Members
- Richard Meddings, Chair
- Sir David Behan, Non-Executive Director
- Mike Coupe, Non-Executive Director
- Julian Kelly, Chief Financial Officer
- Wol Kolade, Deputy Chair
- Sir Jim Mackey, Interim Chief Operating Officer
- Dame Ruth May, Chief Nursing Officer
- Professor Sir Munir Pirmohamed, Non-Executive Director
- Amanda Pritchard, Chief Executive Officer
- Professor Sir Mark Walport, Non-Executive Director
- Professor the Baroness Watkins, Non-Executive Director
Attendees
- Kate Brintworth, Chief Midwifery Officer
- Duncan Burton, Deputy Chief Nursing Officer
- Tom Cahill, National Director for Learning Disability and Autism
- Dr Vin Diwakar, Interim National Director of Transformation
- Ngozi Edi-Osagie, Consultant Neonatologist and National Specialty Advisor for Neonatal Critical Care
- Dr Navina Evans, Chief Workforce Officer
- Sarah-Jane Marsh, National Director of Urgent and Emergency Care / Deputy Chief Operating Officer
- Katie Neumann, Head of Board Governance
- Clare Perry, Office of the Chair and CEO
- Steve Russell, Chief Delivery Officer / National Director of Vaccinations and Screening
1. Welcome
1.1 Welcome to Dr Vin Diwakar and Sir Jim Mackey.
Apologies for absence
1.2 Apologies for absence were received from Rakesh Kapoor (Non-Executive Director), Susan Kilsby (Non-Executive Director), Sir Andrew Morris (Deputy Chair), Jacqui Rock (Chief Commercial Officer), Jeremy Townsend (Non-Executive Director) and Professor Sir Simon Wessely (Non-Executive Director).
Declarations of interest
1.3 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 27 July 2023 (BM/23/29(Pu))
1.4 The minutes from the Board meeting held on the 27 July 2023 were approved.
2. Chair update
2.1 The Chair thanked his Non-Executive and Executive colleagues for their support and contributions to NHS England’s (NHSE’s) work outside of the Board, noting the board committee meetings that had taken place since the July Board.
2.2 The Chair noted that Christmas Day-level cover is being provided during periods of industrial action (IA); however, demand is far exceeding that historically experienced on Christmas Day which is generating significant pressure across NHS services. The equivalent of one calendar month of clinician time has been lost due to IA and significant concerns were raised around the NHS’s ability to sustain delivery across all services and minimise the impact on patient safety and experience should IA continue.
2.3 An update was provided on the conclusion of the Lucy Letby trial, noting the launch of a corporate manslaughter investigation at the Countess of Chester Hospital by the police and the statutory public inquiry that is underway, with NHSE’s full support. The launch of the Fit and Proper Persons Test Framework was also noted.
2.4 The Chair informed the Board of the work underway to review and strengthen the approach to Freedom to Speak Up (FTSU) within NHSE and across the NHS, including improving board-level oversight and engagement on FTSU matters.
2.5 The Chair provided an update on the Creating the New NHSE Programme, which is on track to deliver an approximate 35% reduction in the size of the organisation, equating to over 8,500 whole time equivalents.
2.6 Members noted that Mike Coupe and Jeremy Townsend had been re-appointed as NEDs for a second term, and Sir David Behan’s term had been extended to 31 August 2024. The recruitment process for new NEDs was also in the final stages, with the proposed appointments awaiting approval from government.
2.7 The Chair updated the Board on his engagement with external stakeholders since the previous meeting, including an integrated care board (ICB) chair and chief executive officer (CEO) event on patient safety, engagement with wider stakeholder groups on the care model for older people and the frail, attendance at the NHS Assembly, and a Q&A session with mental health trust chairs on the challenges and opportunities across mental health services.
3. Chief executive update
3.1 The Chief Executive set out the work underway and actions being taken following the Lucy Letby trial, focussing on improving the approach to and oversight of patient safety, patient experience and quality of care. An update was also provided on the work underway with NHSE’s partners to strengthen NHS leadership and management, focussing on training and development, patient safety, governance and reporting, and ensuring patients are at the heart of service design and delivery.
3.2 The Chief Executive reiterated the focus on IA over the past 10 months and updated the Board that more than 60 days had been directly impacted by strikes, with the challenge of maintaining activity while ensuring safe and effective services increasing with each period of action. Negotiations are ongoing between government and the British Medical Association (BMA) to facilitate an end to IA, and the Board was informed that NHS England has written to the BMA on the need for rapid resolution of these negotiations considering the impact of IA on patient safety.
3.3 Noting the impact of IA on operational delivery, Members commended NHS staff for their continued hard work which had ensured continued delivery across NHS services, including an increase in diagnostics activity and a reduction in the elective waiting list. An improvement had also been delivered in the number of patients being admitted, transferred, or discharged within four hours, and an average of 1 million more primary care appointments were being delivered each month, with over half of these booked for the same or the next day. An update was provided on winter planning and urgent and emergency care (UEC), noting the importance of the winter vaccination plan to support people to stay well during winter. The acceleration of covid vaccination delivery in response to the new variant identified in the UK was noted.
3.4 The Chief Executive highlighted the progress made and planned launch of the Federated Data Platform (FDP) for the NHS. There was strong consensus on the need to address the fragmentation of systems for managing and sharing data across the NHS and the FDP will play a core part in connecting data held by NHS trusts and regional systems. The safety and security of the FDP was emphasised, with assurances provided. The capacity for the FDP to transform care delivery was considered and the Board supported the intention to engage with patients and the public on the opportunities for digital and data transformation in the NHS.
3.5 The Board welcomed the government’s announcement of new measures to stop young people smoking, including proposals to raise the legal age for smoking. The links between these measures and wider work on preventative healthcare and addressing health inequalities was considered.
3.6 Noting the update provided by the Chair, the Chief Executive thanked the New NHSE Programme team and staff across the organisation for their continued support and hard work to maintain and improve delivery across NHSE’s portfolio. The scale of the Programme and the impact of this on staff was acknowledged.
4. Performance update (BM/23/30(Pu))
Operational performance update
4.1 The interim Chief Operating Officer (COO) introduced the operational performance update, highlighting the continuing pressure on NHS services due to high demand and ongoing IA. The high levels of activity maintained in spite of these challenges and improvements against previous years, as referenced by the Chief Executive, were emphasised.
4.2 An update was provided on the week-on-week reduction in the 65-week elective waiting list and the actions underway to drive further progress. The increase in diagnostic capacity was highlighted and assurance provided that the commitments set out on the establishment of community diagnostic hubs and surgical hubs will be delivered in line with current plans.
4.3 The interim COO provided a breakdown of the 7.7million elective waiting list, which is comprised of over 80% elective diagnostic procedures and over 6 million people, some of whom are waiting for multiple elective procedures. Consideration was given to the reliance of elective delivery on effective proactive care planning and the impact of IA on providers’ ability to do this, which is impacting productivity. The support in place to help manage this and the need for ongoing focus on the recovery of children and young people elective services were discussed.
4.4 The Chief Delivery Officer / National Director for Vaccination and Screening updated the Board on the resurgence of measles in the UK following a progressive reduction in MMR vaccination rates over the last 10 years. An outbreak plan and a recovery plan have been developed to manage this, including a community-based outreach offer focusing on both polio and MMR to educate the public and increase vaccination uptake. The potential to introduce targeted polio and MMR vaccination programmes for 2024/25 was noted.
4.5 The Board also considered the position on flu and covid vaccinations, which are critical for healthcare workers during winter. Uptake trends could not yet be identified through vaccination data; however, high impact interventions are being implemented across all NHS organisations to drive uptake. It was noted that 4,500 covid vaccination and 11,000 flu vaccination sites were set up across England.
Financial performance update
4.6 The Chief Financial Officer (CFO) provided an overview of the month 5 2023/24 financial position, noting the total deficit position of over £1 billion against plan, which represents approximately 2% of spend year to date. The cost of IA is considered the dominant factor behind the deficit and is assumed at £700m to end of August. The additional financial pressures generated from lost elective activity, delays to transformation of care programmes, inflation, increased prescription activity (noting the growth in the prescription of direct-acting anticoagulants and hormone replacement therapy were positive indicators of the activity being carried out across the NHS), and the provision of turnaround and improvement support to the most challenged systems were also discussed. The CFO emphasised the focus on encouraging providers and systems to maintain elective activity and to continue to put in place the arrangements and controls that will support resilience as we move into winter.
4.7 Members discussed the potential impact of increased prescription activity on pharmaceutical waste. Assurance was provided on the incentives being offered through the medicines optimisation programme for reviews of prescription activity and the work underway with ICBs to review prescribing patterns across their systems to better understand activity based on demand to help prevent over-prescribing and reduce pharmaceutical waste.
5. Learning Disability and Autism Programme Update (BM/23/31(Pu))
5.1 The Chair reflected on the Oliver McGowan training the Board had completed in the private session, and thanked Vicci Livingstone-Thompson, Jeanie Northover and Tim Heaven from Inclusion Gloucester for their time and support in leading the training.
5.2 The National Director for Learning Disability and Autism summarised the work underway through the learning disability and autism programme, the challenges faced in delivery of these services and the actions being taken and planned to address these. The actions being taken to address inequalities in health and care for people with a learning disability and/or autism, as set out in the report, were also considered.
5.3 The Board discussed that 41% of people with a learning disability and/or autism currently in inpatient settings should be discharged or cared for out of hospital. While progress had been made, with approximately 80% of the individuals in inpatient settings in 2015 no longer in hospital, work continues with each integrated care system to address the ongoing barriers to discharge for these patients. The particular focus on increasing the provision and accessibility of mental health support in community settings which will materially reduce admission rates was highlighted. The links between this work and implementation of the NHS Long Term Workforce Plan to support the required increase in workforce supply was noted. The funding allocated to provide housing for people with a learning disability and/or autism, including modifications to properties as required, and the further work needed and planned on this were considered.
5.4 Considering Oliver McGowan’s experience, Members also discussed the approach to prescribing for people with a learning disability and/or autism and the engagement and transparency with families on clinical decisions to optimise care.
5.5 The National Director for Learning Disability and Autism highlighted that ‘Ask, listen, do’ is core to transforming services in partnership with the voluntary sector, government, providers and other health and care partners to improve the quality of care and quality of life for people with a learning disability and/or autism. The importance for this to also consider the interfaces between care pathways to support integrated care management and delivery was emphasised.
6. Three-year Delivery Plan for Maternity and Neonatal Services – delivery update (BM/23/32(Pu))
6.1 The Chief Nursing Officer (CNO) updated the Board on the progress made against the three-year maternity and neonatal delivery plan published in March 2023. The Board were informed that Sam Allen, CEO of North East and North Cumbria ICB had been appointed as the new Chair of the Maternity and Neonatal Board. The CNO had also been confirmed as the Senior Responsible Officer for the independent review of maternity services at Nottingham University Hospitals and Members noted the decision taken by the NHSE Quality Committee to move to an opt-out methodology for the review.
6.2 The Chief Midwifery Officer, Consultant Neonatologist and National Specialty Advisor for Neonatal Critical Care and Deputy Chief Nursing Officer summarised the work underway to support and drive improvements across maternity and neonatal services, in particular the leadership programme, work to improve data and reporting, actions to improve quality of care as evidenced in improved Care Quality Commission inspections, and work on training, recruitment and support for maternity and neonatal staff.
6.3 The Board commended the progress made on the recovery plan, though expressed concern around the position on data and insights and the need to strengthen the use of data and analysis to identify issues in quality of care and delivery. An overview was provided of the actions being taken to develop the data and tools available to enable trusts to identify issues earlier and take action, looking at triangulating workforce metrics, quality indicators, family feedback, and patient information to provide a wholistic picture of services. It was requested that a dashboard of available maternity data and analysis of this across maternity and neonatal pathways should be shared with the Board.
ACTION: CNO
6.4 Members discussed the demand on the maternity and neonatal workforce to deliver improvements in care and assurance was provided that the delivery plan consolidates and streamlines the number of initiatives in place to help prioritise delivery.
7. Delivery Plan for Recovering Urgent and Emergency Care Services – delivery update (BM/23/33(Pu))
7.1 The National Director of UEC / Deputy COO introduced the update on the progress made against the UEC Recovery Plan and the actions taken to support winter planning and preparedness. The improvements delivered in ambulance response times and wider UEC performance against increases in both attendance and admissions, including the 13% reduction in 14 day length of stays, were highlighted. Members noted that establishment of 5,000 additional general and acute beds, 10,000 virtual ward beds, and care transfer hubs are all on track. The publication of the intermediate care framework was also noted.
7.2 The Board considered the progress made on winter planning and the support in place to drive implementation of the ten high impact interventions set out in winter planning guidance across each system. A discussion took place on the resilience of system plans and the interdependencies between winter plan delivery, financial delivery and social care performance. The improvements in data and reporting at organisation and system level to support oversight and management of delivery and the establishment of system control centres to oversee capacity and manage patient flow were discussed. Members also considered the arrangements in place to oversee and support delivery in NHSE nationally and regionally, supported with daily review of operational data to identify risks and inform early intervention and support.
7.3 The benefits delivered through initiatives implemented to date across UEC services were considered, including additional senior clinician support in accident and emergency centres, deployment of fast response vehicles as part of ambulance fleets, and redirecting ambulances to manage demand and patient flow. The Board commended the team and staff on their continued hard work and support, and on the quality of the work delivered to date.
8. Update on Atamis Roll-out across the NHS (BM/23/34(Pu))
8.1 The Board noted the update on the roll out of Atamis across the NHS, a single eCommercial system for procurement, including the benefits and savings realised through the roll out, issues identified around onboarding, and the forward plan and mitigations in place to progress this work.
9. Report on the use of the NHS England Seal (BM/23/35(Pu))
9.1 The Board noted the report on the documents that had been authorised and sealed with the NHS England seal between 24 March and 19 September 2023.
10. Any other business
10.1 There was no other business discussed.