Highlights by Anne Gray, Knowledge Officer, Arden & GEM CSU
Papers and videos will available here: https://www.england.nhs.uk/about/board/meetings/previous/
Agenda
1. Minutes of the Previous Meeting
2. Chairman’s Report
3. Chief Executive’s Report
4. Planning for 2018/19 in light of the Budget
5. Items which should not be routinely prescribed in primary care: findings of consultation and next steps
6. Congenital Heart Disease Services for Adults and Children: Future Commissioning Arrangements
7. National Guardian for the NHS – Annual Report for 2017
8. Supporting and applying research in the NHS
9. NHS performance and progress on the implementation of ‘Next Steps on the NHS Five Year Forward View’
10. NHS Finance Report
11. Reports from Board Committees
i. Commissioning Committee
ii. Investment Committee
iii. Specialised Services Commissioning Committee
iv. Audit and Risk Assurance Com
4. Planning for 2018/19 in light of the Budget
The NHS was allocated an additional £1.6 billion at the recent budget making a total of £113.4 billion for 2018/19.
The paper lays out considerations to support work to finalise budget plans for 2018/19 which will be discussed at the Board meeting on 8th February 2018.
A. Deal with current levels of unfunded care (deficits) that need funding going in to next year.
B. Set realistic activity plans for growth in emergency care
C. Seek to protect planned investment in mental health, cancer, and primary care.
D. Be realistic about what can be expected from the remaining available funds.
Through “scrutiny of unfunded new expectations that are loaded onto the NHS. For example, new advisory NICE guidelines can only expect to be implemented locally across the NHS if in future they are accompanied by a clear and agreed affordability and workforce assessment at the time they are drawn up.”
E. Ensure that where government sets pay rises above the currently budgeted 1% cap these are separately funded.
Discussion included:
· Using the learning from Accountable Care Systems to integrate fragmented systems, and new care models through Vanguards to produce efficiencies.
· Helping staff to make improvements on the front line, removing instances where money flor does not incentivise improvements, and supporting the role of technology and self care.
· The importance of public consultation to support difficult choices about what to stop.
· The need for “tough decisions and trade-offs” (Malcolm Grant)
5. Items which should not be routinely prescribed in primary care: findings of consultation and next steps
· Results of the consultation on proposals to limit the prescription of 18 products which it was felt should not be routinely prescribed in primary care, and around potentially limiting the prescribing of medicines that are available over the counter.
· The basis of the guidance is around low clinical effectiveness (lack of robust evidence of clinical effectiveness or there are significant safety concerns); where more cost effective products are available, and products which are deemed a low priority for NHS funding.
· Consultation resulted in a proposal that NHS England recommends that the Secretary of State formally consider blacklisting the following drugs:
Co-proxamol • Glucosamine and Chondroitin • Herbal Treatments • Homeopathy • Lutein and Antioxidants • Omega-3 Fatty Acid Compounds • Rubefacients (excluding topical NSAIDS).
New Guideline : Items which should not routinely be prescribed in primary care: Guidance for CCGs, NHS Clinical Commissioners is available in Annex D.
· Further consultation will proceed around over the counter products which should not be prescribed in primary care.
7. National Guardian for the NHS – Annual Report for 2017
Data on the “Freedom to Speak Up” campaign in the NHS in England and work of the Freedom to Speak Up Guardians.
There are currently 40 people undergoing introductory training to become Guardians across NHS England and CCGs.
8. Supporting and applying research in the NHS
Stresses the importance of closer working between NHS England and NIHR to ensure that bureaucracy does not get in the way of progress, and that research matches the priorities of NHS England. A list of research needs will be published by April 2018.
The report lays out the 12 Actions to Support and Apply Research in the NHS developed by NHS England and NIHR:
Simplify NHS research processes:
1 1. Manage excess treatment costs better.
2. Eliminate delays in confirming multi-site trials.
Articulate the NHS’s own research priorities better:
3. Set out research priorities for national NHS programmes.
4. Increase research focus and capability on value and cost.
5. Set out local NHS research and innovation priorities of Academic Health Science Networks and Sustainability and Transformation Partnerships.
Enhance our data infrastructure:
6. Increase GP practice participation in the Clinical Practice Research Datalink
7. Back 3-5 local NHS systems as they create interoperable local care records that are also research-ready.
Support advanced research into leading edge technologies:
8 Develop the NHS genomic medicine service.
9. Develop the application of artificial intelligence in pathology and radiology at scale.
Improve and simplify our adoption ecosystem:
10. Use NHS England’s specialised commissioning and commercial medicines clout, combined with NICE appraisals, to drive faster uptake of affordable, high impact innovation.
11. Back AHSNs to become the main local NHS delivery vehicle for spreading innovations.
12. Review and simplify the number of different national innovation projects and programmes.
· There are plans to launch a consultation around how to simplify bureaucracy around excess treatment costs, and trial set-up, in particular multi-site trials.
9. NHS performance and progress on the implementation of ‘Next Steps on the NHS Five Year Forward View’
An outline of progress in addressing the following priorities identified in ‘Next Steps’:
• Urgent and emergency care
• Primary care
• Cancer
• Mental health
• Integrating care locally (through Accountable Care Systems)
• Information and technology
o building a digital service, built on the NHS.uk platform, called NHS Online
o testing an online version of the NHS 111 service with full roll out across the country by December 2018
10. NHS Finance Report
Consolidated Month 7 2017/18 Financial Report
“To note that CCGs are likely to end the year with a deficit in excess of £500m. We are working to identify sufficient non-recurrent central mitigations to cover this within an overall balanced position in 2017/18, but this is not yet secure, and a recurrent funding solution will be required in 2018/19, as central mitigations of this magnitude will not be available.”
Deficiencies are driven by
· increased cost per case
· efficiency deliveries falling short of target
· unbudgeted pressure caused by reimbursement of drugs to community pharmacies.
11i. Reports from Board Committees: Commissioning Committee
· The Committee supported the proposals to refresh CCG remuneration guidance and external auditor requirements to review relevant CCG remuneration packages.
· The committee approved six proposed CCG mergers with “more expected”.
Date of Next NHS England Board meeting: 08 February 2018
