Members

• Richard Meddings, Chair
• Mark Bailie, Non-Executive Director
• Duncan Burton, Chief Nursing Officer
• Mike Coupe, Non-Executive Director
• Jane Ellison, Non-Executive Director
• Dr Claire Fuller, Medical Director for Primary Care (deputising for Professor Sir Stephen Powis, National Medical Director)
• Julian Kelly, Chief Financial Officer and Deputy Chief Executive Officer
• Wol Kolade, Non-Executive Director
• Dame Emily Lawson, Interim Chief Operating Officer
• Professor Sir Robert Lechler, Non-Executive Director
• Sarah Jane Marsh, Deputy Chief Operating Officer/National Director of Urgent and Emergency Care
• Sir Andrew Morris, Deputy Chair
• Amanda Pritchard, Chief Executive Officer
• Professor Sir Mark Walport, Non-Executive Director
• Professor Sir Simon Wessely, Non-Executive Director
• Professor the Baroness Watkins, Non-Executive Director

Attendees

• Dr Tom Downes, National Clinical Director for Older People and Integrated Person Centred Care
• Dr Amanda Doyle National, Director for Primary Care and Community Services
• Dr Vin Diwakar, Interim National Director of Transformation
• Navina Evans, Chief Workforce Officer
• Rebecka Fosher, Office of the Chair, Chief Executive Officer and Chief Operating Officer
• Professor Dame Sue Hill, Chief Scientific Officer
• Chris Hopson, Chief Strategy Officer
• Professor Simon Kenny, National Clinical Director for Children and Young People
• Katie Neumann, Head of Board Governance
• Steve Russell, Chief Delivery Officer/National Director of Vaccinations and Screening

1. Welcome

1.1 The Chair welcomed everyone to the meeting.

Apologies for absence

1.2 Apologies for absence were received from Tanuj Kapilashrami (Associate Non-Executive Director), Professor Sir Stephen Powis (National Medical Director), Jeremy Townsend (Non-Executive Director), and Suresh Viswanathan (Associate Non-Executive Director).

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.

Minutes from the Board meeting held on 5 December 2024 (BM/25/01(Pu))

1.4 The minutes from the private Board meeting held on 5 December 2024 were approved as a correct record.

2. Chair’s update

2.1 The Chair noted that this was Wol Kolade’s and Sir Andrew Morris’s, Deputy Chairs, last meeting (pending a potential extension of Andrew’s term, subject to Department of Health and Social Care (DHSC) approval). The Board thanked them for their substantial contributions to NHS England and the wider NHS and their leadership of the organisation since joining in 2018.

2.2 The Chair provided an update on his engagements with the healthcare sector and partner organisations since the December 2024 Board meeting, including discussions on the frailty pathway, longevity linked to frailty, and the 10 Year Health Plan (10YHP). The Board was also informed of the outputs of the Genomics England Summit and discussed the progress delivered on genomics to date.

2.3 The Chair reflected on the achievements delivered and progress made under the Executive’s leadership over the past 2 years. In particular, the Board highlighted the record levels of health care currently being delivered across the country, the improvements delivered in primary care access, and digital transformation of healthcare, including the Federated Data Platform, digital telephony, the use of artificial intelligence (AI) and assistive technology, and virtual wards. The further progress that could be made through virtual wards to support the shift from hospital to community was discussed. Members considered the completion of the Creating the New NHS England Programme in parallel with the establishment of integrated care boards (ICBs) to support the operating framework and the progress made to implement a system-first approach to health and care commissioning and provision to ensure to best meet population health needs. The Board emphasised the key role NHS staff have played in delivering these innovations and improvements.

2.4 Consideration was given to the further opportunities for improvement and the significant level of ambition for the future of health and care, noting the work underway through the development of the 10YHP to articulate this.

3. Chief Executive Officer’s report (verbal)

3.1 The Chief Executive Officer (CEO) provided an update on key developments since the 5 December 2024 Board meeting. The CEO noted the publication of the Independent mental health homicide report into the treatment of Valdo Calocane and extended her condolences to the patients and families impacted by these events. The work underway to ensure that learnings from this are identified and implemented across the NHS were considered. A report was requested to a future Board meeting on the actions being taken to address the report findings.

Action: Secretariat, COO

3.2 The CEO noted the publication of the operational planning guidance and summarised the planning process that will be implemented over the coming months to develop, review and approve system plans. The efficiency goals set for NHS England, including targeted reductions in both pay and non-pay spend, and the NHS for 2025/26, the approach and support that will be provided to deliver this were considered. It was emphasised that reductions in NHS England spend would be focused in those areas where NHS England does not add value, and would be driven by the cessation of work aligned with reductions in pay spend. The CEO assured the Board of the continuation of work on culture and organisational development across NHS England, emphasising that this remains a priority for the Executive.

3.3 Members noted that World Cancer Day took place on 4 February and the CEO updated them on the government’s plan to develop a new national cancer plan. The Board was also informed Dame Cally Palmer, National Cancer Director had announced that she will step down from her role after almost 10 years in post. Members commended the progress made under Dame Cally’s leadership and thanked her for her substantial contributions and commitment to NHS England and the wider NHS. It was noted that she will continue in her role as Chief Executive of The Royal Marsden NHS Foundation Trust.

3.4 The CEO, supported by the Board, highlighted the substantial progress made through the NHS Jewish BRCA Testing Programme, which had processed nearly 200,000 home test kits since launch, with 235 of these testing positive and enabling those patients to access cancer screening early. The CEO also reported on the planned roll out (following National Institute of Health and Care Excellence approval) of a one-off gene therapy for older children and adults with a severe form of sickle cell disease.

4. Performance update (BM/25/02(Pu))

Operational performance update 

4.1 The Chief Operating Officer (COO) summarised the latest reported operational performance, highlighting the substantial progress made and improvements delivered across the service each day, and the opportunities to drive further forward going forward.

4.2 Key highlights included:

4.2.1   Elective: The total wait list size had reduced, though further work is needed on long waits. Efforts are underway to shift focus to delivering the 18-week referral to treatment target.

4.2.2   Cancer: All 3 standards have improved year-on-year, with Faster Diagnosis Standard (FDS) exceeding the plan.

4.2.3   Diagnostics: 2.44 million diagnostic tests had been delivered, and the diagnostics waiting list had reduced. Continuous demand growth necessitates optimising capacity utilisation, alongside a need to establish the evidence base for expanding community diagnostic centres (CDCs) and work with national and local teams to maximise the value delivered through CDCs.

4.2.4   Mental health: Increased activity was reported across perinatal and maternity mental health services. Demand had also increased across children and young people (CYP), with further work needed to understand the variation in demand and access across pathways.

4.2.5   Urgent and emergency care (UEC): The National Director of UEC/Deputy COO summarised UEC performance, noting that the data reflected that strong NHS 111 performance was foundational to good UEC outcomes. Despite recent challenges, the NHS has rapidly recovered performance during pressure spikes. The measures adopted to facilitate recovery and the impact of these on patients and staff were discussed, with learnings from this winter being fed into the 2025/26 planning process. The Board was informed that the development of a UEC improvement plan is forthcoming, with a focus on patient safety and dignity

4.3 The emphasis on productivity and efficiency to optimise delivery and drive improvement was highlighted. The underlying demand growth was discussed, and members endorsed the plans to use data sciences to integrate demographic changes with technological and innovation changes that impact demand into a single model.

4.4 Key areas for managing demand include neighbourhood health, senior clinical engagement at the emergency department (ED) front door, specialist engagement in EDs, and strengthening the relationship between secondary and primary care to avoid admissions or enable earlier discharge. It was emphasised that approximately 40% of admissions could be avoided or managed more appropriately elsewhere. Alternative routes into the NHS, such as digital telephony, e-consult, and directory of services, were discussed.

4.5 The Chief Delivery Officer/National Director of Vaccinations and Screening (CDO/NDVS) provided an overview of the flu, respiratory syncytial virus and COVID-19 vaccination campaigns. Uptake of the flu vaccine was in line with 2023/24 uptake rates, with some improvement in 2-3 year olds and school age cohorts. Further work is planned through regions to improve uptake across the clinical at-risk group. A decrease in COVID-19 vaccine uptake was also noted.

Financial performance update

4.6 The Chief Financial Officer (CFO) summarised the latest NHS financial position at M9 2024/25. While the financial position had deteriorated further, the pace of deterioration had slowed and the NHS was anticipated to deliver within budget at year end. The continuing pressures associated with workforce spend were discussed, noting the focus on reducing temporary staffing costs given the circa 20% increase in substantive workforce across the NHS in recent years. The targeted support in place for the most challenged providers was considered.

4.7 The CFO reiterated, as noted by the CEO, the ambitions for 2025/26 in the planning guidance and discussed the timeline to finalise ICB plans by the end of March. The Board emphasised the scale of the challenge facing the NHS for 2025/26.

5. NHS productivity (BM/25/03(Pu))

5.1 The CFO provided an update on productivity, highlighting the progress made, current initiatives, and next steps. The focus was on realising productivity opportunities to release funding and capacity for innovation and improvement in care delivery. Members discussed the longer-term timeframe for realising benefits through various innovations currently being implemented, emphasising immediate investment for long term gains. The productivity improvement was noted at 2.7% for this year, with a target of 4% for the next year.

5.2 The Board considered the differences between the private sector and NHS approaches to and measures of productivity, discussing both limitations and opportunities. The expansion of productivity measurement into non-acute providers was commended.

6. Children and young people update (BM/25/04(Pu)

6.1 The Chief Nursing Officer for England introduced the update on delivery and transformation plans for children and young people (CYP) services, noting discussions held on this through the Board’s Quality Committee. The challenges faced and actions planned to drive improvement in CYP services were highlighted. The Board welcomed the National Clinical Director for CYP who further elaborated on these challenges and the ongoing work within NHS England and with partners through the CYP Transformation Programme. A particular focus was placed on shifting care from hospitals to the community and emphasising prevention to optimise care, maximise impact, and improve outcomes. The launch of deterioration monitoring in EDs and of proxy access to allow parents to access CYP records through the NHS App were highlighted.

6.2 Members discussed the importance of improving and strengthening CYP services, including physical, dental, and mental health, noting that these services have the highest net cost over a lifetime. The need to consider this in prioritisation and planning to facilitate proportionate investment was discussed, noting that budgets had been largely de-ringfenced at system level in 2025/26. Linked to this, the Board considered that CYP must be integrated into core pathways in addition to targeted CYP pathways. The improvements realised in data collection and reporting on CYP to date, in particular on community and mental health services, which would support this integration were noted. The spike in mental health (MH) demand was considered, with a need to better understand the reasons for the increase and the actions required to address it.

6.3 Collaboration with public health colleagues on dentistry was noted, highlighting improvements in children’s oral health and continuing challenges around deprivation. The longer elective waits for CYP compared to adults were discussed, warranting focused intervention and action. Health inequalities across this cohort were also considered, with both electives and health inequalities (HI) included in the wider action plan.

6.4 The Board considered the approach to engagement and seeking learnings to adopt and adapt through the action plan. The importance of building on existing practices and knowledge bases was emphasised, with collaboration with external partners, including the Academy of Medical Science. The coverage of 0-5s and the impact of health visitor reductions were discussed. Health visitors were commissioned by local authorities, but there is close collaboration with the Chief Public Health Nurse on supporting health visiting. Members highlighted that partnership working is essential beyond just this area.

6.5 It was agreed that regular updates on CYP services and transformation should be reported to the Board, with members of the Youth Board in attendance to inform and support discussions.

Action: DB, SK

7. The NHS Genomics Medicine Service: achievements in 2024 (BM/25/05(Pu))

7.1 The Board welcomed Professor Dame Sue Hill, Chief Scientific Officer, who provided an overview of the NHS Genomics Service and the achievements delivered in 2024. Members emphasised the pace of change in the field of genomics and considered the progress made and clinical advancements developed and rolled out across the NHS. The shift to multiomics as the core biological analysis approach for the NHS in the long term and the investment and changes in ways of working required to facilitate this were discussed.

7.2 The industry’s growth was emphasised, highlighting substantial opportunities for the NHS to adopt and lead in growth and innovation. While data and digital opportunities are evident, the variability in digital maturity across the NHS’s core technical infrastructure presents a challenge. It was noted that progress will largely depend on aligning existing systems.

8. Transforming the frailty pathway – progress, pilots and next steps (BM/25/06(Pu))

8.1 The National Director of Primary Care and Community Services introduced the report, summarising NHS England’s plans to improve care for older people living with frailty, focusing on shifting care from hospital to community settings, and delivering services through a neighbourhood health service. The ongoing design of the programme and evaluation approach for the neighbourhood health initiative was discussed. The potential to use the National Institute for Health and Care Research and Applied Research Collaborations for this evaluation was considered.

8.2 While good practice is evident in parts of the NHS, there is a lack of consistency, and the Board supported the focus on scaling and spreading these practices to ensure consistent and sustainable implementation. It was requested that, in future discussions, clear timescales for the test and learn environment be provided, detailing what implementation and potential scale-up would look like.

Action: AD, TD

8.3 Assurance was provided on the coordination and alignment of this work with other pathways, particularly the integration of efforts on frailty through the urgent and emergency care (UEC) pathway. The Board considered the need to systematise innovations to support effective neighbourhood health teams for the elderly and frail cohort, who prefer not to go to hospital. The collaboration required with partners in primary care, social care, and the voluntary, community, and social enterprise sector to facilitate this was emphasised.

Delegation of commissioning functions – vaccination, screening and CHIS (BM/25/07(Pu))

9.1 The CDO/NDVS introduced the report and summarised the recommendations for the delegation of vaccination, screening and child health immunisation services (CHIS). The rationale for the recommendations for the delegation and retention of vaccination, screening and CHIS services, and the implications of delegation on the delivery model for services were noted.

9.2 Members considered the ongoing discussions on the potential funding approach for public health services. Assurance was provided that the delegation agreement would include an outcomes framework, which would inform planning and allocations at ICB level to support delivery.

Resolved:

9.3 The Board resolved to approve that:

9.3.1 Commissioning of all vaccination services is delegated to ICBs, in line with the vaccination strategy;

9.3.2 Commissioning of most components of screening services is delegated to ICBs, with the exception of the following functions which are delivered across large footprints and are more suitable to be retained and commissioned by NHS England:

i. bowel cancer screening hubs (n=5)

ii. bowel cancer screening managed service provision (n=1)

iii. Cervical Screening Administration Service, CSAS (n=1)

iv. HPV cytology laboratories (n=8)

v. newborn bloodspot laboratory services (n=13); and

9.3.3 Commissioning of CHIS is retained by NHS England.

9.4 The Board noted that delegation will be subject to final approval of ICB readiness assessments, with formal delegation from 1 April 2026 and closer working leading up to this to strengthen join up on these services

10. Any other business

10.1 There was no other business

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