Malcolm Grant Chairman, NHS England
Preamble Good morning ladies and gentlemen and welcome
to this meeting of the Board of NHS England.
We are meeting this morning in public in Leeds, and on behalf of the Board I would like very
much to welcome those of you who have joined us in the meeting room this morning.
It is a meeting in public rather than a public meeting; in other words, we are this morning
transacting quite a volume of business, as you will see from our agenda, and we will
be spending quite an amount of time on some really important issues.
At the end of the meeting we will go to a private session, but I would like to say informally
that members of the Board are very happy to talk to individuals in between the two meetings.
The private meeting this afternoon will be addressing a number of issues which are commercial
in confidence and which we are not able to take in the public meeting.
I should say the reason of doing this stuff in public is that we on NHS England get it:
that we have an extraordinarily serious and honourable responsibility, which is to ensure
that decisions are taken about the care that is provided by the NHS and commissioned through
the funds which reside with us, are taken in public, openly and transparently.
I am therefore insisting on every occasion that the business brought to the private meeting
has a good, substantial reason for it being taken privately.
We also meet as a Board informally from time to time, around what we call strategy or development
sessions.
Some of the early work of business that comes formally to the Board is undertaken by a combination
of executive members, non-executive members around the table and development sessions.
For example, yesterday, we spent the morning thinking about the future of the potential
impact of technology in the provision of healthcare within England, not only looking at IT and
data, but other technologies which may come onto the market.
In the afternoon we will look at genetics and genomics, to try to understand how these
played a role in not only the changes that we might expect within healthcare globally,
but also the Five-Year Forward View that we published recently and which we will return
to this morning.
So in that context, the items that we will be attending to this morning are items of
business that we believe absolutely do need to be taken and considered in public.
Agenda A note on the agenda: you will see at the
end of the agenda, under item 12, there are several items of Board Committee feedback
that are starred, the purpose of which is to invite any member of the Board to un-star
and to invite discussion on those items, otherwise we will take them as reports to the Board
that are read.
I have a notice so far of a request to un-star the item relating to quality and clinical
risks; Sir Cyril Chantler will be joining us at the table later this morning when he
arrives, and I know he's very keen to speak about to paper.
So, I have opened the Board meeting formally.
I would like to invite members of the Board to declare any interests in any of the business
under consideration, if they have any?
I have no declarations, thank you.
I have apologies from Lord Adebowale; he has written to me, and I have circulated his note
relating to items on the agenda to all members of the Board, and I have invited those who
will be presenting on those items to reflect on Victor's comments in their presentations.
Safety One final bit of business is to say that there
is no fire alarm tests scheduled for the course of the meeting, and if the alarms do sound
our team will escort you to a safe place.
Minutes of the last meeting Well, thank you very much.
Then may I move into the business of the meeting.
We have the minutes of the last meeting; are there any issues on the minutes?
No, there are not.
I do not have notice of any matters arising, so therefore we will take the minutes and
pass on.
We have now the Chief Executive's report and I'll invite Simon Stephens to introduce it.
Chief Executive’s report Simon Stevens
Chief Executive, NHS England
Preamble Thank you, Malcom.
I am going to be quite brief, because most of the items are covered at greater length
elsewhere on the agenda, but I just wanted to pick out three things.
Five-year forward view Publication
Firstly, to note the publication of the NHS Five-Year Forward View on 23rd October which,
as the Board will remember following our conversation at the last meeting, was a joint production
from the six national leadership bodies in the National Health Service, Monitor, TDA,
Care Quality Commission, Health Education, Public Health England and NHS England.
This was all six of us setting out a shared point of view and a set of actions that we
commit to take in order to help work with local partners and broader stakeholders on
three big questions: why does healthcare in this country need to change?
What will it look like when we have done so?
And how are we going to get there?
I think we were all gratified by the support and the reception that the Five-Year Forward
View received, which in part was precisely because it does represent a very significant
latent consensus on a number of these big-ticket questions, which is sometimes concealed either
by the immediate issues in front of us or by some other debates that are sometimes obscure.
People do understand why, although the health service has done very well last 15 years or
the last five years, doing more of the same is unlikely to be sustainable over the next
five.
And so we are going to have to make some big changes on prevention and demand, some big
changes on how care is organised and some big changes on how to drive efficiency and
investment in the system.
So it provides a good route map for a lot of work that is now required, both to continue
the joint national working that exemplified this effort, but also to ensure that we have
a proper national-local dialogue and that we continue to properly engage with broader
patient groups, citizens groups, local government and all of the partners who help shaped this
in the first place.
Regional meeting David Bennett, David Flory and I have conducted
four regional meetings around the country within the last ten days or so for the chief
executives of our provider organisations, CCGs and local authorities to begin dialogue
about how to now advance the priorities set out in the Forward View.
We will obviously be doing further work between us and coming back to this Board on what that
will look like.
We want to make some pretty substantial progress on this by spring.
Elements of it will be embedded in the shared planning guidance that we will be issuing
for 2015–16, so there are a set of immediate things that we want to get on with as well
as some long-term choices and positioning that is now required.
Waiting time Winter period
So, that’s the Forward View.
For here and now, as you know and can see and will discuss in the NHS Performance Report,
huge mobilisation of efforts across the National Health Service to ensure that we get waiting
time back on track.
Hospitals in particular are engaged in a major effort to treat long waiters by the end of
November, to give themselves headroom for the winter period.
Barbara will describe significant work right across the country on managing A&E pressures,
ambulance pressures, particularly in combination with TDA and Monitor, ensuring that the Health
Service is pulling out all the stops to try and be sure that our patients get the care
they are entitled to over this winter period.
Mental health You will also see that we published for the
first time mental health access standards which will begin to take effect from next
year.
We think these are very important, both at the severe and enduring mental health end
of the spectrum and also for our anxiety and depression services, and that is just the
first step in a longer journey that we want to take.
Also we recognise that we are going need to continue to see much more progress on child
and adolescent mental health services, as recently underlined by an important report
by the Health Select Committee earlier this week.
Contingency planning Ebola
The third and final set of things I would just like to draw attention to would be some
contingency planning which is going on in respect of both of the industrial relations
dispute that is going on across the Health Service and in particular planning and preparedness
for Ebola.
I might, Malcom, just ask Barbara to briefly update the board on the Ebola preparedness,
where again, huge cross-sectional action, recognising that the Department of Health
and Public Health England have leadership responsibilities here alongside us.
Barbara Hakin: The Board will be aware of NHS England’s specific role in contingency
and planning for unusual episodes for emergencies.
Industrial action is one, and there is already a lot of activity to ensure that we are prepared
for the first round of industrial action and that a lot of continuing activity to make
sure that particularly our ambulance services are supported and ready if there is any future
industrial action.
But there is a specific focus at the moment on Ebola, and because this is deemed as preparedness
for an emergency then NHS England’s role changes and we are responsible for ensuring
that the NHS is completely prepared for all aspects of dealing with this serious illness.
As part of that, we take a different role.
Under normal circumstances when we are dealing with routine care for patients, we commission
the care, we describe the services and we are responsible for ensuring that the services
that we don't have direct command or control of are provided by a provider organisation
who are overseen by Monitor and the NHS TDA.
That changes when we have emergency planning, and in terms of Ebola NHS England are in a
position, should it be necessary – and of course the trusts and the provider organisations
always comply and are very keen to support us on this – but we do have the ability
to direct and therefore communicate directly with them.
Over the last period I have been communicating directly with trust chief executives about
this issue, which I wouldn’t normally do on others.
Six pillars of support So, the overarching responsibility under the
direction of Cobra is managed by the Department of Health, but you can see that we have got
a very significant role working very closely with Public Health England and other partners.
There is a great deal of activity, but there are six things particularly that other programme
planners put together that the NHS needs to do in terms of supporting.
First of all, there is some support in West Africa.
So a lot of our staff are going out to West Africa to support there, give clinical advice,
anything else we need to do to help control the disease there.
The second, and we already had one instance of it, is repatriation, if someone needs to
be brought back from elsewhere.
I think we had an excellent result: they are all free, we have the two very specialist
beds at the moment and it was a great relief when an individual was returned, looked after
in one of those beds and is now well again.
The third is screening at entry ports, and whilst Public Health England and the Department
of Health are overseeing the actual screening, should screening result in the individual
who is suspected of having Ebola then it is entirely to the NHS.
It is the response the NHS makes in ensuring that the patient is properly dealt with until
we determine whether or not they do have Ebola.
Another big part of the work is the awareness and preparedness of the staff.
I think this is the one where we put in the most effort, and there is still more work
to do.
We need to ensure that all first-point-of-contact health staff understand what questions they
should be asking.
If there might be a suspicion that an individual could have Ebola, we need to be sure that
they are aware what precautions they need to take if the suspicion turns into significant
assumption that the patient might be effective.
So we have got a major communications exercise with GP practices and every provider organisation
to do that.
We then move on to the fifth, which is the handling of a suspected case.
So, what we do with individuals when we think it's really likely that they have Ebola?
How are we with the full treatment rather than just that initial contact?
And then finally, dealing with patients who are diagnosed as having Ebola, and a major
part of the work for us is the resilience of the system if the numbers increase.
At the moment we have had no cases diagnosed in this country.
We hope that that continues, but clearly the NHS has to be in a position to deal with however
many patients we need to, and the plans to open extra beds both at the Royal Free and
across other parts of the NHS in England to treat patients who have Ebola is a critical
part of the workstream.
Just to assure the Board, we are doing a lot of awareness training and we are also assuring
ourselves that those six passes of work are being put into place.
We have written to all the provider organisations to ask that they assure us that their staff
are fully briefed and have the right equipment and would know how to use that equipment,
and we are doing some spot-checks to make sure that at A&E departments and GP surgeries
the right information is available to staff.
Malcolm Grant: Thank you Simon.
I know that the Board would wish me to express our thanks and congratulations to all of those
who were involved in the preparation of the Forward View.
We are going to come back to it this morning, but at this stage of the meeting we recognise
that this is an extraordinary collective effort which has involved not only a large number
of people within NHS England, but of course in our partner NHS organisations.
To have produced a report of such clarity with such convergence of opinion, and to have
found such support amongst patient organisations and think-tanks and other groups who can share
with us the strength of view as to how the NHS needs to transform over the next five
years, has been a very significant achievement.
As we come back to it later this morning you will hear from the Board various commitments
to how we now drive you and the executive team very hard forward for delivery but I
would like formally to put on record our thanks to the team and you particularly for your
leadership.
Moira Gibb: I echo that, Malcolm.
I just wanted to suggest that the Board puts on record our appreciation for all the staff
involved in preparation for Ebola.
It is on top of very demanding jobs in a way, and it is incredibly important for the country
that we should express our sincere thanks.