we take and the responsibilities that we bear are of intense public interest. The faith
and confidence that the public of England have in the National Health Service befits
that we should consider issues affecting its funding, its future and its transformation
in a public setting.
Two caveats to that. The first is that we will conducting the principal business of
this meeting in this public setting but always there are confidential items that we need
to take in a private meeting at the close of this the public meeting. Secondly, to stress
always of course that although this is the high point of the conduct of business by the
Board we do a lot in other forums. We do a lot in committees. There will at the end of
today's formal agenda be some reports from committees and I would highlight particularly
a new committee, the Commissioning Committee, that met for the first time yesterday, under
the chairmanship of David Roberts. He will be making a report to us today on the business
that they were able to transact.
A couple of days ago we had a meeting of the Task & Finish Group on congenital heart disease.
We will be bringing to the July Board a paper that has been worked up over an extensive
process of public consultation.
Yesterday the Board met with the NHS Citizens and participated in a session with them here
in Leeds, yesterday afternoon, which I think I can say on behalf of all of the Board we
found exceptionally interesting. It helps us to get away from some of the high level
issues of funding and trying to drive change and to actually engage with, not just listen
to but engage with people who are having a daily experience of the services that the
NHS provides across the country. To work with them around issues of improving service and
co-design and actually working through with them a number of issues that they had raised
with us last September at our AGM. We were able to report on what progress we had made,
where there had been success, where there was disappointment and what our commitments
were for future development.
We also spent some time yesterday afternoon in what we call a Development Session, which
is the Board in informal session thinking about the longer-term strategic issues and
particularly in the really tight funding settlement that we have got for 2015/16, what will be
the priorities and how we will address them. We will come back to some of that in the course
of today's meeting when we review the principles that will underline our business plan for
next year.
That I hope gives a contextual picture of the way in which the Board operates. I have
always been very keen to ensure that this was not a Board which at a formal meeting
received proposals that have been worked out by the Executive Team, subjected them to cold
scrutiny and then dispatched them. This is a Board that works together as a team across
the whole business.
Just one final issue which is to say that we have been experimenting for the last couple
of years with producing our Board papers in electronic format so you will see Board members
referring to iPads. These contain the full Board papers. They are not being used for
Angry Birds or any other illicit function. When Board members' eyes are fixed on their
screens they are totally focused on the business of the Board. I hope that is clear.
Let me please then declare the meeting formally open and move into the formal business to
say that there is no fire alarm scheduled in this building this morning. If the alarm
does sound we will evacuate the building and we will be led by our team. Secondly, I am
going to invite Board members to declare any interests that they may have in specific items
of business on the agenda.
I need to declare in relation to Item 7, which is genomics, that I am a Board Director of
Genomics England Ltd. Two things about that. First of all, that is a company wholly owned
by the Secretary of State for Health to carry forward the 100,000 Genomes Project. Secondly,
I am not NHS England's representative on the Board. There is a Board Director. My responsibility,
my fiduciary duties are to the Board of Genomics England but my presence on the Board is, I
think, a valuable way of balancing the quite complex partnership that we, NHS England,
have with Genomics England.
Are there other declarations of interest? Moira?
>> Moira Gibb: I should just re-state that I am the Chair of Skills for Care and related
to the Adults with Care paper.
>> Malcolm Grant: Thank you. There are no other declarations of interest. I have no
apologies for absence. This is a full house and indeed we will be complemented during
the morning by David Pearson, who is the President of ADASS, and Carolyn Downs, Chief Executive
of the Local Government Association, who will speak to the paper on social care.
The handling of business, we will probably take the two items of committee reports that
are formally on the agenda as starred items unless in the course of the meeting anybody
indicates that they would like to open those items. However, the report from the Commissioning
Committee I will take as a full item of business.
I would like to invite the Board to signify their approval of the minutes. Thank you.
I have no matters arising that are not otherwise on the agenda. Anybody else? No, thank you.
>> Simon Stevens: Thank you, Malcolm. I would first of all like to thank all of the staff
of the National Health Service who were involved in NHS Change Day, two weeks ago, which was
a fantastic mobilising of energy and optimism, dare I say it, on the part of tens of thousands
of nurses, junior doctors, therapists, porters, other staff across the Health Service, all
of whom were identifying things that they could see they wanted to change in their part
of the Health Service, making commitments to do so and taking action on the back of
that. I think that is a good corrective to the understandable pressures that everybody
is under and a sense of real ability to re-shape services, which is obviously what we are going
to need over the period ahead.
I spent the day with a nurse called Andy Tysoe from Countess of Chester Hospital. He gave
me my Dementia Friends training. Then I spent part of the afternoon with a group of people
with learning disabilities and their families, and met a young woman who had been living
in institutional care for years. She came to show me her video of her sailing in the
Solent as a result of having taken control of personal budget for those services.
I met another woman called Jean Riley, from Yorkshire who described the massive impact
on the care of her daughter that being able to take more control of the health and social
care that she had. In fact I was so impressed with what Jean Riley had to say that I took
her with me, the very next day, to a speech I was giving to the Royal College of Physicians
in Harrogate and we did a double act together. She explained precisely how care can change
on the back of the frankly revolution in the balance of power that has occurred. Those
are great sources of optimism. Huge thanks to all of the frontline staff involved in
NHS Change Day.
Changing gear a little, as we think about the current position in the National Health
Service, later on the agenda we will have the report from Barbara describing the current
pressures performance. We are obviously at a point in the annual cycle where providers
and commissioners, CCGs, NHS England, working out what is the appropriate way of squaring
the circle between funding and investment and activity and improvement for the year
ahead. No doubt that this is going to be a complex task over the next four to six weeks;
everybody using best endeavours to do the right thing for patients in their local communities.
Over the Easter period, looking out for April, we have asked, 'we' being ourselves, Monitor,
the Trust Development Authority, that CCGs continue to fund all of the extra services
that were in place over the winter period through April while the Better Care Fund kicks
in and the contracting round is concluded.
I think we cannot avoid the fact that there clearly are very substantial cost pressures
which have been building in the hospitals over the course of this year. I think that
has to be a call-to-action on the part of the NHS collectively going into the new year.
What I think it clearly shows is that the single biggest cause of pressure has been
the big increase in extra staffing, particularly agency staffing, temporary staffing. What
that shows is that the combination of a fair national pay system but then leaving individual
employers to try and hire temporary staff by themselves, that combination is not working
in that has produced an overspend of £697 million across just the Foundation Trust sector
in the first nine months of this year.
That tells us something very important about how we have got to change our approach to
managing the workforce of the National Health Service and it tells us something very important
about how we are going to deliver on the broader efficiencies, the £22 billion or so, that
are going to be required whoever turns out to be the next government.
This collective action issue is something that NHS England together with our partners
in the other five national leadership bodies of the National Health Service and employers
across the NHS are working on intensively now. I suspect we are going to need to take
a radically different view to things like setting maximum rates for agency staff employees
over the course of the next six months or so. That is the sleeves rolled up conversation
we have to have. It will be better for quality of care. The RCN themselves say that there
is enough funding to potentially convert that spending into more than 20,000 permanent nurse
posts. That is the job of work that we have got to now engage with our partners across
the NHS on.
Looking more broadly at the Five Year Forward View agenda, we have made really quite substantial
progress on kicking off a number of the active ingredients that are going to be needed for
success. We have got a paper later on in this meeting, Malcolm, on the first 29 vanguards.
The energy on the part of the many hundreds of groups of nurses and doctors who came to
talk at the Oval for three days, debate what the future would look like, I think was a
source of great encouragement and inspiration.
We have with Public Health England kicked off the first national diabetes prevention
programme, which is obviously not going to solve our health or financial problems next
year but is an important start to a broader programme of taking prevention seriously.
We have got a discussion later on this morning on health and social care. Again, with the
Integrated Personal Commissioning bringing together health and social care budgets for
individuals and the, in principle, agreement to move in that direction in Greater Manchester.
I think NHS England is showing the seriousness with which we are taking action on that agenda.
Then today, in respect of the innovation agenda, we are, together with the Office of Life Sciences
and the Department of Health, kicking off the worldwide call for innovators and entrepreneurs
who want to come and use the NHS as a test bed for improvement. We are never going to
be the healthcare system that pays the highest prices in the world but we ought to be the
destination of choice for people wanting to try new innovations that produce a good pay-off
for patients and for tax-payers.
This week we have also launched the Mental Health Task force, which as prefigured in
the Forward View, will help us chart the key priorities for mental health improvement and
parity of esteem over the next five years. Similar to the process we have kicked off
with cancer under the leadership of Harpal Kumar.
Today we are announcing the membership of the Maternity Review Team that we, at the
time of the Morecambe Bay inquiry, said would be required in order to review the UK and
the international evidence on responsive and efficient maternity services, ensuring that
women get safe and appropriate choices and that staff are supported in the provision
of that care. We are asking Baroness Julia Cumberlege to
chair that review panel with Sir Cyril Chantler as the Vice-Chair and then a wide cross-section
of interests and expertise including neighbourhood midwives, consultant midwives, the National
Childbirth Trust, Mumsnet, the Royal College of Obstetricians & Gynaecologists, the Royal
College of Midwives. James Titcombe, who is a bereaved father from Morecambe Bay, has
also kindly agreed to serve as a member of this panel. High expectations, important work
to be done here on all of our behalf over the course of the rest of the year.
Finally, and we will talk about this in a moment I know, Malcolm, our business plan
for the year ahead: we expect, subject to the Board approval today, to be able to publish
that tomorrow.
The last thing I should say by way of a piece of important processes that work for the National
Health Service is obviously we are about to go into the election period and it is entirely
legitimate and desirable that in a democracy there should be vibrant debate on the future
direction for the National Health Service. All of us working in the NHS recall the standard
guidance that applies to the National Health Service over this period of time. Decisions
on whether to permit visits to NHS property are of course the responsibility of the individual
NHS providers but there should not be disruption to services and the same facilities should
be made available to all candidates. Election meetings should generally not be permitted
on NHS premises.
Those standing rules kick in the moment that parliament is dissolved and the reality, of
course, is that we go into this election with the NHS having a plan for what the future
needs to look like; a widely-agreed game plan with a lot of agreement on the type of care
re-design that is going to be required, a clear proposition to whoever is the next government:
'Give us the tools and we will do the job.'
>> Malcolm Grant: Thank you, Simon, on that high note. May I invite members of the Board
to raise any queries or comments on the Chief Executive's Report? No. Well done. Thank you
for that and indeed much of what you have presaged we are of course going to be coming
to in the course of the meeting. Thank you very much.