Video of the NHS England Board Meeting – 23 September 2025
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– Good morning, everybody, and welcome to the NHS England Board. We are live streaming this, and
to everyone who’s joined us, members of the public sitting
at the back of the room and people who are watching this online, you are very welcome and
we look forward to a good and constructive discussion this morning. Before we get going, I will
do a quick run round the table and have everybody introduce
themselves, not least, because we have a number of new people we are moving towards. We’ve got a number of new
non-executive directors, but also we are moving towards
a number of interim posts in the new combined structure
that’s across NHS England and Department of Health and Social Care, which was announced last week. And so I think important
for everyone who’s both here and watching online that
you know who everybody is. So Ravi, we’ll start with you. – Hi, I’m Ravi Gurumurthy,
just joined in my day job, I’m the chief executive of Nesta. – Good morning, everyone.
My name is Tom Cahill. I’m the National Director
of Learning Disability and Autism here at NHSE. – Good morning, everyone. Chris Gormley, Chief
Sustainability Officer NHSE. – Good morning, everyone. Habib Naqvi, Chief Executive of the NHS
Race and Health Observatory. – Good morning. Dianne Addei, Director of Healthcare
Inequalities Improvement. – [Tom] Tom Kibasi, Executive
Director of Strategy. – Glen Burley, Financial Reset
and Accountability Director. – Mark Bailie, non-executive chair of Digital, Data and Technology Committee. – Claire Fuller, National
Medical Director, and I’m the National
Priority Programme Director for Neighbourhood. – Morning, everybody. I’m Louise Ansari, one of the
new non-executive directors and also the Chief Executive
of Healthwatch England. – Good morning, everyone. I’m David Probert, Deputy Chief Executive. – Morning, everyone. I’m Rob
Checketts, Strategic Adviser. I’m in charge of the comms
and engagement in NHS England. – Good morning. Paul Corrigan,
new non-exec director. – Duncan Burton, Chief Nursing Officer, and interim national priority
director for maternity, women’s health, and
children and young people. – [Andrew] Andrew Morris, deputy chair. – [Penny] Penny Dash, chair NHS England. – [Jim] Jim Mackey, chief exec. – [Elizabeth] Morning.
Elizabeth O’Mahony, CFO. – Jeremy Townsend, I chair the Audit and
Risk Assurance Committee. – Morning, everyone. I’m Ming Tang, I’m the Interim Chief Digital
and Information Officer. – Morning. David Bennett,
new non-executive. – Morning, everybody. I’m Sarah-Jane Marsh, national director of
urgent and emergency care and operations. – Sam Everington, a NED and
a GP in the East London. – Good morning. Meghana Pandit,
National Medical Director. – Robert Lechler, I’m an old NED. I’m the chair of the Quality
Committee of NHS England. – Mark Cubbon, I will be the National
Priority Programme Director for Planned Care. – Morning. Suresh Viswanathan, associate NED, and also on the digital,
data, and tech committee. – Hello, I’m Jo Lenaghan,
Interim Chief Workforce Officer. – Morning, everyone. I’m Carolyn May. I’m Director of Leadership, Talent and Management Development. – Good morning, everybody. Lindsey Hughes, Director
of Research NHS England. – Good morning, everybody. Alex Churchill, deputy director for
policy for Clinical Trials from Department of Health and Social Care. – Okay, thank you, everybody. And I will obviously have to be on my toes with so many people around
the table to keep us to time. Just before we start, we’ve
got apologies from Amanda Doyle who leads for primary care, and Vin Diwakar who
leads on transformation. And I would like to say that Suresh, who is our associate NED, this
is his last board meeting, and I’d like to say big thank you for all that you have contributed to this. We do have a declarations of interest and the register is
published on the website, and I would ask whether
anybody has anything which isn’t on the website that they would like to declare today. Okay, thank you very much. So I’ll get us into the agenda. First substantive item is the minutes from the last board meeting. Does anybody have any
comments on those? No. Okay, so we’ll take those
as an accurate recording of the last meeting. We’ll come on to some updates
from board committees. We haven’t had as many of
those just to be very clear. We are, because we’ve
got a number of new NEDs, we are moving into the
new committee structure and hopefully at our next board meeting, we’ll have more updates
from the various committees. But we do have an update on
audit and risk from Jeremy. – Thank you, Penny. Just
quickly, we met last week. We are making good progress
on our risk register and mitigations and increasingly
working with the department to bring the risk register together and the same with the internal audit plan. We’ve got an update from
the internal auditors, but also on how they’re working together with the DH internal audit team
to bring the plans together. We took an update from Gus Williamson on the Primary Care
Support services systems, identified a number of risks, and a paper on that topic is
going to come to the executive to give it a bit more profile
and make sure we’ve got a plan for transition over the
next two, three years. Really good progress from the
executive on open audit items. It’s a bit of a canary in the coal mine in terms of the overall culture. More to do there, and again, an issue for the executive to look at, I think is to how the, particularly the priority
ones can be resolved. Good progress from the team
on getting the accounts out. It’s quite a challenging situation and the audit recurrence have changed, but good progress on the
NHS England accounts, and they should be coming before
the board in early October, and the provider accounts
hopefully shortly thereafter. And then finally we are about to move on to a new accounting system. It’s going to affect
the whole system, ISFE2. We’re all holding hands together and hoping it all goes well, but I think the team has done
a really good risk assessment, contingency planning,
communication intersystem, and well done to really
be involved in that. It is a mammoth effort. I think most of the team are in Leeds now, trying to make sure it goes okay. So, well done to Elizabeth,
Vicky and the team for that. – Okay, thank you. Any questions, Paul? – I was at the committee and
when we get the risk register, I’d just really like to
draw everyone’s attention to what was one of the main risks and the mitigation for that risk. One of the main risks is
we’re too slow in bringing about the change and so I
think one of the things we need to keep in mind is whether
we are making that slower or quicker because if
we’re making it slower, we make the risk greater. So the mitigation that we’ll
be looking at through all of our activities is are we
up for the pace of change? – So can I suggest that we come back to that when we discuss
the 10-year plan update? ‘Cause I think that’s the moment at which we should really be scrutinising. Are we doing enough? Are
we going quickly enough? But is your question, Paul,
also to Jeremy and Elizabeth, about are we capturing the
risk of that accurately? – I think we were in the
committee, in the risk committee. It’s just that when you come out of that, I think the conversation we had is that most people’s
experience of risk is change. And when we say the biggest
risk is not changing, that for a lot of people is
counterintuitive because, and it’s true, actually
it’s true at the moment. The risk for the National Health Service is not changing fast enough. I think most people experience
risk as changing too fast. – I think the point you made
in the meeting was the risk is that in the system
in hospitals and GPs, the risk that we’re planning to take will be seen as being risky. And so we just need to be
careful as to how we communicate, how we get the message across, and how we deal with that
potential barrier to change as we’re trying to deliver
what we’re trying to deliver. – Absolutely. So key point, and let’s say keep hold
of that for when we come onto talking about it. Elizabeth. – Yeah, Penny. Just to echo something that’s just been said really
and this ISFE2 systems. So it’s a new globally system
for finance and accounting, and it’s just a thank you actually to all of the financial control
teams out in the wider NHS because it’s 42 ICBs, it’s HSSIB, it’s all the CSUs and it’s NHS England, it’s been a couple of years in the making, and yesterday we made the decision that we were ready to proceed with a go live date effectively
of the 1st of October. So it’s a huge amount of
work and a lot of people work in long, long hours and over weekends. So again, to those financial control teams that are finishing accounts
and they’re moving quickly into this work, just a massive thank you, ’cause some of them are part
of a change process as well. – Okay, thank you. And
yes, we would echo that. Okay, so that’s quite a
nice then link into update from the digital and data committee, digital, data, and technology committee. And Mark, perhaps you
might like to also reflect on the point that Paul’s raised, ’cause this is one of the areas where sometimes we look
at the risks associated with adopting new technology,
but we don’t look at the risks associated with not adopting it, so. – Of course, Penny. So the DDAT met yesterday, some really good progress in some areas. So progress on cybersecurity
across NHS England and the resilience plan that
the board’s been pushing on for 18 months is good. There’s clearly quite a
lot more work to be done in the system and in
particular in the supply chain, which I think will continue from here. I think the team working on the single patient record
should be congratulated. Three options are now in
proof of concept build. So no longer in PowerPoint, but
actually in practising code. I think that brings home we need to start doing a lot more work on the engagement plan that goes with it, ’cause to your point about
things that need to be adopted and will be changing for the whole system, the single patient record is
a massive vehicle for change and needs to be delivered. The NHS app look continues to
go from strength to strength. If you look at the adoption,
unique users, monthly logins, it’s probably, and I need to check this, the most used app in the country. There is absolutely clear use
cases for managing access, managing treatment paths,
and also driving prevention. I think the key task at the moment is to select a small group
of really high impact cases where we’ve got clear
clinical sponsorship, which is something I’ll come back to, which can deliver both
improvements to patients and productivity. And I think that list is there. I think we just need to
get to the shorter list and start executing. The operating model
work for the combination of the department, and
then HSE is going well, and I think we’ll have
a substantive proposal by the next meeting. I think if there’s one theme and it comes back to what Paul said, consistently there seems
to be a lack of sort of operational ownership and vision driving the
technology team harder. And what I think that’s
causing is us slowing down. And I think if you look at the need both to reduce waiting lists to
improve performance in UEC, access to general practise,
improving prevention, technology is the answer, and we need to drive
the adoption much faster and the risk of not
adopting it is we continue in the position we’re in today. – Okay. Before we take questions, Ming,
anything you’d like to add? – No, we had quite a long debate yesterday on how can we align better and work better in the matrix form between
the technology teams and you know, the clinicians
and also the ops teams, which we are starting to do. We’ve had some really good
engagement and workshops, but it’s a starting of the
journey rather than the finish. – Yeah. And on the single patient record. So, good to hear that progress,
Mark. What’s your sense? I mean, neither of you,
when will we have it? – Which day? – [Penny] I’m happy to go
with a quarter of a year. – We should have a prototype
ready for review kind of end of the year, end
of this calendar year. – [Penny] Okay. – For adoption and further
development to be honest, ’cause we will then have down selected to hopefully one pattern
that we want to deliver. We are not really going through
this as a, we will buy this. What we are really looking
at is what’s the concept we’re trying to achieve
and what’s the modularity, how much of it have we already got? What do we actually add to? And then how do we accelerate the change? So in all this work,
as Mark said, you know, we want to find the really great
use cases that we can drive through and make sure that
it does all those things ’cause we’re going to
iterate this over time. It’s not going to be
one, you know, quick bang and it’s done. – Okay. All right, thank you. So I’ve got Robert, I’ve got Louise. So we’ll take, and Suresh, I’ll take all three questions first, and then come back to Mark’s comment. – So it’s more of a
comment than a question, but I think as Mark said, I
think the progress is terrific. The point of these technologies is to enable pathway redesign
and productivity gain. And I think the conclusion we came to, is that a great opportunity
to build these technologies, for example, single patient
record into pathways is the modern service framework work. So that’s where you begin to see how you can re-engineer a pathway, a whole pathway using these technologies. – Yeah, we might come back to that, and talk about partly
modern service frameworks, but also all clinical pathway redesign. Suresh. – I just wanted to add that
really productive session. My observation is that there is a lot of measurement technology that’s built outside of the NHS
watches, wearables, rings, pick your favourite. I think our vision should
be bolder and braver to encompass what’s happening
in the outside world and bring it back in, especially as we are
focusing on prevention. – [Penny] Okay. Louise. – Yes, thank you. So it does absolutely seem
like fantastic progress and we know that people really on the whole welcome using the app. Can you tell us more about how
you’ve involved service users in the development of it? – Okay, so, go on,
Sarah-Jane, do you want to go? – Just to, totally, ’cause we’ve had a really
productive meeting, didn’t we? Mark, Ming, and I, about
what we might do on UEC here. I do think we need to
acknowledge that for many of us, we don’t really know
the art of the possible. So if we are waiting for
the, I know we’re not, but if we were to wait for
the vision to just come from current operational
and clinical leaders, I’m not sure it’s there. It’s got to be the meeting
of the genesis of the art of the possible with the tech teams to really drive ourselves forward, ’cause I think a lot of us
start to invent or start to work on what was last year’s technology, not the technology for
three to five years. So we need pushing on, so
we’re all up for the challenge, but I don’t think it’s as simple as we just have a clear
vision and then off we go, and try to implement it. We need to be really pushed
I think by the tech people in terms of what will be
possible in a few years time. – Okay, so I’ll try and
weave all these together. So there’s essentially
some ways similar question about how do we really get
tech embedded into all services and do that both in a push and a pull. So we’re not waiting as
your point, Sarah-Jane, for staff to say, it’s about how do we say
these are good ideas, let’s start trying them. How do we really, Robert’s point, adopt that into all of our care pathways, whether the modern service
frameworks or role, or the care pathway designs,
how do we involve users as we’re developing different products? And then how do we open up the app which was part of the 10-year
plan to be able to, for people to put in their own data from
wearables and other devices? Ming, or you can ask it for Mark. – So I think we should pick up, let’s deal with the user input, ’cause I think the app team are
one of the prime example of- – So we actually have a
bank of about 25,000 people that we test the
functionality of the app with, and that’s done on a regular
basis just as routine. Every kind of feature that
they change is actually tested with that bank of users. So it’s quite a lot of engagement. And then there’s local engagement as well. – And then on the sponsorship, I think in all periods of change, you get these slight dislocations. I think Sarah-Jane’s point
about the meeting with UEC, what the technology can do,
what the vision for UEC is, I think we need to mirror that. I think similar work’s been
done on outpatients and cancer. We need to do the same
thing on primary care, but pulling the business
closer to technology and technology closer to the business and actually creating
this after the possible and some pace I think is the key. And it’s, I think collectively
everyone on the committee, this is no longer a technology challenge, this is a business change challenge. The tech can be done, the progress made on single patient record in six months has basically
proved we can do this. It’s now a question of execution. – Okay, I think we might
need to come back to this ’cause I think there is a bit
about how do we help the ante on it or what’s the
best way of doing that. So maybe we take that offline, have a think about how to do that, take some specific things. And then wearables into the app. – There are some experimentation
already being done on wearables. I think again the standards
are there, you know, we just need to decide
where we integrate it. Is it with a single patient
record? Is it into the app? And then how do we hold that
data and how do we curate it? So it is not, the technology’s there, it’s the usage of that, and how we want to use that
to change pathways really. – Okay. All right, good. To your bit, Louise. We should have a board meeting
up in Leeds sometime soon to make that happen. And there’s a whole team there of people who do some really cool stuff
with tech and you can go and try it yourself and really
interesting particularly about looking at people who
find it harder to use tech. So we could go on a board visit
and actually test out some of the stuff that they’re
doing live, a good thing to do. Alright, good. Let’s
move on to performance. So we have a very detailed
performance report. This remains working. Oh
sorry, I jumped over Jim. – That’s fine. You honestly skip past it. – Sorry, Jim, your update first. Thanks, David. – Just very briefly then. So September’s always,
it feels very chaotic. It’s always very busy
in the national system. We’ve had a busy couple of weeks in terms of public accountability,
public accounts committee, health select committee, stock takes with the prime minister, various other things which
were all sort of scheduled, but an important point of
the year when we’re starting to think about how we’ll land this year, how do we complete this year
as well as we should do, how do we navigate the
tricky winter, et cetera. They’ve crystallised a few
things for us to really focus on, which we’re working on
over summer as well, which, and we’ll touch on it in a second. Lots of progress in our operating model and we’ve appointed chairs of cluster, ICBs, chief execs soon
to be announced as well. We do have a tension in all of this about the voluntary redundancy scheme, which has been well-publicized and in a pretty long awkward conversation with treasury colleagues about it all, just trying to unlock that. And at some point in
the next couple of weeks if we’ve not managed to land that, we’ll have to work through a plan B option to allow our ICB colleagues to move on, and similarly within NHS in NHS England, but a lot of really good work there. Also, the work led by Glen and colleagues on the oversight framework, I
think it’s really taken shape. It’s that and the weekly
tables that are sent out, et cetera, common discussion
points now in the service, absolutely not fixed yet, so still a lot of refinement
to do, but fantastic progress. Also through summer, which
we’ll touch on later on, we’ve done a lot of work with
colleagues in the service and across government on
bringing a 10-year plan to life. So what we’re really
trying to do is we’re set out in the letter at the end of last week is get the balance rate
between short term delivery landing this year on our financial and operational imperatives,
but start building the future. Going back to some of the
points raised earlier on, there’s a really difficult
balance we’ve got to strike in all of this between the
being really ambitious, but not making it break. So in the same sentence,
we can talk to colleagues who want more change, more rapid change, but are saturated by the amount of change that’s already going on. And that’s just a live dynamic that we’re all trying
to manage well together. It feels like a long time ago
since we had our last board as well and if you remember
the main dominant issue in that board was industrial action. And I think, you know, I think it’s fair to say the
service led by colleagues here, but right throughout the service did a fantastic job
managing a difficult set of circumstances in really
minimising the amount of disrupted activity. That said, we are a little
bit off track on some of our metrics as a consequence, but really significant
progress over previous rounds in terms of maintenance of activity levels and there are a lot to learn
in that if we do have to go through it again. And then I’ll come back to Mark’s point and challenge on the tech. In those process I’ve described, the publicly accountability
sessions, et cetera, Our work with the service, great chief exec session last Tuesday. There are two standout
things we have to unlock, and technology is a part of the solution. Outpatients is the
thing we have to unlock. We’re just having another go
now about how we get into that, but it is the thing that we
have to find a way forward on, and also how we change our
service model to uncrowd our EDs. So I started the day yesterday with a Society of Acute
Medicine in Manchester, ended the day with
Penny, with the president of the Royal College
of Emergency Medicine. Wherever you talk, whoever you talk to, there’s a lot of tension in
that system and technology, new pathways is probably
a big part of the way out. So I would say if we’re looking for things where there’s a really strong operational and business imperative to
bring technology to life, they are probably the two
things for us to focus on. And then just very finally
I just want to say, we say this all the time
and it’s really true. Last Tuesday session was really fantastic. We are trying to work with the service alongside the service,
keep everybody with us, keep everybody as
motivated as they can be, but realistic about what’s possible. The leadership response right
through it throughout the NHS so far this year has been
absolutely fantastic, and we as a board really
need to try and nurture that, develop that and keep
it going through this, what will be a tricky period. Winter’s always a tricky
period for the NHS. So I’ll stop there, Penny. Happy to take any
questions if there are any. – Great. Questions for Jim? Yeah, stunned everyone.
– Back to David. – Just before that, just
because we’ve got a couple, I think what we say a bit
more, Jim, about, you know, that working with the chief exec community ’cause there are a few things
which really struck me. One is that you are including
GP leaders in that group, which is really crucial, you know, not something that’s
happened historically, but it’s obviously a really important part of the healthcare system. And the second bit is that you
are asking amongst that group of the leadership group
essentially of the NHS to work with colleagues here to develop proposals, whether it’s for neighbourhood healthcare, whether it’s for outpatient
redesign, and so on. So just say a bit more about that. – So I’ll bring Glen in a second as well, who’s led a lot of this,
the stream work over summer. But we are absolutely
trying to work together alongside each other rather
than in a hierarchical ways, partly recognition. You can’t run everything centrally, this kind of size of
organisation or system. And colleagues have really
stepped up with that. So whether that’s
10-year plan work streams and bringing IHOs to life,
neighbourhood care to life, you know, et cetera, et cetera. We are also getting a lot of people come forward
all the time with ideas, suggestions about other
operational issues. So wherever that happens, we’re just trying to
go where the energy is, and keep people involved and, you know, there’s some practising chief
execs in the room as well. It minimises the risk then of us, thinking we’re solving problem A, it’s actually problem B,
or they find a solution. When you see it on the other side, it actually doesn’t fix the problem. Partly recognition of,
it’s just very complicated. There’s an awful lot of
complexity out there, but that’s really worked. I started the day with a
conversation with a chief exec who told me quite clearly, we’re not going fast enough
when IHOs, which is good, you know, so there’s good
healthy challenge out there and we’ve opened up an awful
lot of channels for all of us to have those conversations. – Okay, and well, just one thing, we’re holding this in the public, IHO is Integrated
Healthcare Organisations. – Yeah. – Concept of saying that a single provider could provide a broader range of services across the acute spectrum,
including primary care, community care. – Yeah, and taking whole population risk for that population.
– Yeah. – Glen. – I’m still practising
as a chief exec after… – [Jim] You’re getting better though. – Every day in every way. The engagement has been great actually. And so we basically,
anyone who put their hands up at the previous chief exec session, we brought them in and it was great to have the GP leaders there too. And then also I don’t think we’re turning down any other option to engage. So mental health chief execs
forum last week, et cetera. So everyone’s really enthusiastic. They also like the fact
that we are going to them with a rough set of principles that they are enhancing and adding to. It’s not us giving an answer and engaging. It’s about them co-producing it, and they really welcome
that and that will continue. – Great. Rob. – Thank you, chair. I think the leadership being shown by the chief executive
community now replicated in the other professions, it’s really starting to create a coherence across the service. So Elizabeth, I think you
brought the FDs together for the first time in over six years. We’ve got the chief operating
officers coming together in October. We’re doing the same with the
communications professionals so that coherence that’s
been driven centrally by the chief exec community,
the GP leadership, it’s kind of echoing in each of the different professional areas. And that’s I think creating
much more ambition out there in the service instead
of waiting for a policy or a strategy to tell us
how we need to do something. You’ve got a lot of folks coming forward with really innovative ideas that perhaps we haven’t thought of that, then start to lead the way
in terms of what we’re doing. So it has a multiplier effect across the whole leadership community. – Great, good. Right,
let’s go on to performance. So there’s a lot in here. I think, presume everyone has read it. – [David] 86 pages, we
can take you through. – No, thank you. And I know we’ve got
quite a lot of questions and comments so, but do you
want to do a quick intro? – Yeah, thank you very much, chair, and thank you colleagues
who have helped develop this performance report,
colleagues around the table, many of whom we’ve interacted with. So just a brief reminder and
then I’ll just perhaps touch on some of the areas
of improved performance and some of the areas that perhaps a little bit more challenged, noting as always that my
colleagues around the table are the real experts
in each of these areas in delivering some of these key metrics. So first and foremost, we have adapted the structure
to focus on six key areas, improving health, reducing inequalities, effectiveness and experience
of care, patient safety, people and workforce, all
of the access targets. And finally, finance and productivity. And you’ll see different to the
last time we met as a board, we focus particularly
with board advice on areas such as primary care,
maternity, community, cardiovascular, diabetes, and prevention. So there are, and we’ll
see in the next item, but we can perhaps gather it in the same where there are areas we
can look to improve on, and develop these metrics
and we are keen to, but noting as I just said,
there rather flippantly, we’re at kind of 86 pages. So the key thing is how do you adapt it? How do you make sure
it feels real and live, and we don’t swamp people with paper? The other thing the team are doing, and a big thank you to
the performance team, have worked really hard to
pull this together is seeing how we could use statistical
process control a bit better so we can really look at
themes and trends in a way that perhaps this report
doesn’t necessarily pull out at this stage. So if I could just take
you through a couple of areas particular of highlight in terms of improved performance, noting that most of the data
here completes the end of June and in some cases where we
have complete lockdown data, we have it in July as well. So breast cancer screening
obviously an important part of our overall objective is returning back to much higher levels from the pandemic. The number of inpatients who are autistic or having learning disability is reducing, which is something we will
pick up I’m sure later on, but has been a big area of focus. There are a number of key
metrics around general practise with which the service
should be very proud. Firstly, access to first appointment, which continues to improve. Secondly, the percentage of patients who are describing booking
their appointments as easier or easy up to nearly 75%, which is a record in terms of the levels of performance we have. In urgent and emergency care, which I’m sure Sarah-Jane
will pick up later on. We’ve seen improvement continuing
in cat two response times, which we know is really
relevant particularly as we enter the darker and colder months. And finally in areas like
children and young people, particularly with focus
on mental health services, we are seeing a much increased improvement with regards to access. Community mental health more generally, the access rate as well
continues to improve, which I think matches the
commissioning intentions and the good work that many
providers have put in place. So there’s a lot more that
we should be very proud of, and we should congratulate our
colleagues out in the service who are working really
hard in all of these areas. There are, however a number of areas where performance remains challenging and these remain our priorities of focus. I’m sure Mark will pick up
particular areas of elective and cancer should we raise, but actually some really
good areas of improvement in many of those particular areas. But the percentage of
patients waiting over a year for community services is
something we have focused substantially on of late
because that isn’t going in the right direction at the moment. This is an area of priority and in the early data that we
started to see most recently, this is starting to change and improve again with the
way we commission work, but this is an area of
significant concern. The percentage of patients waiting with suspected autism over
13-week continues to be an area of concern and running the
regional performance reviews, this is an issue in almost every region and is a significant
area of priority for us. Cervical screening again
continues not significantly, but is not perhaps making
a stead way forward that one would hope. Percentage of mental health beds that are out of area continue
to concern all of us, particularly those of us
looking after hospitals where we know we’re not
able to offer the type of care we would always want to, to colleagues with mental health, and that includes mental health trust where length of stays over
60 days are continuing to not decrease at the
rate that we would like to. So this is the latest
set of operational data. What we are aiming to do,
chair, as I mentioned earlier, is refine this so we can
get better trend analysis. You’ll see at the end of each of the pack, there are further areas
we can look to include, and welcome colleagues’ views
on that either at this meeting or happy to take comments
outside of this meeting. We’re also thinking about how we deep dive on each of the performance reports. So not at length and we may
do this through subcommittee, but for example, we know that the work that Duncan is leading in
maternity has a performance impact on every region and every system. Is that an area we would
like to deep dive on? Sepsis is an area where we’re
continuing to focus energy and actually seeing some
really impressive areas of performance. Is that an area to deep dive on? So those would be perhaps
the questions are then with, chair, but happy to take questions as I know my colleagues would be as well. – Okay, great. And thank you, Dave. And I know we’ll have lots of questions. I might just kick off with a couple, but if you keep a note, I’ll keep a note, and then we’ll go round. I mean I think you didn’t
emphasise in the sort of areas for improvement overall
health and page seven for me is actually probably
a really important page which is declining number of
years lived in good health, really worrying to see that
we know it’s happening, but it’s just worrying
to see it that starkly and that feels to me like that’s a metric that we should be, I know that we’re not going
to see it change week on week, but we need to continue to look at that. And then, you know, as you pointed out some of
the other things in there, cervical cancer screening is
not where we want it to be. Immunizations, MMR is
not where it needs to be to support population health. And indeed across all of these metrics, we know that we have
considerable variation, and we’ll come on and talk
about inequalities later. Exactly as you say, we should have a big
focus on maternity care. We’ve got a lot of really good data there and I think really helpful that we bring that a bit more into the
public domain to do so. So those are the ones from me, but I know colleagues have got others that they’d like to raise. So I’ve got Ravi, I’ve got
Louise, I’ve got Duncan, I’ve got Andrew, I’ll
take those four first. Ravi. – [Ravi] So a couple of points. Firstly, just picking up on your points about the average conceals variation. – [Penny] Yeah. – I think it’d be incredibly
helpful for all of these to show the dispersion about the mean so we can integrate the
inequalities conversation with this performance conversation, and also just ask ourselves
what can we systematically learn from the top decile
performance and, you know, are we on the bottom
decile and is it moving, are they consistently staying the same? And just on the primary care access, figure that you mentioned,
it’s on page 73, it’s a really interesting
progress from like 60% in August 24 to 74% now and
having plateaued for a while, it’s now seemingly trending up. I just want to know what had driven that, and how high can we go, you know, what are the top performers doing, but also is that showing
any impact in terms of reduced pressure on
hospital admissions, et cetera, A&E, or is there no correlation
between this improvement and pressure on the system elsewhere? – [Penny] Okay, let’s keep going round, but can we come back on some of that? Louise. – Yes, so thank you, David. And I found the slides and the
data really easy to digest, so thank you very much
for the team for that. Building on Penny’s point
about healthy life expectancy, in the population health
section, I was sort of looking for a sort of underlying
population outcomes framework which we’re asking ICBs
to commission on the basis of do we have an understanding nationally of where we want health to be effectively. So, and then I had questions
about nearly every slide, but I’m sure, happy to check, your point about deep dive is really good. I mean things like cervical cancer, where are we on self-testing? You know, almost every slide. But when I thought, there
were emissions on experience, I thought the maternity slide and experience was really good actually. But then there are lots
of areas of experience that aren’t here about
smoothness, efficient referrals about experience with the
complaint system about, you know, being supported by waiting
about accessible information. So I wonder if the quality
committee could potentially start to think about other metrics of experience that could be included in that section. – Thanks. – So keep going around
and collect questions, but I think on that point, Louise, about wanting to go into a lot of it, what we need to do is think
through which bits do we cover at which subcommittees, and how do we quite
systematically make sure that we bring some of those
deep dives as it were areas of focus to the board
meetings over a year, ’cause we won’t be able
to cover everything. – Yeah. – Duncan? – Yeah, thanks, Penny. I
guess just a couple of points. One being about children and
just recognising about 24% of our population are children, how we look at this through the lens of the needs of children
across our different measures. So I guess an ask on that. On maternity, I think absolutely right, we’re doing some work
with trusts at the moment, looking at what measures
we’re expecting boards to look at for maternity. So I think it’s really important
that we mirror that here so we could perhaps bring that
back at a future deep dive. And then I guess with the shift
from hospital to community, just really thinking through,
we’ve got enough visibility on some of our quality measures
within community services. So for example, you know,
leg ulcer healing rates, you know, under 12 weeks for
example might be a good way of putting some visibility on that, and links into some of the conversations we’re going to be having
today about greener and cost savings, et cetera as well. And then I know we’ve got the team talking about inequalities, but there is something about
kind of how do we structure and perhaps it’s for the deep dives, a rhythm of looking at inequalities through multiple different
lenses, ethnicity, women’s health, men’s health for example. – So, and geographical.
– [Duncan] Yeah. – Declaration. Absolutely. And I’d add to your list,
mental health as well. We don’t have enough data. Andrew. – So just to echo the
points around maternity, I think this board should see
the maternity performance data by system at least once a
quarter given, you know, all of the kind of media coverage and interest that board members
have had in this service. My main point was around
four hours, can’t, so, you know, we’re at a kind of
pivot point in the sense that, you know, we’ll be getting
ready for preparation for winter and we’re slightly behind
the curve at the moment. So what do you think
the causes are in terms of the fact that we’re not quite there in terms of meeting our trajectory and going into the next six months? How can we help organisations deliver? I mean it may be a separate topic area, but I think it’s really important that we keep a tab on
this ’cause, you know, every day there’s a million
people touch general practise, but there’s also, you know,
a big slice of our local, national population that go
into the emergency departments. And normally at this time of year, we do have that conversation around prep for the next six months. – Okay, so, ’cause I think we
may have some more questions just to make this a bit manageable. I think all the questions about where we know we need
more data and better data and how we do deep dive, let’s take that offline and
we’ll come back and manage that. I think two specifics,
if you could focus on, or ask a friend, primary care access, why has it got better and
how do we continue that? Has it really got better, maybe as well? And how do we continue that trajectory and then four hour performance. And then I’ll take more questions. – Thanks very much, Penny. So I will ask a friend on the first one and that friend is Claire. – Thanks very much. So Ravi,
thank you for the question. The reason why GP access
has improved so much is we had a plan and
we’ve delivered the plan, would be the short answer. So three things. So one, we invested in
cloud-based telephony, so we’ve moved all of, well, practically all of our GP surgeries over onto cloud-based telephony, which means then we can, if people phone, we can
then call them back. We know how many people are waiting, we’ve got better data to look at, around call answering times. Number two, we’ve changed
the operating model. So for people that have
been struggling with access, they’ve been supported through
the GP improvement plan and moving over to
modern general practise, which is about how you deal
with all the calls coming in, and you triage to identify greater need on the days you can see the
people that need to be seen. And then thirdly, it’s
the use of technology. So we’ve increased the
amount of online access, but also the use of the app. So the increase in the number
of people that are accessing and ordering their repeat
prescriptions via the app takes a lot of traffic out of calls coming to general practise. And then on your second point about has this made any difference, what we’ve found from
the PCN test site pilots is actually for those practises
that have got their access under control and by access under control, I mean that they’re answering
their call within one or within two minutes
consistently across the day, including at 8:00 AM, and that they can offer
on the day appointments of those people that need it. When they’ve done that, they
then have got the head space and the capacity to start to properly deal with the proactive care and start to look after their complex patients
and start to look after, and increase their management
of long-term conditions. And where they’ve done that, you can start to see the impact. Our problem is, and we’ll talk
about this this afternoon, but our problem is that we’ve
got that in small pockets and what we’ve got to do is scale it. – Thank you. And the PCN work
is primary care networks. – [Claire] Sorry. Thank you, Penny. – Where Claire and
colleagues have been working with a number of those to
look at what are they doing that’s working well and where
could that be learned from, and taken more widely. Four hours. – Yeah, thanks, Andrew. So I think just to break
it into the two parts, we’ve got the what can we do to try and make a step change
improvement in four hours and then we’ve got the
link to what that tells us about winter preparation, given that we know in mid-September, so I think on four hours
as you’ve just said, essentially the word is stuck so the performance is pretty consistent, but consistently not where it needs to be. The NHS’s own trajectories
were showing an improvement over the summer period, which
essentially hasn’t happened. So it does feel like we’re in that place. In terms of things that we
are doing about that now, there’s some real stuff
just around consistency. So we know that the departments that do well stream away from
the front door into the UTCs, they use their UTC capacity consistently and it’s open, you know,
longer and extended hours. So we’ve got a focus look at that. We’ve still got people with UTCs that are letting UTC type patients through into the emergency department. And then in terms of the pathways within, although we’ve had a lot of
focus on admitted, again, we are quite stuck. We’ve done a big piece of work
on what the first 72 hours of care should look like
and the standards in terms of the clinical input into pathways. But the non-admitted group
we know is also a big driver of the four-hour performance. And there we’ve got real
lack of consistency in terms of the way that people have
developed services inside. So people who’ve got, the way
people are using their SDECs, their CDUs, the pathways. – [Penny] Sarah-Jane.
– And the way things- – [Penny] Explain what all
those things are, SDEC. – So once you go through an
emergency department door and someone said go, you know, this is, it is not consistent at all. You wouldn’t expect the
consistent obviously to be laid out the same hospitals look different, but I think as a member of the public, you could reasonably
expect that, you know, the services there would be quite similar, that if you are in this kind of area, a same day emergency care, you get this type of treatment,
it’s counted in that way or if you’re in a clinical decision unit, it’s this part of treatment
that gets counted that way. It is all, so what we’re trying to do is just bring back some
of those data definitions, standards and methods that we know work. The more departments we
go and look close up to, the more exactly the same
care is being counted very, very differently. So we need to get back into all of these, I’m going to call them basics,
but we know the basics. Things are often hard. And then just to complete the picture, some of it is technical, but
some of it is hearts and minds, I think, because there’s
so much complexity, Jim said the departments are overcrowded, big focus on corridor care. I think there’s a sense
that it’s become impossible and actually it isn’t
if we get back to some of those basic things that we know works. So there’s a bit of a
technical and a bit of a hearts and minds, but in terms
of prep for winter, that’s also continuing at a huge pace. So since we last met at a board, all the regions have come together, and we’ve had these EPRR
style exercises planning against three scenarios. People have taken their
learning away in terms of what they need to
do to tighten up plans. So there’s no doubt it’s going
to be a challenging period, but I think the preparation that we’ve done this year
has been more extensive, not just in terms of what
people are going to do, but how they’re going to
respond under pressure, what triggers they’re looking for, how they step up and coordinate across. So yeah, two activities
that are connected, but I think we, as Jim
said at the beginning, really we just need to complement how the leadership have stepped up, particularly on the winter preparation ’cause I think we’ve seen
quite a different level of planning and planned response so far. – Okay, so more questions. I’ve got Jeremy, I’ve got
Meghana. Let’s take those two. – Just a quick thought
really, David, for the pack, I think it’s great, but
does risk becoming infinite? And just a thought from the retail world as whether we could digitise
it and make it interactive and have various lenses on
it so that rather than trying to print out everything, if you’re wanting to drill into maternity or look at various performances,
you just click on the link and work it through, put it on an app, it would be much more
accessible, so just a thought. – And a bit more red, amber, green. – [Jeremy] Yeah. – Meghana. – Just wanted to add to
what Sarah-Jane was saying in terms of urgent emergency care, clinical leadership obviously is vital. So in addition to
collaborating well with care before coming into excellent emergency or emergency departments, it’s the internal processes
that matter as well. So there are tools like the
iRefer tool for radiology to reduce unnecessary diagnostics. I think that is being used and
needs to be used even more. Specialist opinion
trying to get specialists in the first 72 hours
of care within hospitals is again crucial so that people are seen and taken to their right destination for the right care in appropriate time. And then lastly, again
coming back to tech. So for discharge to stop
the delays and the pharmacy, take home drugs, et cetera, all of those things have to
be implemented consistently across all the organisations
to sort of make sure that the discharge process isn’t held up, and the focus on all of this
led clinically is something that we are definitely doing. – Okay, so I think let’s come back to probably the next board meeting because otherwise it feels like the same conversation every year. What does our medium term
UEC strategy look like? I know you’ve been doing a
lot of work on that. Robert. – Just a very quick one in winter prep, just an update on the vaccination, how good the vaccine uptake
has been for flu and COVID. – We can bring that, I mean for most organisations,
including my own, that starts on October 1st, but we’ll make sure we bring the details. – The paediatric and
the maternity campaigns have been launched, but the
general population campaign starts on the 1st of October. So, but yeah, I think it is well piled up, and the actions that we committed to each of those have been ticked off, Robert. So the ability to be
able to book appointments and all those kind of
things, we’ve really done, taken the learning from
last year on those, so, but we’ll start to feed the figures through on a weekly basis
from the beginning of October. – Okay, last comment from Rob, and then we’re going to finance. – And just linked onto that vaccination, there’s been a huge response
and energy from the service in terms of staff vaccinations
at a couple of sessions with a 250 attendees on each from comms and the clinical community. So I think there’s a real energy to try to do even better than- – Back to the future Rob- – Yeah, exactly. Even better than what’s
set out in the UEC strategy in terms of our, and if we
can get it right for staff, that’s going to help us I think in terms of getting it right for patients as well. – Thank you. Elizabeth. – Yeah, thank you. So moving on to the money then, financial performance update,
it’s at a quite high level, but currently the paper covers
both revenue and capital. It highlights the main
risks as we move forward, and some of the forward actions, and I think David and I will
also cover what we intend to do during the mid-year review. But first and foremost, I’d just like to thank
the service actually ’cause the level of grip that we’ve seen that people have actually continues to show up in the numbers. So the NHS at month
four is broadly on plan. We are currently reporting
a 57 million pound overspend in aggregate, which is about 0.1% of the
year to date allocation, which is a significant improvement
on this time last year, which was close to 500 million. Key drivers. The pressure points that
I talked about last month, they remain unchanged. So we see in missed efficiency
targets and rising workforce and pay costs, also in the
month four numbers will be some of the costs of the five
days of industrial action that took place in July. We know this has had a measurable impact, but many providers have
reported back to us that they’ve covered these
increased costs in their plans and we have ensured that
there are two systems which haven’t received their
deficit support funding as at month four, but that
deficit support funding is included in the aggregate numbers. You’ll also see from the
report, there are six systems that account for half
of the overall overspend and 16 systems and 44% of
providers are currently on plan, and the full detail is within the pack. We continue to forecast that at the end of this financial year,
we will deliver the plan that was signed off earlier in the year by all of the boards out
there in the systems. And we are making sure that
the cash flows appropriately to keep the business running. We have tightened the cash rules, but we are being very pragmatic and working through that very
closely with individuals, CFOs, and boards. Having said this and at
the leadership event, we talked about this, we do know the plans are
back loaded not to the degree that it has been in previous years, but even so and therefore we
are asking people to be very, very focused for the
residual months of this year and into the second half of the year. This midpoint is going
to be absolutely crucial. So the conversations we are
having around boards needing to be clear and not take comfort
from year to date variances to really look at run rate spend, and what’s driving their
financial performance. And we’ve also signalled at the event that we are going to do
a mid-year review process that we’ll talk about shortly. And that is very much
focused on not looking back, but making sure that boards
have got credible plans to deliver not just on finance, but across the board for
the remainder of this year. We have talked quite extensively
to the CFO communities that are signalling, you know, how challenges looking for
the remainder of the year about risks and the opportunity
to mitigate some of those through detailed recovery plans and some of those recovery
plans are in motion. And also at month six, we have signalled that we’re going to do something
called a true-up exercise. Now this is mainly because
we have got a scenario where anecdotally we were hearing that people were stopping some
of their elective recovery because of finance. So we’ve gone back to have a
look at the reality of that, and what we are actually
seeing is a very mixed picture. So we are seeing that some
providers absolutely seem to be constraining in activity
as a consequence of finance and there we are going back to make sure ICBs have
commissioned the appropriate level of activity to deliver the standards. Conversely, we’re also
seeing that some providers have actually earned income in twelfths, and they haven’t delivered the activity. So this month’s six exercise
is going to be really important because as we think about
what the recovery is for the remainder of the year, we need to know the issue
we’re actually tackling, and we need a lot of transparency on this. So that’s going to be important. On capital, so we’ve spent about 13% of the
full year budget on capital. That’s not unusual. So it’s 1.28 billion. And we are currently
forecasting a 240 million pound underspend at the end of this year. Again, we’re going to
do a mid-year review. It’s actually kicked off
where we are asking people to really look at their
capital forecasting. The plans don’t look as good
as they should have been, and I think more focus was put on revenue. And as a consequence of this, if people come forward and say
they’re going to underspend on their capital and
they do it early enough, we’re going to look at how
we actually broker this across the wider NHS so that people can carry forward
any capital into next year. However, if this happens
in the last quarter or towards back end of the
year in an unplanned way, then that is going to be a
bit of a travesty to be honest ’cause we are not, it’s going to be too late
for us to do anything. And capital is a hugely scarce resource. So no surprises we’re asking for, and I keep asking wherever I go, please just keep talking
to myself and the team around capital. And then on to just
quickly emerging risks, I suppose it’s the unfunded
redundancy across ICBs and obviously national bodies, it’s cost pressures in especially
specialised commissioning, particularly high cost devices. And I think I mentioned this
in a previous board meeting, that we have got a scenario
where there are cost effective high cost devices that providers
and clinicians could use, sorry, could use a more
cost effective device, but they are still choosing even though that there’s not a clinical reason to choose the higher cost one. So we are looking at how
we reimburse on that, even partway through the year,
we may change our approach. And then the other material
risk will be the further risk of industrial action. Within the paper as well,
there is an update on VPAG, an industrial engagement, chair, where VPAG is Voluntary Scheme
for Branded Medicine Pricing, Access and Growth. It’s a bit of a mouthful, which
is why we shortened to VPAG. And really it’s just to
conclude, I suppose, you know, the NHS has engaged with
pharma companies to look at, and proactively engage about
how we might look at working with the industry in
a more responsive way. All of the proposals have
been put forward to date. The pharma companies
have responded negatively to including withdrawal of
new drugs from the UK market. And as a consequence, we are
where we are at the moment, we are, we remain with
our existing arrangements, and I’m sure we will wait
to see what happens next. – Okay, thank you.
Questions for Elizabeth. Andrew. – Can I just raise a point
around the deficit support, the 2.2 billion that’s gone in, is that tapered, Elizabeth,
for over a number of years? Or is it a cliff edge that providers drop or systems drop at 31st of March? – Yeah, so it’s annual and
in the 10-year health plan, we signalled that we would move away from the deficit support funding approach through the work that we’ve been doing with extensive engagement,
actually over 600 people to date around some of this, around
the allocation formula. We are looking to actually put some of our deficit support
funding into core allocations to move people closer to target and the withdrawal of deficit support, how it’s actually described
in the 10-year health plan, which we are working through, is we will start to
withdraw it from ’26, ’27. – [Andrew] And if you are
overspent, let’s take an example, blanks, they’ve got 164 mil of
support, they’re over by 20. So what happens at the
year end if they’ve had that money and they’re still over? – So- – [Andrew] Does the overcommitment, does that get locked
off the following year or is it just written off? – [Elizabeth] The
overcommitment, sorry, sorry. – [Andrew] So if the outturn
is more than 164 deficit- – [Elizabeth] Yeah. – [Andrew] For that particular system, what happens to that lump of
cash that they’ve exceeded? – Yeah, so if in for example, a system actually does
not deliver its plan- – [Andrew] Yeah. – The deficit support funding is withheld. At the end of the year,
that could be reallocated. We’ll make sure that there’s
cash to pay staff and bills. However, if a system goes off
plan at the end of the year, that is carried forward effectively and it goes into the
historic debt profiling so you don’t get it written off. – [Andrew] Okay. – I think we need to be really clear that the deficit support
funding will flow this year if people are on plan. – [Andrew] Okay, thank you. – I’ll just follow up on that one and then take some wider questions. First off is, in that annex one, could we have a 1A and a 1B? So 1A shown as it is, but 1B
ordering by deficit support so we can see the sort of true costs. The second is when we start
getting systems coming back with their medium term plans,
will we be able to see, is this system overspent
because they’re spending money on either care which
doesn’t impact health? So they’re not allocating
money in the most impactful way or because they are
spending their unit cost, either provider costs are
higher than they should be, i.e., they’re paying for
inefficient services. Will we be able to see
where they are on that, i.e., are they, is it
allocative efficiency or is it technical efficiency? That’s their challenge. – Yeah. Okay. – Do you think we will be
able to see that when they- – I think we’ll have, I’m thinking of the
timing of some exercises. So the bit about the
efficient delivery of care, you would usually see through
reference cost indices, but that happens at a different timeframe. We’ve got lots of points of data. They wouldn’t all coincide
with a medium term plan. So I think we would look
to triangulate that. What we will have though, Penny, is we’ll have the very
detailed productivity plaques that we can overlay against
the medium term plan to see what the scale of the
opportunity is at that point and whether or not they’re factoring that into the plan to address it. – Okay, thank you. So I’ve got Louise, I’ve
got Robert, I’ve got David. – Thanks, Elizabeth. So how can we make sure that
patient care isn’t impacted if trade offs are being made by systems in order to reach their
efficiency targets? You touched on it a
bit with the electives. – [Penny] Yep, let me
take all the questions and come back to that. Robert. – A comment on the question
on the drug pricing challenge, I think this is a very,
very menacing threat. It’s had a lot of press coverage so you refer to withdrawing drugs, but AstraZeneca pulling back
on its investment in Cambridge and Merck pulling out
completely of its building in King’s Cross. One of the government’s
top priorities is growth. So I don’t feel that the burden should appropriately
fall entirely on the NHS. I mean this is a national issue, but the NHS should lobby
for its importance in terms of us being at the
forefront of innovation. So my question I suppose is
the steps that you’re taking, which are absolutely
terrific and appropriate, how reassuring can you be
that this is registering and it’s going to turn things around? I forgot to add that the
problem is intensified of course by the Trump administration, which is bearing down
on drug costs in the US which have been bankrolling
pharma until now. And so it’s not surprising, but it’s coming home to roost here. – [Penny] David. – Just a small technical
point to reinforce your point about making the tables more useful, can we put a column in with these numbers as a percentage of turnover? ‘Cause it’s difficult to judge how significant these
numbers are without that. – Yeah. – Okay, so quality versus cost, and then the pharma industry. – Yeah, so absolutely. So Louise on the quality,
you know, and cost dynamic. So all of the work that we are doing, we are consistently asking those questions and asking for quality impact assessments. We don’t in finance,
definitely not in this team, work in isolation of
our clinical colleagues. So that is a first and foremost. And also as we are making the
CIPs or productivity savings, we triangulate them with a
number of quality indicators. So you know, if we are looking at some of our policy changes, we are
looking at readmissions rates, we are looking at harm, we are looking at some
of those mechanisms. And in some of the efficiency
savings we’ll also have a, it’s called waste, which I
know that waste and harm, I think people don’t
like those terms in terms of the buckets, but we
are constantly driving and making sure that the
conversations that we’re having and are both with the finance community, but also our clinical colleagues. So I feel there’s a lot
of work that goes on. I can definitely bring it out
in the report going forward. Touching on something
that Jeremy described, we’ve got so much information maybe again, it’s about enabling a drill down, ’cause whichever way I present it, we could always present it a different way and people will be looking
at different things and then just touching on the
report that David’s described, we’re trying to bring it
to make it more holistic so that you can look across a range of indicators to see that
triangulation yourselves. – Okay, one thing it would
be great for us to get to, and I recognise it’s not easy, but it’s a bit linked
to what I said before, is we should be looking
to say to what degree are we allocating money
to maximise the health of the population, which is our ultimate remit is to do that. So we ought to be able to say, if we were really spending money in order to improve health outcomes, where do we think we would
be spending the money? What would be the sorts of
services we’d be spending the money on and how close are
we to that in each ICB sort of, you know, we don’t have that yet, but we ought to be able to do that. And then the second bit, which
I know you are working on, is to say how do we define from the national service frameworks, the modern service frameworks,
the care pathway design, what does really high
quality care look like? And crucially, what should that cost? ‘Cause we think that it
probably should cost less than what we’re spending now, because we have big productivity
opportunities in there. But if we could define that, I think more clearly and demonstrate that, that should give assurance that driving on improved productivity
and getting the money to work better is actually
focusing on improving quality, not distracting from it. – [Elizabeth] Yeah, yeah, absolutely. – So you want to talk about
the pharma industry piece? – Yeah, so I think in the
report we highlight the way that NHS England’s actually
continuing to engage with the industry and trying
to be incredibly proactive. But as you’ve described, I
think the scale of the risk, it’s bigger than just for the NHS. I think we, I get a sense we
are absolutely being heard in terms of our conversations
both through with colleagues at the Department of Health
and through to Treasury. I’m not sure there’s much
more I can say at this stage if I’m honest, but the
conversations are live, and I guess what we should do
as NHS England at the moment is continue to build those relationships, invest in the things that only we can do. And I think that some
of the wider decisions around macro investment have to happen, those decisions have to happen elsewhere. – Okay, thank you. Right. So we’ve gone through performance, we’re now saying what are
we going to do about it. Jim, 10-year plan. – Yeah. – I think to pick up
Paul’s point from earlier, the risks of us not
reforming and adapting. – Absolutely. So as we discussed earlier
on the 10-year plan was published, landed very well, lots of enthusiasm in the service. We have tried very hard to
resist issue in a big dock, big delivery plan with
lots of instructions in. We’ve worked with colleagues
in the service around a bunch of work streams that are
all about bringing the plan to life. We’re now in a process of
refining those mainly round impact to make sure we know that
these things have a purpose in the end and there’s
a quantifiable purpose. I would expect that to be
complete in the next week or so. And then we’re trying to dovetail this into the medium term plan process, which we’re still aiming to
get out into the service end of September, early October. There’s an awful lot to be
done to be able to do that. A key part of all that,
as you said, Penny, is to try to get the balance right between short term
imperatives and long term, but also the extent of which
these long-term changes actually address our short-term problems. And we’re trying very hard
with colleagues to just keep that balance right and get
the prioritisation appropriate and the sequencing appropriate in terms of what happens next year
and in subsequent years. So I think we’re in very good shape. I think there is a, if we’re honest, there is a tension with this
thing about not giving lots of instruction where I think
that’s generally welcomed. But every now and again,
you can have a conversation that says I really don’t
want lots of instruction, but can you tell us what to do? And we just have to live with that. We’re in transition phases. It’s a difficult process that we’re in. But I think really
fantastic progress so far. – Okay, good. And look forward to seeing more of those subsequent pieces evolving. Okay, great. So let’s move on to a conversation about healthcare inequalities or rather healthcare inequalities
improvement programme. Dianne, Habib, over to you. Assume the paper has been read, but if you want to just say a
couple of points in summary, it’d be good and then we’ll
open it up for questions. – Thank you very much. I took over from Professor
Bola Owolabi a month ago and have been working with the
programme to move it forward for the future, for the
work set for the future. As Penny has said, I take
the paper as being read and I thought I would just
highlight two specific examples of impact that we’ve
delivered over the last year. So if you take the elective reform and it’s been very helpful
hearing about the progress with the performance as David outlined, he talked about electives in
terms of the granular data that has been published. And I think in the discussion, we talked about the
average hiding the detail between what is really going on, who is doing well, and
who is not doing well. And one thing we’ve pushed with the elective reform programme, we’ve worked very
collaboratively with them and we outlined a healthcare
inequalities improvement ask. And you would see that in
July, the data was published, granular data was published
disaggregated by age, by sex, by deprivation, and by ethnicity. And that highlighted
where the challenges were, which groups had challenges, and what differences could be made by addressing those challenges. So we see for example that people in deprived populations
are waiting much longer. We see for example, women
are waiting much longer. We see for example that people in working ages
are waiting much longer. This had previously not
happened and it’s, you know, with the work that we’ve done,
that has been highlighted, and we are now working with systems to say we’ve highlighted the problem. What are you doing about it? These are some of the
things you can do about it. The second point I wanted to
highlight as a success has been that with executive support, we actually started supporting systems to deliver a quality improvement
programme with sickle cell. We had significant challenges with UEC. The main reason a
patient with sickle cell, we’ll go to the emergency room is for an uncomplicated crisis. They utilise the emergency
room high intensity users. What we’ve done is we have over the year delivered seven emergency
department bypass units. I visited Lewisham last week. They have for the very first
time since NICE published its guidance in 2012 about
achieving a 30-minute target when patients come to emergency
have for the very first time delivered pain relief, 97% of the time hasn’t
previously happened, spoke to patients, engaged with patients, has made a significant
improvement in their experience, spending less time in hospital, has decreased admission time, has improved patient experience. Patients are going home much
earlier, improved productivity. They were not utilising clinicians, they have proposed a different model where they’ve used advanced
clinical practitioners. So it hasn’t been so much of
a challenge to get people in. Moving forward, we have proposed
in our report you would see to pivot our work programme
to enable delivery of the 10-year plan. We are also rephrasing our narrative so that it takes on board the challenges the system currently faces and
the priorities that are going to be delivered by the system. We will be focusing on
working with various teams, the finance team to
address resource allocation so that it is balanced and as Penny said, it addresses the issue of
how will we allocate finances if we want to improve outcomes and care and reduce healthcare inequalities. We’ll be doing that work
with the finance team and we’ve prioritised that. We’ll be working with the
system development team to hardwire addressing inequalities through all the work we are doing. If we are not going to be
asking the system explicitly every year in planning
guidance that this is what you should be delivering, then it’s got to be in the
system so that they know that this is what we should be doing and this is what good looks
like if we are addressing what health inequalities are. So we’ll be working with
the system development team to ensure that happens, whether it’s about
strategic commissioning, whether it’s about
developing integrated health organisations or whether it’s
a foundation trust contract. So we’ll be doing that. We’ll also be working with, and
David doesn’t know this yet, but we’ll be working with you to- – I’m a bit concerned, we want
to have time for questions. – [Dianne] Sorry. Okay. – So you’ve set up here
your six priorities. So I think we’ve got that, we understand, and we’ll come on and ask
some questions about that. – Underlying all this will have to be data and so I’ll be working with Ming on that, to ensure the granularity
of the data feeds through all this. – [Penny] Okay. – I’ll pass on to Habib. – I’ll be very quick. The observatory continues
to be a delivery partner for NHS England and for
the Department of Health and Social Care. Our role is not just to highlight
the scale of the challenge but to provide solutions. And on that basis, I’ll
highlight three quick examples. Firstly, bringing together
evidence and insight, our partnership with the
National Institute for Health and Care Research to build in equity and inclusion within the criteria
for commissioning research is ongoing and progressing. We are bringing together secondly, in terms of driving policy change, we are bringing together all of the healthcare
regulatory bodies to work from the same page when it
comes to equity and inclusion in terms of accountability,
which is a key lever in terms of shifting the dial on inequality. We have a groundbreaking
partnership with NICE, the National Institute for
Health and Care Excellence to de-bias current clinical guidelines across a range of areas. And also working with them to
build processes within NICE so that the development
of any new guidelines do not have those biases
built in from the outset. And thirdly, in terms of
implementation support, we’re working with eight ICSs to look at closing down
the maternity mortality gap by ethnicity and looking at
neonatal testing as well. And with, or in collaboration
with Duncan and the team, we rolled out mannequins
and birthing stimulators in different skin tones for
the first time in the history of the NHS across every
maternity unit in the country. And working on mental health, Gypsy, Roma Traveller
mental health as well. Looking ahead very quickly, we’re engaging with a 10-year plan team and the neighbourhood health services team to look at building levels of trust and confidence in healthcare
services more generally. And of course finally
if we’re in the business of tackling health and
inequalities, which we are, then we need a workforce
as fully supported and engaged at all levels. So we’re focusing on looking at the independent ethnicity
pay and progression gap across the NHS workforce, and secondly looking at
closing down the gap in terms of bullying and harassment by ethnicity, but also decreasing the
overall levels of bullying and harassment across the
whole of the workforce as well. – Great, thank you. Okay, so questions, I’ve
got Duncan, Louise, and Sam. – Yeah, thanks. I guess
just a couple of points. One, the first being
about are we doing enough to integrate into the broader strategies that we’ve got under
development at the moment? And I was, we reflected the
other day, Dianne, you know, obviously there’s a piece of work, we’re looking at the LGBT
health evidence at the moment, and we make sure that permeates through all the other strategies so it doesn’t sit in isolation. So just any reflections on what
we do enough in that space. And then the race and health observatories got a really respected
brand associated with it. It’s doing a phenomenal amount of work and I’m just wondering
whether we are doing enough to leverage the impact
across the NHS with all of the parts of that. And I just welcome some
reflections on that. – Okay, I’m going to take all
the questions first. Louise. Yeah. – So yeah, thank you, Habib and Dianne, for your fantastic work and
that your reports were great. So two questions. The first is, in your view,
how should funding flows change to reduce inequalities and health? And the second is about racism of which we’ve seen some
manifestation in public recently. What do you think the
NHS’s role is in helping to reduce racism because we know it has a
significant impact on health? – [Penny] Okay. Sam? – Yeah, Penny rightly pointed
out in the performance report page seven, which is really worrying, and a drop in healthy life expectancy. And in my community it’s even
worse, in some ethnic groups, women are living shorter
lives and more unhealthy lives than men, which is why we’ve
got free swimming given by our mayor, all women
over the age of 16. My question though is
actually have you got the data that breaks this down
into ethnicity in terms of healthy life expectancy
that we see on page seven? And secondly in terms
of socioeconomic groups so that we know the expectation by 2040 is that healthy life expectancy
will be 20 years difference between rich and poor. So if you live in a poor area, you will expect to hit chronic
disease by the age of 50. So have we got this sort
of breakdown of data? And finally, I think all
of this data is beginning to show us very clearly the
moral cost of not dealing with inequalities. But do we know what the cost is to the NHS of not dealing with these
various inequalities? – Okay, were you going to ask
a question? Sarah-Jane? No Okay. So just make sure
we try and tackle these. I think we’ve got key thing from Duncan on how do we make sure we
weave an inequalities lens into all of our ongoing work. Maybe focus on that. I think the question
on funding strategies, Louise’s question, I see that
as baked into priority four. But there’s a question on
all of these six priorities about what are the metrics, how are we going to know whether
we’re making a difference and what are we going to look at? Which then links into Sam’s question about have we got more data
that allows us to scrutinise in terms of actually probably
all the performance data we looked at, how does it
vary by geography, by sex, by racial groups, and so on,
a whole load more of that. So there’s quite a bit on
that all related to data and how do we make this
more comprehensive. And then we had quite specific questions on Louise’s question about how
we’re thinking about racism. Was that in services
or in society or both? – [Louise] What’s the role
of the NHS to support health when racism exists in society? ‘Cause racism impacts on
health and people of colour. – Okay. In a way that hasn’t been picked up by what’s already been shared in terms of what we’re doing. – [Louise] If people want
to say more about it, I’d be grateful. – [Penny] Okay, does that cover? I think let’s try and tackle those. Otherwise, we run out of time. – So in terms of integrating
health inequalities in all that we do, I am
meeting with all the directors and working with them to ensure that we are sighted on the
work that they are doing, that we can input into
what good looks like, for reducing inequalities. So that’s an ongoing piece of work. And I’ve worked, met with
actually several of the directors who are owning some of the programmes. I’ve met with them already and we’ve started ensuring
that will happen going forward for those who’ve missed us out. In terms of the issue to do
with what the funding flow looks like, I think it would be
exceptionally important to include deprivation,
explicitly include deprivation. When you look at the data on
what is driving inequalities, deprivation is a significant factor and that needs to be included in a way that hasn’t previously happened. And that needs to be data-driven. The last point I was
making was about data. If we cannot measure it, if
it has not been highlighted, then it is not surfaced for
leaders to take action on. If we want to build a coalition
of people who are determined to drive down inequalities,
they need to have granular data. And that is going to be the
focus of our discussion. Ming and I spoke to your team
with David Ashley yesterday. If we don’t have the data
broken down, granular, bringing together community
primary care, secondary care, and looking at the whole care pathway, we cannot drive improvements. We cannot drive improvements when we are looking at performance. We need the data. It’s not negotiable. – [Penny] Okay. – The point on racism- – [Penny] Pick up, please. Yeah. – Yeah, sure. So the NHS is
a microcosm of wider society. 1.3 million people working in the NHS. What happens in the wider world is bound to be reflected within our workplaces. The NHS has a role to play, but it cannot be the
only enabler for equity and we know that. But the role that is playing includes setting up the NHS
race and health observatory, if I may say that. And the work that we are
doing in terms of looking at maternal health, looking at how we can apply
an anti-racism approach to QI methodology, which is
a method that’s used a lot across the whole of the NHS. And then going back to the
point around the cost of racism, I think, which was also raised, I think that’s an important point because we need to know
the impact that racism has, both in terms of the human cost, but also the productivity
and financial cost as well. And that’s a piece of work that we are commissioning later this month to really kind of focus on and
to provide even more evidence to help kind of focus on the solutions to the longstanding
challenges that we have, not just in the NHS, but of course across the whole of society. – Thank you. Okay,
really good conversation. Thank you, Dianne, for
taking up this work, and thank you, Habib, for joining us, and we’ll make sure we come back to it. I think we have a risk that
coming out of this morning, Ming has even more work to do,
but we’ll keep going, right? Learning disability and autism programme. Who’s presenting on this? – Tom.
– Tom. – Hi. Good morning, everyone. Tom Cahill, National Director of Learning
Disability and Autism, former chief exec, not practising anymore. Just want to bring you up to
speed on learn disability. I have the paper so I won’t go
through the paper in detail, but we’ve just finished
talking about inequalities. If you’ve a learning disability, the chances are you won’t make 50. If you’re a learninv disability with a profound learning disability and you’re from an ethnic background, you won’t make 34, 35, 36. So have a look around the room and how many people would make that life. So just, I want to bring that home that this is about people
and we can do something. Learning disability programme
came out of a failure. Winterbourne goes back, I’m
sharing this with the board ’cause I know a lot of
you might be new to this. And back in 2015, really,
really difficult circumstances, people were treated very poorly. Over 2017, 2019 became
part of the long-term plan, government strategy around
building right support for one, getting people out of hospital, but two, helping people live
longer, healthier lives. And that was the BTRs. Despite the narrative of failure, I’ve been doing this for four years. If you go around the country, there’s some fantastic care and support, whether it’s through key workers, what the people at acute
hospitals are doing, seeing people at home before
they come in for an operation. There’s really good stuff. And we need to build
that far more good stuff than the raise of failures. But we do hear the failures,
and when we do, they’re loud. Programme is established in 2019 particularly I talked about, and there’s two distinct
groups, just to share with you. So we’ve got people with
a learning disability and some of them are autistic, about 30%. And then you’ve got a group of
people who are autistic only. I’ll just deal with those very briefly. In terms of learning disability, we had two real targets or work to do. So getting people out of hospital, particularly those who
shouldn’t be in hospital, not everybody. And we’d done some work about
two and a half years ago and about 40% we knew that
should not been in hospital. We’re not convinced that
60% that should be there. We’re getting the right care either, but we need to work on that. And we have broadly achieved
that for learning disability, not for autistic people. And I’ll come to that in a second. The second part, we were
focusing on health outcomes around annual health checks. 80% target and achieved, but
there’s 1.3 million people. There’s only about 330 on GP registers. So you can see that
there’s still a big gap and that 1.3 million,
there’s more we can do. If you see on the LeDeR report, the median age of death
is improved about a year over a seven-year period,
eight year period, so really positive. And the avoidable deaths
are reduced from 47% to 38%. And these are really important because these are things we can do. And if you think about
where we want to go next, we can target that. You’ve then got autistic people
and autistic people only, they have a propensity to
experience mental health more than the normal population. Suicidal ideation, a significant risk. And what we are seeing is autistic people, young and or old coming into hospital, coming into mental health beds,
particularly not into older and disability beds as we
might have formally known them. And that’s a significant increase. So we’ve been working
over the last year to try and reduce that, make sure
that the pathways are in place, working with mental health teams, particularly to make sure
that they’re autism friendly. And you can see there on paragraph 12, it tells you the sort
of work this autism team has been doing with across the system. Also a lot of research, a lot
of areas of good practise, whether it’s in Manchester and Stockport with Jonathan Greening’s work,
whether it’s NELFT in London, not knowing what they’re doing around the neurodiversity pathways. Some significant work there
and we’re seeing progress, but equally autistic people
have the same life impacts as well about health outcomes. So we’ve got to continue to do that. So aligning ourselves
with the 10-year plan, real opportunity for
us and for this group. Neighbourhoods, you
really get basic and get into the local population and
to start making a difference and start putting things in place. And because of LeDeR, we’ve
been doing it for eight years, we know what we need to do. And I’ll say a little bit
about that in a second. Digital transformation, huge opportunity. I’ll hear colleagues shouting at me, don’t forget to tell them about the risks because not everyone can accessible. But that is something we can work with. And Ming, we have people who
got 11 colleagues on our team who could be testing for you,
who’ve got lived experience. So happy to do that. And clearly prevention programmes
and workforce planning, and workforce planning and training. And when we talk about training, you might be talking about
the Oliver McGowan Training and making sure, ’cause we know that changes
people’s perspectives, it changes people’s
perspectives about people who are seen in A&E or wherever. So finally from me, chair,
I just, this is doable. This is not beyond NHS,
particularly on the NHS term. We know there’s education,
we know the social care. You know, if we do the training for staff, if we do the reasonable
adjustments that people need to get the right care at the right time. We have a digital flag,
which is for disability, but is a game changer. And if we can use that, make sure that we use it
properly on both ends, it’s completed, and people then, when people turn up for
clinics, hospital appointments, people understand what the
reasonable adjustments are. Vaccinations, particularly flu, COVID is less of a concern now. Flu and respiratory is a big issue for us. Clinical pathways, respiratory,
cancer, CVD, diabetes, obesity, the things that we know. And if systems and ICBs
together put these in place, we can make that difference. And clearly annual health
checks for everybody, we really indicate, and we’re talking about
mental health people, SMI, we’re talking about learning disability, and we’re talking about
autism, combined health checks, and we’re quite excited about that. So quick canter through,
chair, of the paper. But the challenge, I think we
can make a difference here. – Thank you, Tom. Very good. Good example of what gets
measured gets done. Okay. Any questions for Tom? Andrew, yeah. – [Andrew] Tom, can I just ask a point around the voluntary sector? So where do you see the voluntary
sector impacting on some of the measures that you’ve outlined? – Where we see, we work very closely with the voluntary sector
at the moment and they, we call them our stakeholders. They do a lot of support that’s probably not on the health
side, but getting people to GPs, promoting annual health checks. But working alongside is
much more on the social side, on the social side of this,
that’s where I see that. – [Andrew] Okay, thank you. – [Penny] Louise. Claire. – Thank you. So look forward to seeing a kind of, or the board discussing a fuller
neurodevelopmental pathway piece incorporating the really good work of the ADHD task force. I’ve got a question about the
table C and the waiting times, and it says, you know,
referrals open at least 13 weeks has seen a significant
increase year on year. What’s the range? So at least 13 weeks, what’s the kind of
higher level of the range and how are people being
supported whilst they wait? – Chair, honestly, I will
give you the range here. Our support, we’re
certainly doing a lot of, with teams on supporting
people and maintaining well while in the pathways, doing a lot of work with ADHD task force about how can we reduce
those on the pathways, but supporting families,
supporting people, reaching out, there are some significant
waits, you know, and it is something
we’re going to deal with. I don’t think, if we’re honest, we can deal with it
without additional funding. But actually we can’t
just stand still either. And that’s part of the eight-point plan that we’re working with
Minister Kinnock and colleagues. – Yeah, and key bit we
need to come back to, so. – I would’ve thought so. So there is a good news
story in there from, and I, and sorry, I didn’t share it,
the ICBs have been really, really working well and
you can see for two months, we’ve levelled off in
terms of the increase and the closures. They’ve narrowed that gap. So, and that’s without additional
resources from the centre. So it’s really good stuff. We need to support that and build on it. – Yeah, there’s a lot more we need to do. Claire, and then I’m going to move us on. – Thank you. So thank you, Tom. Really good, very clear paper. It was just a little bit more about the reasonable adjustments ’cause I think people sort
of go into a little bit of a blind panic when they sort of think about reasonable adjustments. But actually, I mean, and
so I have an autistic child, so very familiar with the needs and actually what we should think about, is rather than designing environments that work for autistic people, actually just in designing environments, if you think about the things, the reasonable adjustments
that most people would need is don’t suddenly change my
appointment at the last minute, don’t suddenly send me to
a different appointment, different room, give me information in a way
that I can understand it. Let me bring somebody with me, and make sure the environment
is as calm as possible. So I don’t think actually we should focus on reasonable adjustments. We should talk about actually how we design services in a
way that works for people. – So we have done quite a bit and particularly the autism team about what new services should look like, and how they’re designed, so
inpatient areas, flooring, noise, all of the
sensory issues, lighting, all of those things are really helpful. I think Claire, you’re probably, it’s where we’ve got existing facilities, how do we work for those? But it isn’t just as you said,
it’s not just environment. It’s about how do we treat people. – Okay, great. Right,
we’re going to move us on. So management and leadership development. Jo, Carolyn, I assume it’s been read. – Yes, I will. I’ll be
really quick, thank you. Just two things. So thank you. We’re seeking the board’s review and approval of the management
leadership framework today, which basically for the first time means that there’ll be a clear
set of consistent standards and expectations of managing
needs at all levels. So from entry level right to
board level, which, you know, incredibly we’ve never had before. So we are at the start of
very long overdue journey. The reason why we’ve got where
we are is not thanks to me, thanks to people like Carolyn May and the team who’ve
done work with thousands of people across the system working with the Chartered Management Institute, and lots of people that
Carolyn can tell you about to get to where we’ve got today. So as say, is the beginning of
a journey, it’s not perfect. I will say that. I think there’s what,
were many sort of refines in the language as the
10-year plan evolves, I think our notion of what management and leadership is required will change and we need to keep that
under constant review. It’s a foundation that
we can start to build on, and develop from there. And then secondly, if
the board approves that, then in the light of that, we
need to align the standards with the board competency framework. And so we’re recommending in ’26 and ’27, we use this new leadership framework for board level managers and leaders. So, take questions. – Okay, let’s take questions. So David, Paul, and Robert, and Ming. Okay, take all those, we’ll
take all the questions together. So David. – I welcome this approach.
I would make three points. One, hopefully it has both developmental and assessment aspects to
it, performance assessment. On assessment, I would observe that to do
this sort of thing well, it’s very resource intensive. So for example, if you are
evaluating the performance of someone ideally that is not just done by their line manager where
all sorts of issues arise. The moment you have a group of
people assessing individuals, then it starts to get
very resource intensive. Secondly, an assessment, sorry. And then finally on development, we know that the best way
to learn is on the job by observing other people
who do things well. And so coaching I think needs
a lot of emphasis in terms of the performance indicators for line managers all
the way up the chain. – Okay, let’s keep going round, ’cause we might find we’ve
got some common themes. Paul. – And linking to David’s point about how to make this improvement happen. 85% of people had appraisal and 26% said it improved their job. So appraisal plays very well at the moment and therefore given that by
April next year, we are going to be wanting managers to
manage a great deal of change. The nature of appraisal
from then will have to be quite a lot better. And so therefore the
developmental programme to develop appraisal by next April better get going quite quickly. Otherwise, and since coming
back to my very first point in this board about
change, you lose a year. So given we’re going to need managers to be managing difficult things, the appraisal of those
managers needs to get going, and as David said, it
is resource intensive, but the loss of resource
of having only 26% of people improving their
performance is gigantic. – [Penny] Robert. – I mean this is just so mission critical. It’s crucial and I think
you’re doing a great job. My question really is around the college that’s being established, whether appropriate uses
being made of skills from outside the NHS from other sectors and also whether business
schools in universities, some of which are very
motivated to engage with this. I know the one at King’s is for example, whether that is being drawn in to help. – Okay. And then Ming. – Thanks, Penny. Jo, I just wanted to link
the last two conversations. So around learning disabilities ’cause I kind of chair
the neurodiversity network and quite often a lot of the conditions that we create at work are not great, and line managers haven’t
been given that support. So I just wanted to make sure in any new programme that we did that we do consider those kind of environmental things as well. – Okay, and Andrew was
whispering in my ear whether this applies to NHS
England as well as providers. – So I think every employer
should guarantee an appraisal. We should be saying every year, you should have a
conversation with your boss. We have failed to do that in
NHS England comprehensively, unfortunately. So if we’re implementing this, we should apply it to
our own organisation. – We’re going for it through
at the moment, Andrew, every minute of every day. – Okay, I’m going to have Mark and Glen, and then I’ll add a few things, then we’ll come back
to you, Jo and Carolyn, including what do we do
next, which I recognise. – So this is great thinking, having just been through
a five-year journey of something like this. Embedding is always the
almost impossible task. And the reflection I have
if I look past is we started off with something this long, literally this long and we
ended up with eight words and this is impossible to implement. So the thinking is amazing. I think the next task
is how you synthesise it down to something that’s
repeatably consumable by people at every single level. And it’s the sort of
Winston Churchill quote, “If I had more time, I’d
write you a shorter letter.” I think you probably
need a shorter letter. – Glen. – Yeah, I agree with
Mark’s comment on that, but I think it is a great framework. I think it concentrates
on how we develop people that we have. I wonder whether we need to look more at values-based recruitment and to ensure that we have people that we can more easily develop. – Yeah, good point. Okay, well, can I, I’ve got
a few just to add as well, which I think very much build on what other people have said. So I have to say I was very
much where David and Paul was, it felt to me like this needs
an evaluation framework. So I think it’s great the
starting point, the stage one, stage two, stage three, stage four, but that almost says this
is what we think you need. It doesn’t say this is what
sub acceptable performance would look like, this is
what good performance, this is what very good, and this is what exceptional
performance would look like. And I think we need that
for all of these bits that would make it longer. But that would almost be
the implementation piece to support colleagues across the system. So if we’re going to do it, it would need something that embeds that, that then if we did that well
ought to take the 20% up, because actually it ought
to then give people, even looking at an evaluation
framework tells you this is what really good looks like. And so it gives you a bit
of something to aspire to, or a learning curve. It feels like we need a lot more on that. I think there is this crucial bit about the developmental bit that David raised and then Robert raised. So how we bringing much more
external expertise into this. You know, we know that we
have some great management expertise in the NHS. We know that some skill sets
that we are missing and lacking and I think we don’t quite
bring enough of that into it. And then I have to add a
bit of a personal problem with some of the language in here. So you know, is one on self-effectiveness, keep safe, what does that mean? Does that mean I walk
slowly down the corridor or, and we keep using that word, I wouldn’t know what that meant. And we’ve got things in here
like patient-centered care. I dunno what that means. We’ve got a whole lot of
really good patient experience metrics which we could be aspiring to. So we’ve got a bit too
much fuzzy language in here and I think we need to be
much clearer on the sorts of things we’ve been talking about today, like do we have a group of managers who can really think
about resource allocation? We do refer to that, but I’m not sure it’s quite tight enough. Are we really thinking
about great user experience? What’s that mean? Are we really thinking
about this point Paul made at the beginning about
the risks of not changing, sometimes greater than
the risks of change? So I think it’d be good
to hear your thoughts on how do we make this much more, how do we embed evaluation
throughout this? How are we thinking about development that goes alongside this,
including in external expertise? How can we tighten up some of the language and then what do you want to do with this? So do we want to roll it out
as it is recognising some of the questions, concerns, or do you want to do a bit more work on it and then roll it out? – There’s quite a lot there, Penny. So just I’ll come in on some of those, and then I’ll ask you to
come back into the specifics, then I’ll wrap up in
terms of the next steps. But yeah, I completely
agree with you, Glen, about values-based recruitment. If we want to change the
culture within our workforce and actually it’s the
people that we recruit, and the people who join the NHS tend to be much more values-based anyway and the younger generation even more so. So I think we need to reflect that in the 10-year workforce
plan that we’re developing and absolutely marking, Penny, we need to, it’s fantastic work. I think it’s been very
much facing the people who’ve been developing
it and we need to flip it and make it, as you say,
succinct and meaningful to those who are going to use it and
talk about it drawing on all of that great work. I think it is definitely
meant to be developmental and I might ask explain
sort of how we’re doing that and how we’re involving
other sectors in that. – Yeah, certainly. Thank you all very much
for your questions. So absolutely this is a
developmental framework and the intention is to launch with a self-assessment toolkit, excuse me. And then a 360-degree feedback
tool next year picking up on David’s point around feedback from other people recognising
it’s in resource intensive behind this then sits a
national development curriculum linking to the code and standards which will guide development in terms of the core competencies
and expectations for leaders and managers at different levels. I think the key point
is we’ve engaged hugely on this piece of work. So over a thousand people have fed in. So of course sometimes
the language isn’t exactly what everyone would want and
it’s been a balance to try to get everyone kind of
satisfied with the feedback that’s been given. Just on the point about external
guidance and development and learning from other sectors as part of that national development curriculum, lots of that is featured there
and case studies and learning and how people can apply
that learning in the NHS. Excuse me. The other thing I just
wanted to pick up, Penny, with your point about what does good and not so good look like. That’s exactly what we’ve
had actually developed for the code of practise in terms of what’s really good
behaviour and values, what does that look like? What’s unacceptable? And the plan is to publish
that alongside the framework so people know what one
line managers know what good and not so good looks like. Just on the appraisal,
yeah, really important. The very next step for us is
working with a steering group to develop that appraisal core framework. But we also think training for line managers is going to
be absolutely critical there ’cause this is a kind of cultural change about how to do appraisal really
well in a motivational way. Apologies for my voice. – Carolyn’s just getting
over tonsillitis Sorry. So she’s been really good to come in, but I think you’re good about
timing, Penny, is really key. We were planning to launch this in autumn so I think it’s how quickly
we can sort of take it offline and just address and finesse
particularly the language and the succinctness
without losing the pace. I’d like to think we could
still sort of crack on, but I think it’d be a problem
if it went beyond autumn, wouldn’t it, in terms of
what we were trying to do. – Well, it delays because the
intention is to ask people to self-assess against
the framework as part of the next appraisal round. So obviously we need a
kind of final version of the framework and final version of the appraisal framework
for them to do that. – Okay, and Andrew’s reminding me, which I was involved in
that when we had the chairs and the NEDs framework, it
went down like a lead balloon. – So I think the trick is
to take up Mark’s point around making this succinct
and giving some latitude for boards around, you know,
just doing it your way, ’cause everyone will want to put their own kind of spin on this. So, you know, we are
offering a way of doing this that’s proven to work, but
you may have situations where a board particularly
wants it done in, you know, X, Y, Z way. And I think we should
give people that latitude. And last time round this,
this didn’t go down well with some people, but I think if we try and make it succinct as possible, we hopefully will be a lot more successful ’cause there’s some
really good stuff in here. – Okay, so can I make a suggestion? Here I go. So it’ll still
be autumn in November. So- So we’ve got a couple of months. I think there’s a lot of
expertise around this table. So can I suggest we take
views from around the, because we don’t have time to do that now. We take views from around this table. You’ve heard some of them. We can come back and try
and get people to do that. So I think we would ask
everyone here to come back with their thoughts and comments quickly, like I might say by the end
of September, and then you, the two of you have a
chance to reflect on that, perhaps bring it back for
another shorter conversation with Jim and exec colleagues
take on board the things that have been said and
then we make a decision about what to do with it during October, which would allow us to
meet, is that alright? – That sounds good. I was just thinking, you look
at slide eight as an example, if this went out as it
is, chief people officers and organisations
generally will realign all of their appraisal
documentation and the frameworks and there’s quite a lot
of work involved in that. Some of ’em have just done it, some of ’em have been an
established partner being happy with it, et cetera. So on your point, Andrew,
I dunno if you’ve done it, but just it’s worth talking
to some colleagues out there about what would take to
actually bring this to life without everybody tearing everything up. – Yeah. – Starting again from scratch and that actually then taking longer. – Yeah. – Just to come back on that, Jim. So we’re engaging with over
130 organisations in terms of early adoption and we’re already doing that engagement piece about
how do we implement this well and work with them with
community to practise. So, thank you. – Okay, so are you okay
with what suggested in terms of next steps, Jim? – Yep. – Okay. Alright, good. Right, now onto, covering
an awful lot today. Greener NHS. David. – So thanks, Chair. So I’ll hand over to Chris in a moment, but just say a couple of
very, very quick things. Firstly, delighted that
we’ve got this report in public board. This is part of the delivering
the net zero strategy. And I suppose as you’ll see in the report, it presents good examples in two things. One, the moral obligation to
get involved with this work, which the NHS has and you’ll
see, you’ll hear from Chris, has done incredibly well. Secondly, and highlight
throughout the report, genuine cost savings and
efficiency as a result of being involved in this. And then finally, and I can say this, as a hospital chief executive, this stuff really matters to our staff. So there is a third benefit
from the good work that Chris and his colleagues have left, Chris . – Thank you, David. Thank you, Chair. I’m delighted to present
to the board today, both an improved understanding of our carbon footprint in the NHS, but also a report setting out progress over the last five years. The headline figures are a 16% reduction in our carbon footprints. So those are emissions
we can directly control. And for those emissions
that we can influence, having seen them go up
during the pandemic, we’ve actually seen them return to broadly pre pandemic levels. And that’s despite an
increase in activity. Those improvements across
our carbon footprints are across our estate,
they’re across our fleet, they’re across the medicines we use, and they’re delivered in partnership. So really crucially through our colleagues in royal colleges, through
the government departments and through our suppliers as well. And if I just take a
couple of notable actions out of the progress report, we’ve virtually eliminated the use of certain anaesthetic gases with high global warming
potential such as desflurane. We’ve seen huge innovation in our fleet, we’ve delivered the
world’s first double crewed electric ambulance and more
recently we’ve partnered with great British energy to
invest over a hundred million to deliver a triple increase in the amount of solar generation across our estate. That’s going to pay back three times over, and that will add to the 5 million pounds that we already see in savings each year through existing solar. So that’s just a two or three examples. There are many more really, really good examples
throughout the progress report that we seek to publish today. And much of that delivery
against our ambitions is really through the incredible efforts and dedication of staff
right across the NHS. I’d just like to take this opportunity to say a big thank you to them
for their continued effort and support to deliver greener NHS. Thank you. – Take questions, comments.
Sam, Duncan, Ravi. Sam. – Yes, if you look at
some systems, some areas, advice and guidance can
reduce travel to outpatients by up to 60%. And in some systems, guess what? You don’t need to go to outpatients before or after to have your blood tests. You can get them done in primary care. My question underlying
this is to what extent are you looking at or are policy
documents in this instance, particularly on
transformation of outpatients to look at some of these
potential green gains? And the second question is if
you sit in a general practise, you’ll have a popup. So we’re doing great things on inhalers, but you’ll see a popup saying you have to have a new plastic spacer every year. And actually when there was
a parliamentary question about this, it was very unclear as to
who’s driven this process, but it costs millions. But hidden within that question is also what you have talked about, David, which is about engaging people out there. This is very engaging
for a lot of clinicians and staff at the NHS, but to what extent do we engage
’em on a day-to-day basis and do they see their
ability to reach the top of the organisation and
see action taken on things like the spacers? – [Penny] Duncan? – Yeah, so I would, just
to build on the point about engagement from staff, this is one of the things particularly that really heavily motivates
nurses and midwives, particularly if you see
that generational shift where we’ve got a much more
climate aware generation in our workforce now and
it’s certainly will be one of the strands that we’re working
on through the development of the nursing, midwifery
strategy for England. I guess there’s something
about the pace of adoption and are we doing enough
to drive some of the pace of really good examples that
are going on across trust and make sure that they
are adopted and are we, do we need to do more on
a kind of zero tolerance on stopping certain products for example, where we know we have an impact and we’ll have an impact on cost? And then I guess the risks around some of the other developments. So my understanding is that AI and some of those changes
requires a big heavy input of power. And so I guess the risks
for the next five years and the work that we need to
do in terms of transformation, are we going to replace one
improvement with another kind of increase in carbon? – Ravi. – On similar lines, I
was struck by the fact that secondary care energy
bills have doubled since 2019 to over 1.4 billion. Just made me wonder about
whether we are maxing out on all the energy efficiency and solar generation projects that could potentially reduce bills. It sounded like you’re doing some through the public sector
decarbonization fund that I think is stopping plus GB Energy. But are we doing all of them or are we constrained by the
kind of finance available? ‘Cause if we are, if there is other MPV
positive stuff that is there, we should be able to look at
other ways of financing this and particularly thinking about the distribution
network operators actually as a potential way of doing that. – [Penny] Meghana. – Thank you. So not answering your question, just making a comment about more sort of clinical engagement
throughout the NHS actually because we are pushing on an open door and with my CEO hat on, I can tell you about the
difficulties experienced. So the first was measurement. People couldn’t get through the detail to understand the conversion
from sort of pounds to carbon. So that was the first thing. So we actually did a pilot project with Harvard University’s
Professor Kaplan and Ramona and we focused on the
hip replacement pathway to look at scope one, two, and three in terms of how
much carbon is accounted for, for the day of admission
to the day of discharge for the most commonly done operation. And that’s now being rolled out, and as a result of that understanding and working with the manufacturer who produces the hip implant, so looking at supply chain as well, it was very easy to then focus on, well, how do we improve this? What steps do we need to do, you know, cycling to work or whether it’s switching off the theatres overnight
or stopping the manufacturer, sending the implant to Germany
for a coat just to come back to England. So all those things are, you know, currently in practise and
people are really focused on delivering this. – Right. Glen. – In answer to your question
about access to capital and whether this is
constraining our progress, well, it is, Salix is
a good example of that, and as far as I’m aware, when the Salix funding becomes available, it switches on and then
within a few hours, everyone has, all the money’s gone, and you can’t bid anymore. So there’s a load of Salix
related projects out there that have not been funded today. So what’s the future of
Salix moving forward? – Okay, so I think great
bit is you’ve got lots of enthusiasm here, which is really good. I think quite a few of these
are in some ways more prompts for more work and more focus rather than
necessarily questions to answer. I would just add a couple of bits as well and then you can come back on how we take this forward really. So I think Sam’s point on outpatients, I thought the report of
about five, six years ago, Royal College of Physicians did, 5% of all cars on the road
are going to an outpatient. Staggering figure. Words to Sam’s point, you know, is that a good use of those car journeys? I would add to Sam’s bit on
inhalers, wider EpiPens have to be replaced in schools
every single year. Does everyone need to wear plastic gloves? Does everyone need to
wear a plastic apron? I’ve never seen what a
plastic apron does, can’t, doesn’t seem to me to anyway. But you know, the list goes
on and on and on and on. Should we have a proper review of those? Should we ask NICE to
look at the evidence-base behind some of these things and whether or not we really do need to
keep replacing everything ’cause it costs a lot of money
and so it’s the environment. For me the most staggering
figure which we know, but anyway, 27 million of
square metres of buildings. So yes, energy efficient use of them, but we don’t need probably
whatever, quarter a third, even half of that space. So how we actually going
to exit buildings in order, and you know, using that as an argument for going greener would be good. And then I think really important is, which bit, Meghana is a
bit about doing deep dives, but even at the high
level figures one and two, you don’t need to answer that now, but I couldn’t align the
data across the two of them, so don’t get into that now. But there’s a bit about
sort of being very clear on where are there
opportunities to improve and therefore what can we do. So you’ve got lots of enthusiasm. Tell us what we can do next. – Sure. Thank you for enthusiasm. I’ll try and bundle a
few of those together. So look, staff engagement,
clinical engagement is massive. Last time we surveyed, we knew nine in 10 of our
staff wanted a greener NHS. So we know that’s there. In terms of focusing on clinical pathways and opportunities especially around reuse. We’ve partnered with GIRFT, Getting It Right First Time programme. We’ve done our first
greener deep dive there on bladder cancer pathway. We’ve seen that actually
whilst we save two and a half thousand tonnes
through that revised pathway, we’re also reducing the
number of appointments, outpatient appointments, faster diagnosis, patients spending less time in hospitals. So there’s mutually beneficial
points for both our programme and the wider NHS in bringing clinicians into this programme. In terms of some of the other points around patient travel, inhalers, we published our revised
green plan guidance earlier this year. It’s for the first time sets out a lot of best practise about where
organisations such as Jim’s and David’s, they’re referenced
I think in there in terms of taking action and actually
trying to replicate that. We know that there are some
high performing trusts. We know that there are some
who probably need to catch up, and it’s trying to bring, bridge that gap. Just on the point of capital delivery, there’s a lot we can do in our programme to reduce emissions
without spending money, but capital delivery particularly. And I think the paper talks
about heat going forward. So it talks about Salix and public sector decarbonization scheme. They are the same thing
that they’re in high demand and actually perhaps our
biggest challenge in terms of staying on track over
to our interim targets and longer is actually finding a way to find financial models
and vehicles to be able to deliver some of that decarbonization. So there’s a few challenges there which we’d love to take
further beyond this board. – Alright, great. Really
good conversation. Look forward to seeing
16% get to 30% next year. Good. Okay, let’s move on to the next one, increasing research activity. So Lindsey, I think you’re
going to do this. Yep. We good. – Thanks very much,
Chair. Thanks, everybody. So I’ll take the paper as read. I just want to make a couple of points before I hand over to Alex,
who’s my colleague from DHSC. We work very closely with
our colleagues in NIHR and DHSC on this agenda. The paper frames this particular
issue within the context of the life sciences sector plan, but we really do want to focus
the board’s attention today on the setup of clinical trials. It’s a real political focus at the moment. It’s in both the life sciences sector plan and our 10-year health plan. But it was kind of stimulated
by the prime minister making a commitment in
April to move to set up of clinical trials in
organisations in 150 days or under. Unfortunately at the
moment we are only managing that in about 30% of studies
that are on the NIHR portfolio. So we have a long way to go. That said, there’s a
significant amount of work that is ongoing working through
our colleagues in the sector through the UK clinical
research delivery programme and the paper sets out the
work that we’re doing there to standardise, streamline, and remove duplication
across organisations. It also sets out some of the requirements that we put out to the
system following feedback Vin Diwakar wrote to
organisations in May asking to increase board visibility and board accountability relating to this. And I think both Alex and
I smiled to each other, Penny, when you said what
gets measured gets done. We would love to move this agenda to what gets measured gets done. But we do really need this board’s support to make sure that we are measuring it and then we understand what is happening. So really what we would like
the board to think about, and give us a steer on today is what more could we do if
you think there are areas that we aren’t addressing, and if there are areas like
using the planning guidance, et cetera, where we can
actually pull some levers, are they appropriate? I’ll pass on to Alex who I know
wants to make a few comments from DHSC point of view. – Yeah. Thanks, Lindsey. And I just wanted to
bring sort of perspective from the ministers and the
government’s perspective. I think just to focus on sort of vision and then why we want to do it and the asks that the government wants,
I mean from the vision, the vision really is that we
want research embedded as part of everyday care and we want
the NHS seen to be competitive for clinical research, both for
non-commercial and academic, but in particular, commercial research. And just to flag, you know, commercial clinical
trials is the lifeblood of the life science industry. And at the moment, that isn’t working. Why we want to do it? We want to do it because we want to bring new
treatments to patients faster. We want your support and the workforce so that they can be more productive and we can free them up to do
tasks that in reality matter. I know the minister’s
very concerned about this. In fact I spoke to the
minister yesterday and he said, “Alex, do you want me to
come along to the board to really emphasise this?” So it is a very high political
agenda item at the moment, just to reiterate that. I think the three key asks for me and from the minister
really are, first of all, can we really make sure
that research is embedded as fully as everyday care and
it’s not seen as an add-on or separate from healthcare? Secondly, I think, reflecting
what Lindsey’s just said, you know, if we can get NHS trust boards to actually measure the
150-day metric as well as the other key performance
indicators we’ve got, that will make sure that a performance in commercial
trials gets delivered. And then thirdly, we have set out a number of policy guidances and
recommendations essentially and if we can embed
those more effectively, we are really keen and I think
that from our perspective, that will really help
deliver some of this. So those are the three asks. Thanks. – Okay, thank you. I’ve got Sam, Mark, and David. Okay, Sam. – Yeah, so one of my hats
is an honorary professor of primary care at Queen Mary University. And when I see the change
in research opportunities, in other words, the capture
of the 2 million database in primary care, the discovery
project that connects it to the acute sector, the
opportunities are massive, but we still have a research base which very much focuses on hospital. We haven’t managed to
shift it towards the system and it plays I think to
Robert’s point earlier on, about the drug companies
and the risk of them exiting because of costs. Have we done enough to sell the research
opportunities particularly to the drug companies that
are unique in this country? – Okay. Mark. – So I had a few points. First, welcome the paper
and the conversation that we are having, really important area. There’s a few things though. One, I was unsure reading the paper about what the delivery
vehicle’s going to be for these priorities. It’s a little bit mixed I think, you know, ’cause regions of course will need to play a role at some
point in the future, but given the changes
going on at regional level, I think just putting our focus on strengthening the
capability and capacity at regional level I think will mean that we don’t realise the pace
of change that we’re going to need to see in this particular area. Final point was around cost recovery because it is important for us to make sure we’re covering costs, but that will not give us the growth that we’re going to need to
see for commercial research. And I think that’s something that we just need to think through. Not be silly about investments,
but really thinking ahead about where we know
there’s going to be likely growth in research activity and
making sure we have a model that’s going to support the increase at the pace they have an
opportunity to do to go out. Thanks. – [Penny] David. – Yeah, I mean really welcome the paper, I suppose just to remind everybody and the figure keeps changing, but every pound invested as
an eight to 10 pounds return to Mark’s point, it doesn’t, to the UKPLC, it doesn’t necessarily fall in the place where you spend the money,
which is part of the challenge. Just to Sam’s point, I chair the North London
clinical research network, which we’ve done for 10 years. The fastest growing
research is in primary care in terms of number. So there’s opportunity there, but you’re absolutely right, we need to harness it
differently and think differently about how we approach it going forward. And I suppose two final things. One, there are still
organisations out there and I understand the challenge where they are not spending money on research allocation
to save money overall, even though the letter’s
gone out from colleagues, even though we’ve tried to reinforce it. So we need to find a different route to make that message stronger. And very finally, I had a good conversation
with Lucy last week, Lucy Chappell, and I’ll support
her with a shelf of trust to seeing whether we can
benchmark some opportunities to speed up some of this
150-day target work. – Okay, so just, ’cause it
falls within your remit, David, the question about should we
be measuring this and measuring and looking at that variation
across all providers, is that something we
could add to that master? – Yeah, I mean it will be
relevant to a proportion of providers, absolutely, and research active
providers do measure it, but probably even not as
frequently as they should do. Organisations like mine,
like some of them represented down the table should be looking at this as they are the four-hour access target to be honest if we are prioritising this. So yeah, we’ll take that away, and think about how best we can do that. – Okay, great. Thank you. Okay, so I’ve got Robert,
I’ve got Elizabeth, I’ve got Meghana, I’ve got Louise. – Yeah, well, there’s lots
of great stuff in this paper and it’s very welcome, and congratulations on what’s going on. I think picking up on a couple of things. So picking up on Sam’s point and I think the health
data research service plan is brilliant, I assume that’ll
include primary care data and this links on to open safely, which is on the May , but we’re not discussing it,
which is a great way to ensure that that data’s really for you accessed. This is focused on phase three trials and I understand that
and it’s very important, but if you think about seven
F and partnering with industry to drive growth and innovation, early phase trials I would say
are also extremely important. And I don’t think I saw a single mention of the university in this paper. And if we want to drive innovation
and industry partnerships and everything else,
we need on the one hand to have patient data readily available. That’s what industry wants. But we need university
research to be drawn in, and then we need life sciences clusters, that bring those three sectors together, which is what is going to drive some of those early phase trials
to drive novel therapies. Because as I’m sure you know, 50% of the drugs in the pipeline
are not small molecules. They’re advanced
therapies, biologic cells, and genes, and all that. And that requires these NHS
academia industry clusters to be really thriving. – [Penny] Elizabeth. – Yeah, in past, David said
what I was going to say just about the return on
investment being compelling, but not always the cashable savings arrive in the NHS so the
engagement can be muddied, but I had the pleasure of
meeting with Lindsey and Vin about this topic and what
I was also surprised by, is the amount of work
that actually goes on, but the lack of cost recovery, even though the providers
have actually done the work, they don’t follow through
to have recover those costs from commercial contract research. So there is an opportunity
there for us in the sector and it’s on our agenda for
the 9th of October when we, or the 8th of October, sorry, when we bring the CFOs together again, and it’s gone out in a kind of a, these are the things we
should be looking at, and with Lindsey, we
are trying to identify which providers are doing the work, but not recovering the
income, which is surprising, which just makes me think it’s not linked through to the board or
execs or something is odd that’s going on ’cause
for us to follow up on. – Meghana. – Thank you. Thank you for the paper. So I completely agree that, you know, we have to make it clear that
research is not an add-on. It is part and parcel because
there’s clear evidence that research active organisations have lower mortality rates and there’s a lot of research
in primary care actually. So I would support adding the
metrics related to research to the board frameworks. The point is it’s not
just about the time taken to set up trials, it should
also be about access to research for diverse populations
and what percentage of diverse populations that come to clinic have that
research, you know, exposure. That’s the second thing. And third thing is standardising
pathways is really good. It’ll cut a lot of duplication and number of days taken to set up. However, if you get
organisations to do a process map of that pathway, you will find
specific delays at key points and one of them being pharmacy. – Yeah. – And that’s not because
they are not quick, it’s because there are
resource implications. So I think working through
those challenges will be key, and there’ll be different
at different organisations. But I know that pharmacy is a key issue. – So I think we also need a
kind of corresponding narrative for the public and for particular groups about the importance of
taking part in research and I don’t think people
associate research with primary care for example. And you know, it’s kind of how do you
change that expectation? Sorry, Sam. – Yeah, that links into
the app allowing you to participate and so on. Tom? – So I come from a position
of having tried and failed to set up a commercial
clinical trial in the NHS having some direct personal experience, I didn’t see anything
in the paper that I saw as fundamentally changing the paradigm that we’re currently in. I don’t think there’s any question that if you ask any leader in the NHS, they’ll tell you that they
think research is important. So just telling people
that it’s important. I don’t think it’s going to
particularly change anything. I think we need to have
a discussion on the table about two things. Firstly, some clearer incentives. So this point about cost recovery. At the moment, I think the mindset for
most NHS organisations is that this is yet another thing to do, and it will involve some cost as opposed to being an opportunity
to generate some income. So I think shifting from a, this is a cost centre to
this is an income opportunity is the most significant
shift that we can make, and we need to construct some incentives to actually make that shift occur. And that also means
that the incentives have to be understood in the wider system. The second thing, and I
think we should explore this with our partners, is that we currently approach
UK assets like UK Biobank and presumably HDRs on the same basis as kind of global public goods. So any researcher anywhere in the world can access UK Biobank. Given the kind of pullback that we are seeing from the
pharmaceutical industry, I wonder whether it’s time to explore whether there
should be privileged access to those UK assets for those companies that are research active in the UK, because at the moment
we’re making them available on a completely equal basis
to any company anywhere, regardless of whether they
contribute to UK life sciences or they don’t contribute
to UK life sciences. I think we should explore
that as a possibility. – [Penny] Paul. – Just reflecting on this being a cost and not seen as an investment
which can get a return, I think in probably the last 15 years, many universities have made that shift where research was sort of a
hobby that some people took and was a cost ’cause it
kept away from teaching to the universities recognising that they can get some return from this. But that is a change in not just mindset, but a change in organisational pattern. And so I think we could go
to not just the universities that have done this well for 50 years, but universities that
learned how to do that change and to transfer that learning into the National Health Service ’cause it’s quite recent
in these institutions. – Okay, so this has turned
into a bit more of a workshop, which I think is great. You’ve got low, I think I’ve written
down quite a few of them. You will have done lots
of really good ideas, thoughts, inputs. I think we have agreed that
we need to measure this and I think that includes
measuring what happens, maybe some stuff around finances, certainly how much is done in
primary care, wider settings. We don’t have time for you
to come respond to it now, but I think take all these things away, come back with almost a
beefed up version of this, including some choices
like Tom’s put a few like provocative choices out there. There are a whole wider set of actions for NHS England in the
life sciences sector plan. So what I propose that we
do is we’ll bring it back with all of the actions
and include this sort of, I guess set of wider things that people have raised across the table. But thank you for bringing that. – Thanks for everybody. – Very good discussion. Okay, I’m doing very badly on my timing. Next item is for us to
accept without discussion the improved access data and analytics. I do actually have quite
a few things I’d quite like to raise, but I won’t do that. Are people comfortable to
accept that set of directions? And we might pick up separately some of the questions that come from it. Okay, so we have some
questions from the public which Jim and Duncan and
Glen are going to respond to. Duncan, do you want to go
first with your two questions? – Yeah, so the first one is around, a question around the Supreme Court ruling on biological sex,
which happened in April. And the question is around
what is NHS England doing about this? And I think just to say that we are reviewing
our relevant policies and procedures to make sure that that is aligned with the ruling, but we do need to wait for the EHRC, which is the Equality and
Human Rights Commission to update its code of practise
for services, functions, and associations, which will
set out the legal framework of how services are delivered
in line with the Equality Act. And we need that available before we can make final
decisions about national policy. So the updated code of practise
will be published shortly subject to parliamentary approval and we will therefore
once that has been done, update the guidance and publish that. So we are kind of waiting on
that timeline essentially. And then there was a question, Penny, about the graduate guarantee
for nurses and midwives, which was launched in August this year, recognising that some
student nurses and midwives that were qualifying this year
were struggling to find jobs. There was, the government
announced the graduate guarantee, which essentially we are working on, and working the regional teams and across trusts have been
really leaning into this to make sure that we
support student nurses and midwives to find
roles not just in the NHS, but more broadly ’cause there aren’t just
vacancies in the NHS. There are vacancies across social care, the independent sector, and other places. And so we are trust as supporting measures about recruiting ahead of turnover, which we know happens every year, making sure that they’re
using vacant roles creatively. And we’ve also made a million pounds worth of funding available
specifically for midwifery to convert temporarily some
maternity support worker roles which are vacant into midwifery roles. The guarantee is for this year, clearly there is work that’s going on on the new 10-year workforce plan and the nursing midwifery strategy, which will look at future years. – Okay, thank you. Jim, voluntary
redundancy for ICB staff. – Yeah, we touched on
this briefly earlier. So a few weeks ago we met
with new cluster chairs and chief execs and talked
through where we are, where the potential is for a plan B if we don’t reach agreement
with the treasury. We are actively in discussion,
as I’ve said earlier, with treasury and hopefully
we will resolve that soon. But if not, we’ll have
to revert to plan B. That’s probably two, three weeks time. I think we’ll have to draw a line, and then at that point we’ll engage again. Every ICB has a plan that they can enact. It is limited by the
resource that they’ve got, so it would be more of a stage process. The benefits would be less
and slower than anticipated. But we will activate that as
soon as we’ve reached a point of either concluding the discussions or needing to revert to plan B. – Okay, thank you. And Glen, questions about
regional differences in terms of how vacancies are managed. – Yeah, so links to the question
Duncan’s already answered about the graduate guarantee
and who does what question in the new framework of the NHS. So we set out in the
model region blueprint on the eighth of September and that’s the first version of that. And we’ll do an updated version. That’s a high level mandate which sets out the
functional roles of regions, but also is to ensure
consistency across the regions, particularly on this issue. They will take the role of
strategic workforce planning at regional level and as part
of the oversight framework, we will be monitoring the performance of individual provider
organisations, but also ICBs. We will do a further
update of model region when we’ve completed the
10-year workforce plan, which will reinforce some
of those responsibilities. – Okay, thank you. Does anyone have any other
business they’d like to raise? Okay, well, thank you all very much. I think you’ve been extremely
broad ranging conversation and we will take forward the
various actions highlighted and look forward to the next time. Thank you.