Malcolm Grant: May we then move on to the business plan for 2015/16? I am going to invite
Karen to introduce that for us, please.
Karen Wheeler: Thank you, Malcolm. The business plan this year reflects a lot of work that
we have been doing. Clearly the business plan is an important document. It sets out the
work that we really need to do this year to take forward, not only the delivery of our
mandate, but also the critical change work that we need to start initiating and that
is presaged in the Five Year Forward View, to ensure that the mandate and outcomes can
be delivered in years to come on a financially sustainable basis.
The business plan this year, we have tried to respond to lots of comments that we have
received through the year to focus down onto ten key priorities, rather than trying to
cover everything that we do. Focusing on ten key priorities where we need to make a significant
step-change and difference during the course of this year.
Those priorities cover a number of themes that will endure even though our priorities
this year may change from the priorities that we choose to take forward next year. The themes
that we are working within are likely to endure. Those are in transforming care for patients
and particularly this year we are focusing on making the step-change in cancer, in mental
health, learning disabilities and preventing diabetes. In designing services around patients
and transforming those services. We also have a big priority associated with achieving financial
sustainability through making whole system change, obviously working very closely with
all of our partners in the system. Underpinning all of that, we need to put some significant
enablers in place to drive and support all the change across the system.
We had a discussion with Board members yesterday and we are in the process of capturing and
finalising the Business Plan and we would like to ask the Board today to delegate approval
to Malcolm and to Simon for finalising that so it can be published tomorrow. The other
thing I should say is we have been doing a lot of work as well around our budget allocations
to ensure that our budgets are aligned with and support all of our core priorities.
Malcolm Grant: Thank you very much, Karen. Let me invite comments from members of the
Board. Ciaran?
Ciaran Devane: Karen, thank you for the swan-like delivery of that. I think we all know there
was a lot more paddling underneath. Significant enablers, can I just pick you up on the word?
If we are going to make these changes, one of the ten priorities is this whole system
change, which is slightly a large priority, we are going to have to do things in a very
different way. It has got to be much more data-based. Do we have the analytical capability
and will we generate the right insight in the right time? What about culture, behaviours,
collaboration, partnerships? We are not always good at that either. The 'how' as well as
the 'what'.
Karen Wheeler: Absolutely. That is fundamental. One of those pieces of work under the key
enablers is the work that we are doing within our own organisation to improve our own capabilities.
There are definitely some capabilities that we do need to improve in terms of data and
information so that we can use the right strategic insight to create the best strategies for
the future. Not only the capabilities, as you say, it is critical that we start to change
the way that we operate inside our organisation and with our partners. Working really closely
with our partners as a routine is fundamental. Working closely with patient groups and Citizen
Groups so that we properly understand what they want to achieve out of all of the change
that we are doing. That is another cultural change for us to continue to make that journey.
And, perhaps most importantly, working in a way which facilitates and enables local
change with less focus on performance management associated with targets - even though performance
management is absolutely critical to ensure that we continue to deliver our service targets
as well.
Ciaran Devane: Are you confident we are putting enough weight behind it? If we look at NHS
Citizen yesterday, there was one quote which was fantastic which was, 'This feels like
real consultation, not like so often in the past.' You can either see that as brilliantly
encouraging or you can say are we confident that as we go out and about, trying to make
the change happen, we will truly engage individuals, patient organisations, clinicians, partners?
That is a skill. It is not just something you say. Are we going to be able to develop
that and deliver that?
Karen Wheeler: It is absolutely something that we are working on. Tim has set up, with
Victor chairing a Task & Finish Group, specifically to ensure that across the organisation we
are, in all of our business areas, working differently in order to do that. I, like you,
do not underestimate the scale of the challenge in people being able to make that change.
That said, there are lots of good areas where we are already doing that. We need to work
on the good practice that already exists. We know, for example, there are many CCGs
as well who do that as a matter of course. We need to learn from their good practice
as well as build it into our own processes.
Malcolm Grant: David?
David Roberts: Just picking up on Ciaran's theme, it is good to see the alignment between
the financial dynamic and the Business Plan objectives. I guess the other key side to
this is have we got the appropriate people, leadership, talent to be able to focus on
what are critical priorities for patients? Are we sure that we can mobilise them quickly
enough?
Karen Wheeler: There is a piece of work that we have been doing, which is again something
that we will be discussing later on today, about leadership improvement. Ed has been
chairing a piece of work around that, which is precisely to look at how we can ensure
that the capability that we have in the system, and particularly that we nationally fund and
support through NHS England, is directed and aligned with the work that we need to do for
the Five Year Forward View and trying to connect that more explicitly with the local systems
that are responsible for making those changes happen but connect it very clearly with the
strategic direction of the Five Year Forward View. Yes, that is a piece of the work. That
is one of our themes and priorities that we will need to take forward this year.
Malcolm Grant: Moira?
Moira Gibbs: The word 'commissioning' actually appears on this slide only once. The role
that NHS England is playing in these is often a leadership one, rather than a straightforward
commissioning one. It is reliant on lots of partners. How much consultation and how confident
are you that the partners are aligned with the priorities here?
Karen Wheeler: We have obviously talked to our partners about our emerging Business Plan
and we have seen their emerging business plans as well. Clearly, we each as organisations
have a different focus on the work that needs to be done, but the core of this is that what
we are building our Business Plan around is what we see as strategically essential to
support the Five Year Forward View. Each of those organisations are doing exactly the
same. I am very confident that, not only collectively, but also individually around the individual
priorities, we are working extremely closely. Undoubtedly though this is something that
we need to spend even more time on and make just the normal way of doing our business,
in ensuring that everything we do, we do collectively. I think we are putting a lot of energy into
trying to do that now.
Malcolm Grant: Margaret?
Margaret Casely-Hayford: The foundations for change include an enormous emphasis on digital
improvement and my question is can we assume that the digital agenda includes a real focus
on understanding and preparing for the best that we can achieve in terms of security?
I suppose this is a question that sits between you and Tim, but that requires a massive oversight
capability from our perspective.
Karen Wheeler: I will perhaps let Tim answer that one. As far as NHS England is concerned:
absolutely while we have not particularly majored on security in our priorities, it
is core to our business-as-usual. It is absolutely fundamental to everything that we do and we
are continually improving everything that we are doing around data security and particularly
cyber security, given the risk that we all know is there. Tim, perhaps you want to talk
about the NHS priority?
Tim Kelsey: As we will discuss a little bit later on, in one aspect we are wanting to
very urgently make the additional offer, not just to our clinical colleagues, but also
to patients and citizens. The quid quo pro is that we can demonstrate that we have set
a new standard in the way in which we will do our level best to be at the cutting edge
of science in delivering secure data sharing environments. There are lots of real challenges
there, many of which have never been developed anywhere. How do you handle identity assurance
at a scale? In this kind of context that has never really been developed before. We have
got lots of questions we have not answered but just to reassure you this is a fundamentally
important part of delivering the Five Year Forward View. In my view without the underlying
digital architecture existing we cannot deliver the kind of integration, the communal opportunities
that we want to provide.
Malcolm Grant: Thank you. Noel?
Noel Gordon: Karen, in one sense this Business Plan is of course now designed primarily as
a means of communication with our people within the NHS. In subsequent incarnations of this
it also becomes a series of pledges that we are going to make to patients, public and
citizenship more generally. Will we eventually in subsequent incarnations become more specific
about what outcomes we are going to deliver?
Karen Wheeler: Yes. I think that is really important. Clearly some of the work that we
have outlined in the Business Plan is very clear and well-established and some is absolutely
new and fresh-thinking based on the Five Year Forward View. However, in both of those areas
we need to connect it with the outcomes that we are trying to achieve and deliver for patients.
That is always tricky in that we want to make it very real and visible for patients and
for staff as to what will be the difference. We want to do that in a way which sets a stretching
agenda and targets. Equally we do not want to get into more target and performance management,
I guess, around the Business Plan, but be clear where we are trying to get to. Yes,
absolutely, we will be aiming to try to link this to target outcomes.
Noel Gordon: Thank you.
Malcolm Grant: Thank you, Karen. I think that the Board can reflect on, first of all, the
fact from last year's Business Plan with 31 priorities we have come down to ten. Secondly,
the Business Plan that we will sign off I think is the product of quite a lot of hard
work and development which involves the Non-Executive Directors as well as the Executive Directors.
There is not a culture clash. There is a culture blend from those with extensive experience
in the NHS and those who have extensive experience in other environments as to what a business
plan might look like.
I hope that we have captured the best of both worlds but certainly, as a Board, our emphasis
I think is on simplicity, clarity, an ability to communicate to those whom we employ and
across the NHS more generally, what it is we regard as absolutely top of the list, an
ability to assure the Department of Health that we are in a position to satisfy the objectives
of the mandate and an ability to ensure the Board at large that we know what is happening,
what we are committed to, how we measure it and how we hold the Executive to account.
I think that the Business Plan is on track. I do not think these things are ever the perfect
finished article. However, it has been a very valuable experience for us all.
On that note may I invite the Board to approve, in principle, the Business Plan and to authorise
the Chief Executive and me to do the final editing and to sign off the fully polished
version? I think I have the assent of the Board. Thank you very much.