Corporate report

Department of Health and Social Care Outcome Delivery Plan: 2021 to 2022

Published 15 July 2021

This was published under the 2019 to 2022 Johnson Conservative government

Secretary of State for Department of Health and Social Care

Rt Hon Sajid Javid MP

Permanent Secretary

Sir Chris Wormald KCB

Second Permanent Secretary

Shona Dunn

Chief Medical Officer

Professor Chris Whitty

Foreword

The coronavirus (COVID-19) pandemic has been the greatest challenge to our health and care system in living memory and its impact will continue throughout 2021 to 2022. The pandemic will have lasting consequences for the health and demography of the nation, the economic, social and political context for our work, and the health and care system itself.

Work on COVID-19 will remain the single most important operational and policy focus for the whole department and the wider health and social care system. But as the immediate emergency response phase reduces over time and vaccination rates increase, the department’s work to help the system recover and return to a new normal will gather pace.

We will continue to support the health and care system through delivery of our 5 priority outcomes as part of the government’s agenda to build back better. As this delivery plan will make clear, the department will be overseeing a huge range of activity including taking the Health and Care Bill through Parliament, reforming public health, revolutionising the use of data and digital capabilities, reforming mental health, providing vital infrastructure for a modern health and care system and enabling an affordable, high-quality and sustainable adult social care system.

This plan sets out our key programmes and activities for the next 12 months but is by no means a full list of everything that the department is delivering. To support the delivery of our priorities, we will continue to ensure we have the right people, skills and structures in place which support innovative ways of working and better outcomes.

A. Executive summary

Vision and mission

The Department of Health and Social Care (DHSC) supports its ministers in leading the nation’s health and care system.

Our vision is to help people to live more independent, healthier lives, for longer.

Our priority outcomes^{[footnote 1]}

This delivery plan sets out in detail how we will deliver our priority outcomes, how we will measure our success, and how we will ensure we continuously improve.

1. Protect the public’s health through the health and social care system’s response to COVID-19.

2. Improve healthcare outcomes by providing high-quality and sustainable care at the right time in the right place and by improving infrastructure and transforming technology.

3. Improve healthcare outcomes through a well-supported workforce.

4. Improve, protect and level up the nation’s health, including reducing health disparities.

5. Improve social care outcomes through an affordable, high-quality and sustainable adult social care system.

The department is also supporting the delivery of the following priority outcomes led by other departments:

Priority outcome title	Lead department
Reduce crime	Home Office
End rough sleeping through more effective prevention and crisis intervention services, and reduce homelessness by enabling local authorities to fully meet their statutory duties	Ministry of Housing, Communities and Local Government (MHCLG)
Support the most disadvantaged and vulnerable children and young people through high-quality local services so that no one is left behind	Department for Education (DfE)

Strategic enablers

To deliver our priority outcomes – and reinforce the ambitions of the Declaration on Government Reform – we will focus on 4 key enablers:

1. Workforce, skills and location
2. Innovation, technology and data
3. Delivery, evaluation and collaboration
4. Sustainability

B. Introduction

1. Context

All of our lives are touched by the health and care system, often in our most vulnerable moments. A great health and care system will drive better health behaviours and outcomes as well as boost the economy, through employment in the NHS and social care sectors, and the UK’s successful life sciences industry. Government spending on healthcare comprises around 20% of public service expenditure. The department’s work also supports the delivery of wider government and societal objectives, such as contributing to government’s target of net zero carbon emissions by 2050.

The COVID-19 pandemic has been the greatest challenge to our health and care system in living memory and its impact will continue throughout 2021 to 2022. The pandemic will have lasting consequences for the health and demography of the nation, the economic, social and political context for our work, and the health and care system itself. It has also led to significant changes to the work of the department through the establishment of NHS Test and Trace and the Joint Biosecurity Centre. COVID-19 has also shone a light on the public health challenges facing the UK population such as obesity, and we intend to strengthen our focus on such public health challenges through the establishment of the Office for Health Promotion.

It will be critical that the department and wider health and care system reflect and learn the lessons from the pandemic – both to improve our preparedness and response to health emergencies as well as to embed broader learning. We must also seize any opportunities for change or reform so that we can build back better. This is driving much of our work including legislative reform such as the Health and Care Bill and updating the Mental Health Act for the 21st century.

Critically, the new UK Health Security Agency (UKHSA) brings together the health protection elements of Public Health England with NHS Test and Trace and the Joint Biosecurity Centre.

These considerations all underpin the department’s Outcome Delivery Plan as outlined in this document.

2. Governance and delivery agencies

Our governance structure.

The department’s objectives are delivered in conjunction with our arm’s length bodies (ALBs).

3. Overview of strategic risk

DHSC manages a wide portfolio of risks. Our most severe risks are managed by our Performance and Risk Committee and Audit and Risk Committee. Below these committees, risks are managed locally by senior civil servants at programme or project level. Risks from the wider DHSC family of arm’s length bodies are also managed by DHSC sponsor teams and escalated as required.

At strategic level DHSC manages a number of different risks across the health and social care landscape including system risks relating to the NHS, external risks such as cyber attack, and internal risks.

The COVID-19 pandemic has clearly impacted the risks managed by the department in areas such as the risk of future or concurrent pandemics, risks associated with the ongoing COVID-19 response and risks to the recovery from this pandemic. These risks are managed as part of the department’s COVID-19 response with the most severe managed by our COVID-19 Oversight Board.

4. Our resources

Our finances:

1. departmental expenditure limit (DEL): £186.3 billion
2. resource DEL (including depreciation): £177.8 billion
3. capital DEL: £8.5 billion
4. annually managed expenditure (AME): £10.0 billion

Control totals included in this document are in line with those presented in the Main Supply Estimates 2021 to 2022. Any changes arising from the Parliamentary approval process will be reflected in due course.

Source: Main Supply Estimates 2021 to 2022.

5. Our people

As at 31 December 2020, DHSC had 3,030 full-time equivalent employees.

Source: Office for National Statistics (ONS) public sector employment data. Release schedule: quarterly.

Breakdown of resource by work

In this environment, the importance of our work has never been greater. We need to have the resources to do our work effectively and respond to new priorities as they arise. Figure 1 shows how our resources are allocated within DHSC.

Figure 1

Director general (DG) group or business area	Budget (£m)	Workforce (FTE)
COVID-19	19,906	950
NHSX	684	160
Global health	1,545	240
NHS policy and performance	1,396	510
Adult social care	866	330
Public health and prevention	444	260
Chief Scientific Adviser	1,313	250
Commercial	396	320
Finance and group operations	267	1,010

Our breakdown of resource is provided by DG group or business unit to reflect the way we set budgets within DHSC. Our budgets are set by the departmental structure which cuts across numerous priority outcomes.

C. Priority outcomes delivery plans

Priority outcome 1: protect the public’s health through the health and social care system’s response to COVID-19

Lead minister

Rt Hon Sajid Javid MP

Senior sponsor

Clara Swinson, Director General for Global Health

Jonathan Marron, Director General for Public Health

Outcome strategy

The pandemic is the most significant challenge the country and our public sector has faced in a lifetime. Work on COVID-19 is the single most important operational and policy focus for the whole department and wider health and social care system. Continuing to be informed by the best available scientific evidence, the department’s programme of work is to suppress the virus and protect the NHS in order to save lives and provide a route back to normality. This includes:

• vaccine and therapeutics development and deployment
• protecting the UK from global threats and new variants
• ensuring the resilience of the NHS and adult social care sectors
• the supply of critical equipment and goods
• reducing transmission through non-pharmaceutical interventions
• delivery of effective mass testing, contact tracing, and isolation support services through local partnerships, with tailored support for the most vulnerable

It will be critical that the department and wider health and care system reflects and learns the lessons from the pandemic – both to improve our preparedness and response to health emergencies as well as to embed broader learning. COVID-19 has caused, and will continue to cause, substantial short, medium and long-term effects to healthcare in the UK. It has also shone a spotlight on many of the strengths and challenges faced by our health and care system.

Our performance metrics

People who tested positive for COVID-19 at least once

Date (in weeks)	Number of people
24/6/21 to 30/6/21	135,685
17/6/21 to 23/6/21	79,248

Source: Weekly statistics for NHS Test and Trace. Release schedule: weekly.

Percentage of close contacts who were identified, reached and told to self-isolate

Date (in weeks)	Percentage contacted
24/6/21 to 30/6/21	91.8% (for those where communication details were available) 86.2% (for all contacts identified)
17/6/21 to 23/6/21	90.6% (for those where communication details were available) 84.4% (for all contacts identified)

Source: Weekly statistics for NHS Test and Trace. Release schedule: weekly.

Percentage of contacts that were reached and told to self-isolate within 3 days of the case that reported them taking a test (for cases not managed by local health protection teams)

Date (in weeks)	Percentage contacted
24/6/21 to 30/6/21	91.0%
17/6/21 to 23/6/21	90.0%

Source: Weekly statistics for NHS Test and Trace. Release schedule: weekly.

Personal protective equipment (PPE) inventory maintained at sufficient level to meet modelled demand requirements (initially 120 days’ demand)*

Date	Stockpile maintained
30/11/2020	On 30 November 2020, DHSC held a stockpile exceeding the 120-day demand for each of the 9 categories of PPE included in the commitment.

Source: Stockpile of PPE. Release schedule: TBC initially one-off publication.

*Nine categories of PPE are included in the target: aprons, body bags, clinical waste bags, eye protection (goggles and visors), FFP3 face masks, IIR face masks, gloves, gowns, chemicals for hand hygiene.

UK-make capacity is in line with planned category strategies to ensure resilient supply to address future demands*

Date	% of PPE that is UK-made
1/12/20 to 28/3/21	UK-made supply comprised 82% of the expected demand for PPE in England for the period 1 December 2020 to 28 February 2021.

Source: PPE made in the UK. Release schedule: TBC initially one-off publication.

*Eight categories of PPE are included in the target: aprons, body bags, clinical waste bags, eye protection (goggles and visors), FFP3 face masks, IIR face masks, gowns and chemicals for hand hygiene.

Additional metrics for 2021 to 2022

The government’s response to COVID-19 is a dynamic programme of work, with metrics continuing to be developed as the situation evolves. The above metrics represent our current best available metrics for Test and Trace and PPE.

On vaccine uptake, we continue to triangulate various sources of data and intelligence to inform our uptake strategy and plan insight-driven interventions to maximise uptake. These sources include attitudinal data on vaccine hesitancy from the ONS and YouGov, uptake data captured by NHS England and NHS Improvement, and various pieces of quantitative and qualitative research.

How our work contributes to the delivery of the UN sustainable development goals (SDGs)

Priority outcome	Link to SDGs
Priority outcome 1	SDG 3 – ensure healthy lives and promote wellbeing for all ages (targets 3.8, 3B)

Projects and programmes

To ensure the sufficient stock, distribution and use of PPE.

To provide an integrated approach to testing, contact tracing, and certification, so that together they have the greatest possible impact in supporting our strategic goals.

To safely and effectively administer vaccinations to the adult population of England (contributes to SDG 3, SDG target 3.8).

Outcome evaluation plan

DHSC invests significantly in research and development via the National Institute for Health Research (NIHR), the nation’s largest funder of health and care research. Our people, programmes, centres of excellence and systems together represent the most integrated health research system in the world.

The NIHR invests over £33 million a year in a dedicated Policy Research Programme (PRP), which is the main external mechanism for delivering robust evidence to inform policy development and implementation, including evaluation of policies, including pilots; and research to fill longer-term evidence needs and gaps. The NIHR PRP includes a set of 15 policy research units which are mainly university-based and all of which have evaluation capacity. The independent nature of these units ensures academic rigour and transparency in the evaluations they provide.

Examples of NIHR-funded policy evaluations that have had impact, and are informing policy thinking, include a study to investigate public attitudes towards, and use of, COVID-19 contact tracing apps. We have also commissioned a major initiative through the NIHR PRP of research projects to inform policy responses to COVID-19 in health and social care on Recovery, Reset, Renewal from COVID-19. A learning and evaluation workstream has been initiated focused on mapping and sharing best practice examples from phase 1 of the COVID-19 vaccination rollout across national and regional teams.

Priority outcome 2: improve healthcare outcomes by providing high-quality and sustainable care at the right time in the right place and by improving infrastructure and transforming technology

Lead ministers

Edward Argar, Minister of State for Health

Nadine Dorries, Minister of State for Patient Safety, Suicide Prevention and Mental Health

Jo Churchill, Parliamentary Under Secretary of State for Prevention, Public Health and Primary Care

Senior sponsors

Director General for NHS Policy and Performance

Clara Swinson, Director General for Global Health

Andy Brittain, Director General for Finance

Matthew Gould, CEO for NHSX

Outcome strategy

It is our ambition to manage the immediate pressures of COVID-19 while supporting the NHS to deliver long-term transformation. We need to invest in getting the NHS and acute services back on track first, in order to then address the strategic challenges of an aging population, multi-morbidities, and the need to support health and wellbeing across the whole life course, as set out in the NHS Long Term Plan.

Our vision for improved support to people with mental health conditions, learning disabilities and autism and our corresponding priorities firmly align with the government’s wider priorities for future years and the department’s vision for an NHS that is more resilient, more collaborative, and one where local systems and staff are empowered to innovate. This includes a strong focus on levelling up to tackle health and socio-economic inequalities across the country and improving the quality of NHS services and health outcomes.

Improving uptake of bowel, breast and cancer screening will enable the earlier detection and treatment of disease, reducing the number of lives lost to cancer and reducing costs to the NHS by preventing people from requiring more intensive treatment. While reducing the number of stillbirths, maternal and neonatal deaths and neonatal brain injuries will improve safety outcomes for mothers and babies.

Primary and community care is the first point of access for the majority of the population and good community management prevents conditions from escalating. It is therefore essential that we continue to push increased access in areas where provision has historically been more limited and improve access for vulnerable groups. We will increase the number of children supported by mental health support teams in schools and provide more children and young people with access to community mental health services.

We will progress the Health and Care Bill that will implement reforms to meet policy ambitions of the Secretary of State, DHSC, and NHS England and NHS Improvement. This bill builds on the commitments made in the NHS Long Term Plan around integration and collaboration, as well as implementing measures from the COVID-19 response which should be made permanent. Taken together, they will help us build back better after COVID-19. We will remove the barriers that stop the system from being truly integrated. We want to help integrated care systems play a greater role, delivering the best possible care, with different parts of the NHS joining up better; and the NHS and local government forming dynamic partnerships to address some of society’s most complex health problems. It will help us deliver our manifesto commitments, including 40 new hospitals. We will use legislation to remove much of the transactional bureaucracy that has made sensible decision-making harder, and the reforms will help enable us to use technology in a modern way, establishing technology as a better platform to support staff and patient care.

NHSX will help manage increasing demand and restore elective care, working with local teams to transform services, including to set up new ‘care at home’ models, including for hypertension, cardiovascular disease, and mental health. To help systems work collaboratively we will define the high-level architecture for shared care records and set out the roadmap and help get basic shared care records in place. We will also support care providers to implement Digital Social Care Records, ensuring that they are connected to shared care records so that information can be shared, and care workers are equipped with the information they need. We will announce future cohorts of digital aspirants to work towards levelling up providers, including mental health and community trusts, helping services to become more resilient in the face of rising demand.

Our performance metrics

Treatable mortality rate

Year	Rate per 100,000 population, all-person all-causes, England
2019	80.3
2018	83.3

Source: Annual age-standardised mortality rates for causes considered treatable in England: ONS. Release schedule: annual.

Number of appointments in general practice

12-month rolling sum	Total number of appointments in general practice
Mar 2020 to Feb 2021	275,280,000
Mar 2019 to Feb 2020	311,900,000

Source: GP appointments data, estimated England total count of appointments: NHS Digital. Release schedule: monthly.

Percentage of cancers diagnosed at an early stage

Quarterly	Yearly rolling average for the percentage of cancers diagnosed at stage 1 and 2
Q1 2019	54.8%
Q1 2018	54.0%

Source: National Disease Registration Service: Staging data in England: Public Health England. Release schedule: quarterly.

Cancer survival rate (one-year)

Yearly	One-year cancer survival rate (%)
2018	73.9% in 2018
2003	63.6% in 2003

Source: Index of cancer survival for clinical commissioning groups (CCGs) in England: adults diagnosed in 2003 to 2018 and followed up to 2019: Public Health England. Release schedule: annual.

Number of people accessing Improving Access to Psychological Therapies (IAPT) services

Year	Number of first treatments, 12-month sum
Feb 2020 to Jan 2021	1,019,418
Feb 2019 to Jan 2020	1,165,338

Source: Psychological therapies, report on the use of IAPT services: NHS Digital. Release schedule: monthly.

Number of children and young people accessing NHS-funded mental health services

Year	The number of children and young people, regardless of when their referral started, receiving at least 2 contacts (including indirect contacts) and where their first contact occurs before their 18th birthday
January 2021	25,256
January 2020	28,681

Source: Mental health services monthly statistics: NHS Digital. Release schedule: monthly.

IAPT recovery rate

Year	The proportion of referrals classed as clinical cases (at ‘caseness’) that have finished a course of treatment (2 or more sessions) and recovered
January 2021	50.4%
January 2020	51.1%

Source: Psychological therapies, report on the use of IAPT services: NHS Digital. Release schedule: monthly.

Rates of births resulting in stillbirth or neonatal death

Year	Number of stillbirths per 1,000 total births	Number of neonatal deaths per 1,000 live births at >/= 24 weeks gestation
2019	3.8 stillbirths per 1,000 births in 2019	1.4 deaths per 1,000 live births >/= 24 weeks gestation in 2019
2010	This represents a 25% reduction in the stillbirth rate since 2010	This represents a 29% reduction in the neonatal mortality rates at >/= 24 weeks gestation since 2010

Source: Child mortality (death cohort) tables in England and Wales: ONS. Release schedule: annual.

Percentage of patients waiting more than 52 weeks for consultant-led treatment

Year	Percentage of incomplete Referral to Treatment (RTT) pathways over 52 weeks
January 2021	6.62%
January 2020	0.04%

Subject to change due to the ongoing Clinical Review of Standards.

Source: Consultant-led Referral to Treatment waiting times: NHS England. Release schedule: annual.

A&E performance

Month	Percentage of attendances admitted, discharged, or transferred within 4 hours
February 2021	83.9%
February 2020	82.8%

Subject to change due to the ongoing Clinical Review of Standards.

Source: A&E attendances and emergency admissions: NHS England. Release schedule: monthly.

Financial performance against the NHS budget (£ million), underspends and (overspends)

Financial year	Providers’ net deficit	Commissioners and other NHS underspends	Net underspend against the NHS budget
2019 to 2020	(£899 million)	£973 million	£73 million
2018 to 2019	(£827 million)	£916 million	£89 million

Source: DHSC Annual Report and Accounts. Release schedule: annual.

Difference between the best and worst performing CCGs for cancer survival (one year)

Yearly	Gap between the best and worst performing CCGs for cancer survival (one year)
2018	8.9%
2003	14%

Source: Index of cancer survival for CCGs in England: adults diagnosed in 2003 to 2018 and followed up to 2019: Public Health England. Release schedule: annual.

Additional metrics for 2021 to 2022

Patient-reported experience of general practice.

NHS productivity growth rate.

Number of new hospitals under construction.

Percentage of patients receiving a thrombectomy following a stroke.

Percentage of eligible patients accessing cardiac rehabilitation.

Difference in the stillbirth and neonatal mortality rate between that for BAME women and the national average.

Number of sustainability and transformation partnerships (STPs)/integrated care system (ICSs) with 50% or more of its partners connected (also expressed as approximate % of the population in England covered by those STPs/ICSs).

Number of authorised user views of Shared Care Records per 1,000 population connected (weighted).

Number of people receiving digitally supported care at home.

How our work contributes to the delivery of the UN SDGs

Priority outcome	Link to SDGs
Priority outcome 2	SDG 3 – ensure healthy lives and promote wellbeing for all ages (targets 3.1, 3.2, 3.4)
Priority outcome 2	SDG 9 – build resilient infrastructure, promote sustainable industrialisation and foster innovation (target 9.1)

Projects and programmes

To establish a formal programme for elective recovery, including transformation.

To support NHS England to deliver commitments in the Cancer Strategy and Long Term Plan on cancer and to introduce measures to improve early diagnosis and treatment of all major conditions; improve cancer survival so that 75% of cancer patients diagnosed at stage 1 or 2 and for 55,000 more people to survive 5 years or more by 2028 (contributes to SDG 3, SDG target 3.4).

To make the NHS the best place in the world to give birth through personalised, high-quality support. Working with system partners to improve maternity services and outcomes to meet our National Maternity Safety Ambition for a 50% reduction in stillbirth, neonatal and maternal deaths and brain injury by 2025 and a reduction in the national rate of pre-term births from 8% to 6% by 2025 (contributes to SDG 3, target 3.1 and target 3.2).

To set direction for policy and delivery on mental health and wellbeing across the health and care system and across government in the context of recovery from the pandemic.

To deliver an additional 50 million general practice appointments a year by 2024 to 2025.

To deliver on the commitment to build and fund 40 new hospitals by 2030 and 20 hospital upgrades (contributes to SDG 9, target 9.1).

To progress the Health and Care Bill through Parliament to implement a series of reforms around integration and collaboration as well as implementing measures from the COVID-19 response.

Outcome evaluation plan

The NIHR PRP would be used as the main external mechanism for delivering robust evidence to inform policy development and implementation, including evaluation of policies, and research to fill longer-term evidence needs and gaps around improving healthcare outcomes.

We intend to commission an evaluation of the implementation and the impact of core proposals within the ‘Transforming children and young people’s mental health provision: a green paper’. There is an ongoing evaluation of the Children and Young People’s Mental Health Trailblazer Programme, focusing in particular on the first wave of areas participating in the programme and activities related to 2 of the programme’s main components: the senior mental health leads in education settings and Mental Health Support Teams. We are looking to commission research into strategies for making large improvements in acute waiting times, and research into the impacts of waiting on patient outcomes (for example on cancer mortality). Research is underway to explore current and future unmet demand in community healthcare services. Understanding community healthcare services in the context of COVID-19 is also a priority; we are considering options for taking this forward. 

Priority outcome 3: improve healthcare outcomes through a well-supported workforce

Lead ministers

Helen Whately, Minister of State for Care

Jo Churchill, Parliamentary Under Secretary of State (Minister for Prevention, Public Health and Primary Care)

Senior sponsor

Director General for NHS Policy and Performance

Outcome strategy

The NHS is the biggest employer in Europe and the world’s largest employer of highly skilled professionals. 1.3 million people across the health service in England are devoting their working lives to caring for others. However, over the past decade, workforce growth has not kept up with need, and the way staff have been supported to work has not kept up with the changing requirements of patients (NHS Long Term Plan, 2019). Health and care staff are feeling the strain due, in part, to the unprecedented COVID-19 pandemic and the number of vacancies across many roles and in many parts of England that already presented significant challenges.

The NHS Long Term Plan committed to and highlighted the need to tackle pressures about funding, staffing, increasing inequalities and pressures from a growing and ageing population. To deliver the Long Term Plan, the NHS needs more staff, working in rewarding jobs and a more supportive culture. By better supporting and developing staff, NHS employers can make an immediate difference to retaining the skills, expertise and care their patients need. They can, and will, also do more to improve equality and opportunities for people from all backgrounds to work in the NHS.

As we invest in our workforce, we need to ensure the NHS has primary care and generalist skills, to complement what has been a major move to more specialised hospital-based care in recent decades. As part of the response to COVID-19 there has been a changing grade mix, this emergency response has accelerated potential productivity opportunities. However, it is difficult to know the medium- and longer-term impact to service delivery with fluctuations in productivity due to changes in service provision, activity and staff availability.

The challenge is substantial, but there are real opportunities to make improvements. More people want to train to join the NHS than are currently in education or training. Many of those leaving the NHS would remain if they were offered improved development opportunities and more control over their working lives.

To ensure that the NHS has the workforce capacity, capability and flexibility it needs to deliver the services required during the pandemic and beyond, as we recover to previous levels of elective activity and then go further and faster. We will work closely with NHS England and NHS Improvement to plan for the next phase of the NHS response to COVID-19.

Our performance metrics

Sickness absence rate

Month	Sickness absence rates in the NHS in England
November 2020	4.9%
November 2019	4.7%

Source: Monthly sickness absence rates in the NHS in England: NHS Digital. Release schedule: monthly.

Staff engagement rate

Year	National average score for staff engagement
2020	7.0
2019	7.0

Source: National average score out of 10 against the staff engagement theme in the NHS Staff Survey: NHS Staff Survey Results. Release schedule: annually.

Percentage of staff who say they have personally experienced harassment, bullying or abuse at work

Year	Staff experiencing at least one incident of harassment, bullying or abuse at work from managers	Staff experiencing at least one incident of harassment, bullying or abuse at work from other colleagues	Staff experiencing at least one incident of harassment, bullying or abuse at work from patients or service users
2020	12.4%	18.7%	26.7%
2019	12.3%	19.0%	28.6%

Source: National average score for questions 13a, 13b and 13c in the NHS Staff Survey: NHS Staff Survey Results. Release schedule: annually.

Additional metrics for 2021 to 2022

Number of registered nurses employed by the NHS (in all settings).

Number of doctors in general practice.

Number of additional primary care professionals in general practice (excluding doctors and nurses).

How our work contributes to the delivery of the UN SDGs

Priority outcome	Link to SDGs
Priority outcome 3	SDG 3 – ensure healthy lives and promote wellbeing for all ages (target 3C)

Projects and programmes

To help ensure the successful development and implementation of the NHS People Plan by NHS England and NHS Improvement, which reflects the changes needed in supply, culture and leadership in order to deliver both on the immediate changes needed due to COVID-19 and the ambitions of the Long Term Plan.

To deliver on the manifesto commitment for 50,000 more nurses in England by 2024 to 2025 (contributes to SDG 3, SDG target 3C).

To support NHS resilience and recovery by planning for the next phase of the NHS response to COVID-19, to ensure that the NHS has the workforce capacity, capability and flexibility it needs to deliver the services required.

To deliver commitments to strengthen the primary care workforce by working towards 6,000 more doctors in general practice; 26,000 more primary care professionals, such as physiotherapists and pharmacists.

Outcome evaluation plan

The NIHR PRP, including the NIHR Policy Research Unit in Health and Social Care Workforce, would be used as the main external mechanism for delivering robust evidence to inform policy development and implementation, including evaluation of policies, and research to fill longer-term evidence needs and gaps.

Ongoing research and evaluation projects include an evaluation of the nursing associate programme, research to understand regional pay as well as research into strategies (i.e. ‘what works’) to improve staff morale and on the ethical recruitment of international health workforce. Ongoing research also includes analysis of the Electronic Staff Record (ESR) to derive insights, for example on post-maternity working patterns, to improve workforce planning and understand gender pay gap issues.

Priority outcome 4: improve, protect and level up the nation’s health, including reducing health disparities

Lead ministers

Jo Churchill, Parliamentary Under Secretary of State for Prevention, Public Health and Primary Care

Senior sponsor

Jonathan Marron, Director General for Public Health

Outcome strategy

Protecting the public’s health and improving the health of people and communities not only delivers direct health benefits to the individual, including levelling up unacceptable health inequalities, it also creates a more economically and socially active population and reduces the burden on the NHS and the economy.

Our ability to continue to respond to COVID-19 and our future pandemic resilience are critical to UK recovery. To be able to respond and recover from all types of threats now and in the future, we need world-leading health protection capabilities, including increased pandemic preparedness and resilience. The UK Health Security Agency (UKHSA) is bringing together the existing health protection responsibilities discharged by Public Health England with enhanced capabilities of NHS Test and Trace, including the Joint Biosecurity Centre, to anticipate, deter, withstand and to recover from all types of threat and hazard. This includes being a global leader in science and innovation, with an ability to rapidly scale up capacity in times of need, and the resilience needed to bounce back more quickly, mobilising a whole-of-society approach that connects the capabilities that exist at local, national and international levels.

We are establishing the Office for Health Promotion within DHSC: a dynamic, multi-disciplinary unit that will oversee policy development, expert advice and implementation on prevention of ill health, with professional oversight from the Chief Medical Officer.

We know that living with obesity reduces life expectancy and increases the chance of serious diseases such as cancer, heart disease and type 2 diabetes – costing the NHS £6.1 billion annually. COVID-19 has further outlined the need for action. To maintain the momentum generated by the obesity strategy, we propose a comprehensive package of measures to tackle obesity that aims to prevent and treat obesity and those who are overweight, helping both adults and children achieve a healthier weight and ensure we target inequalities. They will increase the resilience of adults against COVID-19, and for children, potentially deliver half of the 50% reduction in childhood obesity we are seeking by 2030.

We will develop and deliver a health promotion strategy which improves population health by promoting healthy behaviours, reducing risky behaviours and tackling the underlying causes of increases in NHS demand. This includes measures to tackle drug addiction that is focused on treatment, recovery and prevention and a UK wide cross-government addiction strategy covering drugs, alcohol, tobacco and problem gambling.

A robust and resilient health protection system relies on a population being as healthy as possible, with a focus on preventative public health and ongoing investment to reduce inequalities. Our core offer is delivered through a range of partners and routes, including through the NHS, and through the Public Health Grant (PHG), which funds front-line public health services.

Departments supporting the outcome delivery

A number of government departments have crucial contributions to the delivery of this outcome, including:

• Department for Digital, Culture, Media and Sport (DCMS)
• Department for Education (DfE)
• Department for Environment, Food and Rural Affairs (DEFRA)
• Department for Transport (DfT)
• Ministry of Housing, Communities and Local Government (MHCLG)
• Department for Business, Energy and Industrial Strategy (BEIS)
• Department for Work and Pensions (DWP)
• Home Office
• Ministry of Justice (MoJ)
• HM Treasury
• Department for International Trade (DIT)

Over the coming months, we will establish a new cross-government ministerial board to drive joint action on health improvement.

Our performance metrics

Disability-free life expectancy

Year	Disability-free life expectancy at birth – female and male (England)
2017 to 2019	62.7 (male) 61.2 (female)
2016 to 2018	62.9 (male) 61.9 (female)

Source: Health state life expectancies, England: 2017 to 2019, ONS. Release schedule: annually.

Inequality in disability-free life expectancy

Year	Inequality in disability-free life expectancy at birth (as measured by the slope index of inequality) – female and male (England)
2017 to 2019	17.2 (male) 16.3 (female)
2016 to 2018	17.1 (male) 16.7 (female)

Source: Health state life expectancies, England: 2019, ONS. Release schedule: annually.

Smoking prevalence in adults

Year	Percentage of people aged 18 years and above who are current smokers (England)
2019	13.9%
2018	14.4%

Source: Annual population survey, 2019, ONS. Release schedule: annually.

Under-75 mortality rate from cardiovascular diseases considered preventable

Year	Under-75 mortality rate from cardiovascular diseases considered preventable (directly standardised rate per 100,000 population) (England)
2017 to 2019	28.2 (per 100,000)

Source: Public Health Outcomes Framework, Public Health England. Release schedule: annually.

Obesity prevalence

Year	Obesity prevalence (% obese using body mass index (BMI)) – adults and children aged 2 to 15
2019	28% (adults) 16% (children)
2018	28% (adults) 15% (children)

Source: Health Survey for England, NHS Digital. Release schedule: annually.

Percentage of children and adults who are physically active

Year	Percentage of children and adults (16+) who are physically active (defined by the Chief Medical Officer’s recommendations for physical activity)
May 2019 to May 2020	62.8% (adults) 44.9% (children)
Nov 2018 to Nov 2019	63.3% (adults) 46.8% (children)

Source: Active Lives surveys, Sport England. Release schedule: annually.

How our work contributes to the delivery of the UN SDGs

Priority outcome	Link to SDGs
Priority outcome 4	SDG 3 – ensure healthy lives and promote wellbeing for all ages (targets 3.4, 3.5, 3.7, 3A)

Projects and programmes

Lead the health and care sector input to cross-government programmes to end rough sleeping; and to help prevent violence and abuse and better support the victims including supporting the implementation of measures in the Domestic Abuse Act.

Establish the Office for Health Promotion and develop and deliver a prevention strategy which improves population health by promoting healthy behaviours, reducing risky behaviours and tackling the underlying causes of increases in NHS demand, including on alcohol, drugs, sexual health and physical activity (contributes to SDG 3, SDG targets 3.4, 3.5, 3.7 and 3A).

To publish the new Smokefree 2030 Tobacco Control Plan (2021 to 2030), and continue to deliver the 2017 Tobacco Control Plan for England commitments.

Improve the health of people and communities through an ambitious Obesity Programme to deliver commitments to halve childhood obesity by 2030 through delivery of the commitments established in the Childhood Obesity ‘A plan for action’ chapters 1 to 3.

Improve future pandemic resilience through redesigning the public health system to ensure it is fit for the future.

Outcome evaluation plan

The NIHR PRP, including the NIHR Policy Research Unit in Public Health (hosted by the London School of Hygiene and Tropical Medicine) and the NIHR Policy Research Unit in Obesity (hosted by University College London), would be used as the main external mechanism for delivering robust evidence to inform policy development and implementation, including evaluation of policies, and research to fill longer-term evidence needs and gaps.

Ongoing evaluations include an assessment of the impacts of the Soft Drinks Industry Levy and the out-of-home calorie labelling policy. Research in preparation for an evaluation of proposed restrictions on TV food advertising and online food marketing to capture baseline data for a process evaluation is due to begin shortly. In addition, we will be commissioning evaluations of the Adult and Children Weight Management Programmes and other regulatory policies from the recent obesity strategy.

Underpinning research for policy development on healthy weight is being commissioned through new, enhanced capacity in the NIHR Policy Research Unit in obesity. We also plan to review:

• the stop-smoking system design and delivery
• the role of harm reduction products (including e-cigarettes) to help smokers quit
• inequalities in smoking
• the use of stop-smoking technology in helping people quit and innovation in improving service design

And we will be commissioning research into the health conditions that have the biggest impact on inequalities in disability-free life expectancy, to understand the effectiveness of interventions in narrowing the gap in disability-free life expectancy between the richest and poorest groups and regions.

Priority outcome 5: improve social care outcomes through an affordable, high-quality and sustainable adult social care system

Lead minister

Helen Whately, Minister of State for Care

Senior sponsor

Michelle Dyson, Director General for Adult Social Care

Outcome strategy

The social care system is an integral part of our society and the economy, affecting the daily lives of millions of people. The current system has strengths which we can build on as we drive recovery from the COVID-19 pandemic and level up. We see local authorities, providers, the care workforce, carers and local communities all finding new ways to provide support that enables people to live fulfilling, independent lives. But we are also facing deep-rooted challenges and the COVID-19 pandemic has heightened the urgency for reform.

The government is committed to sustainable improvement of the adult social care system and will bring forward plans for reform in 2021.

Our objectives for reform are to enable an affordable, high-quality and sustainable adult social care system that meets people’s needs, while supporting health and care to join up services around people. We want to ensure that every person receives the care they need and that it is provided with the dignity they deserve.

We are working closely with local and national partners to ensure our approach to reform is informed by diverse perspectives, including of those with lived experience of the care sector.

Departments supporting the outcome delivery

The department is working closely with MHCLG on adult social care reform proposals. Adult social care is delivered by local government and is funded largely through the Local Government Finance settlement. Local government’s net current expenditure on non-ringfenced services was £50 billion in 2019 to 2020, and adult social care was the largest reported area of local authority spending, accounting for 34% of this non-ringfenced spending.

Our performance metrics

Percentage of Care Quality Commission (CQC) locations with an overall rating of outstanding or good.

Date	Percentage good or outstanding
31 March 2020	80% Good 5% Outstanding
31 July 2019	80% Good 4% Outstanding
31 July 2018	79% Good 3% Outstanding

Source: CQC State of Care. Release schedule: annual.

Social care related quality of life

Year	Social care related quality of life (out of 24)
2019 to 2020	19.1
2018 to 2019	19.1

Source: Adult social care outcomes framework. Release schedule: annual.

Carer-reported quality of life

Year	Carer-reported quality of life (score out of 12)
2018 to 2019	7.5
2016 to 2017	7.7

Source: Personal social services survey of adult care in England. Release schedule: every 2 years.

Percentage of people who use social care services who say that those services have made them feel safe and secure

Year	Percentage of people who use social care services who say that those services have made them feel safe and secure
2019 to 2020	86.8%
2018 to 2019	86.9%

Source: Adult social care outcomes framework. Release schedule: annual.

Staff turnover rate for directly employed staff working in the adult social care sector

Year	Staff turnover rate (%)
2019 to 2020	30.4%

Source: Skills for Care. Release schedule: annual.

Vacancy rate in adult social care sector

Year	Vacancy rate (%)
2019 to 2020	7.3%

Source: Skills for Care. Release schedule: annual.

How our work contributes to the delivery of the UN SDGs

Priority outcome	Link to SDGs
Priority outcome 5	SDG 3 – ensure healthy lives and promote wellbeing for all ages (target 3.8)

Projects and programmes

To support high-quality, affordable, sustainable social care for all.

To support health and care services join up around people.

To lever the potential power of data, digitalisation and technology for social care.

To develop assurance processes which drive improvements in adult social care quality and outcomes.

To bring forward proposals for adult social care reform in 2021.

Outcome evaluation plan

The NIHR PRP, including the NIHR Policy Research Unit in Adult Social Care (hosted by the London School of Economics) and other policy research units that are also contributing to social care research, would be used as the main external mechanism for delivering robust evidence to inform policy development and implementation, including evaluation of policies, and research to fill longer-term evidence needs and gaps.

Using a range of commissioning routes and methods, we aim to develop a comprehensive and cohesive approach to evaluation and evidence-based policy making in adult social care. This will include working closely with the NIHR and other external experts to design and conduct robust impact evaluations to assess the value for money of different interventions and policies against the department’s priority of outcomes of enabling an affordable, high-quality and sustainable adult social care system that meets people’s needs.

Building on progress made during the COVID-19 pandemic, work is continuing throughout 2021 to 2022 to improve the quality and timeliness of adult social care data. We are working together with local authorities and providers to enhance the collection and flow of data; this represents an important foundational step to underpin the oversight and assurance of adult social care provision and to enable future research and evaluation.

Ongoing research includes exploring social care system demand, user needs and models of provision – including research on funding challenges and on the effectiveness of different models of care for people with moderate care needs. We will be exploring options for commissioning future research and evaluation in priority areas, such as:

• evaluation of the value for money of different interventions for different types of care users, including residential care, domiciliary care and supported housing
• research on both the potential impact of labour market interventions on recruitment and staff turnover and the impacts of turnover on care quality, productivity and provider resilience

D. Strategic enablers

Workforce, skills and location

Our people are at the heart of a great department of state. We will continue to develop our leaders to be confident and empowering. We are committed to creating an inclusive culture where difference is valued, and diversity is harnessed and reflected in our workforce. We are committed to identifying, growing and developing our people to be successful in their roles in leading the health and care system.

We will:

• reinforce the systems for talent management and performance management to address the personal and professional development needs and reward performance in line with government and departmental priorities
• ensure that our organisation reflects the country we serve by relocating staff, including senior civil servants, from London
• continue to remove barriers to recruitment, development and promotion of a diverse workforce

People survey engagement score

Year	Engagement score
2020	69%
2019	66%
2018	63%

Source: Civil Service People Survey. Release schedule: annually.

Representation of female staff, ethnic minority staff and disabled staff

Year	Total number of staff	Female	Ethnic minority	Disabled
2020	Data not yet published	Data not yet published	Data not yet published	Data not yet published
2019	1,762	64.5%	24.3%	6.4%
2018	1,546	64.4%	23.4%	5.9%

Source: Civil Service Diversity and Inclusion Dashboard. Release schedule: quarterly.

Innovation, technology and data

We aim to improve health and social care – including through the response to and recovery from the COVID-19 pandemic – by giving people the technology they need and to support innovation. This will be supported by strong tools, processes and standards to enable safe, secure data sharing that protects the confidence of patients and the public through strong information governance and data protection. It will also be supported by IT projects and initiatives that provide safe, modern tools and services, supporting automation and digitalisation where appropriate and updating legacy IT services where required.

We will:

• provide leadership on the use of digital and technology to enable better outcomes, improve efficiency and reduce costs
• enable better use of data and information; helping to embed a much stronger culture of data-driven delivery in DHSC
• invest in the tools, processes, standards and frameworks needed to enable safe, secure data sharing across departments to support decision-making and improve services
• develop and deliver a DHSC Data and Information Risk and Assurance Framework
• deliver a portfolio of IT projects and initiatives to support safe, secure collaboration tools to enable the department to work with stakeholders inside and outside of government and to renew IT systems and services, to automate and digitise where appropriate and to update outdated legacy IT systems providing modern and secure technologies

Delivery, evaluation and collaboration

We will work to embed an outcomes-focused culture across DHSC and its wider ALB family so that outcomes are considered at every stage of programme development. From internal performance reporting through to policy development and project delivery across the health and care system, our staff will prioritise good planning, accountability, assurance and evaluation. This will involve close working across the professions, with external stakeholders and through our ALBs to encourage collaboration and the sharing of expertise and best practice.

We will:

• strengthen functional expertise and delivery, ensuring adherence to functional standards and effective monitoring of performance
• manage the planning cycle in such a way that it engages all staff in delivering priorities, through a well understood, efficient and transparent process
• provide transparent accountability through regular reporting, both within the department, to the centre and Parliament

Sustainability

We aim to ensure that the department, its ALBs and the wider health and care system are taking the necessary actions to support delivery of the government’s Greening Government Commitments.

We will:

• ensure that we are able to meet our Greening Government Commitments and continue to monitor and track their delivery
• continue to ensure that our estate, activities and policies are sustainable and support climate change, resilience and adaptation

(Contributes to SDG 3, SDG target 3.9. SDG 12, SDG target 12.5. SDG 13, SDG target 13.2.)

Greenhouse gas emissions

Year	Total emissions CO2e
2020	Data not yet published
2019	58% reduction
2018	53% reduction

Source: Greening Government Commitments annual reports. Release schedule: annually.

(Contributes to SDG 3 – target 3.9, SDG12 – target 12.5, SDG 13 – target 13.2.)

E. Our equality objectives

We have set objectives to help us advance equality. These are:

1. We aim to build an inclusive culture within the department which values and respects diversity, where everyone can achieve their potential. As an employer we are also committed to the Civil Service ambition to become the UK’s most inclusive employer.

2. We will continue to build and develop our relationships with stakeholders and the public, including those that represent groups with protected characteristics, to improve our functions and services.

3. We will improve the capability and understanding of the Public Sector Equality Duty in the department to make better policy decisions and improve the health and lives of the nation.

4. We aim to improve the department’s assurance processes to the Public Sector Equality Duty to ensure it is clear throughout the policy development process, how we have paid due regard to the Public Sector Equality Duty.

5. We will build senior engagement in the department and stakeholders to highlight and promote the importance of equalities and encourage senior staff to tackle equality issues.

For further information please refer to our DHSC equality objectives 2019 to 2023.

1. Provisional priority outcomes and associated metrics will be adjusted through the next Spending Review as necessary, including to deliver the Integrated Review of Security, Defence, Development and Foreign Policy. ↩