Members

• Penny Dash, Chair
• Mark Bailie, Non-Executive Director
• David Bennett, Non-Executive Director
• Duncan Burton, Chief Nursing Officer
• Paul Corrigan, Non-Executive Director
• Sam Everington, Non-Executive Director
• Aiden Fowler, National Director of Patient Safety and Deputy Medical Director (deputising for Meghana Pandit, Interim National
• Ravi Gurumurthy, Non-Executive Director
• Tom Kibasi, Executive Director of Strategy
• Robert Lechler, Non-Executive Director
• Jim Mackey, Chief Executive Officer
• Sarah-Jane Marsh, Urgent and Emergency Care and Operations Director
• Andrew Morris, Deputy Chair
• Elizabeth O’Mahony, Chief Financial Officer
• David Probert, Deputy Chief Executive Officer

Attendees

• Glen Burley, Financial Reset and Accountability Director
• Rob Checketts, Strategic Adviser
• Mark Cubbon, Elective Care, Cancer and Diagnostics Director
• Amanda Doyle, Director for Primary Care and Community Services
• Jules Hunt, Interim Director General, Technology, Digital and Data
• Jo Lenaghan, Interim Chief Workforce, Training and Education Officer
• John Lester, Director of Corporate Governance
• Katie Neumann, Assistant Director of Secretariat
• Matthew Style, Director General, System Development

1. Welcome and apologies

1.1 The Chair welcomed all to the meeting.

Apologies

1.2 Apologies for absence were received from:

• Louise Ansari (Non-Executive Director)
• Claire Fuller (Interim National Medical Director – Primary Care / Interim National Priority Programme Director for Neighbourhood Health)
• Meghana Pandit (Interim National Medical Director – Secondary Care)
• Jeremy Townsend (Non-Executive Director)

Declarations of Interest

1.3 No other declarations of interest were raised above those already on record, and no interests were declared in relation to the items on the agenda.

Minutes of the meeting held on 23 September 2025 (BM/25/42(Pu))

1.4 The Board approved the minutes of the meeting held on 23 September 2025 were approved as an accurate record.

2. Board committee updates (BM/25/43(Pu))

Strategy Committee

2.1 David Bennett, Non-Executive Director (NED) and Chair of the Strategy Committee, reported that the Strategy Committee had held its inaugural meeting held on 16 October. 4 topics were covered:

1. Agreement of terms of reference, focusing on NHS delivery of 10-Year Health Plan priorities.
2. Establishing a consistent methodology and approach to achieving these priorities.
3. Reviewing current strategic projects.
4. Ensuring the Committee addresses all relevant business.

2.2 Consideration was given to the anticipated coverage of business on an annual cycle and key priority areas. It was noted that the Committee had identified 15 priorities, although not all would progress simultaneously. 5 or 6 topics were expected to receive detailed focus. In the short term, the Committee would concentrate on aligning initiatives, both in terms of narrative and quantitative analysis, to demonstrate how they collectively deliver the objectives of the 10 Year Health Plan (10YHP).

Finance and Performance Committee

2.3 Andrew Morris, Deputy Chair and Chair of the Finance and Performance Committee raised the following 3 key points from the first meeting of the Committee on 22 October:

1. Deficit Support: £2 billion had been allocated this year, primarily to providers and some systems. Significant effort had been devoted to ensuring boards meet financial targets, as slippage would materially affect overall performance. The deficit support regime was agreed to last a maximum of 3 years, with the current year considered “year zero”.
2. Capitation: The Committee agreed to accelerate progress towards capitation, while recognising the need to avoid destabilising organisations at either end of the funding scale. Implementation would proceed in a timely manner.
3. System Reform: Approval was given for a 20% marginal rate for Emergency Department activity for the next year. Tariffs would be used to drive strategic shifts, including community care and outpatient reform, and to apply best practice tariffs to support service transformation, particularly the move from acute to community settings.

People Committee

2.4 The Committee met on 10 November and noted 3 main areas of focus:

1. Voluntary Redundancy Scheme: The scheme had been signed off and was now open. The Committee agreed to maintain oversight, as in previous mergers, to ensure arrangements were fair and equitable and that there was no adverse equality impact.
2. Recruitment of NHS Chairs and NEDs: A national recruitment campaign was underway to attract candidates from diverse backgrounds, including younger individuals, private sector professionals, and directors encouraged by their employers to take on NHS roles. The Committee emphasised the importance of diversity and thorough execution of the programme to address shortages in some regions. The Board was also informed that recruitment for regional chairs was live. These roles would support the 7 Regional Directors, strengthen networks with integrated care board (ICB) and trust chairs within their regions, contribute to chair appraisals, and report to the NHS England Chair.
3. Culture and Organisational Development: The Committee discussed the need to define and embed the desired culture for the new Department of Health and Social Care. This work would build on commitments made during the previous merger between NHS England, NHS Digital and Health Education England and remain a priority alongside routine responsibilities such as appraisals and maintaining good employment practices.

2.5 In discussion, members raised concerns about ensuring the calibre of chairs and NEDs, given the breadth of recruitment. It was agreed that development programmes, mentoring, and support would be essential for those appointed. The Committee highlighted the importance of strong partnerships between chairs and chief executives and the need to improve leadership development across the NHS.

2.6 Members also discussed clinical leadership at board level. It was noted that the NHS had fewer clinicians in senior leadership roles compared to international counterparts, and increasing clinical representation would strengthen decision-making and support reforms. The Committee agreed that more opportunities should be provided for clinicians to take on leadership roles.

2.7 Finally, it was confirmed that oversight of the 10 Year Workforce Plan (10YWP) sat with the Strategy Committee, while the People Committee’s focus remained on NHS England’s internal workforce.

Data, Digital and Technology Committee

2.8 Mark Bailie, NED and Chair of the Data, Digital and Technology Committee provided an overview of the discussions held at the meeting on 18 November. -Key points were raised as follows:

1. Digital Maturity and Productivity: The Digital Maturity Assessment confirmed that more digitally mature operations are more productive. The Committee discussed the need to accelerate the transition from strategic intent to practical deployment, including robust processes for AI adoption to enable technologies such as ambient voice, which offer significant frontline benefits. Members also emphasised the importance of modern, fully digitised service frameworks to deliver productivity gains.
2. Federated Data Platform (FDP): The Committee undertook a deep dive into the FDP, noting that deployments with 6 or 7 core components have delivered clear benefits for interoperability and productivity. Most implementations do not yet include the full suite, so accelerating rollout and adoption, supported by robust data and analysis on utilisation, was agreed as a priority.
3. Medium-Term Planning – Digital Triage: The Committee reviewed plans for digital triage within the NHS app, focusing on actions and decisions required to move from concept to practical implementation. Progress was noted, but significant work remains.

2.9 The Board discussed the effectiveness of electronic patient records (EPRs). While 95% of trusts have EPRs, success depends on integration with clinical pathways and adequate training. Poor implementation had resulted in temporary reductions in productivity, whereas well-embedded systems delivered significant benefits.

2.10 Members emphasised the need for professional regulators to keep pace with technological change, particularly in relation to AI adoption and codes of conduct. Members agreed that alignment between clinical work, care pathways, and technology remains essential.

3. Chief Executive Officer update (verbal)

3.1 The Chief Executive Officer (CEO) updated the Board on the progress made since the previous meeting, including the issue of medium-term planning frameworks and agreement of 2-year allocations enabling forward planning, activation of the voluntary redundancy scheme, and developments on neighbourhoods, the advanced foundation trust pipeline, and IHOs. The Board commended performance despite operational pressures.

3.2 Flu cases are rising sharply, with 2,000 beds occupied and projections of 5,000–8,000 within a week, impacting capacity as the NHS recovers from industrial action (IA) and prepares for further disruption. The CEO expressed concern over new IA announced by British Medical Associate Resident Doctors during peak winter, warning of significant operational challenges and potential harm. National and local responses are being considered to maintain patient safety.

3.3 Despite challenges, the CEO highlighted examples of outstanding progress, including University Hospitals Birmingham (UHB) achieving a 15% improvement in referral to treatment performance and reducing waiting lists by 45,000 in a year. These achievements demonstrated that significant improvement was possible and provided grounds for optimism.

3.4 Strong performance in primary care, including increased use of online triage and improved patient satisfaction, was also highlighted. The Board acknowledged this success and emphasised the need to strengthen clinical leadership across all professions to support transformation. Work on leadership and management standards would be broadened to include clinical leadership, with proposals to be discussed in the new year. The Strategic Adviser highlighted that clinical leadership had been critical to neighbourhood development and realising the reported improvements in Birmingham.

3.5 Members discussed balancing financial targets with operational performance. The CEO stressed the importance of local decision-making, supported by robust plans and benchmarking data, and advised against framing choices as ‘either/or’. The Interim Director General (DG), Finance reported strong engagement with productivity data and called for better triangulation of activity and commissioning data. Greater use of benchmarking and model system tools was encouraged, citing pathway redesign and innovation at UHB as examples.

4. Winter response (BM/25/46(Pu))

4.1 The National Priority Programme Director for Urgent and Emergency Care (UEC) introduced the report, highlighting the challenging operating context and summarising the development and testing of winter plans, ongoing work on discharge and bed occupancy, and operational response plans during peak pressure periods.

4.2 The Board discussed the 3 priorities for winter, including maintaining category 2 ambulance response times, ensuring effective hospital handovers at the front door, and managing overcrowding and corridor care, which remains unacceptable but may be unavoidable to prevent greater risk to patients awaiting ambulances. The support being provided through regional and national teams, including the Getting It Right First Time Programme, was noted.

4.3 Members expressed concern about the timing of IA during peak winter pressures. While resilience during the strike period will be maintained through consultant cover, the cumulative impact over 2 to 3 weeks, including the Christmas and New Year period, poses significant risk. Discharge acceleration during strikes may lead to steep rises in bed occupancy afterwards. Additional support for frontline leaders is being considered. The CEO stressed the need to balance providing meaningful support without adding burden through excessive calls. Options under consideration include flexing staffing models, increasing use of technology, and accelerating discharge processes. Members agreed that lessons from COVID should inform contingency planning.

4.4 Discharge was identified as the number-one area of concern and opportunity. 3 main issues were noted:

1. Hospital processes: Some improvement has been achieved through process engineering, supported by productivity packs and GIRFT.
2. Interface delays: Significant delays occur in moving patients to domiciliary care or nursing homes, often due to social worker capacity and assessment processes. Trusted assessor and discharge-to-assess models work well where implemented; elsewhere, delays of 4 to 5 days persist. It was noted that length-of-stay stabilisation is also partly driven by increased use of Same Day Emergency Care (SDEC), which should continue to expand.
3. Community capacity: Disconnect remains between NHS and social care perceptions of available capacity. Work is underway to address this.

4.5 A discussion took place on acuity data which suggests around 40% of ED attenders could be treated elsewhere if alternative services were available, and up to 60% of emergency admissions may not be clinically necessary. Members emphasised the need to redesign care models to provide alternatives and reduce inappropriate attendances. The Board noted that approximately £0.5 billion is spent annually on accident and emergency attendances with no significant treatment.

4.6 The Strategic Adviser reported strong local engagement and national support through campaigns such as “24 Hours Not in A&E”. Members agreed to intensify messaging to discourage inappropriate ED attendance and promote alternatives such as 111 and GP same-day appointments. The Board discussed sharing the scale of the issue with the public to influence behaviour during winter and industrial action.

4.7 On flu vaccination, uptake is higher than last year but has plateaued. Members requested further work with the UK Health Security Agency to reinforce messaging on vaccine effectiveness to reduce severe illness and hospitalisation, counter misinformation, and encourage uptake among the public and NHS staff.

ACTION: RC

4.8 The Board agreed to monitor 3 critical indicators through regular reporting:

1. Percentage of ED attendances that could be treated elsewhere (currently approximately 40%).
2. Percentage of emergency admissions that may be avoidable (up to 60%).
3. Excess length of stay (currently averaging 0.9 days per admission).

ACTION: SJM, DP

5. Risk Management (BM/25/44(Pu))

5.1 The Director of Corporate Governance introduced the update on the strategic and operational risk registers. The following changes and developments were noted:

1. The quality of care risk score has decreased slightly, reflecting progress on mitigations including development of the National Quality Board, integration of quality and safety into model ICB and regional frameworks, and improvements to internal quality governance structures.
2. Each top risk is now mapped to a board committee with a scheduled deep dive in the coming year to examine causes, impacts, mitigating actions, and trajectories for reducing risk scores.
3. Work continues with DHSC on aligning risk management approaches. A joint audit committee session will be held on 12 December to agree ambitions and explore integration of common risks across registers to avoid duplication and reduce burden.

5.2 Members queried why target scores for 3 risks remain at 20 (red rated). It was noted that some risks are partly outside NS England’s control, limiting mitigation through internal actions. The Board requested a review with risk owners to identify additional measures, clarify what is within NHS England’s control, and report back on steps needed to bring these risks to amber.

ACTION: JL

RESOLVED:

5.3 The Board resolved to approve the Strategic and Operational Risk Registers, subject to the further work requested around target scores and mitigations.

6. Performance and delivery update (BM/25/45(Pu))

Integrated performance report

6.1 The Deputy CEO / Interim DG, Performance and Delivery presented the latest operational performance. Key improvements were noted, including reductions in adult inpatients with autism or learning disabilities, lower ambulance conveyance to emergency departments, improved cholesterol management for patients with cardiovascular disease, increased referrals to crisis teams within 24 hours, continued reductions in antibiotic prescriptions for children, record scores for ease of contacting GPs with online access marginally overtaking in-person, and improved access to mental health services for children and young people.

6.2 The Board acknowledged areas where performance remained challenged. Cervical screening coverage and MMR vaccine uptake were below target, cancer 62-day referral performance was slightly under target, and the proportion of patients waiting over 52 weeks for community services was higher than planned. 4-hour emergency department performance was marginally behind target and 12-hour waits continued to deteriorate. Waiting times for suspected autism were longer than anticipated. Diabetes indicators were worsening; the Director for Primary Care and Community Services explained that data was reported annually through the Quality and Outcomes Framework and was not yet available. Incentives had been shifted to prioritise secondary prevention of cardiovascular mortality. Further work was requested to break down the impact of individual diabetes and cardiovascular disease interventions, both with and without exceptions, and report back.

ACTION: AD, DP

6.3 Operational pressures remained significant. 4-hour emergency department performance in October was 74.1% and Category 2 ambulance response times remained challenged. Members queried the drivers of deterioration in emergency department performance and asked what would be required to meet targets. It was reported that both metrics were largely static, fluctuating with demand but lacking sustained improvement. Work was underway with the Royal College of Emergency Medicine and the Society for Acute Medicine to codify best practice from high-performing sites, focusing on emergency department processes and supporting services such as same-day emergency care and medical assessment units. Implementation would begin next year following winter pressures, with immediate priority remaining patient safety.

6.4 Elective waiting lists were reviewed. At the end of September, the overall waiting list stood at 7.39 million, a reduction of nearly 16,000, with 61.9% of patients waiting less than 18 weeks against a March 2026 target of 65%. The Board noted that 286,000 patients were seen for urgent suspected cancer referrals in September, equating to approximately 13,500 per day. Performance against the 28-day faster diagnostic standard was around 74%, close to the constitutional target. It was discussed that pickup rates for prostate and breast cancers had not changed significantly, while gastrointestinal cancers had improved due to bowel screening. Lung cancer screening had delivered material improvement in earlier diagnosis, with more Stage 1 and 2 cancers detected. It was confirmed that increased referrals through the 2-week pathway reflected elective delays rather than higher incidence. Work was underway to ensure patients were referred to the correct pathway, noting that approximately 5% of referrals resulted in a cancer diagnosis.

6.5 Members requested that effectiveness and experience metrics be separated in future reports and in the NHS Oversight Framework. Concerns were raised about declining healthy life expectancy post-pandemic, and the Board asked for comparative international data to be included in the next iteration of the report.

ACTION: DP, GB

6.6 It was noted that the Chief Medical Officer reports place the UK mid-range in Europe in relation to health life expectancy, which is below expectations, and this issue would be addressed in the forthcoming Quality Strategy.

6.7 Vaccination uptake was discussed. Members queried variation and its drivers. Cultural and demographic factors were significant, particularly in London, and targeted work was underway in specific communities. Members requested further work on this to inform behavioural insights and change to drive improvement, with the outcome to be reported to the Board..

ACTION: AD, RG

Month 6 Financial Position 2025/26          

6.8 The Interim DG, Finance presented the month-6 financial position, reporting a £55 million overspend in non-ringfenced RDEL and a £289 million overspend in systems. The Board noted that the reported overspend was largely driven by costs related to industrial action, withheld deficit support funding, slippage on efficiency plans, and workforce changes that had not materialised as anticipated. It was noted that 6 systems accounted for more than half of the total overspend. Despite these pressures, the position was significantly stronger than the same point last year, when variance was approximately £700 million. At month 6, 22 systems and 68% of providers were delivering their plans, and this trend appeared to continue into month 7.

6.9 On cash, the Interim DG, Finance assured the Board that all providers began the year with sufficient funds to deliver approved plans. Where plans were not met, some providers requested support under strict conditions, including enhanced scrutiny and evidence of corrective action. Accountability for cash management remained a priority, alongside concerns about allocations and the move to fair shares.

6.10 Productivity continued to improve, with agency staffing down 46% and bank spend down 10%, delivering savings of around £1 billion year to date. The Interim DG, Finance confirmed these gains were genuine and expressed confidence in year-end forecasts, noting some back-loaded plans under close review. Consideration was given to the drivers of the improvement given that major 10YHP changes were not yet implemented. Members cited clarity, transparency, and discipline during planning, combined with clinically led change and examples of best practice. Members agreed that learning from these examples was essential.

6.11 The Board also discussed sickness absence, which remains high compared to the private sector and drives agency costs. The ambition is to reduce rates from 5% to 4.1% per annum, equating to 40,000 staff. Initiatives include the Staff Treatment Access service and measures in the 10YWP to improve staff health.

7. Summary of Equality, Diversity and Inclusion in Health and Care Research Pilot Directions 2025 (BM/25/48(Pu))

7.1 The Board noted the Summary of Equality, Diversity and Inclusion in Health and Care Research Pilot Directions 2025.

8. Public Q&A

8.1 The Board received questions from members of the public in advance of the meeting with responses provided by Executive leads.

9. Any other business

9.1 There was no other business.

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