Our 2019 Annual 20 Report Health and high quality care for all, now and for future generations HC 1057 NHS England Annual Report and Accounts 2019/20 NHS England is legally constituted as the National Health Service Commissioning Board. Presented to Parliament pursuant to the National Health Service Act 2006 (as amended by the Health and Social Care Act 2012). Ordered by the House of Commons to be printed 28 January 2021. HC 1057 © Crown copyright 2020 This publication is licensed under the terms of the Open Government Licence v3.0 except where otherwise stated. To view this licence, visit nationalarchives.gov.uk/doc/open-government-licence/version/3 Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned. This publication is available at www.gov.uk/official-documents Any enquiries regarding this publication should be sent to us at: NHS England and NHS Improvement, Quarry House, Quarry Hill, Leeds, LS2 7UE. ISBN 978-1-5286-1952-3 CCS0320331828 01/21 Printed on paper containing 75% recycled fibre content minimum Printed in the UK by the APS Group on behalf of the Controller of Her Majesty’s Stationery Office Contents A view from Lord David Prior, Chair ................................................................ 7 About NHS England .......................................................................................... 10 Performance Report .......................................................................................... 13 Chief Executive’s overview ................................................................................. 14 Performance of Clinical Commissioning Groups ................................................. 17 Performance Overview ...................................................................................... 18 How we supported the wider NHS .................................................................... 26 Chief Financial Officer’s Report .......................................................................... 29 Our priorities for 2020/21 .................................................................................. 33 Accountability Report ....................................................................................... 35 Corporate Governance Report ........................................................................... 37 Board Committees ............................................................................................ 46 Statement of Accounting Officer’s responsibilities .............................................. 58 Governance statement ..................................................................................... 59 Remuneration and Staff Report ......................................................................... 84 Annual Accounts ............................................................................................... 117 Notes to the financial statements ...................................................................... 123 Appendices ........................................................................................................ 167 Appendix 1: How we have delivered against the Government’s Accountability Framework to the NHS ......................................... 168 Appendix 2: Public and patient contact and complaints ..................................... 172 Appendix 3: Meeting our Public Sector Equality Duty ......................................... 175 Appendix 4: Reducing health inequalities ........................................................... 178 Appendix 5: Working in partnership with people and communities .................... 182 Appendix 6: Sustainability ................................................................................. 186 Appendix 7: Glossary ....................................................................................... 188 A view from Lord David Prior, Chair I never had any doubt that the NHS would rise to the extraordinary challenge of coronavirus. In a crisis, the people who work for the NHS and within the NHS are magnificent. It is not overly hyperbolic to plagiarise the words of Winston Churchill after the Battle of Britain: “so much owed by so many to so few”. Who would have thought that the Nightingale hospitals could have been built in a matter of days? Who would have thought that hospitals could double critical care capacity? Who would have thought that a deliberately fragmented institutionalised structure could transform itself into an integrated system, the holy grail of healthcare so quickly? Who would have thought that we could cope with 32,000 hospitalised COVID-19 patients at one time? Who would have thought that 90% of GP practices would go virtual delivering more than 500,000 online consultations every week? And that in June alone the NHS could deliver over 1.6 million outpatient appointments remotely? It is truly remarkable that one of the world’s largest organisations showed itself so agile, so innovative and so ‘can do’. It was also humbling that many NHS staff left their families at home and came into work at a time that was scary for all. But that does not mean that everything in the garden is rosy. COVID-19 exposed many weaknesses, not just in the national and international response to the pandemic but more broadly. The health and care system is too fragmented. We have to move quickly to integrated care systems and this must include social care and care homes. Procurement and distribution processes were strained. The digital and data infrastructure responded well but we are a long way from embedding digital into our normal way of working. Laboratory capacity had to be scaled. Finally, the disproportionate impact of COVID-19 on People from Black, Asian and minority ethnic backgrounds reveals again the unacceptable growing health inequality that shamefully disfigures nearly all western societies. Whilst COVID-19 has exposed weaknesses it also obscures a more profound issue. Healthcare systems across the developed world be they publicly funded, private or a mix of the two are under great stress. To put it simply, demand for treatment across the globe is growing faster than the funding to pay for it. So, the pressure to increase the value received from every pound spent will be relentless. Approaching this in a Gradgrindish kind of a way will not be the right solution. It is not penny pinching or traditional cost reduction that is needed but a much more profound transformation, this will require a far greater emphasis on keeping people healthy rather than treating people who are sick. It will mean giving citizens greater power over their own lives through giving them access to more insightful data about their health. It will mean new clinical pathways that, where appropriate, support people out of conventional healthcare settings in particular, it will mean treating more people outside hospitals. It will mean much earlier diagnosis for illnesses such as cancer. It will mean truly personalised medicine as we incorporate genomics into mainstream diagnosis and treatment. ANNUAL REPORT 2019/20 | 7 It will mean far more insightful personalised health predictions based on new methods such as polygenic risk scores, which combined with health data will enable effective population health management, as well as more informed – and therefore empowered - patients. It will mean better access to healthcare through digital means and better care as we incorporate continuous remote monitoring of many diseases. All this adds up to a paradigm shift in how healthcare is delivered: prediction, prevention, personalisation. And the only way to achieve this is through stepping up what we are already doing, bringing down the barriers between different parts of the NHS so we work together, and in the patient’s eye that means as one NHS. Only then can we truly start transforming the whole NHS to work better for patients after COVID-19. The NHS has long been seen as a good healthcare system and emblematic of British fairness and social justice, that will remain, but it has also been viewed as a cost rather than an investment. Increasingly, we should see the NHS as part of the UK’s economic recovery. The NHS is an anchor institution and that means as local employers, as the organisation which keeps the workforce healthy, and as often is the case the biggest physical estate in the many towns and cities across England, the NHS is at the centre of each local economy. That’s why it’s so important that we ramp up our capital spend to get our buildings in modern order – benefiting patients, staff and the local construction economy. It’s why we should be more open to innovation and support British businesses in export markets. We should work in partnership with pharmaceutical, biotech and medtech companies so we can get the latest drug devices and medicines to patients fast, keeping local communities healthier for longer, and so more productive. We should be a pioneer of digital health and digital therapeutics, partnering with local tech companies, experts and researchers. We must accelerate access to the NHS, encourage uptake of new products and encourage innovation. We should work hand in hand with our great research institutes and universities, one of the brightest feathers in the UK’s cap. With their research excellence, a unique data set and our ability to trial and test new methods of healthcare we can be the health research centre of the world. The RECOVERY trials have set a new standard