Simon Stevens>> EPRR?
Malcolm Grant>> No, no.
I think we carry on?
Thank you, right, okay.
Let me turn to item 10, and we have delegation of primary medical services functions.
Ian?
Ian Dodge>> The purpose of this item is to seek formal agreement from the Board to the
delegation of the function of primary medical services commissioning to 51 CCGs as a kind
of second wave.
This is in the context of extant NHS England policy to support applications from CCGs to
take on these functions as part of the joining up of NHS commissioning functions to provide
a better focus on place and better integration of services.
Secondly, within the context of the robust management of conflicts of interest, including
our new strength and guidance, which we have just discussed.
Thirdly, and I have touched on this already, a formal assurance process, overseen by commissioning
operations directorate and our regions.
Then fourthly, what I would describe as an initial, broadly positive set of information
of the likely benefits from co-commissioning, including through a survey of CCGs that have
gone for either delegated or joint arrangements, discussions with NHS England, regional teams
who have been involved in their functions hitherto and many continue to, and some emerging
examples of CCGs.
However, it is still relatively early days to be able to make a full assessment.
We are nonetheless keen to get independents and clear feedback on the efficacy of the
new arrangements, including through a formal independent evaluation which is being undertaken
by the policy research unit for commissioning.
We will have, as I say, further data in due course.
On the basis of that brief explanation, I invite the Board to approve the delegations.
Malcolm Grant>> This is an extension of what we are already doing.
We have some understanding of how that is working in practice, and we know we will have
more in due course.
On that basis, may I invite the Board to approve the proposals in the paper?
Good, thank you very much.
I would like to move now onto item 11, which is the emergency preparedness, resilience
and response paper, and to invite Bruce to speak to it.
Bruce Keogh>> Thank you very much, Chairman.
Under the Civil Contingencies Act 2004 and the Health and Social Care Act, this Board
has responsibility for taking over the effective functioning of the NHS in the face of significant
disruption, and the aim of this paper is to assure the Board that we are assuming that
responsibility effectively but not to induce any sense of complacency.
I will not run through the paper itself, but I would like to make a few remarks about some
additional issues.
The first is that about a month ago we were part of an exercise called Unified Response,
which was one of the biggest exercises ever undertaken in Europe to simulate a major disaster,
with over 1,000 casualties; there were teams from three other countries.
It had been over 18 months in the planning, and the end result of that was the health
component of that stood out very well with no major deficiencies exposed.
The second issue that I would like to raise, which is in the particular context of clinical
experience, is that we have had two learning events to try and understand what happened
in the Paris attacks and what could have been done better.
The most recent of those was 8th March in Birmingham, and major trauma centres, the
military and other people of interest took part.
We are currently awaiting a call with the French Health Ministry to exchange our learning
with them, but I think it would be fair to say that we have a good understanding of that
and that we believe our major hospital incident plan is equivalent to their white plan and
it is as effective, and that our mass casualty plan is the equivalent of the French red plan
and is just as effective.
The third thing I would like to say is that during the course of the year we had to deal
with the Ebola epidemic emerging in West Africa, and I think it would be remiss of me not to
say that our first lesson that we learn from that, and I would like to say this on behalf
of the Chief Nursing Officer and myself as Medical Director, was an example of remarkable
selfless professionalism from many people working in the NHS who demonstrably put their
own health at risk for the sake of others.
I think we owe them a debt of gratitude.
I believe that we have acquitted ourselves pretty well in the Ebola epidemic.
The risk that ensues from that is that somehow or other some complacency does emerge, and
that all our protocols, our structures that we put in place and the learnings, just somehow
or other get stuck on a shelf and they gather dust.
To ensure that that does not happen, and that we maximise the relationships that were built
throughout the United Kingdom – not just England – for attacking Ebola, and that
they are cast into the DNA of the way we do business with highly infectious communicable
diseases, we have asked Mike Jacobs, who was the lead clinician for the Ebola epidemic,
who works at the Royal Free Hospital, to help us distil those learnings and to embed them.
The fourth area that I would like to pass comment on is that pandemic flu remains on
the National Risk Register as a very significant and potential problem, and that the Department
of Heath will be conducting a major exercise to try and understand how we would deal with
that in October this year.
The fifth and sixth issues are related, and they refer to the junior doctors’ strike.
So next week, between 08.00 on Wednesday and 08.00 on Friday, junior doctors will be undertaking
another of their strike actions.
Emergency services will be covered.
We have undertaken, or are in the process of undertaking, a data collection to understand
how each trust will deal with this and to assure ourselves that we are in a reasonable
place.
That data collection closes at 17.00 this evening, but early indications are that we
do not expect there to be any difference with this 48 hour disruption to the previous 48
hour.
However, there is one small caveat to that, and that is that the strike next week will
coincide with the changeover of about a fifth of junior doctors in the country between different
organisations.
So we have had to work closely with Health Education England to ensure that we have the
right induction processes in place to ensure that those junior doctors who are changing
institutions, and particularly those who might be on call the following weekend, are properly
inducted.
The consequence of that is that most trusts will be running two inductions processes,
one on Wednesday and one on Friday, to ensure that that is covered.
The next issue is the subsequent strike in the last week of April, which I think will
elevate the potential disruption to the NHS both in terms of safety and maintenance of
service in a way that we have not seen so far, because during working hours junior doctors
will be withdrawing cover for emergency services.
Now, we propose to undertake data collection and initiate our assurance process immediately
after next week’s strike in order that we can have a deeper understanding of exactly
what the implications are for that, so that we will have that analysis complete a week
in advance of the strike.
We would then propose to share that with the British Medical Association in order to put
in place the agreed protocols that we have with them and the mitigations, to ensure that
the risk to both the NHS and our patients is minimised.
Thank you.
May I invite comments and queries?
No, well I think, Bruce, thank you for that very thorough report and we will watch each
of those developments with great concern.
However, can we also endorse what we said about the Ebola response, which I thought
exemplified some of the very best practices of medics and other clinicians and other staff
right across the NHS.
Malcolm Grant>> Right, we turn now to committee reports.
We have, first of all, commissioning committee.
David.
David Roberts>> Nothing to add to the report, Malcolm.
Malcolm Grant>> Thank you very much.
Investment committee, Moira?
Moira Gibb>> Nothing to add to the report.
Malcolm Grant>> David again, audit and risk?
David Roberts>> Nothing to add or report on.
Malcolm Grant>> Right, that brings me to any other business, on which I have two items
if nobody else does.
First is just to record that the Board yesterday made some awards to celebrate outstanding
performance by several of our staff who had been identified by their line managers.
They were people who had gone the extra mile and I was very happy to host, along with Simon
and the other members of the Board, a ceremony and also a luncheon to celebrate what our
key staff do for us.
The second is to record again, as I did at the outset of the meeting, that this is Margaret’s
last meeting as a Board member of NHS England, and to invite the Board in a moment to express
their appreciation for all that she has done.
Margaret joined us in 2012 as one of the pioneers on what was called the NHS Commissioning Board.
She was then company secretary and legal counsel to John Lewis partnership, and brought many
of those values of retail and wrapping the package, as it were, around the client, around
the patient that has helped to steer us over the past four years in our thinking about
the way in which we should organise our activities through NHS England; and also, Margaret, consistently
around issues around governance and propriety of behaviour, for which we are immensely grateful
to you.
So may I, on behalf of all the Board, wish you well now in your new role as Chair of
Action Aid, and thank you on behalf of all of us for the enormous contribution you have
made to our thinking and to our proceedings over the past four years.
Thank you very much.
So I now invite the Board to pass the usual resolutions, we move into private business,
and I declare this meeting closed.
Thank you very much.