Right, thank you very much for that, and may we now turn to the board assurance framework.
If I can draw the boardís attention to two or three changes, particularly changes that
have been in the risk register since the board viewed it last time.
Firstly the reduction in the risk around urgent care demand, as we move through towards the
end of winter, with evidence that the NHS has come through this really well.
A second reduction: I am really glad that Paul left me the glory and did not steal my
thunder on reporting to you that we have reduced the risk on transition of the transfer of
assets and liabilities risk likelihood, on the grounds of agreeing an accounts direction.
I think one issue that we should note is an increase of the risk on activity to control,
which is exactly what Paul alluded to earlier, that we still have real concerns that we do
not have the sort of contract monitoring activity that we would really like to have, which is
having an impact on our contractibility, particularly around specialised commissioning and on the
basis of the decision to increase the risk at the executive risk committee, a range of
other actions put in place to improve around that information.
And also if I can get the board to note that some new actions were added around emergency
preparedness, and around 111.
The ones around 111 were very much around safe transfer of NHS Direct which of course
has now happened.
And if I can remind the board that this is the last time they will see this specific
version of the risk register.
Next year we will have a new version, but we will be very careful to ensure that all
these risks are mapped carefully onto the newer risk register and none of them are lost.
They are either clearly closed down because it is appropriate, or they can be tracked
onto the new register.
Thank you very much, Barbara.
Any comments for Barbara?
Can I just say, it is quite interesting that we have started the year with a risk register
that was bright red, in tooth and claw and in every respect, and it is good to see some
shoots, green shoots coming through at different points, but as we move to the new model we
will have a new way of tracking risks and our way of management.
One thing just to reinforce, at this time last year we never published any of this data,
we are the first big organisation to do it, the first time in the history of the NHS that
it is been published in this way.
And entirely true to the values of the organisation.
But thank you very much.
We move then to item eleven, which is winter performance.
Thank you.
And what I want to do is repeat much of the stuff that I commented on in the performance
report, because the board asked for a review of how well we managed winter, and a look
forward to managing winter next year.
So I, as I said, the detail of our performance, I have already mentioned that I really do
think we should commend the NHS, because an awful lot of people, of our staff on the front
line, have done an absolutely fantastic job in maintaining a great service for our patients.
The paper, as well as giving quite a lot of detail of some of the aspects of what we do
to monitor performance which I will not go through, but the board has them all on the
paper, describing the winter health check, the kind of information that we have been
putting into the public domain every week about how we are performing and managing winter,
and the information that we get from what we call the sit-reps, on a regular basis.
This year we have continued the daily sit-reps through March, normally they would end at
the end of February, we have continued them through March because if you look back at
last year there were some significant problems around delivery that actually went through
March and into April.
The paper then goes on to inform the board about the precise uses of the winter funding,
from paragraph 26 onwards, and where we have targeted that.
But I would then like to move on to talk about our planning for 2014-2015.
Again, we know we have got a population that is getting older, having more ill-health and
more things that we can treat, and what we need to make sure as we go through into next
winter is that those treatments, as we talked about when I talked about the better care
fund, that can be delivered outside hospitals, in communities, so that people do not need
to go to the A&E department or be admitted into hospital unless it is absolutely the
right thing for them to do, that we need to make sure that we are putting those in place.
The working arrangements are excellent with our other partners, those who oversee the
providers and our partners in the local government.
I also think that for next year we have learnt some lessons that last year we did not work
closely enough with the voluntary sector and the independent sector, because they obviously
both have a great deal to offer in managing and support in winter.
As I said, I think the last board meeting we had a round table session with the senior
leaders from the independent voluntary sector which I chaired, and out of that has come
some comprehensive work program so that we can support each other, to be ready for next
winter.
So paragraph 34 identifies the work streams that, the key work streams that we are undertaking
with our partners to put in a better place for 2015, and I think that our absolute determination
that needs to be much more on the front foot to make sure that people understand whatís
available, what help and support is available to them much earlier in the year, and that
we ask for and assess plans much earlier in the year, so we can further improve our resilience.
Thank you.
Let me invite comments on the winter performance report.
We will have to move very quickly to make it happen.
Thank you very much.
That is, I think, a genuine vote of gratitude and congratulations from across the whole
board.
Thank you for that.
Right, we are now turning to other business.
I said at the outset that I had two items of other business that I wished to bring to
the board.
Now, the first is to note the secondment of Jo Wass from NHS England to the University
of Leeds, and to invite the board to join me in extending congratulations to Jo on taking
on this new assignment, and to wish her the very best in the new role.
The University of Leeds is one of the top universities in the country, and the culture
I can assure you of universities is slightly different from the culture of the NHS, but
a fantastic opportunity.
But for our purposes, simply to record that Jo was responsible for leading a major part
of the operation of setting up NHS England, and particularly the transitioning of staff
from the old organisations into this organisation, and ensuring that we were fit for purpose
on day one.
Not only that we had staff in place, and they were properly resourced and provisioned, but
also they were paid at the end of the month, and those of us who have watched that from
month by month and seen, I think, in the first month we had five successive pay rolls at
the end of the month to make sure that we got there, and that, by the way, is dedication
way above the normal course of duty for the director of HR.
But secondly, Jo, I would say the way in which you helped us to set the tone and the style
of the organisation, the values the organisation will develop and processes that we have been
throughÖ We are not there yet.
This is a new organisation with a new culture, but your contribution to that has been outstanding
work, we are very grateful.
Thank you for that.
The second item of business is to record that this will be David Nicholsonís last meeting
of the board as its chief executive, and to say in respect of that that David was appointed
the chief executive of the NHS in its old guise back in 2006.
I think, David, that you served five secretaries of state, was it Patricia Hewitt, Alan Johnson,
Andy Burnham, Andrew Lansley and Jeremy Hunt, all of them outstanding individuals.
And then he transferred from that regime to this, but not only transferred but was very
much the architect of the model within the health and social care act that established
for the first time an independent board, with responsibility for the management and the
day to day organisation through commissioning of the NHS in England.
I think that the extraordinary effort which was undertaken of dual running of the old
system, based in Richmond House, and at the same time setting up this new system, and
the run up to 1st April 2013, was probably something that no other country has attempted
to do and which many, I think, pessimists as we now call them, would have thought was
impossible for any country to do.
I have to say, it was a huge risk, and I am serious that our risk register in those early
months was bright red, and it has been I think a tribute to Davidís delivery of NHS England
into an area where we can now, although cognisant of all the risks that surround us, have a
real sense of purpose and strategy, and of future, is entirely down to David and his
leadership.
I see it as not only a matter of having exerted appropriate grip on the organisation to ensure
that it moved from one model to another, but also of an intellectual rigour that has allowed
us to envisage what an NHS might look like that can transcend political timelines and
can do the really extraordinary things that we have been discussing this morning, which
will, I hope, secure the future of an NHS free at the point of need for patients for
the coming generations.
So, David, your contributionís been extraordinary, it is not just over the past seven year, but
of course since ñ well, thirty-six years.
I think it is very difficult for anybody to have served an organisation that is had a
consistent set of values over that time, and to leave the organisation, but to leave it
in a situation where it is fit for purpose, is up and running, has a sense of its future,
and a sense also of its challenge, is a major tribute to you, and I think the board would
wish to join me, first of all in thanking you for all that you have done, for wishing
you the very best in the future, which I am sure will continue to involve Nottingham Forest,
I think running an independent twitter account, and of course, continuing to keep a close
interest in all our affairs but on behalf of the whole board, thank you.
Well, I just thank the board for their support over the period, just a few, a couple of things
I would like to say.
This is an enormous task, but it is an enormous privilege to be involved in the NHS at any
level, I guess, whether it is at a treating patients level or at a level like ours, and
it is an enormous privilege to have served patients over the period.
It is been undoubtedly a very difficult period for the NHS over the last few years, well
documented, not only have we attempted to improve services for patients, we have had
to change the nature and way in which the system works.
And I think the Board have done a fantastic job.
Actually, I have not worked with a better board, a more committed board to the values
and principles of the NHS as the one that we have got here today.
Two or three things, one of them is I will, for the next board meeting I will not be here,
but I will be sat with my daughter watching it live streamed, tweeting my responses to
everything that you say, and all that.
But one thing that politicians need to do now is they need not to fiddle about with
the organisation of the NHS, no top-down reorganisations I think is the thing, that it is important
that the NHS needs a consistency of purpose, it needs the commitment to thinking beyond
the next month, but over the next four or five, four or five years to enable the NHS
really to become part of the future of this country, it is very important that they do
that, and although it is my last board meeting I have not gone yet, so anybody who works
for me, please realise that, you know, the work continues until the very last minute
that I am here.
Thank you.
Well, thank you very much.
I think we all take that message and can I say that we will now pass the normal resolution
which is that we go into private meeting for a few items of business for the rest of the
day.
But thank you, David, and thank you everybody at this morningís meeting.
Thank you.