Guidance

NHS public health functions agreement 2023 to 2024

Published 8 February 2024

Applies to England

Introduction

The NHS has a vital role to play in securing good population health and preventing disease. This agreement with the Secretary of State for Health and Social Care enables NHS England to commission certain public health services that will drive improvements in population health, including our world-leading childhood and adult immunisation programmes, and screening programmes that span the many opportunities to detect, act and, in some cases, prevent serious diseases across the life course. These services sit alongside and complement the work of wider public sector-commissioned health services.

Preventing ill health, detecting ill health earlier when it occurs and working better together in a more personalised way for individuals and families remain central to the ambition of (at least) 5 extra healthy, independent years of life by 2035, while narrowing the gap between richest and poorest.

NHS public health functions 2023 to 2024

This agreement sets out the arrangements under which the Secretary of State for Health and Social Care delegates to NHS England responsibility for certain elements of the Secretary of State’s public health functions. This agreement and the functions delegated by it are additional to, and distinct from, the health service functions exercised by NHS England under the National Health Service Act 2006 (‘the 2006 Act’). This agreement is made under section 7A of the 2006 Act.

This agreement focuses on achieving positive health outcomes for the population and reducing disparities in health through provision of the services listed below in Annex A (‘section 7A services’).

NHS England is accountable to the Secretary of State for delivering its responsibilities under this agreement and how well it drives improvement in section 7A services.

Objectives

NHS England’s first objective under this agreement is to secure the operational delivery via its commissioning and accountability processes of high-quality section 7A services in England with efficient use of resources, seeking to prevent avoidable ill health and achieve earlier diagnosis with positive health outcomes while promoting equality and reducing health disparities.

Achieving this objective would mean that:

• NHS England will have secured services - for example, by setting national NHS contract service specifications to commission providers (registered with the Care Quality Commission for services delivered within this agreement). NHS England will have effectively ensured contracts are managed so that providers deliver the required performance, and so that variation in levels of performance between different geographical areas is reduced. The NHS Standard Contract, where appropriate, will include the key performance indicators (KPIs) set out in this agreement
• NHS England will have shown evidence that timely and effective contract and performance management has been exercised to ensure providers deliver and assure to the requisite quality and safety standards, including the quality of patient experience, with patients able to access equitable services delivered by providers with a suitably qualified and diverse workforce

NHS England’s second objective is to:

• be responsible for the operational delivery of changes in services or introduction of new services that are agreed with the Department of Health and Social Care (DHSC)
• continue to transform section 7A services (including, where relevant, subsequent to UK National Screening Committee (UK NSC) and Joint Committee on Vaccination and Immunisation (JCVI) recommendations, informed by appropriate assessment of practical impact and feasibility for the NHS)

Programme changes should be carefully planned, taking account of relevant clinical or public health expert advice from the UK Health Security Agency (UKHSA) and Office for Health Improvement and Disparities (OHID), while seeking to minimise NHS service disruption and improve overall outcomes.

Roles and responsibilities

As part of the ‘comprehensive health service’, full achievement of the desired public health outcomes envisioned in this agreement is predicated on a range of organisations at national, regional and local levels fulfilling their roles.

The Secretary of State (and hence DHSC) is the overall steward of the system, and holds NHS England to account for commissioning and operational delivery under this agreement.

UKHSA provides:

• expert clinical and public health leadership on immunisation to the whole public health system, including advice on policy, programme design and implementation
• authoritative clinical guidance and advice to professionals and providers, leading on public communications and information resources, alongside outbreak control and individual case management
• expert clinical and public health advice and leadership to prisons and places of detention, including supporting surveillance, outbreak control and case management

In addition, UKHSA provides the secretariat for the JCVI and co-ordinates collaborative activity on immunisation across the 4 nations and internationally, provides public health and commercial expertise to support vaccine procurement, and co-ordinates the supply and distribution of vaccines UK-wide.

OHID provides advice on matters of health improvement and hosts the secretariat for the UK NSC. For screening programmes that are section 7A services, OHID produces core end-to-end pathway requirements, which describe the requirements at each stage of the pathways for the NHS screening programmes in England, based on UK NSC recommendations. The detailed care pathway specifications produced by NHS England bring together standards and guidance and programme-specific operating models for quality assurance.

Health and justice services are required to deliver on both national section 7A targets (for example, for immunisations and screening) and unique indicators relevant to the population residing within prisons, immigration removal centres and other prescribed places of detention (PPDs). These unique services are commissioned directly in PPDs by NHS England to address health disparities experienced by this vulnerable population group and ensure equivalence of care. Individuals accessing health and justice services can present with varied health needs. Therefore, health and justice have unique indicators providing additional assurance on factors such as substance misuse services and infectious disease screening.

Providers of section 7A services are expected to:

• undergo appropriate training
• follow all relevant clinical and professional guidance
• deliver the agreed programme standards
• evaluate their performance

Legal framework

Pursuant to this agreement, NHS England will exercise functions of the Secretary of State described (at the time of writing) in sections 2A, 2B and 12 of the 2006 Act so as to provide or secure the provision of section 7A services. Where NHS England exercises these functions, they are referred to in this document as ‘public health functions’.

NHS England is a commissioning organisation, as made clear by its principal functions set out in section 1H(3) of the 2006 Act.

Following commencement of relevant provisions of the Health and Care Act 2022, a range of joint working and delegation arrangements are permissible involving diverse NHS and non-NHS bodies as detailed in powers under new section 65Z5 of the 2006 Act and related provisions. These powers are applicable to public health functions exercisable by arrangements under section 7A (subject to any relevant regulations that may be made under section 65Z5(3) and the terms of agreed delegation arrangements themselves).

In order to ensure the ongoing coherence and consistency of national public health programmes covered by this agreement, NHS England will discuss any plans for onward delegation of section 7A services (for example, to integrated care boards (ICBs)) at a formative stage with DHSC and UKHSA, and obtain the consent of the Secretary of State to those arrangements before proceeding.

Under any such agreed delegation arrangements, NHS England will remain accountable to the Secretary of State for the delivery and performance of section 7A services via the mechanisms set out in this agreement.

The provision of section 7A services are steps that the Secretary of State considers appropriate for the purpose of protecting the public in England from disease or other dangers to health and may therefore be provided and arranged pursuant to the Secretary of State’s duty under section 2A of the 2006 Act. Alternatively, or in addition, the provision of a number of section 7A services are steps the Secretary of State considers appropriate to improve the health of the people of England and may therefore be provided or arranged pursuant to the Secretary of State’s power under section 2B of the 2006 Act.

References in the 2006 Act to NHS England’s functions will generally include functions exercisable under section 7A arrangements (except where the context requires otherwise). This means, for example, that NHS England’s general power in section 2(2) (to do anything that is calculated to facilitate or is conducive or incidental) and its general duties (such as to improvement in quality of services and reducing inequalities) apply to the functions exercised by NHS England under this agreement as they do to its other functions.

The objectives in this agreement are in addition to those objectives set for NHS England by the Secretary of State under section 13A of the 2006 Act (‘the mandate’).

NHS England may exercise its other functions in order to deliver the objectives set out in this agreement.

In exercising the public health functions referred to above, NHS England must comply with the public sector equality duty (section 149 of the Equality Act 2010).

This agreement is not a contract in law and should not be regarded as giving rise to contractual rights or liabilities. The Secretary of State and NHS England will jointly aim to resolve any dispute that might arise in relation to this agreement as quickly as possible through the processes outlined in this agreement.

As set out in section 7A(5) of the 2006 Act, any rights acquired, or liabilities (including liabilities in tort) incurred, in respect of the exercise by NHS England of any functions exercisable by it by virtue of this agreement are enforceable by or against that body (and no other person).

In this agreement, references to ‘DHSC’ are to parts of the Department of Health and Social Care, including OHID, but do not include UKHSA.

The Secretary of State and NHS England may be collectively referred to in this document as ‘the parties’ where convenient.

Accountability and partnership

The agreed set of shared principles that supports development of the relationship between DHSC and NHS England are:

• working together openly and positively for all patients, people who use and deliver these services and the public, and secondary users of information (commissioners, service providers and the research or academic community), demonstrating our commitment to the values of the NHS set out in its constitution
• respect for the freedom of individual organisations to exercise their functions in the way they consider most appropriate
• recognition that the Secretary of State is ultimately accountable to Parliament and the public for the system overall
• working constructively and collaboratively with each other and with other arm’s length bodies (for example, UKHSA) and other organisations within and beyond the health and social care system

DHSC, NHS England and UKHSA will continue to collaborate centrally, with NHS England taking the lead on relationships with regional teams, integrated care systems and local areas that are considering how system and place-based models of commissioning or delivery may support improved provision of section 7A services to their local population.

DHSC, NHS England and UKHSA will continue to work as appropriate to plan and deliver the digital enablement that will secure screening and immunisation and child health information service (CHIS) transformation that is required to support efficient and effective operational delivery.

NHS England will work with partners to support improvement in areas where significant performance issues are identified, ensuring action plans are developed and that progress is made in implementing these plans through the assurance process, including actions on addressing inequalities.

Oversight arrangements

DHSC will convene meetings of an oversight group, chaired by the responsible director general called the ‘NHS public health functions Section 7A Accountability Meeting’, and expected to be convened twice a year to:

• provide arrangements for accountability in relation to this agreement
• make recommendations to the Secretary of State and NHS England, including any recommendations in relation to proposed updates of, or variations to, this agreement

In addition, an annual ministerial accountability meeting will be arranged at a convenient point.

Membership of the accountability meeting will include DHSC, NHS England and UKHSA and be otherwise determined by the chair with the consent of NHS England. The accountability meeting will determine its own working arrangements, including the functions of any subgroups.

The parties recognise that the objectives set out in this agreement may be delivered by a combination of the exercise by NHS England both of functions under this agreement (public health functions) and its other health service functions, including primary care functions. For the purposes of accountability, the Secretary of State and NHS England recognise that the funding referenced in the ‘Finance’ section below is intended to provide the resources necessary to achieve the objectives of this agreement, having regard to contributions expected to be made by the exercise of NHS England’s other functions.

Assurance and reports

Assurance in relation to performance under this agreement, and as referenced under Annex B, will be consistent with the principles mentioned in the above section without imposing excessive burdens.

NHS England works in partnership with DHSC and UKHSA, including through representation at NHS England-convened screening and immunisation programme boards and the national NHS England Oversight Groups, and an assurance group (co-chaired with UKHSA) on programmes in health and justice settings. Collectively, the parties will work together to provide or secure the following information for assurance:

• regular reports of relevant indicators of the Public Health Outcomes Framework in relation to national levels of performance of section 7A services
• reports of progress in relation to achievement of objectives of this agreement, including introduction of service changes (including, where relevant, those recommended by UK NSC and JCVI) that will enable continued transformation of these services, and in reducing variation in local levels of performance, and securing the full implementation of service specifications in contracts with providers
• reports, at agreed intervals, to demonstrate progress in promoting equality and reducing health inequalities in relation to section 7A programmes, including data on performance variation between different areas and populations. For example, setting a programme trajectory to demonstrate the aggregate uptake and a narrowing of the gap between the lowest and highest achieving regions
• reports of financial information that show a breakdown of planned and actual expenditure on section 7A services

The accountability meeting may determine what, if any, further information is required for the purpose of assurance in relation to the objectives of this agreement.

NHS England’s duty to report annually on how it has exercised its functions (section 13U of the 2006 Act) also applies to the functions exercised under this agreement. NHS England will report annually to the Secretary of State in relation to its achievement of the objectives in this agreement, including on the use of the funding referenced under ‘Finance’ below and, if different, the total expenditure attributable to the performance of functions pursuant to this agreement. NHS England may include all or any part of its report in relation to this agreement as part of its overall annual report, or as a separate document provided to DHSC as soon as practicable after the end of each financial year.

Information

To fulfil the purposes of this agreement, DHSC, NHS England and UKHSA should each have the requisite timely and objective data and information available to them to fulfil their respective roles. It is necessary that public health experts and officials accountable to the Secretary of State, including the government’s Chief Medical Officer, receive information in relation to matters of expert, clinical or Parliamentary concern at the earliest possible time.

DHSC will ensure that UKHSA shares operational information with NHS England on activity, emerging evidence and the work of JCVI, and similarly for OHID in relation to UK NSC, in line with the arrangements described under ‘Assurance and reports’ that will support strategic planning and transformation of section 7A services. Reciprocally, DHSC will ensure NHS England shares information with UKHSA to enable it to fulfil its roles and responsibilities.

NHS England will also work to ensure early and effective communication of clinically accurate and safe information and guidance around any programme changes takes place with service providers.

NHS England will without delay inform DHSC in writing of any significant concerns it has in relation to the provision of section 7A services.

Variation of this agreement

This agreement is intended to support priorities DHSC has identified that it requires NHS England to deliver in the relevant financial year or to prepare to deliver in future financial years, and that need to be enabled by the annual NHS commissioning cycle.

This agreement may be varied by the Secretary of State and NHS England by written agreement. However, it is acknowledged that variations that would have an impact on the commissioning obligations of NHS England should rarely occur in-year, and the parties note that the achievement of the objectives of this agreement could potentially be jeopardised by unplanned changes.

Circumstances may require consideration of a prospective variation to this agreement and the accountability meeting may recommend a variation. A prospective variation includes any change that would impact on the commissioning obligations of NHS England under this agreement or that is required for clinical reasons at the direction of the Secretary of State. The circumstances in which a prospective variation may be considered include any of the following:

• a significant new threat to the health of the people of England
• an unexpected and significant new opportunity to protect their health
• a recommendation that would provide significant freeing up of resource

Consideration of a prospective variation should be based on joint DHSC, NHS England and UKHSA assessment of the following factors:

• evidence of impact (including on NHS service provision and participants), cost-effectiveness and (where relevant) cost savings
• other evidence of rationale, including obligations under the NHS Constitution for England and the NHS England mandate
• assessment of deliverability, taking into account existing operational resources, including commissioning capacity and service, and workforce capacity, estate, capital and/or service reconfiguration requirements
• any mitigating measures, such as lower expectations of performance in other services while delivery is implemented
• any alternative options or timelines for delivery
• affordability and confirmation of the availability of sufficient financial resources for delivery

The parties would expect to engage in timely and thorough consideration of the matters mentioned above. DHSC expects that this will involve the views of the DHSC director general responsible for finance and the NHS England chief financial officer at a formative stage before recommendations on programme decisions are considered by ministers.

The parties consider that public announcements about the likelihood of any additional commissioning should be avoided until a recommendation has been formulated with all appropriate inputs and considered by ministers. The parties will seek to ensure that public communications are consistent with this approach in relation to UK NSC and JCVI advice or recommendations on section 7A services or any prospective variation to this agreement.

Dispute resolution

Any differences should be resolved quickly and constructively. The following provisions describe procedures to be followed to resolve any dispute in relation to the exercise of functions under this agreement or any aspect of collaboration in relation to this agreement.

At their discretion, an authorised senior representative of NHS England or DHSC may at any time declare a dispute under this agreement by a written notice to the chair of the accountability meeting. The notice should provide information about the dispute, and how resolution of the matter has been attempted and failed. The day when the chair is notified is the ‘date of notification’. The chair will have joint responsibility with the responsible NHS England director to resolve the dispute.

Any dispute remaining unresolved after a maximum of 5 working days from the date of notification shall be reported to the chief executive of NHS England and the DHSC Permanent Secretary. They shall take steps to resolve the dispute within no more than 10 working days from the date of notification.

If the matter is not resolved in accordance with the steps set out above, the matter must be referred to the Secretary of State for final determination. The Secretary of State must, after consultation with NHS England, appoint a person independent of DHSC, UKHSA and NHS England to consider the dispute and make recommendations within a period specified by the Secretary of State on appointment. The Secretary of State must make a final decision within 10 days of receiving the recommendations. DHSC and NHS England agree to be bound by the decision of the Secretary of State and to implement any decision within a reasonable period.

This agreement is without prejudice to the exercise of the Secretary of State’s powers in respect of NHS England, including his powers in relation to any failure by NHS England to discharge, or to discharge properly, any of its functions.

Finance

Funding for the exercise of functions under this agreement forms part of NHS England’s funding envelope as set out in the relevant financial directions, and delivery of section 7A services is expected to be factored into future financial planning accordingly. Prior to the COVID-19 pandemic, ring-fenced funding was provided by the Secretary of State to NHS England from the public health budget for the purposes of this agreement. However, due to uncertainties arising from the pandemic, no ring-fence was set in financial directions for the services for 2020 to 2021 and 2022 to 2023.

Similarly, the intention for this year is that NHS England will manage the provision of the services as appropriate within the totality of its resources, working closely with DHSC to share financial data to assure of its spending plans and provide appropriate financial monitoring information. DHSC may reinstate the ring-fence in future financial years. Practically, funding may comprise more than one specific funding stream - for example, funding for COVID-19 vaccination under current arrangements is separately identified from funding for routine vaccination programmes.

As mentioned in ‘Oversight arrangements’ above, it is acknowledged by both parties that some public health activity is supported by the wider arrangements for commissioning primary care, which is funded via the total allocation of resources to NHS England.

Annex A: services to be provided

Under this agreement, NHS England will be responsible for providing the services set out below.

Immunisation programmes

The following immunisation programmes:

• targeted mpox (monkeypox) immunisation programme
• COVID-19 immunisation programme
• neonatal hepatitis B immunisation programme
• pertussis pregnant women immunisation programme
• neonatal BCG immunisation programme
• immunisation against diphtheria, tetanus, poliomyelitis, pertussis, Hib and hepatitis B
• rotavirus immunisation programme
• meningitis B (Men B) immunisation programme
• meningitis ACWY (MenACWY) immunisation programme
• Hib or Men C immunisation programme
• pneumococcal polysaccharide (PPV) immunisation programme
• pneumococcal conjugate (PCV) immunisation programme
• DTaP/IPV and dTaP/IPV (pre-school booster) immunisation programme
• measles, mumps and rubella (MMR) immunisation programme
• human papillomavirus (HPV) immunisation programme
• HPV immunisation programme for men who have sex with men
• Td/IPV (teenage booster) immunisation programme
• seasonal influenza immunisation programme
• seasonal influenza immunisation programme for children
• shingles immunisation programme

Population screening programmes

The following population screening programmes:

• NHS infectious diseases in pregnancy screening programme
• NHS fetal anomaly screening programme - screening for Down’s, Edwards’ and Patau’s syndromes (trisomy 21, 18 and 13)
• NHS fetal anomaly screening programme - 18+0 to 20+6 weeks fetal anomaly scan
• NHS sickle cell and thalassemia screening programme
• NHS newborn blood spot screening programme
• NHS newborn hearing screening programme
• NHS newborn and infant physical examination screening programme
• NHS diabetic eye screening programme
• NHS abdominal aortic aneurysm screening programme
• NHS breast screening programme
• NHS cervical screening programme
• NHS bowel cancer screening programme
• severe combined immunodeficiency (SCID) - in-service evaluation
• non-invasive prenatal testing (NIPT) - in-service evaluation
• HPV self-sampling - in-service evaluation

Public health services for children and adults in secure and detained settings

All public health services for children and adults in secure and detained settings.

Sexual assault services

All sexual assault referral centres (SARCs).

Child health information services

All child health information services (CHIS).

Additional functions

Functions providing national support for service commissioning and delivery of high-quality, safe, effective, equitable and acceptable screening programmes

Functions relating to the development, oversight and quality improvement of extant and new population screening programmes, including:

• undertaking work to evaluate the effectiveness of innovation and changes in delivery models, and advising other bodies and organisations about these functions
• arranging or securing the provision of IT and other services to support the provision of population screening programmes, and enable reporting and evaluation
• responsibility for data publications and the necessary analysis for the production of these reports
• responsibility for commissioning live IT services for screening
• responsibility for production of all public-facing information
• responsibility for running the research advisory committee process and access to screening data for academic purposes via the Office for Data Release
• responsibility for delivery of in-service evaluations for UK NSC

Screening programmes will continue to be defined by the Secretary of State, drawing upon recommendations of the UK NSC.

Provision of an effective screening quality assurance service (SQAS)

Functions undertaking analysis, audits and inspections to assess and assure the quality of screening programmes, including:

• with appropriate arrangements for timely internal sharing of quality assessments to support learning and mitigations, and transparency via published reports to ensure public confidence
• advising and supporting identification and management of screening safety incidents, including sharing lessons learned
• provision of public health, clinical and expert advice internally and to commissioners and providers on quality and safety matters
• expert teams with specific responsibility for quality of screening should closely support commissioning and operational delivery. They (and all NHS staff) should have the ability to escalate through a separate NHS England reporting line or to the Care Quality Commission if necessary

Setting standards and guidance for screening

Functions to include setting appropriate evidence-based standards and guidance for screening programmes to measure and improve the quality and safety of the screening pathway.

Healthcare public health functions - applying public health sciences to the planning, commissioning and provision of healthcare services

The promotion of healthcare public health, including through:

• the provision of training in public health with due regard to any standards and requirements set by other national bodies
• supporting healthcare organisations to understand and use population health data, including understanding their existing health inequalities and the evidence base for improving population health and reducing inequalities
• supporting healthcare organisations to:
  • interpret population health data and evidence
  • undertake reviews of the likely effectiveness and cost-effectiveness of a range of interventions, developments and strategies on population health outcomes
  • identify gaps or deficiencies in current care and produce recommendations for improvements, including in relation to specific pathways of care
• using and supporting health organisations to use health economic tools to:
  • support decision-making and the interpretation of data about the surveillance or assessment of a population’s health
  • improve health outcomes and reduce health inequalities
• the development of population health policies and strategies, and their implementation

Annex B: performance indicators and key deliverables

In relation to ‘List B1: performance indicators for services provided pursuant to this agreement’, below, please note the following points:

• the indicators are to be used as evidence in relation to the achievement of this agreement’s first objective
• where relevant, indicators drawn from the Public Health Outcomes Framework are indicated by use of the appropriate reference number (for example, D03e)
• where a programme is delivered for schools, it is commissioned over the academic year and performance is reported on the academic, not the financial, year
• for each screening programme listed, also refer to the NHS population screening standards
• the list includes several references to the annual flu programme letter - for more detail, see the letter templates published in the Annual flu programme document collection
• indicators 41 to 56 apply (where relevant) to prisons and the immigration removal centre estate - achievement of indicator 53 is predicated on effective contributions from partner organisations

List B1: performance indicators for services provided pursuant to this agreement

Number	Performance indicator	Standard origin	Efficiency standard	Optimal performance standard
1	Pre-natal pertussis vaccine coverage (pregnant women)	UKHSA - DHSC coverage target	50%	60%
2	D03e: population vaccination coverage - rotavirus coverage (1 year old, completed the 2-dose course)	UKHSA - DHSC coverage target	90%	95%
3	D03d: population vaccination coverage - Men B (1 year old)	UKHSA - DHSC coverage target	90%	95%
4	D03c: population vaccination coverage - DTaP-IPV-Hib-Hep B (1 year old)	World Health Organization (WHO) - DHSC coverage target	90%	95%
5	D03f: population vaccination coverage - PCV (1 year old)	WHO - DHSC coverage target	90%	95%
6	D03h: population vaccination coverage - DTaP-IPV-Hib-Hep B (2 years old)	WHO - DHSC coverage target	90%	95%
7	D03m: population vaccination coverage - Hib/Men C booster (2 years old)	WHO - DHSC coverage target	90%	95%
8	D03k: population vaccination coverage - PCV booster (2 years old)	WHO - DHSC coverage target	90%	95%
9	D03j: population vaccination coverage - MMR for one dose (2 years old)	WHO - DHSC coverage target	90%	95%
10	D03i: Men B booster coverage (2 years old)	UKHSA - DHSC coverage target	90%	95%
11	Population vaccination coverage - Hib/Men C booster (5 years old)	WHO - DHSC coverage target	90%	95%
12	D04b: population vaccination coverage - MMR for one dose (5 years old)	WHO - DHSC coverage target	90%	95%
13	D04c: population vaccination coverage - MMR for 2 doses (5 years old)	WHO - DHSC coverage target	90%	95%
14	DTaP-IPV-Hib / DTaP-IPV-Hib-Hep B coverage (5 years old)	WHO - DHSC coverage target	90%	95%
15	D04a: DTaP/IPV booster vaccination coverage (5 years old)	WHO - DHSC coverage target	90%	95%
16	D04e: HPV vaccination coverage - one dose (females, 12 to 13 years old)	WHO - DHSC coverage target	80%	90%
17	D04e: HPV vaccination coverage - one dose (males, 12 to 13 years old)	WHO - DHSC coverage target	80%	90%
18	D04f: HPV vaccination coverage - 2 doses (females, 13 to 14 years old), relating to activity to September 2023	WHO - DHSC coverage target	80%	90%
19	D04f: HPV vaccination coverage - 2 doses (males, 13 to 14 years old), relating to activity to September 2023	WHO - DHSC coverage target	80%	90%
20	D04g: MenACWY vaccination coverage (14 to 15 years old)	UKHSA - DHSC coverage target	80%	90%
21	D06b: PPV vaccination coverage (aged 65 and over)	UKHSA - DHSC coverage target	65%	75%
22	D06c: shingles vaccination coverage (routine cohort, 71 year olds - Zostavax and Shingrix) From September 2023 onwards: Shingles vaccination coverage (routine cohort 66 year olds - Shingrix) Shingles vaccination coverage (routine cohort 71 year olds - Zostavax and Shingrix)	UKHSA - DHSC coverage target	50%	60%
23	Shingles vaccination coverage (mid-programme cohort 75 year olds - Zostavax and Shingrix) From September 2023 onwards: Shingles vaccination coverage (mid-programme cohort 75 year olds - Zostavax and Shingrix)	UKHSA - DHSC coverage target	75%	80%
24	D03l: flu vaccination coverage (children pre-school age including those in risk groups)	Standards for this indicator will be detailed in the annual flu programme letter	Standards for this indicator will be detailed in the annual flu programme letter	Standards for this indicator will be detailed in the annual flu programme letter
25	D04d: flu vaccination coverage (children school age including those in risk groups)	Standards for this indicator will be detailed in the annual flu programme letter	Standards for this indicator will be detailed in the annual flu programme letter	Standards for this indicator will be detailed in the annual flu programme letter
26	D05: flu vaccination coverage (at risk individuals from 6 months to under 65 years old, including pregnant women)	Standards for this indicator will be detailed in the annual flu programme letter	Standards for this indicator will be detailed in the annual flu programme letter	Standards for this indicator will be detailed in the annual flu programme letter
27	D06a: flu vaccination coverage (aged 65 and over)	Standards for this indicator will be detailed in the annual flu programme letter	Standards for this indicator will be detailed in the annual flu programme letter	Standards for this indicator will be detailed in the annual flu programme letter
28	C24a: breast screening coverage (the proportion of women aged 53 to less than 71 years old eligible for screening who had a technically adequate screen at least once in the previous 36 months)	Programme standard	70%	80%
29a	C24b: cervical screening coverage (the proportion of women in the resident population eligible for cervical screening aged 25 to 49 years old at end of period reported who were screened adequately within the previous 3.5 years)	Programme standard - DHSC agreed standard	75%	80%
29b	C24c: cervical screening coverage (the proportion of women in the resident population eligible for cervical screening aged 50 to 64 years old at end of period reported who were screened adequately within the previous 5.5 years)	Programme standard - DHSC agreed standard	75%	80%
30	C24d: bowel cancer screening coverage (the proportion of eligible men and women aged 60 to 74 invited for screening who had an adequate faecal occult blood test (FOBt) screening result in the previous 30 months)	Programme standard - DHSC agreed standard	55%	60%
31	C24e: abdominal aortic aneurysm screening coverage - initial screen (the proportion of eligible cohort men who are tested)	Programme standard	75%	85%
32	C24f: diabetic eye screening uptake (the proportion of those offered a routine diabetic eye screening appointment who attend a routine digital screening event where images are captured)	Programme standard	75%	85%
33	C24g: fetal anomaly screening coverage - 20-week screening scan (the proportion of pregnant women eligible for the 20-week screening scan who are tested, leading to a conclusive result within the defined timescale)	Programme standard	95%	99%
34	C24h: infectious diseases in pregnancy screening coverage - HIV (the proportion of pregnant women eligible for HIV screening for whom a confirmed screening result is available at the day of report)	Programme standard	95%	99%
35	C24i: infectious diseases in pregnancy screening coverage - syphilis (the proportion of pregnant women eligible for syphilis screening for whom a confirmed screening result is available at the day of report)	Programme standard	95%	99%
36	C24j: infectious diseases in pregnancy screening coverage - hepatitis B (the proportion of pregnant women eligible for hepatitis B screening for whom a confirmed screening result is available at the day of report)	Programme standard	95%	99%
37	C24k: sickle cell and thalassaemia screening coverage (the proportion of pregnant women eligible for antenatal sickle cell and thalassaemia screening for whom a screening result is available at the day of report)	Programme standard	95%	99%
38	C24I: newborn blood spot screening coverage - clinical commissioning group (CCG) responsibility at birth (the proportion of babies registered within the CCG both at birth and on the last day of the reporting period who are eligible for newborn blood spot screening and have a conclusive result for phenylketonuria (PKU) recorded on the child health information system at less than or equal to 17 days of age)	Programme standard	95%	99%
39	C24m: newborn hearing screening coverage (the proportion of babies eligible for newborn hearing screening for whom the screening process is complete by 4 weeks corrected age (hospital programmes: well babies and babies in neonatal intensive care units) or by 5 weeks corrected age (community programmes: well babies))	Programme standard	98%	99.5%
40	C24n: newborn and infant physical examination screening coverage - newborn (the proportion of babies eligible for the newborn physical examination who are tested for all 4 components (3 components in female infants) of the newborn examination at less than or equal to 72 hours of age and have a conclusive result on the day of the report)	Programme standard	95%	97.5%
41	Stop smoking services uptake - as a proportion of the eligible population (the percentage of prisoners identified as smokers at reception who are referred to smoking cessation services)	DHSC - UKHSA targets	80%	100%
42	Physical health checks uptake (as a proportion of the eligible population)	DHSC - UKHSA targets	30%	50%
43	HIV testing uptake (as a proportion of the eligible population)	DHSC - UKHSA targets	50%	75%
44	Hepatitis C testing uptake (as a proportion of the eligible population)	DHSC - UKHSA targets	50%	75%
45	Hepatitis B screening coverage (as a proportion of the eligible population)	DHSC - UKHSA targets	50%	75%
46	Chlamydia testing uptake (as a proportion of the eligible population)	DHSC - UKHSA targets	To be confirmed	To be confirmed
47	Tuberculosis testing uptake on reception (as a proportion of the eligible population)	DHSC - UKHSA targets	100%	100%
48	The proportion of individuals in secure settings that engage in structured drug and alcohol treatment interventions who at the point of departure from that secure setting either: - successfully completed a treatment intervention in custody and did not represent to treatment (either in custody or the community) within 6 months of release, or	DHSC targets	50%	75%
49	- successfully engaged in community-based drug and alcohol treatment interventions following release, or	DHSC targets	50%	75%
50	- where they were transferred to another prison or children and young people’s secure estate, successfully engaged in structured drug and alcohol treatment interventions at the receiving establishment	DHSC targets	60%	85%
51	Proportion of new treatment entrants starting treatment in the secure setting within 3 weeks of arrival (from community or another custodial setting)	DHSC targets	70%	90%
52	Proportion of the treatment population receiving clinical treatment who are also receiving concurrent psychosocial interventions to address substance misuse	DHSC targets	80%	95%
53	Proportion of survivors for whom sexually transmitted infections, HIV, hepatitis B and hepatitis C was indicated and were: - a) tested in the sexual assault referral centre (SARC) or - b) referred elsewhere for testing	DHSC targets	80%	95%
54	Proportion of survivors in whom post-exposure prophylaxis following sexual exposure (PEPSE) was indicated who received a PEPSE starter pack within 72 hours	DHSC targets	80%	95%
55	Proportion of survivors in whom emergency contraception was indicated, who were prescribed or were given emergency contraception: - a) in the SARC or - b) referral outside of the SARC	DHSC targets	80%	90%
56	Child health record departments report on newborn bloodspot on moved in babies Denominator: total number of children who were not in residential postcode area at 5 days of age but were at any age up to and including 365 days Numerator: PKU outcome recorded	Not available	Not available	Not available

List B2: Key deliverables for implementing changes to services

Mpox (monkeypox) immunisation

In 2023 to 2024, NHS England will:

• continue to deliver monkeypox first-dose vaccinations to eligible cohorts until mid-June 2023 and second doses until 31 July 2023
• maintain operational flexibility in case a change in epidemiology suggests the need to restart vaccinating high-risk individuals

COVID-19 vaccination

In 2023 to 2024, NHS England will deliver a COVID-19 vaccination programme at pace informed by JCVI advice and consistent with the government’s priorities including reducing vaccine inequalities and supporting high uptake across communities. In line with current JCVI advice, the 2023 to 2024 programme will include delivery of a spring booster and autumn booster campaign for eligible cohorts, and transition of the universal primary course offer towards a more targeted offer focused on those at greater risk of severe COVID-19.

It will also ensure deployment during 2023 to 2024 supports the development of a ‘steady state’, sustainable COVID-19 vaccination operating model that builds on successes and lessons learned from the vaccine rollout. The deployment model should work towards a flexible system that can swiftly and effectively respond to further outbreaks and new variants, while also working for an endemic state, with a sustainable workforce and infrastructure, and value-for-money delivery. This work will include consideration of the interfaces with the flu and routine immunisation programmes.

HPV immunisation

In 2023 to 2024, NHS England will:

• reduce the HPV vaccine programme from 2 doses to a single dose from September 2023, for eligible adolescents and men who have sex with men aged less than 25 years, with implementation of agreed transitional approach to existing recipients of first dose
• provide an opportunistic single dose catch-up for all eligible cohorts up to age 25, except those living with HIV or severely immunocompromised, who are eligible for 3 doses

Flu vaccination

In 2023 to 2024, NHS England will:

• arrange provision of the public flu vaccination programme to groups detailed in the annual flu letter for 2023 to 2024
• deliver timely, high vaccination coverage to the ambitions set in accordance with the tripartite annual flu letter, ensuring providers comply with guidance on specific flu vaccines to use
• deliver the programme flexibly, responding to demand and using data to identify areas of focus and build on the 2022 to 2023 flu season where co-promotion and co-administration with COVID-19 vaccinations was enabled
• ensure 100% offer to all eligible cohorts, and providers should aim to equal or exceed last season’s uptake. NHS England should demonstrate a particular focus on clinical risk groups, children aged 2 and 3 years old, and pregnant women given the decline in uptake rates during the 2022 to 2023 season
• continue to use data to understand and support reduction in regional variation and tackle health inequalities for all under-served groups, supported by improved technology, during programme delivery in 2023 to 2024 and in future years

Shingles immunisation

In 2023 to 2024, NHS England will:

• introduce new vaccine Shingrix for existing immunocompetent cohort from September 2023
• deliver a catch-up campaign for immunocompromised over 50s and ongoing offer to 50 year olds (both from September 2023)
• introduce an immunocompetent cohort to support, bringing forward the eligible age range from September 2023

NHS diabetic eye screening programme

In 2023 to 2024, NHS England will:

• extend screening intervals for eligible people (people with diabetes who have had 2 successive eye screens, showing no signs of diabetic retinopathy and at lower risk of diabetic retinopathy) to every 2 years instead of annually, following an evidence-based recommendation by the UK NSC, from October 2023
• phase this implementation to prevent activity peaks and troughs: 50% of eligible people will be selected for 24-month screening from October 2023 to October 2025, and from October 2025 full implementation of extended intervals will have taken place

NHS bowel cancer screening programme

In 2023 to 2024, NHS England will:

• extend the programme for people with Lynch or Lynch like syndrome, ensuring the offer is part of an end-to-end screening programme including the links with family and genetic services and the identification of the cohort
• extend the starting age of the bowel cancer screening programme to 54 year olds, making clear plans to achieve the recommended FIT sensitivity of 100μg while reducing uptake variation across providers
• model requirements to continue age extension to 50 years by April 2025, and model the potential impact of increasing FIT sensitivity to 20μg

NHS targeted lung screening

In 2023 to 2024, NHS England will work collaboratively with OHID screening colleagues to continue to develop a nationally driven targeted lung health check using a single pathway, standards and quality assurance process to ensure the evidence is followed and the programme is cost-effective.

Digital transformation of screening (DToS) programmes

In 2023 to 2024, NHS England will:

• deliver call and recall (cervical screening management system) to support delivery of the cervical screening programme and implementation of extended screening intervals
• progress the DToS Strategic Programme Business Case (noting delivery milestones are dependent upon speed of the approvals process), with the aim to deliver cohort manager and demand and capacity planner products for the diabetic eye and breast screening programmes by March 2024 (note: this activity is overseen as part of the Government Major Projects Portfolio)

Child health information services

In 2023 to 2024, NHS England will:

• subject to formal approvals, undertake discovery work to deliver a refreshed service specification (including its annexed technical specification), ensuring all CHIS IT systems and services cover the complete range of healthy child programme information including current demographics, service delivery and outcomes
• working with DHSC and internal NHS England stakeholders, review forward requirements for CHIS, through the CHIS strategy, planning and taking steps to transform CHIS IT systems and services, in line with NHS digital strategies

In-service evaluations

NHS England will be responsible for delivering the following in-service evaluations.

Severe combined immunodeficiency (SCID) - in-service evaluation (NHS newborn bloodspot programme)

In 2023 to 2024, NHS England will ensure the delivery of an in-service evaluation of screening for the rare disease severe combined immune deficiency (SCID) and provide a formal report to UK NSC to support recommendations to ministers.

Non-invasive prenatal testing (NIPT) - in-service evaluation (NHS fetal anomaly screening programme)

In 2023 to 2024, NHS England will ensure the continued delivery of evaluative rollout of the use of non-invasive pre-natal testing for Trisomy’s 13, 18, and 21, over the course of 2023 to 2024, providing update reports to the UK NSC for consideration.

HPV self-sampling - in-service evaluation (NHS cervical screening programme)

In 2023 to 2024, NHS England will:

• work with OHID screening to support the engagement of providers and regional commissioners on HPV Validate
• work with OHID screening and research bodies to agree a feasible HPV self-sampling in-service evaluation
• deliver the in-service evaluation according to commissioned methodology and to support the OHID project board

Other screening evaluative work and forward planning

NHS England will be responsible for delivering the following activities.

NHS sickle cell and thalassaemia screening programme

In 2023 to 2024, NHS England will continue the pre-evaluation study into non-invasive prenatal testing and diagnosis currently being delivered by GSST and Oxford University.

NHS newborn blood spot screening programme: cystic fibrosis

In 2023 to 2024, NHS England will review the impact and feasibility of adoption of outcome of research on the use of an expanded mutation panel using next-generation sequencing when published and (subject to the findings) work with OHID to draw up an implementation plan.

NHS newborn blood spot screening programme: tyrosinemia

In 2023 to 2024, NHS England will run implementation and operational feasibility planning workstreams and continue liaising with OHID to ensure alignment and swift progress of this planning with the (OHID-led) laboratory and clinical workstreams.