Members
- Richard Meddings, Chair
- Mark Bailie, Non-Executive Director
- Duncan Burton, Chief Nursing Officer
- Mike Coupe, Non-Executive Director
- Jane Ellison, Non-Executive Director
- Julian Kelly, Chief Financial Officer
- Wol Kolade, Deputy Chair
- Professor Sir Robert Lechler, Non-Executive Director
- Sarah Jane Marsh, Deputy Chief Operating Officer/National Director of Urgent and Emergency Care (deputising for Dame Emily Lawson, Chief Operating Officer)
- Sir Andrew Morris, Deputy Chair
- Professor Sir Stephen Powis, National Medical Director
- Amanda Pritchard, Chief Executive Officer
- Professor Dame Helen Stokes-Lampard, Non-Executive Director
- Suresh Viswanathan, Associate Non-Executive Director
Attendees
- Dr Vin Diwakar, Interim National Director of Transformation
- Amanda Doyle, National Director for Primary Care and Community Services
- Navina Evans, Chief Workforce Officer
- Mark Ewins, Deputy Director for Adult Mental Health
- Chris Hopson, Chief Strategy Officer
- Dr Adrian James, National Medical Director for Mental Health and Neurodiversity
- Dr Andy Knox, Associate Medical Director/Population Health, NHS Lancashire and South Cumbria Integrated Care Board
- Kevin Lavery, Chief Executive of NHS Lancashire and South Cumbria Integrated Care Board
- Katie Neumann, Assistant Director of Secretariat
- Jacqui Rock, Chief Commercial Officer
- Steve Russell, Chief Delivery Officer/National Director of Vaccinations and Screening
1. Welcome
1.1 The Chair welcomed everyone to the meeting, including colleagues from the Lancashire and South Cumbria Integrated Care Board (ICB) who were hosting the Board in Blackpool.
1.2 The Chair noted that this was Professor Dame Helen Stokes-Lampard’s last Board meeting and members thanked her for her support and contribution to the NHS and as an NHS England non-executive director.
Apologies for absence
1.3 Apologies for absence were received from Emily Lawson (Chief Operating Officer), Tanuj Kapiashrami (Associate Non-Executive Director), Helen Stokes-Lampard (Non-Executive Director), Jeremy Townsend (Non-Executive Director), Professor Sir Mark Walport (Non-Executive Director) and Professor Sir Simon Wessely (Non-Executive Director).
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 25 July 2024 (BM/24/34(Pu))
1.5 The minutes from the public Board meeting held on 16 May 2024 were approved as a correct record.
2. Chair update
2.1 The Chair provided an update on his engagements with the healthcare sector and partner organisations since the last board meeting in July 2024. He provided an overview of his visits to Whitegate Health Centre and Chase Farm Hospital’s crisis centre and his engagement with NHS foundation trust and integrated care board (ICB) chairs. He had also attended the Genomics England Board and highlighted the launch of the Generation Study, led by Genomics England in partnership with NHS England, which enabled newborn babies to be offered whole genome sequencing to test for over 200 rare, treatable genetic conditions. The Chief Executive Officer (CEO) echoed the Chair’s comments on the launch of the Generation Study, emphasising the opportunities this presents to improve patient outcomes.
2.2 The Chair provided an update on the strategic development and prioritisation work carried out by the Board, including on the development of the 10 Year Health Plan, the developing work on health and work, and training and improvement in patient safety.
2.3 The National Medical Director informed the Board of the quality risk escalation relating to paediatric audiology services and the review commissioned to understand the issues and inform rapid action to address the challenges identified and prevent recurrence.
2.4 The financial pressures facing the NHS were highlighted and consideration given to the rising demand across the NHS. Members discussed that despite these challenges the NHS was continuing to deliver record levels of activity, though focus and discipline was required to deliver against agreed plans.
3. Chief Executive update
3.1 The CEO updated the Board on the progress made, emerging risks and key achievements since the July Board meeting. She informed the Board of the appointment of Louise Shepherd, CEO of Alder Hey Children’s NHS Foundation Trust, as the new NHS North West Regional Director from early November 2024.
3.2 The CEO reflected on the horrific events in Southport at the end of July and the riots that followed. The Board extended its sincere thanks to the NHS organisations, staff and other public services who cared for their communities during this time.
3.3 The CEO provided an overview on the ongoing collaboration with the new government on new policy initiatives, including the Further Faster 20 initiative, which will build on the Getting It Right First Time Programme (GIRFT) Further Faster Programme to deliver benefits for individuals and local communities and economies through addressing economic inactivity and reducing waiting lists.
3.4 The publication of the landmark report on Lord Ara Darzi’s independent investigation of the NHS in England was highlighted. Members considered the findings in the report and emphasised the opportunity this presented to transform the NHS to meet the changing needs of patients, staff and the public.
3.5 On operational performance, the CEO noted the data published by the UK Health Security Agency on the impact of flu, which reflected the severity of the illness and the criticality of the NHS taking all possible action to enable eligible individuals to get vaccinated.
3.6 An update was provided on the ongoing improvement work being carried out through NHS IMPACT.
4. Performance update (BM/24/35(Pu))
Operational performance update
4.1 The National Director of Urgent and Emergency Care (UEC)/Deputy Chief Operating Officer presented the latest operational performance across the NHS in England. Key highlights included:
4.1.1 Winter preparation: meetings are taking place with each region to consider the key risks and opportunities to improve resilience during the winter period. The winter letter was published on 16 September and members noted that this builds on the ambitions in the UEC recovery plan. Assurance was provided on the support in place for the most challenged organisations to manage safety and experience during winter. Members considered that in the absence of additional funding, NHS England’s work was appropriately focused on the areas that were within the organisation’s control and where improvements can be realised within existing resources.
4.1.2 UEC performance: improvements had been delivered across UEC services, which reflected the increased resilience across the NHS. Members discussed the need for action to improve 12 hour waits given the material impact of this on patient safety and outcomes.
4.1.3 Electives: a marginal increase in the elective waiting list was reported, however the Board discussed that activity levels were at a record high, noting the focus on those patients waiting over 65 weeks for treatment.
4.1.4 Cancer: while referral rates had increased, performance was stable against the faster diagnosis standard.
4.1.5 Diagnostics: the Board noted the increase in demand for planned and unscheduled diagnostics services and discussed that this was being met through the increased capacity established across the NHS, in particular through community diagnostic centres. The need for increased focus on diagnostics to manage the rising waiting list was noted.
4.1.6 Mental health: the dementia diagnosis rate was at 65.2% as at July 2024 against the ambition of 66.7%, with continued improvement reported each month since the introduction of the target in January. Improvements in access to mental health services were reported in several areas, however challenges remained in UEC services for mental health patients. It was discussed that liaison psychiatry services are in place across all acute hospitals which had delivered some improvements, however further work was required to manage demand for patients that require an inpatient bed
4.2 A discussion took place on uptake of the Pharmacy First Service. The planned evaluation of the service which will pick up wider learnings and potential changes needed to the model was discussed. The intention to look at widening access to blood pressure checks beyond pharmacies was noted.
Financial performance update
4.3 The Chief Financial Officer/Deputy Chief Executive Officer (CFO/DCEO) summarised the 2024/25 M4 financial position for the NHS. The NHS had delivered £2 billion efficiency savings at M4, reflecting a £200 million improvement on the same time last year and a 2.8% increase on acute productivity. It was discussed that on a value weighted basis providers were delivering 5-6% more activity than in the previous year, which had resulted in the reported reduction in the waiting list.
4.4 The NHS had reported a £387 million negative variance against plan in aggregate, with the systems reporting a £487 million deficit, which was driven in part by industrial action. The Board discussed the strengthening of the oversight and intervention regime for the most challenged providers and systems to recover the position. The need for providers and integrated care boards (ICBs) to remain focused on delivering their agreed plans and the responsibility for all senior leaders to support their finance colleagues to balance quality, safety, workforce and operational performance with financial delivery was emphasised.
4.5 Consideration was given to the capital position and the ongoing discussions with government to prioritise investment and maximise value for the NHS.
4.6 Members discussed the work underway through NHS IMPACT to drive improvement and to adopt and adapt learnings from GIRFT to improve financial and operational efficiency and improve quality. The opportunity presented through GIRFT’s clinically-led, data-driven and improvement-oriented approach to improve activity, efficiency, outcomes, quality and experience was noted.
5. Integrated health care (BM/24/36(Pu))
5.1 The Board welcomed Amanda Doyle, National Director Primary Care and Community Services, Kevin Lavery, Chief Executive of NHS Lancashire and South Cumbria ICB (LSC ICB) and Dr Andy Knox, Associate Medical Director/Population Health from LSC ICB. Consideration was given to the approach to integrating health and care services to improve access and outcomes for patients. The alignment of this work with the government’s three shifts in how it delivers care to ensure a sustainable future.
5.2 Dr Andy Knox summarised the health challenges facing the Blackpool population, highlighting the high levels of poverty, poor health and lower life expectancy, and complexity of care needs. The approach being taken to improve population health through tackling inequity and the progress delivered to date through integrated community and primary care were considered. The particular benefits delivered through the clinical leaders course on health inequity were highlighted. Kevin Lavery also provided an overview of the long-term and systemic nature of the challenges facing the local population and NHS organisations. The initiatives in place under LSC ICB’s improvement plan to drive financial and operational efficiencies and improve patient outcomes and experience were considered.
5.3 The Board discussed the approach to technology and digitisation to support integrated health and care across the ICB and the maturity of the ICB’s plans around this. The opportunities presented through the Federated Data Platform to optimise data capability and connectivity across the system were emphasised.
5.4 Consideration was given to the governance and leadership arrangements in place to support and drive integration. An overview was provided of the ICB’s 6-point anchor plan with cross-sector partners that was in place to support this and lift the population out of poverty, improve employability and improve the health and wellbeing of the population. The further improvements that could be delivered through bringing services out into the community and strengthening cohesion and collaboration across sectors were discussed.
5.5 Key challenges for improvement included establishing longer-term planning and recovery, reviewing the balance and pace of local and national decision-making around clinical reconfiguration, and optimising the Better Care Fund.
5.6 Assurance was provided on the alignment of this work with Core20PLUS5. Consideration was given to the potential learnings from the ICB’s population health programme and its partnership working with the voluntary sector for the wider NHS. The approach to measuring the impact of this work on health inequalities was also considered.
5.7 The reliance of effective integration on relationship building to foster greater collaboration and collective ambition and commitment to improvement was emphasised.
6. Strategy and actions taken to improve quality and community services for mental health (BM/24/37(Pu))
6.1 The National Medical Director for Mental Health and Neurodiversity introduced the report, summarising the challenges identified across adult community mental health services and the actions being taken to address these and improve quality of care.
6.2 The Board discussed the serious untoward incident that had occurred involving Valdo Calocane who was convicted of manslaughter in January 2024 on the grounds of diminished responsibility due to severe mental health illness. The Board expressed its deepest sympathies for the victims in this incident. Consideration was given to the review commissioned by the former Secretary of State for Health and Social Care from the Care Quality Commission of the incident and the actions taken to date and underway to address the failings identified through this.
6.3 An overview was provided of the request made to each ICB to review to review the services and approaches they have in place for assertive outreach and intensive case management, with the outcome of these reviews to be discussed at ICB public board meetings. Guidance had also been provided on discharge for patients that require access to and support from these services. The plan in place to review ICB returns to inform action for improvement, while balancing risk across the system, was discussed.
6.4 Assurance was provided of the arrangements in place to support access to mental health services during winter, including the 111 mental health service, mental health call out vehicles, and a new Operational pressures escalation levels framework for mental health.
6.5 Members considered the approach to managing physical comorbidities that often present with long-term mental health conditions, and which result in a materially reduced life expectancy. It was proposed that the team engage with the National Director of Transformation on the potential expansion of the digital NHS health check pilot to community mental health services, and on the innovations available through the National Institute of Health and Care Excellence apps that could support this.
ACTION: AJ, ME, VD
6.6 Consideration was given to the role of prevention and effective early intervention in managing demand for mental health services. The work underway with the Department of Health and Social Care to develop a cross-department approach to this was noted. The Board discussed the work needed in parallel to manage inpatient capacity and address workforce shortages across mental health services. The importance of ensuring that learnings from the above mentioned reviews are collated and actioned as quickly as possible to improve patient and public safety in community mental health services was emphasised.
7. Directions and mandatory requests for information (BM/24/38(Pu))
7.1 The Board noted the Summary of All Age Continuing Care Directions 2024 to NHS England by the Secretary of State for Health and Social Care in August 2024.
8. Report on the use of the NHS England Seal (BM/24/39(Pu))
8.1 The Board noted the report providing the detail of all documents that have been authorised and sealed with the NHS England seal between 7 March 2024 and 6 September 2024.
9. Any other business
9.1 There was no other business.
10. Close