Members
- Penny Dash, Chair
- Mark Bailie, Non-Executive Director
- Duncan Burton, Chief Nursing Officer
- Jane Ellison, Non-Executive Director
- Tom Kibasi, Executive Director of Strategy
- Professor Sir Robert Lechler, Non-Executive Director
- Sir Jim Mackey, Chief Executive Officer
- Sir Andrew Morris, Deputy Chair
- Elizabeth O’Mahony, Chief Financial Officer
- Professor Sir Stephen Powis, National Medical Director
- Professor Sir Mark Walport, Non-Executive Director
- Professor the Baroness Watkins, Non-Executive Director
- Professor Sir Simon Wessely, Non-Executive Director
Attendees
- Miranda Carter, Director of System Architecture
- Rob Checketts, Strategic Adviser
- Mark Cubbon, Elective Care, Cancer and Diagnostics Director
- Dr Vin Diwakar, Interim National Director of Transformation
- Claire Fuller, Co-Medical Director – Primary Care
- Professor Meghana Pandit, Co-Medical Director – Secondary Care
1. Welcome and apologies
1.1 The Chair welcomed everyone to the meeting.
Apologies
1.2 Apologies for absence were received from Mike Coupe (Non-Executive Director), Suresh Viswanathan (Associate Non-Executive Director), Jeremy Townsend (Non-Executive Director), David Probert (Deputy Chief Executive Officer), Sarah-Jane Marsh (UEC and Operations Director), Glen Burley (Financial Reset and Accountability Director), and Amanda Doyle (National Director for Primary Care and Community Services.
Declarations of interest
1.3 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.
2. Minutes from the Board meeting held on 27 March 2025 (BM/25/16(Pu))
2.1 The minutes were approved as an accurate record of the meeting.
3. Integrated operational performance report (BM/25/17(Pu))
3.1 The Chief Executive Officer (CEO) acknowledged the recent events in Liverpool and extended his gratitude to NHS staff and emergency services for their support during this challenging period.
3.2 He also recognised the broader challenges currently facing the NHS and the Department of Health and Social Care (DHSC), particularly in relation to the Operating Model and financial planning. A strong leadership response is evident, focused on supporting staff through this period of change. This work necessitates a shift in how organisations operate, adopting more agile and collaborative approaches to effectively deliver the ambitions of the 10 Year Health Plan and enhance service delivery.
3.3 The CEO, alongside the Director for Elective Care, Cancer and Diagnostics, presented the latest overview of operational performance across the NHS. Key focus areas included improved planning, sustained elective care performance, reductions in Referral to Treatment (RTT) times and waiting list sizes, enhanced ambulance response times, and improved access to Primary Care.
3.4 Key highlights from the report included:
3.4.1 Elective Care: A notable 85% reduction had been delivered at year end in 65 week waits, and a 40% reduction in those waiting over 52 weeks. Focus had now shifted to 18-week RTT performance, with performance reported at 59.8% against the target of 65%. It was noted that this shift was in line with the first year of the elective reform plan, with the aim to achieve 92% over four years.
3.4.2 Cancer: Performance against the Faster Diagnosis Standard noted at 78.9%, exceeding both the national standard of 75% and the 2024/25 planning guidance ambition of 77%. For the 62 day treatment standard, performance was recorded at 71.4%, against a national standard of 85% and a planning ambition of 70%.
3.4.3 Diagnostics: Diagnostic activity has increased by 25%, enabling patients to access testing and appointments more quickly, therefore accelerating diagnosis and treatment pathways. Concerns were expressed about the sustainability of diagnostic growth and the need for better use of AI and digital tools. The importance of outpatient transformation was also discussed, particularly the need to expand patient-initiated follow-up (PIFU), which remain underutilised. Clinical leadership and organisational development were identified as key enablers for change.
3.4.4 Urgent and Emergency Care: Significant improvements have been seen in ambulance response times and reductions in 12 hour waits, though four-hour performance remained a challenge. The Board stressed the need for increased capacity, better discharge processes, and a clearer understanding of local plans to achieve a 3% performance gain.
3.5 The Board highlighted the importance of consistent leadership, organisational development, and the use of data driven approaches to drive improvement. There is currently notable variation in performance across organisations. However, operational support is being provided to help address these discrepancies, with an emphasis on data sharing and the adoption of best practices across the system.
3.6 Further work is required to explore opportunities for technological investment aimed at enhancing productivity, improving care delivery, and supporting long-term service transformation.
4. Financial Performance update (BM/25/18(Pu)) and 2025/26 Operating Plan Position (BM/25/19(Pu))
4.1. The Chief Financial Officer (CFO) reported that all systems submitted their revised financial plans for 2025/26 by the deadline of 30 April. The national Planning Guidance sets out ambitious targets for productivity and performance, including a 7.1% efficiency requirement and a mandated 2% reduction in workforce levels, and a 40% reduction in agency staff. Additional support is being provided to organisations undertaking corporate nursing reviews.
4.2 As of the end of February, systems collectively reported a financial planning gap of £4.4 billion, even after incorporating £2.2 billion in revenue support. Further collaborative work has since been undertaken with regions, trusts, and integrated care boards (ICBs) to improve the robustness of the 2025/26 plans. All systems are now aiming to deliver a balanced financial position in 2025/26.
4.3 It is recognised that achieving this represents a significant step change, requiring strong leadership across all systems, the adoption of new models of care, and the continued engagement of clinical leaders. The Board discussed the importance of maintaining quality during financial tightening, with a new policy requiring quality impact assessments for all major changes. These will be signed off by Chief Medical and Nursing Officers and reviewed by boards to ensure patient safety and service standards are upheld.
4.4 Assurance was provided on the further work and plans in place to meeting rising demand across primary care and mental health, including delivery of an additional 700,000 urgent dental appointments, reductions in average length of stay in adult acute mental health beds, and increased access to services for children and young people.
4.5 With the formal conclusion of the 2025/26 planning process, Regional Teams will continue working closely with Trusts and ICBs to support effective delivery and implementation.
5. NHS Performance Assessment Framework consultation (verbal)
5.1 The Director of System Architecture provided an update on the NHS Performance Assessment Framework, noting that the public consultation is scheduled to close on 30 May 2025. Initial feedback indicates that the current draft includes a broad and complex set of metrics, with a clear preference emerging for greater focus and clarity. In response, consideration is being given to streamlining the metrics to prioritise key domains: prevention, access, finance, and quality.
5.2 Following the close of the consultation, there will be a rapid consolidation of responses, with the final version of the framework expected to be published in early July.
6. Specific Equality Duties Review Report – as of 31 March 2025 (BM/25/20(Pu))
- NHS England has produced a Specific Equality Duties (SED) Review Report outlining how it will meet its statutory obligations under the Public Sector Equality Duty of the Equality Act 2010, including associated SEDs, for the period from 1 April 2024 to 31 March 2025
- the report has been formally signed off by the NHS Executive and highlights progress made and ongoing challenges in key areas, particularly in addressing maternity inequalities, and parental mortality among ethnic minority groups
- in light of organisational changes within NHSE and ICBs the updated equality objectives reflect these shifts. Further collaboration with DHSC will be required to ensure full alignment
- the Board approved the recommendations for 2025/26 which balance meeting PSED/ SED requirements whilst taking a flexible approach and working in partnership with the DHSC.
RESOLVED
- the Board approved the equality objectives and targets for 2025/26
7. Strategy and 10 Year Health Plan update (verbal)
7.1 The Executive Director of Strategy provided an update on the forthcoming 10 Year Health Plan, which is nearing completion and will soon enter cross-government review. The Plan is centred around the government’s three key strategic shifts: from hospital to community, analogue to digital systems, and treatment to prevention.
7.2 The Board discussed the need for a robust delivery strategy and alignment with the upcoming Spending Review to support implementation and practical delivery of the Plan.
7.3 As part of the wider strategy work programme, efforts are focused on identifying priority operational strategies and translating the ambitions of the 10 Year Health Plan into actionable delivery strategies. This includes targeted work on prevention, quality, mental health, and cross government strategies.
7.4 The Board also noted the importance of aligning the Industrial Strategy for the Life Sciences Sector with the 10 Year Health Plan to ensure coherence and maximise impact.
7.5 The Board will be actively involved in reviewing the process for identifying priorities, commitments, and ambitions arising from the 10 Year Health Plan and associated strategies.
8. Update on the draft Model ICB Blueprint and progress on the future NHS Operating Model (BM/25/21(Pu))
8.1 The Director of System Architecture acknowledged the significant contributions of System Leaders in co-designing the Model ICB Blueprint. Members recognised the impact these changes will have on staff and emphasised the focus for NHSE and DHSC on providing clarity and certainty to colleagues as early as possible.
8.2 The ICB Blueprint marks the initial phase of a joint programme of work aimed at redefining the role, functions, and focus of ICBs as strategic commissioners. This initiative is closely aligned with NHSE’s broader efforts to reshape its regional structures, central functions, and overall operating model.
8.3 The Blueprint is intended to strengthen the role of strategic commissioners in improving population health and to establish the conditions necessary for ICBs to succeed and deliver the greatest possible improvements in patient care.
8.4 Given the scale and complexity of these reforms, it is essential to account for the statutory responsibilities held by both NHSE and ICBs. Appropriate governance processes will be followed, and where legislative changes are required, NHSE will maintain clear oversight of responsibilities as they transition.
8.5 The draft Blueprint also highlights the importance of building capacity and capability as a critical focus in the next phase of implementation.
8.6 Throughout the development of this work, efforts have been made to ensure alignment and coordination across risk management processes, supporting a safe and well managed transition.
8.7 Once ICB plans are submitted and further modelling work is completed, the Board has requested a detailed update on how the organisation will deliver against the ambitions set out in the Blueprint.
Action: MC
9. Integration update and timescales (verbal)
9.1 The Chief Executive reported that significant progress has been made in recent weeks on the development of the high-level executive structure, operating model, and future ways of working. The intention is to share initial details with NHSE and DHSC colleagues by mid-June, outlining which services will be brought together in the first wave of implementation, scheduled to take place between now and the end of September 2025. The planned launch of a voluntary redundancy scheme for NHSE to support the transition was noted.
9.2 The complexity of the programme and need for careful management in close coordination with government colleagues was emphasised.
9.3 The Chair informed the Board that she is co-chairing the Transformation Board alongside the Lead Non-Executive Director of DHSC. Teams from both organisations are actively supporting the transition process, with a clear focus on streamlining decision-making, reducing bureaucracy, and ensuring statutory functions are appropriately aligned. There was a strong emphasis on empowering staff and clarifying accountability across the new structure.
9.4 The overarching ambition is to confirm the functions and services to be retained at the Centre, and to publish both the 10 Year Health Plan and the target operating model for providers by early July 2025. This will provide greater clarity and a defined direction of travel for the NHS.
10. NHS England – Modern Slavery Guidance and Annual Statement (BM/25/22(Pu)))
10.1 The CFO presented the NHS England Modern Slavery Guidance and Annual Statement for the Board’s approval.
10.2 The report outlines progress made over the past year, including the introduction of new regulations, the outcomes of a recent public consultation, and updates to the draft NHS guidance aimed at addressing modern slavery within NHS procurement practices.
RESOLVED
10.3 The Board approved the contents of the 2024/25 Modern Slavery Statement and agreed to its publication.
10.4 The Board also approved the continued delegation of authority to the Chief Commercial Officer to make non-material amendments to the NHS Guidance on tackling modern slavery in NHS supply chains.
11 Any other business
11.1 There was no other business.