM

5. 10 Year Health Plan update (Verbal)

5.1 The Board received an update on the implementation of the 10YHP, with a focus on balancing short-term delivery with long-term transformation, refining workstreams for impact, and integrating feedback from the service and leadership community.

5.2 The team is refining the workstreams to ensure each delivers a measurable impact, with completion of this process expected in the coming weeks and alignment with the medium-term planning cycle. Efforts are being made to balance immediate operational and financial imperatives with longer-term transformation, ensuring appropriate prioritisation and sequencing.

5.3 The approach places strong emphasis on co-production with system Chief Executives, GP leaders, and other professional groups, to support innovation and coherence across the service.

5.4 The Board discussed that reporting should make clear the counterfactual position, specifically the risks associated with not changing and transforming services including the adoption of technology.

6. Health Inequalities: Improvement Programme and NHS Race and Health Observatory (RHO): End of Year Report (BM/25/36/Pu))

6.1 The Board received an update on the Health Inequalities Improvement Programme, which highlighted data-driven approaches being applied to elective reform, sickle cell care, and embedding equity within research and policy development.

6.2 The programme has published elective waiting list data disaggregated by age, sex, deprivation, and ethnicity. The data reveals disparities, including longer waits for deprived populations, women, and individuals of working age. Work is now underway with systems to address these gaps. As part of implementation support, engagement is ongoing with eight integrated care (ICSs) to close the maternity mortality gap by ethnicity and to expand neonatal testing.

6.3 Seven emergency department units for sickle cell patients have been established, achieving significant improvements in timely pain relief and patient experience. These models are being supported by advanced clinical practitioners to strengthen delivery.

6.4 The programme is working with leaders across the NHS to embed an inequalities lens into all strategies, including funding flows, data collection, and workforce initiatives. This includes a particular focus on deprivation and more granular measurement.

6.5 Substantial work is taking place in collaboration with teams across the 10YHP and Neighbourhood Health Services to deliver a programme that supports the implementation of the national plan.

6.6 Partnerships are being developed with NICE and regulatory bodies to embed equity in research, remove bias from clinical guidelines, and address workforce disparities. This includes tackling ethnicity-related gaps and addressing bullying and harassment.

7. Update on Learning Disability and Autism Programme (BM/25/37(Pu))

7.1 The National Director of Learning Disability and Autism provided an update on the Programme reporting progress on reducing inpatient numbers, improving annual health check coverage, and addressing ongoing challenges for autistic people.

The Programme has met targets in reducing inappropriate hospital stays for people with learning disabilities, improved uptake of annual health checks, and reduced avoidable deaths. However, gaps remain in GP register coverage which require further attention.

A significant increase in long waits for autism assessments was noted. The team is working to support families during this period and is collaborating with the ADHD Taskforce to reduce waiting lists and strengthen support while assessments are pending.

The Board recognised the important role of the Voluntary Sector in supporting access to health checks and wider social support for people with learning disabilities and autism.

Efforts are underway to promote reasonable adjustments and inclusive service design, with a focus on environmental and communication needs. Digital flags are being developed to support personalised care and ensure adjustments are embedded across services.

8. Management and Leadership Development (BM/25/38/(Pu))

8.1 The Board received an update on the new Management and Leadership Framework, which aims to establish consistent standards and expectations for managers at all levels. Board members provided feedback on implementation, evaluation, and external engagement.

8.2 The framework was developed with input from a wide range of stakeholders, including management institutes and external partners. It is intended to serve as a development tool, incorporating self-assessment and 360° feedback components.

8.3 Plans for implementation include aligning the framework with Board level appraisal processes, providing training for line managers, and enabling local adaptation to minimise disruption to existing systems. A steering group has been convened to develop the appraisal framework and ensure training is available for line managers.

8.4 The Board emphasised the need for a clear evaluation framework that sets out expectations for good performance at each stage, provides access to external expertise for development support, and refines the language to ensure precision and clarity. Members requested further refinement of the framework prior to rollout.

8.5 Board members were asked to review and provide comments on the draft. These will be incorporated into a revised version, which will be presented for discussion at the Executive meeting in October, ahead of a final report being brought to the Board in November.

Action: JL / Secretariat

9. Progress report – Delivering a Greener NHS: Fiver Years On  (BM/25/39(Pu))

9.1 The Board received an update on the Delivering a Greener NHS programme, outlining reductions in the NHS carbon footprint, innovations in estates and fleet, and ongoing challenges related to capital investment and staff engagement.

9.2 The NHS is achieving reductions in directly controlled emissions, with notable progress in eliminating the use of high impact anaesthetic gases, deploying electric ambulances and expanding solar energy generation capacity.

9.3 Staff engagement remains high, with widespread support for greener initiatives. Clinical engagement is being further strengthened through partnerships and the development of local Green Plans at trust level.

9.4 Access to capital funding for energy efficiency projects remains a key constraint. Demand for available funds is high, highlighting the need for innovative financial models to enable further decarbonisation.

9.5 The Board agreed to explore financial models and vehicles to support the delivery of decarbonisation projects, including approaches to address the high demand for Salix and Public Sector Decarbonisation Scheme funding.

Action: DP / CG

9.6 Opportunities to reduce unnecessary resource use were discussed, including reviewing the requirement for annual replacement of medical devices and rationalising estate usage. The Board noted the importance of NICE reviewing available evidence and supporting best practice in this area.

9.7 The Board further discussed opportunities to improve clinical pathways, with ongoing work through the Getting It Right First Time (GIRFT) programme to reduce outpatient appointments and support faster diagnosis.

10. Increasing Research Activity in the NHS (BM/25/40(Pu))

10.1 The Board received an update on the initiatives to increase research activity within the NHS, noting ongoing efforts to accelerate clinical trial setup, embed research into everyday care, and improve cost recovery.

10.2 Work is underway to standardise processes and strengthen Board accountability, supported using planning guidance to drive consistent improvements.

10.3 The long-term vision is to make research a routine component of NHS care, with a focus on both commercial and academic trials. Research activity will be measured alongside other key performance indicators to ensure visibility and accountability.

10.4 Significant potential exists to expand research within primary care, leveraging large datasets and the unique assets of the UK, while ensuring opportunities for the inclusion of diverse populations.

10.5 It is noted that some providers are not fully recovering costs from commercial research. Work is taking place to identify gaps and improve financial processes, with recognition that investment in research delivers substantial returns for both the NHS and the wider UK economy.

10.6 The Board discussed the importance of clarifying delivery vehicles for research expansion and the role of regional teams in supporting implementation.

10.7 The Board requested an updated proposal setting out metrics for measuring research activity, financial considerations and cost recovery mechanisms, primary care research expansion, incentivisation options and approaches to public engagement.

Action: DP / LH

11. Summary of NHS OpenSAFELY Data Analytics Service Pilot Directions 2025 issued to NHS England by the Secretary of State for Health and Social Care in June 2025 (BM/25/41(Pu))

The Board noted for information the Summary of NHS OpenSAFELY Data Analytics Service Pilot Directions 2025 issued to NHS England by the Secretary of State for Health and Social Care in June 2025.

12. Public Q&A

12.1 The Board received questions from members of the public in advance of the meeting with responses provided by Executive leads:

12.3 Question 1: Compliance with the Supreme Court Ruling on the Equality Act 2010 – Assurance that NHS England will review and amend all relevant policies and practices to ensure full compliance with the recent Supreme Court judgment, which confirmed that the terms sex, man, and woman in the Equality Act 2010 refer to biological sex.

12.4 Response: The Chief Nursing Officer for England informed the Board that NHS England is relevant policies in light of the Supreme Court ruling on biological sex and is awaiting updated guidance from the Equality and Human Rights Commission before finalising national policy.

12.5 Question 2: Graduate guarantee and jobs for newly qualified nurses and midwives.

12.6 Response: The graduate guarantee for nurses and midwives is being implemented with regional support, including creative recruitment measures and additional funding for midwifery roles, as part of the broader workforce strategy.

12.7 Question 3: Voluntary Redundancy Schemes for ICB Staff – When will Integrated Care Boards receive firm plans and timelines for implementing voluntary redundancy schemes for employees, including details on the funding source and sign-off process? If uncertainty persists due to pending Treasury decisions or other external factors, what steps is the NHS England Board taking to resolve this to provide clarity to ICBs and their employees.

12.8 Response: The CEO informed the Board that there active discussions with the Treasury are ongoing regarding redundancy arrangements for ICB staff, if unresolved a staged Plan B will be enacted, with each ICB having a plan ready for implementation.

12.9 Question 4: Regional disparities and accountability concerns – How will NHS England address and reduce regional disparities and what mechanisms will hold trusts accountable for implementation?

12.10 Response: The Financial Reset and Accountability Director provided a response noting that a regional blueprint has been published to clarify strategic workforce planning and oversight responsibilities, with further updates planned following completion of the 10-year workforce plan.

13. Any other business

13.1 There was no other business.

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