Corporate report

UKHSA Advisory Board: 19 July 2023 meeting minutes

Updated 11 September 2023

Date: Wednesday 19 July 2023

Present at the meeting were:

• Ian Peters – Chair of UK Health Security Agency (UKHSA) Advisory Board
• Simon Blagden – associate non-executive member
• Jon Friedland – non-executive member
• Marie Gabriel – associate non-executive member
• Professor Dame Jenny Harries – Chief Executive
• Graham Hart – non-executive member
• Susan Hopkins – Chief Medical Advisor
• Mark Lloyd – non-executive member
• Raj Long – associate non-executive member
• Sir Gordon Messenger – non-executive member
• Scott McPherson – Director General, Strategy, Policy and Programmes
• Isabel Oliver – Director General for Science and Research
• Cindy Rampersaud – non-executive member
• Andrew Sanderson – Director General, Finance, Commercial and Corporate Services

Observers at the meeting were:

• Sir Frank Atherton – Chief Medical Officer (Wales)
• Lee Bailey – Director of Communications
• Oliver Munn – Director General, Health Protection Operations and Chief Operating Officer, Testing
• Steven Riley – Director General, Data, Analytics and Surveillance
• Sir Gregor Smith – Chief Medical Officer (Scotland)
• Clara Swinson – Director General, Global Public Health (Senior Departmental Sponsor)
• Sir Chris Whitty – Chief Medical Officer (England)

In attendance were:

• Lucinda Eggleton – Director, All Hazards Intelligence
• Hannah Frude – Head of Governance (minutes)
• Caroline Middlecote – Director of Strategy
• 5 attendees who had their names and titles redacted

Apologies were received from:

• Jennifer Dixon – non-executive member
• Thom Waite – Deputy Chief Medical Officer (England)

Announcements, apologies and declarations of interest

23/100 The Chair welcomed participants to the meeting and noted apologies.

23/101 Cindy Rampersaud noted a new declaration of interest as non-executive director with Hipgnosis Song Fund from 1 August.

Minutes of the previous meeting and matters arising

23/102 The Advisory Board agreed the minutes of the meeting held on 24 May 2023 (enclosure AB/23/036) as an accurate record.

23/103 The Advisory Board noted the list of actions from the previous meeting (enclosure AB/23/037).

Chief Executive’s update

23/104 The Advisory Board noted the update from the Chief Executive (enclosure AB/23/038). Highlights from UKHSA activity included:

• supporting summer travel messages with the first Heat-Health Alert (HHA)
• media campaigns seeking stronger take up of measles, mumps and rubella (MMR) vaccination after a recent increase in cases and reaching the lowest UK vaccination rates in a decade
• ending national mpox vaccination response while ensuring support to individuals coming forward for vaccination and further clusters especially in London
• witness testimony for Module 1 of the UK COVID-19 Inquiry hearings

23/105 Corporate developments included ministerial approval for UKHSA’s 3-year corporate strategy which would be published by the end of July 2023. Additionally, the Executive team had further stabilised with the confirmed appointment of Isabel Oliver as Director General for Science and Research, and the extension of Andrew Sanderson’s term as Chief Financial Officer for a fixed period.

23/106 The Advisory Board showed keen interest in the opportunity for the newly announced internal Vaccine Board with the devolved administration keen to support. The Vaccine Board would initially align internal systems in a productive and collegiate way, and then seek wider collaboration with external stakeholders. This would feature as a main topic for future Advisory Board and Science and Research Committee meetings.

23/107 A discussion followed on the award of £20 million to UKHSA to take forward the next phase of the National Biosurveillance Network. The discovery phase of the project aimed to see how datasets across government could be combined to better effect and to drive enhanced decision making. Cross-government support was critical to maintain ambition and innovation with the project. A further update would come to the Advisory Board at an appropriate time. (Action: Steven Riley)

23/108 Further comments were noted on the move to Canary Wharf and connection with other arm’s length bodies. The move affected a small number of staff from total UKHSA employees but would enable the organisation to build connections, come together and retain a touchdown space with Department of Health and Social Care (DHSC) offices.

Financial report

23/109 The Advisory Board noted the financial update to end of May 2023 (enclosure AB/23/039). The overall funding picture showed a balance of spending away from being a predominantly ‘testing’ organisation in terms of financial weight, to being more of a ‘vaccine’ weighted organisation.

UKHSA’s main focus areas for the budget included:

• agreeing enduring capability from core funding and stabilising forecasts; there was a risk of underspend on resource departmental expenditure limits (RDEL) from the continued run rate below budget primarily due to recruitment challenges in specialist posts and to support the expansion of important clinical and frontline areas
• detailing forecasts for the capital budget and complying with new spending controls to avoid delays on capital projects
• addressing ongoing scrutiny of COVID-19 funding pressures and planning in line with preparedness work

23/110 A discussion followed on how to plan spending within ringfenced Vaccines and Countermeasures budget. Decisions were linked to health system planning on prioritisation of vaccine needs and recommendations from the Joint Committee on Vaccination and Immunisation. It was noted the UKHSA’s Vaccine Board could provide additional input in a more systematic way.

23/111 The Advisory Board showed interest in how much capital investment related to laboratory infrastructure. Additional funds for the Science Hub Programme were earmarked by DHSC for inclusion in future capital spending. UKHSA faced difficult prioritisation choices with immediate spending focused on high priority health and safety measures which limited ability to pursue long term capital investment.

Strategy and delivery plan

23/112 The Director General, Strategy, Policy and Programme and Director of Strategy presented the paper on 3-year metrics to measure UKHSA’s progress against strategic priorities (enclosure AB/23/040). A single performance management framework would track progress against the plan and be used across senior accountability forums. The outcome metrics were grouped under 6 strategic priorities with a focus on how UKHSA would achieve impact over a 3-year period.

23/113 The Advisory Board noted the near final draft of strategic plan. Feedback on the outcome metrics included:

• support for an engagement index as indication of public trust with clarity needed on steps to realise benefits of the metric
• more on ensuring UKHSA had the right skillsets and how attractive it was as an employer to those working in government or wider health sectors
• encouraging open access publication standard of 95%; this metric would evolve as UKHSA focused more on the quality and impact of its publications over the number published
• clarity on how behaviours from partners would affect UKHSA’s ability to achieve its target outcomes; UKHSA wanted to lead in specific areas while recognising some levers sat outside the organisation, and it was suggested to include additional narrative on the main external parties on whom UKHSA would be dependent
• being clear that reducing the impact of infectious diseases and antimicrobial resistance would be informed by modelling work already underway
• framing lessons from UKHSA run exercises within whole system response
• how to measure improved datasets on targeted communities or those not captured in current data

23/114 The discussion welcomed the progress of the strategic plan and metrics which would evolve as the organisation matured from a mix of outcomes and process metrics to a purely outcomes focus. The Executive team would reflect on the feedback and provide a short update in September. (Action: Scott McPherson)

Health security threat assessment

23/115 The Director, All Hazards Intelligence and Deputy Director, National Health Security presented the update on the health security threat assessment (HSTA) (enclosure AB/23/041). The HSTA compared health hazards UKHSA was responsible for and how they may develop over coming years. It was noted that the HSTA addressed worst case scenarios for the breadth of health hazards (rather than all pathogens) to cover the possible threats across all transmission routes.

23/116 UKHSA had engaged with wider government partners, internal advisory committees and established a working group to consider the best approach to the methodology. With feedback from these groups, UKHSA had revised scoring of health hazards, improved calculations and strengthened confidence measures. A further 15 hazards were identified for phase 2, which would include combined threats (for example climate change effect on pathogens).

23/117 The Advisory Board noted progress on the HSTA since the concept was presented in a closed February workshop. Discussion followed on:

• the level of investment for surveillance to feed into HSTA data; HSTA work would be used to identify intelligence gaps and the approach to surveillance, including how international partnership could support further data inputs, and there was aspiration to build a data pipeline with next phases of work to identify how and where this could occur
• the importance of global collaborations and consistency between areas to enable better data sharing; UKHSA was encouraged to leverage engagement with regional centres for disease control to support early insights without sacrificing resource
• difficulty of mitigating for disease X; it should be considered more overtly to avoid thinking only of behaviours associated with current pathogens and while example pathogens initiated discussion, one aim was how to detect, characterise and mitigate against disease X
• UKHSA was right to focus on routes of transmission and chemical, biological, radiological and nuclear threats; however, improved presentation of material would foster stronger external engagement in next phases of work
• clarity was needed on which risks could be mitigated with proper investment from government
• it was suggested to reflect engagement with local resilience forums in further work

23/118 The Advisory Board welcomed the update and looked forward to progress on how the HSTA will be used in decision making in UKHSA and beyond. Further updates would be considered on the Advisory Board and Science and Research Committee forward plans.

COVID-19 lessons identified

23/119 The Director of Strategy presented the paper on work to date to identify lessons from COVID-19 and other recent incidents (enclosure AB/23/042). UKHSA had gathered over 200 lessons from activity during the COVID-19 pandemic into a single repository. Along with high level feedback from senior leaders, teams had identified themes which informed input into COVID-19 Public Inquiry responses. Early insights would be formed into rapid action plans and reflected in UKHSA’s 3-year delivery plan.

23/120 The Advisory Board noted the existing work and discussed the importance of lessons for standing and surge capacity, and especially scalability. It was noted that process implementation should not be a barrier with UKHSA teams encouraged to work in an agile way. The Chief Executive acknowledged priority to plan for a variety of pandemic scenarios and be explicit on ability to scale response. Ready to Respond work was in progress and would be aligned with wider learning from COVID-19.

23/121 Discussion continued on the developing advice for ministerial decision on standing and surge capacity. This advice would inform ministerial risk appetite and should be explicit on:

• expected frequency of events
• costs and risks associated with various approaches to standing capacity and surge capacity
• trade-offs in speed of response

23/122 It was crucial for UKHSA and partners to agree planning assumptions for frequency and size of events. An update on this area was expected at the November Board meeting. (Action: Oliver Munn, Scott McPherson)

Board effectiveness review

23/123 The Chair presented the results of the UKHSA Advisory Board Effectiveness Review for 2022 to 2023 (enclosure AB/23/043). A light touch review was used in the first year of the Board’s establishment. Thanks were noted to all for contributing, including Jennifer Dixon’s parallel review of the Chair’s performance.

23/124 Results demonstrated good performance given the contextual instability of the organisation. The Board should evolve to become high performing in the future. Various improvement recommendations were tabled and supported and would be monitored via an action plan. (Action: Hannah Frude)

23/125 Thanks were noted for leadership of the Chair and to the executive team alongside the important work they completed. The non-executive members of the Board agreed to support informal coaching session with executive members and act as advocates, where helpful to the executive team. Further comments included a suggestion to include more context for topics discussed less frequently at Board meetings, to support better discussion and meaningful questions from non-executives.

23/126 The Advisory Board noted the feedback from review and agreed the proposed recommendations for implementation during 2023 to 2024.

23/127 The Advisory Board noted the results of the Audit and Risk Committee Annual Effectiveness Review (enclosure AB/23/044). The review indicated a good foundation year with future focus to include risk appetite, controls frameworks and enhanced mitigation activities.

Advisory Board Committees

Audit and Risk Committee

23/128 The Advisory Board noted the minutes of the Audit and Risk Committee meeting on 28 March 2023 (enclosure AB/23/045). The June meeting focused on challenges in stabilising of the organisation, recruitment and retention effects on culture, internal audit reports, and the supportive and constructive discussion on the financial control and improvement plan.

People and Culture Committee

23/129 The Advisory Board noted the minutes of the People and Culture meeting on 20 April 2023 (enclosure AB/23/046). The July meeting considered the People Experience and Equality and Diversity people data. The increased focus on people issues was noted within the confirmed budget and strategic plan.

Equalities Ethics and Communities Committee

23/130 The July meeting discussed migrant health, the HSTA and health in justice settings. These topics showcased the vital engagement with external organisations in politically and socially challenging contexts.

Questions from members of the public

23/131 No questions were received from members of the public.

Forward look

23/132 The Advisory Board noted the topics for future meetings (enclosure AB/23/047). This was expanded to include all committees, enabling identification of gaps across agendas.

Any other business and close

23/133 There being no other business, the meeting closed at 12:05pm.

Hannah Frude
Head of Governance
July 2023