Corporate report

UKHSA Advisory Board: 17 September 2024 meeting minutes

Updated 25 November 2024

Date: 17 September 2024

Present at the meeting were:

• Ian Peters – Chair of UKHSA Advisory Board
• Simon Blagden – Associate non-executive member
• Jon Friedland – Non-executive member
• Marie Gabriel – Associate non-executive member
• Dame Jenny Harries – Chief Executive
• Graham Hart – Non-executive member
• Luke Heath – Interim Chief Finance Officer
• Mark Lloyd – Non-executive member
• Raj Long – Associate non-executive member
• Sir Gordon Messenger – Non-executive member
• Scott McPherson – Director General, Strategy, Policy & Programmes
• Isabel Oliver – Director General, Science and Research
• Cindy Rampersaud – Non-executive member
• Thom Waite – Deputy Chief Medical Officer (England)

Observers at the meeting were:

• Lee Bailey – Director of Communications
• Emma Reed, Director, Emergency and Health Protection (DHSC)
• Steven Riley – Director General, Data, Analytics and Surveillance

In attendance at the meeting were:

• 4 attendees had their name and title redacted

Apologies were received from:

• Sir Frank Atherton – Chief Medical Officer (Wales)
• Jac Gardner – Chief People Officer
• Susan Hopkins – Chief Medical Advisor
• Sir Michael McBride – Chief Medical Officer Northern (Ireland)
• Sir Gregor Smith – Chief Medical Officer (Scotland)
• Clara Swinson – Director General, Global Public Health (Senior Departmental Sponsor)
• Sir Chris Whitty – Chief Medical Officer (England)

1. Announcements, apologies, and declarations of interest

24/102 The Chair welcomed participants to the meeting and noted apologies.

24/103 The Advisory Board expressed their appreciation to the Birmingham team for hosting the meeting and earlier discussion on the region’s approach to the West Midlands measles outbreak.

24/104 Raj Long advised she had stepped down from her role with the Gates Foundation. There were no other declarations of interest.

24/105 The Chair noted the following personnel changes across UKHSA and the Department of Health and Social Care (DHSC):

• Jac Gardner would be leaving her role as Chief People Officer at the end of October. Jac was thanked for her efforts in supporting the maturity of UKHSA’s people function, contribution to the Board and co-leadership of the People and Culture Committee;
• Clara Swinson was wished well in her move to the mission delivery team in the Cabinet Office. Clara was thanked for her support, sponsorship and advocacy to UKHSA over the previous three years and to predecessor organisations;
• Emma Reed would be moving to the Medicines and Healthcare products Regulatory Agency as Chief Operating Officer. Emma was thanked for her years of support to UKHSA and predecessor organisations;
• Luke Heath was welcomed as the interim Chief Finance Officer.

2. Matters arising

24/106 The Advisory Board noted the list of actions from the previous meeting (enclosure AB/24/033). The current actions were on track or not yet due.

24/107 The discussion on surge capacity from small expert teams would be prioritised following impending financial and health security discussions.

24/108 It was agreed to move the artificial intelligence discussion to early 2025 to align with regular updates planned for the Science and Research Committee.

3. Chief Executive’s update

24/109 The Chief Executive also noted her thanks to the Birmingham team for hosting the meeting, and her appreciation to Jac Gardner, Clara Swinson and Emma Reed.

24/110 The Chief Executive presented her update on UKHSA’s activity (enclosure AB/24/034). The Advisory Board noted the update.

24/111 The main areas of activity included:

• the new administration had voiced positive support for public health and UKHSA’s remit areas (including laboratory capacity and ability for incident response)
• UKHSA was leading the UK response across organisations, supported by DHSC, for the mpox Clade 1b outbreak. It was based on the mpox clade II response from 2022/23 with 150,000 smallpox vaccine doses acquired;
• preparation for the Spending Review was underway to ensure the vision and remit of the organisation was ably supported and specific new challenges are resourced;
• the SCS reorganisation to deliver efficiency across the organisation was on track with substantial engagement with staff;
• public inquiry modules continued with UKHSA managing multiple responses and significant resource and bandwidth being absorbed;
• the respiratory syncytial virus (RSV) vaccine campaign was rolled out with strong support from Minister Gwynne. UKHSA continued work on a vaccines operating model and would evaluate the update and impact of the health system from the RSV vaccine campaign.

24/112 There was interest in the potential for UKHSA to support savings and efficiency across the health sector and to support the wider economy through more productive interventions in public health and stimulation of the economy through collaboration on innovation. Spending Review discussions were advancing at pace with UKHSA aligned to the DHSC aspirations which would ensure health security functions were protected in health spending.

24/113 A particular area of interest for UKHSA was focus on prevention activity to flatten demand in the health sector. The Advisory Board would review this topic as more was known on the health mission in government.

24/114 The Advisory Board showed interest in UKHSA’s involvement in:

• advising on treatment of children affected by mpox;
• promoting awareness of the shingles vaccine;
• demonstrating the value UKHSA can provide to the public agenda with an agreed single measure of economic benefit generated by the agency’s activities;
• the impact of response to the Covid-19 public inquiry in terms of opportunity cost for using core resource and staff wellbeing from the demand on workload.

4. Financial Report

24/115 The Advisory Board noted the financial update to end of July 2024 (enclosure AB/24/035) presented by the interim Chief Finance Officer.

24/116 The following points were raised in respect to the financial position:

• there was good progress in managing the forecast pressure of £36 million on core resource budget arising from public sector pay awards, absorption of the previous COVID-19 budgets, and other cost pressures; DHSC recognised certain areas would require uplifted budget to manage this pressure;
• the overprogramming of the core capital budget was manageable and agreed with DHSC;
• the COVID-19 vaccine unit budget forecast position is crystallising in line with modelling assumptions.
• an additional £2 million on Safe Cyber activities was being sought for immediate action on risk mitigation and to understand scale of gaps in the cyber estate. UKHSA was in conversation with other government bodies on this topic;

24/117 The audit of the Annual Report and Accounts was progressing well with a collaborative relationship with the National Audit Office. Discussions continued on the nature of the audit option.

24/118 Conversations followed on the rapid scale of recruitment which resulted in overspending on forecast budgets for month 4. This was considered in part a positive resolution to the previous year’s recruitment challenge rather than an ongoing issue related to establishment baselines. Staffing levels were appropriate and assurance was provided that a reduction in run rate spend would not compromise UKHSA’s delivery of public health functions. The SCS reorganisation and downsizing was expected to increase effectiveness and drive clarity of accountability against budgets.

24/119 The Finance and Control Improvement Programme continued exploring improvements in budget holder financial analysis which were provided monthly.

5. Antimicrobial Resistance (AMR) Programme

24/120 The Deputy Director: Clinical and Emerging Infections presented an update on UKHSA’s activity against the spread of antimicrobial resistance (enclosure AB/24/036).

24/121 In the previous twelve months, UKHSA played a crucial role in development and publication of the latest UK AMR National Action Plan which included ambitious yet achievable targets to flatten growth rates.

24/122 Upcoming UKHSA activity included:

• genomics transformation targeted to AMR resistant pathogens;
• surveillance to identify new and emerging infections;
• exploring funding strategies for large scale population interventions which would require significant resources alongside current staff investment to deliver on priorities;
• learning from behavioural research into clinical and public behaviours around antibiotics;
• developing a unified metric to communicate with the public and healthcare system to track AMR and effectively inform public health interventions.

24/123 The Advisory Board noted the activities underway in UKHSA to tackle AMR and the inter- and intra-organisation interdependencies to the delivery of the UKHSA AMR programme in support of the 2024-2029 National Action Plan.

24/124 Discussion raised the following points:

• the target of increasing professional knowledge could be more stretching. While the published targets represented a baseline, UKHSA would aim to move beyond these targets where possible;
• the use of a single metric to use across the public, political and professional narrative was supported and should be internationally applicable metric. UKHSA had prepared groundwork to develop an international metric through a scientific advisory panel and UN General Assembly meeting at end of September 2024;
• UKHSA utilised the relationship with IQVIA who provided access to private level prescribing data; UKHSA remained open to working with other private sector partners;
• focus on a specific pathogen could demonstrate powerful intervention and success in the AMR narrative;
• how could UKHSA utilise data on reasons for resistance to target root causes. UKHSA was mapping the patient journey by connecting patient attendance with prescribing data. Additionally, the agency intended to build on ecological trends identified in the One Health report and wastewater capability utilised during the Covid-19 pandemic;
• simplifying the AMR narrative would support public discussion of a prevention agenda;
• it was important to focus behavioural actions through healthcare channels (care homes, pharmacists, GPs and others);
• Minister Gwynne had engaged DHSC on AMR which linked to long term prevention vision for health system. There was opportunity to use UKHSA’s scientific expertise internationally to tackle AMR challenges.

24/125 It was suggested to develop a breakdown of spending on AMR from disparate parts of the organisation, alongside core allocation of £10.7 million via the Chief Medical Advisor Group.

24/126 The Advisory Board welcomed an update in 12 to 18 months to include further narrative with evidence of success in AMR prevention.

6. Technology Strategy

24/127 The Chief Technology Officer presented the update in implementation of UKHSA’s Technology Strategy (enclosure AB/24/037). The 7 guiding principles would ensure UKHSA’s technology estate was well-founded, aligned to the corporate strategy, modern and sustainable.

24/128 The Advisory Board noted the update. Activity in the previous 12 months was focused on getting the basics right and mapping the needs of UKHSA to a business capability model.

24/129 Recruitment and retention remain challenges with positive progress expected shortly from joining the Government Digital and Data Capability Framework.

24/130 Discussion raised the following points:

• Safer Cyber enabled the discovery phase of gaps in cyber risk mitigation. A multi-year programme not currently budgeted fully would be required to address full scale of technology estate;
• Technology was working with other colleagues on the next stages of the Finance and Control Improvement Programme;
• integration between UKHSA systems and across health sector data (for example, Case Incident management System and Notifications of Infectious Diseases) was a building principle across technology systems;
• there were interim mitigations for archiving of data that complied with statutory requirements while long term data archives were developed;
• the 2029 target state descriptions should be more definitive to provide clarity on the end state;
• it was recommended to explore opportunities for measuring user experience.

24/131 The Advisory Board welcomed a further update in 12 months on implementation of the technology strategy. Additionally, it was suggested to hold a closed discussion on the progress of functionality in MaPS.

7. Advisory Board Committees

24/132 The Advisory Board noted verbal updates from the latest Committee meetings as below:

• the Equalities, Ethics and Communities Committee July meeting discussed the framework for the organisation-wide approach to community engagement which would be utilised at national and regional levels; system-wide engagement with the Integrated Care System covering how UKHSA works with NHS partners; the ethical approach to a case of drug-resistant tuberculosis.
• the People and Culture Committee July meeting raised the need for clarity on UKHSA’s establishment figure and to carefully manage recruitment which had occurred faster than anticipated in 2024.
• the Audit and Risk Committee September meeting discussed progress of the Annual Report and Accounts, cyber and information management risks. The Chief Executive welcomed a focused workshop on strategic risks with the non-executive members following the autumn budget.
• the Science and Research Committee September meeting discussed interaction with other Committees of the Advisory Board, health and economic impact of UKHSA activity, scientific workforce and vector borne diseases.

24/133 The Advisory Board noted the confirmed minutes as below:

• the Equalities, Ethics and Communities Committee meeting on 30 April 2024 (enclosure AB/24/038).
• the People and Culture Committee meeting on 24 April 2024 (enclosure AB/24/039).
• the Audit and Risk Committee meeting on 4 June 2024 (enclosure AB/24/040).

8. Questions from members of the public

24/134 No questions were received from members of the public.

9. Forward Look

24/135 The Advisory Board noted the forward look (enclosure AB/24/041), subject to the topics highlighted during the meeting and sequencing of Committee discussions including artificial intelligence

10. Any other business and close

24/136 There being no other business, the meeting closed at 3:21pm.