Members

• Richard Meddings, Chair
• Sir David Behan, Non-Executive Director
• Mike Coupe, Non-Executive Director
• Julian Kelly, Chief Financial Officer
• Wol Kolade, Deputy Chair (until item 7)
• Dame Ruth May, Chief Nursing Officer
• Sir Andrew Morris, Deputy Chair
• Amanda Pritchard, Chief Executive Officer
• Sir David Sloman, Non-Executive Director
• Jeremy Townsend, Non-Executive Director
• Professor Sir Mark Walport, Non-Executive Director
• Professor the Baroness Watkins, Non-Executive Director
• Professor Sir Simon Wessely, Non-Executive Director

Attendees

• Navina Evans, Chief Workforce Officer
• Dr Tim Ferris, National Director of Transformation
• Chris Hopson, Chief Strategy Officer
• Sarah Jane Marsh, Deputy Chief Operating Officer
• Dr Habib Naqvi, Director – NHS Race and Health Observatory
• Katie Neumann, Head of Board Governance
• Professor Bola Owolabi, Director – National Healthcare Inequalities Improvement Programme
• Clare Perry, Office of the Chair and CEO
• Professor Julian Redhead, National Clinical Director for UEC
• Jacqui Rock, Chief Commercial Officer (until item 9)
• Steve Russell, Chief Delivery Officer / National Director of Vaccinations and Screening (until item 9)

Welcome

1.1 Apologies for absence were received from Rakesh Kapoor (Non-Executive Director, Susan Kilsby (Non-Executive Director), Professor Sir Munir Pirmohamed (Non-Executive Director) and Professor Sir Stephen Powis (National Medical Director).

Declarations of interest

1.2 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 18 May 2023 (BM/23/22(Pu))

1.3 The minutes from the Board meeting held on 18 May 2023 were approved.

Chair update

2.1 The Chair summarised the visits planned for the Board across the Birmingham and Solihull Integrated Care System on 28 July and the engagement with system and local government colleagues, focussing on collaboration and partner working.

2.2. The Chair noted that this was Dr Tim Ferris’s, National Director of Transformation (NDT) and Sir David Sloman’s, Chief Operating Officer (COO) last Board meeting and thanked them for their substantial contributions and dedication to NHS England and the NHS.

2.3. The key developments since the previous Board meeting were highlighted, including the publication of the NHS Long Term Workforce Plan (LTWP) and the 75th NHS birthday celebrations. The Board was also informed that the winter plan letter had been published today, and noted the decision taken in the private session to accept the Sponsor-Delivery model for the New Hospitals Programme, with responsibility for the delivery element of the model and the associated delivery risk transferring from the Department of Health and Social Care (DHSC) to NHS England – subject to receiving the appropriate assurances from DHSC.

2.4. The Chair updated the Board on his recent engagement with system partners, DHSC and other stakeholders on a number of key challenges across the NHS, including primary care reform and data and technology systems, and on his visits across the health and care system.

2.5. The Board noted the planned extension of the terms of the Non-Executive Committee Members on the Data, Digital and Technology Committee and the Workforce, Training and Education Committee (who were former NHS Digital (NHSD) and Health Education England (HEE) Non-Executive Directors), which had been established with the merger of NHS England and NHS Digital and Health Education England respectively to support the safe transfer and continued oversight of their functions in the new NHS England.

Chief executive update

3.1 The Chief Executive updated the Board on industrial action (IA) which is ongoing across the health service. The impact of the protracted series of IA on NHS services and the actions being taken to manage this were discussed, noting the particular focus on elective recovery which had slowed significantly. It was discussed that while the NHS afc pay award was above the 3% level at which the NHS was funded, DHSC had identified funding from other sources to cover additional pay costs beyond this level.

3.2 Noting the key developments raised by the Chair, the Chief Executive further highlighted the publication of the LTWP and emphasised the value delivered through the collaborative approach taken to development of the plan. The strong engagement from the service on the 75th NHS birthday celebrations was also noted, and thanks expressed to the NHS Assembly on the deep and rapid engagement carried out with the service on the goals and ambitions for health and care in England in the short and long term.

3.3. The Board commended staff on the progress made on winter planning and the early publication of the winter plan letter, which built on the Urgent and Emergency Care (UEC) Recovery Plan. The planned engagement with trust and Integrated Care Board (ICB) leaders on implementation of the winter plan and the further action that could be taken to manage demand and capacity during winter was discussed. Members supported the early engagement with the service on the approach to 2024/25 planning, which will aid local decision making and empower local leaders to make the best decisions for their populations in line with the NHS England operating framework.

3.4. The Chief Executive updated the Board on the status of the new NHS England Programme, highlighting the impact of the change process on resourcing and capacity across the organisation to date. 95% of staff have been consulted on the design of their directorate in the new organisation and the Board reflected on the significant level of uncertainty that the coming filling of posts process presented for staff and the need for robust support to manage this change while delivering business as usual activity. The Non-Executive Directors extended their thanks to the Executives for their continued leadership and hard work.

3.5. The Chief Executive extended her thanks to Dr Tim Ferris and Sir David Sloman for their hard work and leadership both in NHS England and across the NHS. It was noted that Dr Vinod Diwakar and Sir James Mackey will take on the NDT and COO roles respectively on an interim basis.

Performance update (BM/23/23(Pu))

Operational performance update

4.1 The Chief Operating Officer (COO) introduced the operational performance update, highlighting the continuing pressure on NHS services due to high demand and ongoing IA. The Chief Workforce, Training and Education Officer (CWTEO) provided an overview of the position on IA. Work continues to manage the impact of previous and potential further IA in August on NHS services, in particular, on planned IA by junior doctors in August which will coincide with their rotation to a new specialty.

4.2. The COO summarised the elective waiting list position and the targeted work to address long waits and to manage continued delivery of elective care alongside increasing demand and pressures in winter. An update was also provided on UEC performance. It was noted that performance against the four-hour admission, transfer or discharge and category 2 ambulance response time targets had all improved since the previous update in July, though remained areas of focus. Further work is also planned to reduce the number of patients waiting 12 hours in accident and emergency, focussing on improving patient flow and rapid handover.

4.3 On cancer performance, while the number of urgent suspected cancer referrals remained at approximately 140% of pre-pandemic levels, performance against the 62-day backlog and diagnostics had improved since the update to the July Board. Assurance was provided that sufficient capacity is in place to deliver the diagnostic standard, supported by clear investment standards and aligned demand and capacity planning.

4.4. The Board discussed the potential risk to operational performance resulting from staff shortages across care homes and domiciliary care, and its impact on patient flow and discharge. A report on this risk and the associated mitigations was requested for a future Board meeting.

ACTION: COO

4.5. A discussion took place on the progress made on GP health checks for people with a learning disability and/or autism. Members noted that the average life expectancy for people with a learning disability from an ethnic minority was 34, compared to 62 years for people denoted as ‘white’ (referenced in the NHS Race and Health Observatory (RHO) and University of Central Lancashire July 2023 report, We deserve better: Ethnic minorities with a learning disability and access to healthcare). It was requested that a report on learning disability and autism services and the actions being taken to address health inequalities in health and care for people with a learning disability and/or autism be submitted to the 5 October Board meeting.

ACTION: Claire Murdoch, Tom Cahill

Financial performance update

4.6. The Chief Financial Officer (CFO) provided an overview of the month 2 2023/24 financial position, which reflected an aggregate system position of £340m spend above plan. Discussions are ongoing with DHSC and systems on the actions required to manage this while maintaining activity levels and managing increasing demand and pressures in winter. The support being provided and proposed for the most challenged organisations and systems to drive efficiencies and deliver their financial plans was noted.

4.7. On funding for the NHS afc pay award, the CFO informed the Board that the additional costs above the 3% that was funded for the NHS would be covered through the immigration healthcare surcharge and reprioritisation within DHSC. The Board considered the additional financial pressure faced across the NHS, and all public services, due to inflation running at higher levels than reflected in planning assumptions, and the necessary action required.

4.8. Members discussed the progress made on capital investment programmes, including on community diagnostics and elective capacity, and the support that could be provided to systems to drive delivery of capital schemes. It was highlighted that 173 community diagnostic centres will be established by the end of 2023/24.

4.9 Consideration was given to the need for increased focus on productivity and efficiency across the NHS to manage increasing operational and financial pressures within existing resources. Service and system transformation will be central to this and the Board supported the need to increase the level of spend on technology and transformation in future years. The Board considered that the immediate focus should be on sustaining activity levels and driving operational and financial delivery, to ensure all patients can access the care they need when they need it. The continuing investment in maternity and neonatal services was noted.

Winter plan (BM/23/24(Pu))

5.1 The COO introduced the report on the approach to the development and operationalisation of the 2023/24 winter plan for the NHS in England, which was based on the UEC Recovery Plan, learnings from the previous winter and input from NHS staff, patients and leaders. The alignment of the approach with the Primary Care Access Recovery and Elective Recovery Plans and the NHS England operating framework was also highlighted.

5.2 Members discussed the core elements of the 2023/24 winter plan, including the ten high-impact priority interventions drawn from the UEC Recovery Plan and the focus on ICB-led planning and improved collaboration within and across systems, supported by clear individual organisational accountability for delivery. The improved availability and accessibility of data on frontline services to support winter planning was emphasised. The actions proposed around operational and surge planning and the recurrent funding provided to systems and the availability of Better Care Fund plans to support this and strengthen demand and capacity planning were considered. It was noted that further communications would be provided by Government on the actions required from local authorities to support winter planning.

5.3 A discussion took place on the advice provided to Government by the Joint Committee on Vaccination and Immunisation on the approach to covid and flu vaccination delivery for winter. The intention to coordinate delivery of the flu and covid vaccines as far as possible, pending advice from Government, was supported.

5.4 Members commended the team and NHS staff on the work carried out to date. The importance of continued and consistent support for systems in the lead up to and during winter to support planning and drive delivery was highlighted.

Annual report on NHS England’s work on healthcare inequalities and the NHS Race and Health Observatory (BM/23/25(Pu))

6.1 The Chief Strategy Officer summarised the organisation’s duty to tackle health inequalities and the scale of the challenge faced across the NHS.

6.2 The Board welcomed the Director of the National Healthcare Inequalities Improvement Programme who provided an update on the strategic priorities that NHS England will continue to deliver, and the model of change and delivery ecosystem established through the Core20PLUS5 approach. The progress delivered through this work to date and the areas of focus going forward, including on the life expectancy and healthy life expectancy gap, were considered. The UK Health Security Agency’s adoption of the Core20PLUS5 approach and the deep engagement with Government on its major conditions strategy to support the appropriate and consistent provision of universal and targeted support were noted.

6.3 Noting the comments made in paragraph 4.5, the Board considered the extent to which this and wider findings from the Learning from lives and deaths: people with a learning disability and autistic people review, informed the scope and next steps for the Healthcare Inequalities Programme. The aim to shift the balance from anecdotal to data-based evidence to support and drive this work and examples of this shift in practice across the service was discussed.

6.4 The Director of the NHS RHO provided an overview of the RHO’s work, noting the growing research and evidence base to support the reduction of ethnic inequalities and improved collaboration and partnerships with arm’s length bodies, Government and ICS’s on health and race, including on health research. The RHO’s plans for the coming year were considered, including the planned targeted action to improve staff engagement and support to address health inequalities and drive improvements in patient outcomes.

6.5 The Board considered the initiatives being piloted by individual systems and organisations and the approach to implementing these across the NHS in a way which ensures sustainable delivery and improvement. Members discussed the engagement underway with the Royal Colleges on the integration of health inequalities work into the undergraduate curriculum for new professionals. The additional action that could be taken on prevention in oral health for children and young people to reduce demand and improve patient outcomes was also considered.

6.6 The resource required to scale up this work and the anticipated substantial benefit that can be delivered through this, including productivity gains, were considered. The importance for this work to be integrated into all national programmes and into core performance and delivery reporting was emphasised, with action adapted and implemented through local teams to ensure it addressed the needs of the local population and to improve reach into the community.

Internal Freedom to Speak Up update (BM/23/26(Pu))

7.1 The Board noted the Internal Freedom to Speak Up annual report, highlighting the engagement between NEDs and Guardians and thanking the team for their work. The Chief Executive emphasised the material impact of the organisational change process on FTSU and the Guardians, and the Board requested a substantive update on this work to an upcoming Board in the context of the New NHS England Programme and the culture and organisational development work underway through this.

ACTION: SR, RB, TG

Long Term Workforce Plan (BM/23/27(Pu))

8.1 The CWTEO thanked all stakeholders within NHS England and across the service for their support and contributions to the now-published LTWP and highlighted the continued support needed from these individuals and organisations to drive delivery. It was noted that the plan would be reviewed and moderated with government every two years to ensure its continued relevance and deliverability for the NHS.

8.2. The Plan builds on a number of previous pieces of work, including Facing the Facts, Shaping the Future, the NHS People Plan and People Promise, and Framework 15, and is centred around three core elements of Train, Retain and Reform. The applicability of these elements to all areas of NHS England’s work and the actions being taken to develop robust implementation plans, including capacity plans, to support delivery of all workstreams and the transformation of the healthcare workforce was discussed. It was noted that implementation of the Plan would be overseen through the NHS England Workforce, Training and Education Committee on behalf of the Board.

8.3. The Board commended the team on the quality and publication of the Plan, emphasising the positive response from the service and internationally to this work.

Directions and mandatory requests

9.1 The Board noted the report which provided an overview of the following Directions issued to NHS England since the previous update in March, including their purpose, effect and requirements:

• Wayfinder Services 2023 (Directions) issued to NHS England in July 2023 by the Secretary of State for Health and Social Care (SoS) under section 254 of the Health and Social Care Act 2012 (2012 Act), 13ZC and 272(7) and (8) of the National Health Service Act 2006 (the 2006 Act) and Regulation 32 of the National Institute for Health and Care Excellence (Constitution and Functions) and NHS England (Information Functions) Regulations 2013; and
• Collection of Adult Social Client Level (No 3) (Directions) issued to NHS England in June 2023 by the Secretary of State for Health and Social Care (SoS). These Directions have been issued under section 254 of the Health and Social Care Act 2012 (2012 Act) and section 13ZC and 272(7) and (8) of the National Health Service Act 2006 (the 2006 Act)..

Any other business

10.1 There was no other business.

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