>>Malcolm Grant: We have started today a quarter of an hour later than we normally do because
of the observance of a silence for the victims of the Manchester bombing. We will have a
few more words to say about that in the course of the meeting, and of the NHS response to
it.
But may I start, please, by formally opening the meeting. I have had apologies from only
one director, and that is Joanne Shaw. I need to invite any members of the Board to review,
please, their declarations of interest, all of which are tabled in front of us, and to
advise now if there are any specific interests relevant to any item on the agenda.
No, we have none. Thank you very much.
I should, again, observe that there is no formal expectation of a fire alarm test this
morning, so that if the alarm should go off, please follow the advice and instructions
of our staff, who will escort us safely from the premises.
We have, now, the minutes of the last meeting of the Board. Could I please ask colleagues
to confirm whether they are a true and accurate record? They are, thank you. I've had no indication
of any other business; is there any other business? No, thank you very much.
Sorry, I should have said 'any matters arising'; I'm jumping ahead of myself.
So, let me turn then to the Chairman's Report. I'd like to start off by observing that we're
holding the Board under conditions of purdah, and that that is a cross-governmental requirement
which inevitably cuts in at the time that a general election is called. Had the election
timing been somewhat different, I think we would have rescheduled the meeting of the
Board, but as it is, I think we have to do two things.
One is to be respectful of purdah; the other is to try to ensure that it doesn't conflict
with our requirements of good governance, as a board conducting serious public business
and conducting it in public.
The way in which we have dealt with that in assembling the agenda today requires us to
make some amendments to how we would normally have proceeded. I would suggest that probably
those which are the most significant are that, in relation to the items on the agenda under
the heading 'Governance', we have four items: on the complaints policy, on managing conflicts
of interest, on standards of business and on external whistleblowing, in which I would
like to propose to the Board that we should have a full and open discussion of these issues,
but that the precise policies, we have felt, on advice, that we should not put up onto
the public web at the moment, because of the potential of breaching the purdah requirements.
I think it behoves us to be very cautious about purdah, given the high salience of the
NHS in any general election, so I should apologise to members of the public that the policies
will not themselves be available, but that will not, I hope, inhibit a full discussion
around the Board table.
The other two or three items that I think one should record right at the beginning of
our discussions this morning are, first of all, the publication of the Next Steps on
the Five Year Forward View. That was being finalised at the time of our last meeting,
and it is now a substantive agenda item on today's agenda.
Thirdly, the cybersecurity attack, which affected the NHS very seriously ten days ago; I will
invite Simon to say a little more about that in his Chief Executive's Remarks. But to remark
only at this stage that it, I think, demonstrated two clear things: one, the resilience of the
NHS to the attack; and two, the vulnerability of the NHS to future potential attacks, and
to assure the Board that every possible step is being taken to strengthen that resilience,
working not only through NHS England but through the arm's-length bodies and the Department
of Health.
And then fourthly to, again, make mention of the tragic bombing in Manchester, and the
unfortunate and devastating loss of life and really devastating injuries for those in NHS
care still. Again, Simon will comment further on that, but as an exhibition of the solidarity
which the NHS represents in contemporary society, it's a very, I think, striking reminder of
the ultimate function that we're all here to fulfil.
Let me then turn briefly to update the Board on some of the activities with which I as
Chair have been involved since the last meeting.
A series of public speaking engagements, including work that I've been doing with the Academy
of Social Sciences leading up to the publication of their report on Health to the People, trying
to understand better how the social sciences as well as the life sciences have a role to
play in promoting public health and reduction of mortality and morbidity. A presentation
to the Dementia Conference organised by the Alzheimer's Society last week; again, emphasising
the relationship of the work that NHSE does in the much broader context of social care,
and other interventions that are critical to coping with a major episode of - and growing
episode of cognitive decline across society.
Secondly, a number of visits, including to Moorfields, and also discussions with the
Royal Free Hospital on the use of modern technologies to advance the interests of patients. And
also, a recent visit to the Altogether Better vanguard at Dudley, accompanied by Sir Bruce
Keogh and Sam Jones, to try to understand where our best-performing multi-specialty
community practices providers were heading as we move towards an era in which STPs will
absorb a number of those functions and those concepts, and take them further.
And then thirdly, a number of cross-governmental meetings working on the Genomics England Board
and on the 100,000 Genomes programme. Meetings with the Department of Health across government,
with the new National Guardian on speaking up, with the Policy and Health Services Commissioner,
and working also with the team on the Life Sciences Strategy. So, that is intended simply
to keep the Board abreast with activity conducted as Chair.
I have no further matters to report. I would invite the Board to express any views, comments
or queries on that report, but in the absence of that, invite you please to note it, and
to turn now to the Chief Executive's Report. Simon, over to you.
>>Simon Stevens: Thank you, Malcolm. So, in a similar vein, given purdah, this will - we'll
confine ourselves to immediate operational matters. And, as you say, I want to really
focus on the work that's happened since our last Board meeting, in responding both to
the cyber attack and the Manchester outrage. And as you cast your mind back, you'll remember
that eight weeks ago, at our public Board meeting, we actually reviewed the NHS Emergency
Preparedness and Response arrangements, and the training and the drills that are regularly
run to ensure that they operate smoothly. Unfortunately, since that meeting at the end
of March, we've had these two major incidents: firstly, the cyber attack, which we stood
up a national response to, beginning at 16.00 on Friday, 12th May, which lasted a week.
And then secondly, Manchester.
In respect of cyber, I think the first thing to say is that this was probably the first
national-scale threat that the NHS has received, and some very effective work took place in
response to that. I think there are a number of lessons that NHS Digital, NHS England,
NHS Improvement, the National Cybersecurity Centre, will be taking from that. Some of
them we have discussed as a board, in private, for obvious reasons, due to the security-related
aspects of that, but there's work that, under the leadership of NHS Digital and colleagues,
we will be needing to take as a system over the course of the next sort of several weeks
and months.
But I really just want to actually talk more about the Manchester response. And as everybody
knows, the regional emergency coordination process immediately kicked in on Monday night,
has worked practically flawlessly.
There have been effective trial runs and processes put in place across the major trauma hospital
and ambulance service networks that have been rehearsed very recently, in fact. As of 06.00
this morning, there are 116 people who've received inpatient care in relation to the
incident, and 23 people are still in critical care.
The NHS is also mobilising appropriate support for children and young people, families and
staff, in terms of the psychological consequences of this. And the Board knows that JTAC raised
the threat level from severe to critical earlier in the week, so NHS England has stood up the
national EPRR requirement that every NHS organisation now takes action in the way that we have specified
according to longstanding response protocols, ensuring that all their staff are aware of
what the local incident response arrangements need to be; that they've reviewed, in the
case of acute hospitals, their operating theatre, emergency staffing levels, blood supplies,
ambulance and transport arrangements; and also confirmed what's called the mutual aid
arrangements between different NHS organisations in a geography.
And I think, perhaps finally, Malcolm, what I would say is that I think that term 'mutual
aid' kind of captures the essence of what we've seen in Manchester, not just between
different organisations coming together to respond, but mutual aid as really the embodiment
of what the NHS has been doing for the people of this country. And I don't think it can
be put better than the way in which a senior doctor at Manchester Royal Infirmary involved
in treating patients put it when he has said, 'An atrocity has been carried out which has
had an unmeasurable impact on countless lives. Many casualties were brought to our department,
and dozens upon dozens of my fellow staff arrived to help. The response represented
everything great about this country: compassion, empathy, tireless self-sacrifice and, above
all, profound unity.' So, I think we as NHS England should put on record our huge debt
of gratitude once again to the frontline staff of the National Health Service who have responded
so brilliantly under these terrible circumstances.
>>Malcolm Grant: Indeed, thank you, Simon. We will certainly record that. May I invite
any comments or questions to the Chief Executive? No. Thank you. We'll note that report.
May we move on please, then, to the next item, which is a report on the Next Steps on the
NHS Five Year Forward View. Simon?
>>Simon Stevens: So, for the reasons you said, Malcolm, this is really a sort of formal report
in that, at our March 30th meeting, we were one day before publication of this, and the
content constitutes our business plan, our operating plan, for 2017/2018 in line with
the mandate we are operating under. I think there is now great clarity about the things
that we can see need to get done on urgent and emergency care, and primary care, cancer,
mental health, the 10-Point Efficiency Plan that the NHS has laid out. And without pre-empting
whatever may happen on June 8th, I don't think there's anything in here which would not be
important for the NHS to be responding to over the course of the coming 12 and 24 months.
So, notwithstanding the election campaign going on, in practice the whole of the NHS
is mobilising around making sure we're as well placed as we can be to get this stuff
done for the patients and communities of this country over the course of the next year.
>>Malcolm Grant: Thank you. I'm looking around to see whether I should invite any comments,
but I am conscious that every member of this Board has played a major part in devising
the Next Steps document, and the non-executives have been deeply involved in this throughout
the process. So, unless anybody has anything further to add at this stage, may I actually
commend the Executive on behalf of the Board for the production of the report; to stress
secondly its interdependence with other arm's-length bodies and other players across the system
across for delivery; and thirdly, to note that we will be monitoring the progress of
its implementation and delivery across the country very closely. Are we content to note
that report? Thank you.