Members

• Richard Meddings, Chair
• Mark Bailie, Non-Executive Director
• Duncan Burton, Chief Nursing Officer
• Jane Ellison, Non-Executive Director
• Julian Kelly, Chief Financial Officer and Deputy CEO
• Dame Emily Lawson, Interim Chief Operating Officer
• Professor Sir Robert Lechler, Non-Executive Director
• Sir Andrew Morris, Deputy Chair
• Professor Sir Stephen Powis, National Medical Director (from item 5)
• Amanda Pritchard, Chief Executive Officer
• Jeremy Townsend, Non-Executive Director
• Professor the Baroness Watkins, Non-Executive Director
• Professor Sir Simon Wessely, Non-Executive Director (to item 6, from item 8)

Attendees

• Dr Penny Dash, Designate Chair (from 1 April 2025) (until item 8)
• Dr Vin Diwakar, Interim National Director of Transformation
• Dr Amanda Doyle National, Director for Primary Care and Community Services
• Navina Evans, Chief Workforce Officer
• Chris Hopson, Chief Strategy Officer
• Peter Johnson, National Clinical Director – Cancer
• Sir James Mackey, Designate Chief Executive Officer (from 1 April 2025) (until item 8)
• Sarah-Jane Marsh Director of UEC / Deputy COO (excluding item 6)
• Steve Russell, Chief Delivery Officer / National Director of Vaccinations and Screening
• Rob Stones Director – Delivery, NHS Cancer Programme

1. Welcome

1.1 The Chair welcomed everyone to the meeting.

Apologies for absence

1.2 Apologies for absence were received from Mike Coupe (Non-Executive Director), Suresh Viswanathan (Associate Non-Executive Director) and Professor Sir Mark Walport (Non-Executive Director).

1.3 The Chair informed the Board of Tanuj Kapilashrami’s (Associate Non-Executive Director) resignation, effective from 23 March 2025

Declarations of interest

1.4 No declarations of interest were made over and 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 6 February 2025 (BM/25/08(Pu))

1.5 The minutes from the public Board meeting held on 6 February 2025 were approved as a correct record.

2. Chair’s Update (verbal)

2.1 The Chair reflected that this was his, and other colleagues’, last Board meeting and expressed gratitude to the Board for their hard work and commitment. He described the role as both a privilege and a challenge, highlighting the NHS’s central role in British society.

2.2 The Chair summarised the challenges faced and progress delivered during his tenure, including significant structural and operational changes, including the recovery from the COVID-19 pandemic, the establishment of integrated care boards (ICBs), and the integration of NHS Digital and Health Education England into NHS England. He praised the financial stewardship of the organisation, noting that despite immense pressures, the NHS had remained within its financial mandate. The financial and efficiency challenge facing the service in the coming year were considered.

2.3 The Chair emphasised the NHS’s record levels of care provision and celebrated the NHS’s leadership in innovation, particularly in genomics, digital transformation (e.g. the NHS App), and the development of personalised cancer vaccines. He concluded by stressing the importance of addressing the needs of frail and elderly patients, advocating for a shift in care delivery models to better manage demand and capacity.

3. Chief Executive Officer’s Report (BM/25/16(Pu))

3.1 The Chief Executive Officer (CEO) echoed the Chair’s reflections and extended her gratitude to departing executive colleagues, including Emily Lawson (Chief Operating Officer (COO)), Steve Russell (Chief Delivery Officer / National Director for Vaccination and Screening (CDO / NDVS)), Julian Kelly (Chief Financial Officer / Deputy Chief Executive Officer (CFO/DCEO)), and Steve Powis (National Medical Director), for their exceptional service. She highlighted their contributions to key programmes such as the COVID-19 vaccine rollout, the integration of NHS bodies, and financial and operational leadership. The CEO reaffirmed her support for a leaner central NHS structure and closer collaboration with the Department of Health and Social Care (DHSC), noting the importance of reducing duplication and empowering local systems.

3.2 The CEO outlined recent achievements, including the near elimination of the longest elective waits, improved GP access, and enhanced productivity. She also highlighted the launch of Martha’s Rule, a significant patient safety initiative, and the NHS’s ambition to eliminate cervical cancer by 2040. Looking ahead, she emphasised the importance of the forthcoming 10 Year Health Plan (10YHP), which aims to provide a strategic vision for the NHS and the country, supported by a consistent delivery framework.

4. Incoming Chair and Chief Executive Officer update (verbal)

4.1 The Board welcomed Dr Penny Dash and Sir Jim Mackey, who would take up post as Chair and Chief Executive respectively on 1 April 2025.

4.2 Penny Dash, the incoming Chair, outlined three immediate priorities: implementing the 10YHP, supporting ICBs and regional collaboration, and managing the integration of NHS England with DHSC. She stressed the importance of clear communication and strategic alignment across the system.

4.3 Jim Mackey, the incoming Chief Executive, acknowledged the complexity of the current transition and the anxiety it has caused among staff. He committed to ensuring that the change process would be handled with fairness, clarity, and urgency. He praised the leadership response to recent planning challenges and expressed optimism about the future, particularly the shift towards a more community-oriented and prevention-focused health system.

5. Performance Update (BM/25/09(Pu))

Operational performance update

5.1 The COO presented the latest operational performance across the NHS in England. Key highlights included:

5.1.1 Elective care: The waiting list had reduced to 7.43 million, with 65-week waits down by 84% and 52-week waits declining for eight consecutive months. These gains were attributed to initiatives such as surgical hubs, seven-day operating, and specialty-level recovery plans.

5.1.2 Urgent and emergency care: Four-hour performance improved to 73.4%, and ambulance response times for category two calls dropped to 31 minutes. However, 12-hour breaches remained a concern, despite a 22% reduction. Improvements were driven by increased core bed capacity, same-day emergency care, virtual wards, and better discharge planning.

5.1.3 Diagnostics: Record activity was reported, with 2.51 million tests delivered in January. The six-week breach rate was forecast to fall to 18% by year-end.

5.1.4 Mental health: Services had been expanded across the country, with over two million people in contact with services and improved access to talking therapies. However, challenges persisted in the mental health UEC pathway and out-of-area placements.

5.1.4 Primary and community services: 33 million appointments were delivered in January, with patient satisfaction on access rising to 73.3%. Community care saw virtual ward capacity exceed 10,000 beds, but long waits in children’s services, particularly community paediatrics, remained a concern.

5.2 The Board emphasised the need for consistent leadership, data-driven improvement, and embedding best practices across the system to drive further progress and improvements in the coming year.

Winter performance and preparedness

5.3 Consideration was given to the lessons from recent winters and the need for systemic change. While ambulance response times and community-based alternatives had improved, emergency departments remained overcrowded, with many patients receiving care in corridors. The extent to which the upcoming UEC delivery plan will address short-term needs, with the longer-term solution to be realised through the 10YHP were considered.

5.4 Consideration was given to the drivers of and actions taken to manage consistently rising demand, including through vaccination of higher risk cohorts and expanding access to appropriate mental health services. The discussion highlighted the importance of integrated care pathways, particularly for frail and elderly patients, and the need for consistent clinical leadership and operational discipline within hospitals. The Board agreed that improving flow and reducing unnecessary admissions were critical to sustaining performance gains.

Financial performance update

5.5 The Chief Financial Officer reported that NHS England was forecast to deliver within its financial mandate, with a projected underspend of £25–50 million. Integrated care systems were expected to end the year £600 million off-plan, a significant improvement from the previous year’s £1.5 billion deficit. The total pay bill had reduced year on year, with reductions in temporary staffing costs, in particular agency spend, driving this.

5.6 Productivity had risen in the acute sector and the Board considered the alignment of this with the report published by the Office for National Statistics on NHS productivity. The drivers of this improvement in light of recovery efforts since the COVID-19 pandemic were considered.

5.7 With regard to 2025/26 planning, 37 systems had submitted plans which forecast delivery in-budget, while five systems still showed a combined gap of £300 million. The Board emphasised the need to move from planning to delivery, with a focus on productivity, operational discipline, and investment in digital tools to support efficiency and productivity, such as ambient voice technology. The importance of leadership development and improvement support was also highlighted.

6. The NHS Performance Assessment Framework for 2025/26 (BM/25/10(Pu)

6.1 The CDO / NDVS presented the updated NHS Performance Assessment Framework (NPAF) for 2025/26. The NPAF introduced a revised segmentation model (1–5) to assess ICBs and providers based on performance, with segment 1 indicating high performance and segment 5 triggering recovery support. The NPAF aims to provide greater autonomy to high-performing organisations while offering targeted support and enforcement for those facing challenges. The process of co-creation and engagement with the service and partners to develop the NPAF was highlighted.

6.2 Consideration was given to the proposed metrics across quality, finance, access and leadership. The approach to monitoring and managing performance across mental health services, independent providers, and research activity under the NPAF were discussed.

Resolved:

6.3 The Board approved the NPAF for testing and formal consultation, with final implementation expected by the end of Q1 2025–26.

7. Cancer Programme Update (BM/25/11(Pu))

7.1 The Board welcomed the update on the National Cancer Programme, highlighting progress in early diagnosis, pathway innovation, and personalised treatments. Early diagnosis rates had improved to 58.7%, and lung cancer screening had expanded significantly. Operational targets for faster diagnosis and treatment were largely met, with new, more ambitious targets set for 2025–26.

7.2 Innovations included expanded use of FIT testing, teledermatology, and personalised cancer vaccines. The programme also focused on hereditary risk identification and liver cancer screening. The Board acknowledged the contributions of Dame Cally Palmer, National Cancer Director who had announced that she was stepping down, and reaffirmed the importance of national oversight and local delivery through cancer alliances.

8. Data, Digital and Technology Transformation (BM/25/12(Pu))

8.1 The National Director of Transformation presented a strategic update on NHS England’s digital, data, and technology major programmes of work. He highlighted the scale of NHS digital operations, noting that NHS England supports more users than Amazon UK and more subscribers than Netflix UK. Despite this, digital maturity across the NHS remains low, with only 11% of staff reporting access to basic digital tools and 70% citing poor interoperability between systems.

8.2 The Board considered the progress made on the rollout of electronic patient records, the implementation of the Federated Data Platform (FDP), and enhancements to the NHS App, including appointment requests and digital triage. On patient communications, members discussed the potential to reduce paper correspondence by encouraging patients to opt into app-based notifications, potentially eliminating 36 million letters annually. The savings delivered through the national Microsoft 365 procurement were highlighted, with a focus now on maximising its use.

8.3 Consideration was given to the prioritisation of interoperability, innovation through the FDP, and the development of a patient-owned single health record going forward. The NDT confirmed that the record would be patient-owned, interoperable across care settings, and subject to patient-controlled data sharing. He noted that international collaboration and industry engagement would be key to its development, pending funding approval. Assurance was provided that the NHS number remains a critical unique identifier, with ongoing work to expand its use in linking datasets across sectors.

8.4The Board agreed that digital transformation is essential to improving care, efficiency, and financial sustainability, and that the single patient record would be a foundational enabler. Members emphasised the importance of focusing on broad benefits rather than being delayed by edge-case concerns.

9. Annual Emergency Preparedness, Resilience and Response (EPRR) Assurance Report (BM/25/13(Pu))

9.1 The Board noted the Annual Emergency Preparedness, Resilience and Response (EPRR) report, recognising the evolutionary and continuous improvement approach to emergency preparedness and resilience.

10. Directions and Mandatory Requests for Information (BM/25/14(Pu))

10.1 The Board noted the following Directions and Mandatory Requests for Information that had been issued to NHS England:

10.1.1 Summary of NHS Notify Service Directions 2025 issued to NHS England by the Secretary of State for Health and Social Care in February 2025; and

10.1.2 Summary of National Proxy Service Directions 2025 issued to NHS England by the Secretary of State for Health and Social Care in January 2025.

11. Report on the use of the NHS England Seal (BM/25/15(Pu))

11.1    The Board noted the report providing the detail of all documents that have been authorised and sealed with the NHS England seal between 17 October 2024 and 10 March 2025.

12    Any other business

12.1    There was no other business.

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