Members

• Richard Meddings, Chair
• Sir David Behan, Non-Executive Director
• Mike Coupe, Non-Executive Director
• Aidan Fowler National Director of Patient Safety, (deputising for Professor Sir Stephen Powis, National Medical Director)
• Julian Kelly, Chief Financial Officer and Deputy CEO
• Wol Kolade, Deputy Chair
• Dame Emily Lawson, Interim Chief Operating Officer
• Dame Ruth May, Chief Nursing Officer
• Sir Andrew Morris, Deputy Chair
• Amanda Pritchard, Chief Executive Officer
• Jeremy Townsend, Non-Executive Director
• Professor Sir Mark Walport, Non-Executive Director
• Professor the Baroness Watkins, Non-Executive Director
• Professor Sir Munir Pirmohamed, Non-Executive Director
• Professor Sir Simon Wessely, Non-Executive Director

Attendees

• Dr Navina Evans, Chief Workforce, Training and Education Officer
• Chris Hopson, Chief Strategy Officer
• Dr Alex Morton, Interim Director of Primary Care
• Clare Perry, Office of the Chair and CEO
• Jacqui Rock, Chief Commercial Officer
• Steve Russell, Chief Delivery Officer and National Director for Vaccinations and Screening
• John Stewart, National Director of Specialised Commissioning
• John Quinn, Chief Information Officer (deputising for Dr Vin Diwakar, Interim National Director of Transformation)
• Ming Tang, Chief Data and Analytics Officer

1. Welcome

1.1 The Chair noted that it was Rakesh Kapoor’s, Susan Kilsby’s and Professor Sir Munir Pirmohamed’s last Board meeting and thanked them for their service to the NHS England (NHSE) Board and committees and their substantial contributions to the wider NHS.

1.2 The Chair welcomed Dame Emily Lawson to her first NHSE Board meeting as interim Chief Operating Officer (COO). The Board thanked Sir Jim Mackey for his support in the interim COO role and his ongoing commitment to the NHS.

Apologies for absence

1.3 Apologies for absence were received from Dr Vin Diwakar (National Director of Transformation), Rakesh Kapoor (Non-Executive Director), Susan Kilsby (Non-Executive Director) and Professor Sir Stephen Powis (National Medical Director).

Declarations of interest

1.4 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 5 October 2023 (BM/23/36(Pu))

1.5 The minutes from the Board meeting held on 5 October 2023 were approved.

2. Chair update

2.1. The Chair provided an update on the discussions that had been held on winter planning, the NHS financial position and planning, and NHSE’s risk appetite.

2.2. On operational performance, the Chair highlighted the increase in activity across primary care and in cancer checks against pre-pandemic levels. The increase in admission rates and emergency department attendance and the progress made on Same Day Emergency Care were also noted. Members considered the progress made on virtual wards and the establishment of community diagnostic centres.

2.3. The Board received an update on industrial action (IA) across the NHS to date. The further IA planned during the Christmas and new year period coincides with one of the most pressured weeks of the year for health and care providers, and Members discussed the planning underway to manage this.

2.4. The Chair thanked the Executives for their continued hard work, noting the progress made on the NHS Long Term Workforce Plan, the Federated Data Platform (FDP), and the roll out of electronic patient record systems to 90% of trusts. The Board noted in particular the substantial progress made on the expansion the NHS App functionality and user base and the potential for this to transform access and care delivery.

2.5. The status of the New NHS England Programme, the reduction delivered in the size of the organisation and the impact of this on delivery of the organisation’s work were noted.

2.6. The Board commended NHS staff on the innovations delivered in the current pressured environment, including on medicines, diagnostic procedures through the NHS Genomics programme, NHS-Galleri testing and the roll out of tele-dermatology services.

3. Chief executive update

3.1. The Chief Executive noted the appointment of the new Secretary of State for Health and Social Care.

3.2. Noting the update provided by the Chair, the Chief Executive highlighted the risks for the NHS associated with the planned IA in late December and early January. Long waits had reduced every week since the previous period IA, however current operational pressures will present an increased challenge in maintaining this level of activity. The Chief Executive and the Board emphasised their respect for staff’s right to take action and the importance of fair pay and working conditions for all staff, noting that NHSE’s immediate focus is on supporting the NHS to plan for and prepare to respond to IA.

3.3. The Board considered the impact of IA on patient safety to date and discussed the work underway with the British Medical Association to address this and maintain access to safe and effective services for all who need it. The engagement with staff to ensure sufficient cover is in place to maintain delivery was noted. The importance for people to continue to seek medical help when needed was highlighted. The ongoing work to resolve disputes on pay and working conditions and the potential further action from the Royal College of Nursing and the Royal College of Midwives were considered.

3.4. The Board discussed that the estimated cost of IA to date is £1 billion, which had been covered through a combination of funding from government, redeployment of funds and decisions taken by the Department of Health and Social Care (DHSC) to reprioritise work, including delaying some technology programmes. It was noted that the cost associated with lost activity and patient care were also broadly equivalent to this, and that over 1 million appointments had been rescheduled due to IA. Members were informed that funding had been released to systems to prioritise patient safety and urgent and emergency care services during winter; however, further work will be needed to prioritise activity to support delivery of a balanced financial position at year end.

3.5. The Chief Executive provided an update on progress of delivery of winter plans and delivery of the Vaccination Programme and vaccination rates across NHS staff. The award of the Federated Data Platform (FDP) and Associated Services contract and work underway to support roll out of the FDP was also noted.

4. Performance update (BM/23/37(Pu))

Operational performance update

4.1. The interim COO introduced the operational performance update, highlighting the continuing pressure on NHS services due to high demand and ongoing IA. It was discussed that while attendance and admissions activity had increased, UEC performance and the waiting list position had broadly been sustained since the previous update in October.

4.2. Consideration was given to the prioritisation of health and care services for the upcoming period of IA, which focused on critical care, including maternity and neonatal services. Assurance was provided that local systems are empowered to encourage the public to attend NHS services via the appropriate route and on the improved collaboration across care settings to improve patient flow. It was emphasised that appointments will be rescheduled only where absolutely necessary.

4.3. The position across UEC services was discussed. The interim COO informed the Board of the material improvements delivered across Tier 1 organisations with support from NHS; however, performance in the most challenged organisations remained fragile. The Board considered the learnings from this and the approach to driving adoption of these actions and approaches across the NHS to drive further improvements in performance.

4.4. A discussion took place on the support in place for gambling addiction services and Members requested clarification of the funding arrangements for gambling clinics.

Action: COO, CFO

4.5. The Board also requested further information on the provision of mental health services during winter, including the increase in the prevalence of mental health conditions in children and young people and the impact of this on referral activity.

Action: COO

Financial performance update

4.6. The Chief Financial Officer (CFO) provided an overview of the month 7 2023/24 financial position, highlighting the actions taken to manage the financial impact of IA to the end of October 2023 and the further work needed to manage the reported overspend across the NHS. The impact of higher inflation on the NHS financial position and the actions being taken to manage this were discussed.

4.7. The Board considered that NHS funding has increased by just over 2% in real terms, meaning the NHS has absorbed an almost 4% reduction in funding which is driving significant financial pressure across the service. The reallocation of funding from improvement and transformation programmes to manage this was noted. The reduction of technology investment and funding was also considered and Members recognised the need to review this to ensure sufficient focus on technology and digital programmes to establish more efficient processes, support self-managed care, and help transform care delivery across the NHS.

4.8. The continuing focus on investment in NHS capacity, productivity initiatives and retention and workforce development was noted.

4.9. The CFO updated the Board on the agreement of the new voluntary scheme for branded medicines pricing and access with DHSC and the Association of the British Pharmaceutical Industry.

5. Primary Care Access Recovery Plan (BM/23/38(Pu))

5.1. The Interim Director of Primary Care summarised the progress made to deliver the Primary Care Access Recovery Plan across the four areas of the Plan, empowering patients, implementing ‘Modern General Practices Access’, building capacity, and cutting bureaucracy. The Board thanked colleagues across the NHS for their continued support and hard work to drive delivery.

5.2. A discussion took place on the ongoing work to improve access, including through primary care and community pharmacy partnerships, which had delivered a 17% increase in activity against pre-pandemic levels.

5.3. The next steps to reduce bureaucracy in the primary and secondary care interface which will be informed by integrated care board (ICB) operational plans for 2024/25 was considered.

5.4. The Board discussed the expansion of primary care capacity and requested further information on the criteria underpinning the additional role reimbursement scheme that is in place to support this and the approach to addressing health inequalities as part of this.

Action: AMort

5.5. Consideration was given to the progress made on blood pressure monitoring and the processes in place to support safe and effective patient follow up as part of this. The criticality of technology interoperability and effective information flow to support this was emphasised. The actions being taken to manage over-prescribing were also discussed.

5.6. Members discussed the planned launch of the Pharmacy First service in early 2024. The potential risks associated with this, particularly the complexities of connecting digital suppliers in general practice and community care, and mitigations in place for this were considered.

6. NHS Long Term Workforce Plan update (BM/23/39(Pu))

6.1. The Chief Workforce, Training and Education Officer introduced the update on progress to implement the LTWP since publication on 30 June 2023. The outcome of the recent LTWP summit, the strong engagement with and support for the work carried out to date, and the next steps for this work were considered.

6.2. An overview was provided on the progress made against the train, retain and reform themes of the LTWP, in particular the 205 additional medical school places brought forward into this year, the progress made on recruitment and retention, and the work underway with seven regional trailblazers on enhancing generalism. Members were also informed that data published by UCAS today shows that the number of students accepting places in medicine, dental and midwifery courses has increased and discussed that focus is now on working with local partners to increase application rates and converting these applications into higher acceptance rates.

6.3. Members commended the close working with education partners at a national, system and organisation level to develop the LTWP and considered the ongoing work with them to support implementation. The potential risks around educator capacity, infrastructure, and the pace of reform and the actions being taken to manage this were discussed.

6.4. Sir David Behan updated the Board on his recent visit to Lancashire Teaching which demonstrated the value of collaboration across the system to drive progress on workforce, education and training and establish innovation entry routes and delivery models for education and training programmes. Members considered the approach to convening employers and educators at ICB level to progress discussions and plans for the transformation of education and training services, taking account of the needs of the local population, and the support available from NHSE for this.

7. Federated Data Platform update (BM/23/40(Pu))

7.1. The Chair welcomed the Chief Data and Analytics Officer (CDAO) to the meeting and thanked her and the team for the substantial work carried out to progress the procurement and award of the Federated Data Platform and Associated Services (FDP and AS) contract, which had been awarded to a consortium led by Palantir Technologies. The CDAO also noted the award of the Privacy Enhancing Technology (PET) control to IQVIA.

7.2. Members considered the arrangements in place around data protection and sharing, taking account of existing data sharing arrangements at system and organisation level. A discussion took place on the impact of individuals opting out of data sharing through the FDP, particularly on direct care, the current rate of opt outs, and the communications and guidance being developed for the public on this.

7.3. The Board considered the plans in place to support the next steps for the transition to and mobilisation of the FDP and AS, highlighting the engagement with partner organisations on this to date and going forward. It was noted that an independent check and challenge group, chaired by the Chief Executive of National Voices, had been set up to define, support and check the use cases to be taken forward for the FDP. The work underway with regions, ICBs and trusts to deliver the target adoption rate and optimise functionality of the FDP was also discussed. The incentives that may be offered to support adoption and the workshops underway to support this were considered. Members requested that the focus in our communications and messaging on FDP adoption should be drawn more clearly from the case studies and evidence of the benefits delivered through adoption at the pilot trusts.

Action: MT

7.4. It was noted that the Data, Digital and Technology Committee would oversee mobilisation of the FDP and AS and the PET on behalf of the Board.

8. Specialised Commissioning 2024/25 – Next Steps with Delegation to Integrated Care Boards (BM/23/41(Pu))

8.1. The National Director of Specialised Commissioning summarised the current commissioning arrangements for specialised services and the recommendations for delegation of suitable specialised services to ICBs in 2024/25. Assurance was provided that the recommendations are in line with the principles agreed by the NHSE Board and have been developed in partnership with regional teams and ICBs.

8.2. Members discussed the convergence policy for specialised services to support the move towards population-based funding allocations, with each ICB expected to deliver a minimum level of growth in activity each year, and the potential impact of this on the operation of specialist centres across England. Assurance was provided that this policy will help address health inequalities and will better enable population-health management.

8.3. The Board noted that a review is underway of the 80 highly specialised services that remain with NHSE currently to determine which of these services may be suitable for delegation from April 2025, with a further recommendation to be made to the NHSE Board on this in due course.

8.4. On the interaction between providers and ICBs on delegated specialised services, the Board was assured that the nine statutory joint committees formed between ICBs and NHSE regions will facilitate ICB to ICB collaboration and decision making on delegated specialised services.

Resolved:

8.5. The Board resolved to:

• Note that the list of 59 services that are considered suitable for delegation from April 2024 remains unchanged from 2023/24;
• Approve the recommendations of the National Moderation Panel and endorsed by the NHS Executive to:
• Support full delegation of suitable specialised services to ICBs across the East of England, Midlands and the North West regions; and
• Support the continuation, for one final year, of statutory joint commissioning arrangements between ICBs and NHSE across the London, South East, South West and the North East and Yorkshire regions.
• Delegate authority to relevant Regional Directors to sign the final delegation agreements on behalf of NHSE; and
• Note the steps being taken to ensure commissioning capacity and capability, financial control and provider stability is maintained as we carefully implement these commissioning reforms.

9. Summary of the National Obesity Audit Directions 2023 issued to NHS England by the Secretary of State for Health and Social Care in November 2023 (BM/23/42(Pu))

9.1. The Board noted the National Obesity Audit Directions 2023 issued to NHSE in November 2023. The prevalence of obesity across the UK population and the impact of this on NHS services was considered.

10. Any other business

10.1.The Chair thanked Board members for their continued contributions and support to NHSE and the wider NHS.

11. Close