Our 2018/19 Annual Report Health and high quality care for all, now and for future generations HC 2293 NHS England Annual Report and Accounts 2018/19 NHS England is legally referred to 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 11 July 2019 HC 2293 © Crown copyright 2019 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, Quarry House, Quarry Hill, Leeds, LS2 7UE. ISBN 978-1-5286-1036-0 CCS0219647926 07/19 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 ......................................................................................................9 Performance Report ......................................................................................................13 Chief Executive’s overview .............................................................................................14 How we measure performance .....................................................................................16 Performance analysis ....................................................................................................17 How we supported the wider NHS ................................................................................33 Involving patients and the public ...................................................................................44 Sustainability ................................................................................................................48 Chief Financial Officer’s report ......................................................................................53 Our priorities for 2019/20 ..............................................................................................57 Accountability Report ...................................................................................................59 Corporate governance report ........................................................................................61 Remuneration and staff report ......................................................................................107 Parliamentary accountablity and audit report ........................................................................... 135 Annual Accounts ...........................................................................................................143 Notes to the financial statements ..................................................................................149 Appendices ....................................................................................................................191 Appendix 1: How we have delivered against the Government’s mandate to the NHS ......192 Appendix 2: Equality ....................................................................................................196 Appendix 3: Reducing health inequalities ......................................................................197 Appendix 4: List of acronyms used in our annual report ................................................200 A view from Lord David Prior, Chair Healthcare systems in all developed countries are under growing pressure from ageing populations and slowing economic growth. That is true whether systems are funded publicly, privately, or a mixture of the two. The NHS has not been immune. Over the coming decade, the NHS will inevitably need to look after more people, with greater needs, as a result of our growing and ageing population. Remarkably over this period, the number of people over 85 is projected to increase from 1.3 million to 2 million and one in five of all newborn boys and nearly one in three of all newborn girls will now live to be centenarians. Against this backdrop, the NHS remains one of Britain’s proudest achievements: • The latest GP patient survey showed that the vast majority of people are positive about their GP care – with eight out of ten patients rating their overall experience of their GP surgery as good – and that confidence and trust in GPs and healthcare professionals remains extremely high at 95.6%. • For the first time last year, the NHS in England carried out more than two million checks on people who feared they might have cancer. Cancer survival is at an all-time high with new figures showing 10,000 more patients living for at least 12 months after diagnosis than five years earlier. • 1.44 million people were referred to NHS mental health therapy services in the past year with more people than ever moving into recovery. • Nearly 800,000 more people were seen and treated within four hours in Accident and Emergency (A&E), over 2,000 a day on average. • Half a million extra people received planned treatment in 2018/19 than in 2017/18, an increase of 2.8%. • In December, the 100,000th genome was sequenced through our world-leading 100,000 Genomes Project. This has all been achieved within a constrained budget by historic standards and has only been possible because of significant year-on-year improvements in NHS productivity. A recent study by the University of York’s respected Centre for Health Economics has calculated that NHS productivity has been growing at more than double that achieved by the rest of the UK economy over the last 12 years, meaning more care and treatments for patients and better value for taxpayers. The Office of National Statistics (ONS) reported that in the last year, NHS productivity growth in England was 3%. This is a remarkable tribute to our hard-working NHS staff. But the hard work of our staff on its own is not enough. Simply putting more pressure on the existing service risks breaking the system. We have to face the facts: waiting times are going up and pressure on A&E departments is rising. It is too difficult to see a GP and health inequalities are too great. So, we have to change. Not incrementally but fundamentally, though not in a chaotic, adversarial, destructive way. The last thing we want is another ideological, top down, politically inspired reorganisation. ANNUAL REPORT 2018/19 7 As the internationally respected surgeon and healthcare expert Lord Darzi said, “Simply demanding more for less or promising more money without a plan for better care isn’t good enough”. This is the true achievement of the NHS Long Term Plan that was published in January and backed by the Government’s revenue funding settlement of 3.4% annual real terms growth over the next five years. The Plan sets out a journey of transformational change – going with the grain of the NHS – focused on patient need, it has been clinically and locally led. What are these changes? • The NHS will have a renewed focus on helping people remain healthy, with a particular emphasis on reducing health inequalities. It cannot be right that people from deprived backgrounds die 10 years earlier than the rest of the population. • The NHS will redirect more of its growing resources into primary care, community care and mental health, a very significant change from the last 20 years. • The NHS will join up its services and integrate them much more closely with social care and other public services. Partnership, trusting relationships and cooperation will be more important than competition, fragmentation and organisational autonomy. • The NHS will change its culture to make it a much better employer. In particular, we will improve the opportunities for people from Black, Asian and Minority Ethnic (BAME) backgrounds. • The NHS will embrace the digital and data age, empowering patients and freeing up more time for clinicians to spend with patients who have complex conditions. • The NHS will become the most innovative health system in the world making new science and new clinical technologies available to its patients. • The NHS will re-double its efforts to reduce waste and unwarranted variation, and improve operational performance. To realise these changes, the NHS must have a realistic and well-funded capital investment programme and proper funding for social care and public health. Over the last 70 years the NHS has become integral to British society, the glue that holds us together. The Long Term Plan strengthens that glue not by reinforcing the status quo but by recognising the changing demands of our patients, the vital importance of our people and the extraordinary power of new science and technology. Lord David Prior, Chair of NHS England 8 ANNUAL REPORT 2018/19 About NHS England NHS England is an executive non-departmental public body which leads and oversees the commissioning of healthcare provision in England. We are mandated to improve the country’s health and wellbeing by arranging the provision of high quality care in a way that meets the needs of an evolving population, and that is sustainable into the future. The Department of Health and Social Care (DHSC)