Guidance

NHS public health functions agreement 2024 to 2025

Published 18 December 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 develop and 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.

Supporting people to stay healthier for longer, shortening the time people spend in ill health and promoting greater independence are at the heart of the government’s health mission. Preventing ill health, detecting ill health earlier when it occurs and working better together in a more personalised way for individuals and families will enable us to achieve this and help us reach our goal of halving the gap in healthy life expectancy between the richest and poorest regions.

NHS public health functions 2024 to 2025

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 inequalities in health through continuous development and provision of the services listed below in ‘Services to be provided’ (these services are referred to in this document as ‘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

Objective 1

NHS England’s first objective under this agreement is to secure the operational delivery through its commissioning and accountability processes of high-quality section 7A services in England with efficient use of resources, seeking to:

• prevent avoidable ill health
• achieve earlier diagnosis with positive health outcomes
• promote equality and reduce health inequalities

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 (CQC) for services delivered within this agreement. (Note that different CQC requirements have been agreed between NHS England, the Department for Health and Social Care (DHSC) and CQC for diabetic eye screening.) 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.

In addition, 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.

Objective 2

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 DHSC.

Objective 3

NHS England’s third objective is to drive continuous improvement in section 7A services, through the continued implementation of the NHS vaccination strategy. This includes, where relevant, doing so 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.

It also includes:

• identifying the need for potential programme changes (for example, through national audit)
• evaluating programme delivery and efficacy
• working with DHSC to evaluate potential changes to screening and immunisation pathways
• establishing how to best improve pathway delivery
• supporting externally funded research
• identifying best practice in services

New programmes and changes to programmes should be carefully planned, taking account of relevant clinical or public health expert advice from the UK Health Security Agency (UKHSA) and DHSC, 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  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.

DHSC provides advice on matters of health improvement and hosts the secretariat for UK NSC. For screening programmes that are section 7A services, DHSC 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 adult and children 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 inequalities experienced by this vulnerable adult and children group and ensure equivalence of care. Adults and children accessing health and justice services can present with varied health needs. Therefore, health and justice services have unique indicators providing additional assurance on factors such as substance misuse services and infectious disease screening.

Services delegated under section 7A are not by that fact exempt from any relevant standards or practices that comparable clinical or public-facing NHS services are required to comply with.

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.

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, 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.

Joint working and delegation arrangements, including delegation to integrated care boards

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 through the mechanisms set out in this agreement.

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 in ‘Key performance indicators’, below, 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 UKHSA-facilitated immunisation programme boards, and any other relevant assurance forums - for example, an assurance group 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 will be created, where required, to set out actions taken to support research and inform UK NSC and JCVI decision making
• 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 DHSC 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 and data with UKHSA to enable it to fulfil its roles and responsibilities.

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

NHS England will process and analyse the data received from services to ensure it performs its role in quality assurance and service evaluation effectively.

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 has been set in financial directions for these services since 2020 to 2021.

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 as part of the total allocation of resources to NHS England.

Services to be provided

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

National immunisation programmes

The following immunisation programmes:

• NHS targeted mpox (previously known as ‘monkeypox’) immunisation programme
• NHS COVID-19 immunisation programme
• NHS neonatal hepatitis B immunisation programme
• NHS pertussis pregnant women immunisation programme
• NHS neonatal BCG immunisation programme
• NHS immunisation against diphtheria, tetanus, poliomyelitis, pertussis, Hib and hepatitis B
• NHS rotavirus immunisation programme
• NHS meningitis B (MenB) immunisation programme
• NHS meningitis ACWY (MenACWY) immunisation programme
• NHS Hib/MenC immunisation programme
• NHS pneumococcal polysaccharide (PPV) immunisation programme
• NHS pneumococcal conjugate (PCV) immunisation programme
• NHS dTaP/IPV and dTaP/IPV (pre-school booster) immunisation programme
• NHS measles, mumps and rubella (MMR) immunisation programme
• NHS human papillomavirus (HPV) immunisation programme
• NHS HPV immunisation programme for men who have sex with men
• NHS Td/IPV (teenage booster) immunisation programme
• NHS seasonal influenza immunisation programme for adults and certain occupational health groups
• NHS seasonal influenza immunisation programme for children
• NHS shingles immunisation programme
• NHS respiratory syncytial virus (RSV) 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
• spinal muscular atrophy (SMA) - 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.

National immunisation coverage targets also apply to adults and children resident in secure and detained settings; additional immunisation programmes may also be offered to these settings in line with Green Book guidance.

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 through the Office for Data Release
• responsibility for delivery of in-service evaluations for UK NSC
• collecting and processing clinical data required to monitor and assure the equity, safety and efficacy of the programmes

Screening programmes will continue to be defined by the Secretary of State, drawing upon recommendations from 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:

• making appropriate arrangements for timely internal sharing of quality assessments to support learning and mitigations, and transparency through 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
• ensuring expert teams with specific responsibility for quality of screening 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 CQC if necessary
• collecting, storing and analysing clinical data provided by services, in line with the existing screening programme privacy statement

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.

Immunisation programmes

Functions providing national support for service commissioning and delivery of high-quality, safe, effective, equitable and acceptable vaccination programmes and functions relating to the development, oversight and quality improvement of extant and new population vaccination programmes, including:

• undertaking work that informs the Secretary of State’s decision on whether an immunisation programme should be included in the 7A agreement
• arranging or securing the provision of IT and other services to support the provision of population vaccination programmes, and enabling recording, reporting and evaluation
• undertaking work that ensures that NHS England is ready to deliver the vaccination programme once it has been agreed and included in the 7A agreement
• undertaking the necessary analysis to evaluate the effectiveness of innovation and changes in delivery models, and advising other bodies and organisations about these functions

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

Key performance indicators

In relation to Table 1, 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 40 to 51 apply (where relevant) to prisons and the immigration removal centre estate, and indicators 52 to 54 apply to sexual assault referral centres - achievement of indicator 52 is predicated on effective contributions from partner organisations

Table 1: key 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 - MenB (1 year old)	UKHSA - DHSC coverage target	90%	95%
4	D03c: population vaccination coverage - dTaP/IPV/Hib/HepB (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/HepB (2 years old)	WHO - DHSC coverage target	90%	95%
7	D03m: population vaccination coverage - Hib/MenC 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: MenB booster coverage (2 years old)	UKHSA - DHSC coverage target	90%	95%
11	Population vaccination coverage - Hib/MenC 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/HepB 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	D04g: MenACWY vaccination coverage (14 to 15 years old)	UKHSA - DHSC coverage target	80%	90%
19	D06b: PPV vaccination coverage (aged 65 and over)	UKHSA - DHSC coverage target	65%	75%
20	Population vaccination coverage - shingles vaccination coverage (66 years old) D06c: population vaccination coverage - shingles vaccination coverage (71 years old)	UKHSA - DHSC coverage target	50%	60%
21	Population vaccination coverage - shingles vaccination coverage (mid-programme cohort 75 year olds)	UKHSA - DHSC coverage target	75%	80%
22	D03l: population vaccination coverage - flu (2 to 3 years old)	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
23	D04d: population vaccination coverage - flu (primary school age children)	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
24	D05: population vaccination coverage - flu (at risk individuals)	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	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
26	C24a: cancer screening coverage - breast cancer	Programme standard	70%	80%
27	C24b: cancer screening coverage - cervical cancer (aged 25 to 49 years old)	Programme standard - DHSC agreed standard	75%	80%
28	C24c: cancer screening coverage - cervical cancer (aged 50 to 64 years old)	Programme standard - DHSC agreed standard	75%	80%
29	C24d: cancer screening coverage - bowel cancer	Standards for this indicator will be set following a standards review	Standards for this indicator will be set following a standards review	Standards for this indicator will be set following a standards review
30	C24e: abdominal aortic aneurysm screening coverage	Programme standard	75%	85%
31	C24f: diabetic eye screening uptake	Programme standard	75%	85%
32	C24g: fetal anomaly screening coverage	Standards will be set following a review of ‘settling in’	Standards will be set following a review of ‘settling in’	Standards will be set following a review of ‘settling in’
33	C24h: infectious diseases in pregnancy screening coverage - HIV	Programme standard	95%	99%
34	C24i: infectious diseases in pregnancy screening coverage - syphilis	Programme standard	95%	99%
35	C24j: infectious diseases in pregnancy screening coverage - hepatitis B	Programme standard	95%	99%
36	C24k: sickle cell and thalassaemia screening coverage	Programme standard	95%	99%
37	C24I: newborn blood spot screening coverage	Programme standard	95%	99%
38	C24m: newborn hearing screening coverage	Programme standard	98%	99.5%
39	C24n: newborn and infant physical examination screening coverage	Programme standard	95%	97.5%
40	Stop smoking services uptake - as a proportion of the eligible population (the percentage of detained adults, children and young people identified as smokers at reception who are referred to smoking cessation services)	DHSC targets	80%	100%
41	Physical health checks uptake (as a proportion of the eligible population)	DHSC targets	30%	50%
42	HIV testing uptake (as a proportion of the eligible population)	DHSC targets	50%	75%
43	Hepatitis C testing uptake (as a proportion of the eligible population)	DHSC - UKHSA targets	50%	75%
44	Hepatitis B screening coverage (as a proportion of the eligible population)	DHSC - UKHSA targets	50%	75%
45	Chlamydia testing uptake (as a proportion of the eligible population)	DHSC - UKHSA targets	To be confirmed	To be confirmed
46	Tuberculosis testing uptake on reception (as a proportion of the eligible population)	DHSC - UKHSA targets	100%	100%
47	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%
48	- successfully engaged in community-based drug and alcohol treatment interventions following release, or	DHSC targets	50%	75%
49	- where they were transferred to another prison or children and young people secure estate, successfully engaged in structured drug and alcohol treatment interventions at the receiving establishment	DHSC targets	60%	85%
50	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%
51	Proportion of the treatment population receiving clinical treatment who are also receiving concurrent psychosocial interventions to address substance misuse	DHSC targets	80%	95%
52	Proportion of survivors for whom sexually transmitted infections, HIV, hepatitis B and hepatitis C was indicated and were either tested in the sexual assault referral centre (SARC) or referred elsewhere for testing	DHSC targets	80%	95%
53	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%
54	Proportion of survivors in whom emergency contraception was indicated, who were prescribed or were given emergency contraception either in the SARC or referred outside of the SARC	DHSC targets	80%	90%
55	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

Key deliverables for implementing changes to services

In-year performance improvement ambitions

In 2024 to 2025, and in future years of programme delivery, NHS England will use data to understand and support reduction in regional variation and tackle health inequalities for all under-served groups, supported by improved technology across the programmes itemised in this section. In particular, NHS England will increase vaccination uptake for all vaccination programmes including eligible adults, children and young people and pregnant women year on year towards WHO recommended levels.

Immunisations

Mpox (previously known as ‘monkeypox’) immunisation

In 2024 to 2025, NHS England will introduce a targeted mpox vaccine programme delivered through sexual health services to at risk populations, in line with JCVI advice and policy agreement.

COVID-19 vaccination

In 2024 to 2025, NHS England will deliver a COVID-19 vaccination programme informed by JCVI advice and consistent with the government’s priorities including reducing vaccine inequalities. In line with current JCVI advice, the 2024 programme will include delivery of a spring booster and an autumn booster campaign for eligible cohorts focused on those at greater risk of severe COVID-19.

NHS England will also support the development of a sustainable COVID-19 vaccination operating model 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.

Measles, mumps and rubella (MMR) immunisation programme

In 2024 to 2025, NHS England will:

• work to increase coverage of the childhood MMR programme and reduce regional variation
• increase uptake for unvaccinated cohorts, including by implementing national call and recall campaigns

Flu vaccination

In 2024 to 2025, NHS England will arrange provision of the public flu vaccination programme to groups and in accordance with the arrangements detailed in the annual flu letter for 2024 to 2025.

Respiratory syncytial virus (RSV) immunisation programme

In 2024 to 2025, NHS England will:

• introduce a year-round RSV programme for those turning 75 years old (from September 2024)
• deliver a programme to vaccinate 75 to 79 year olds to complete by September 2025 (from September 2024) and ensure 100% offer to eligible cohorts, with the majority offered in the first 3 months of the programme
• introduce a year-round RSV programme for pregnant women, to protect neonates (from September 2024)
• put in place systems to ensure uptake data can be captured for eligible groups

Varicella immunisation programme

In 2024 to 2025, NHS England will work on implementation and commissioning elements of the varicella vaccine programme for delivery from December 2025, in line with JCVI advice and policy agreement.

Child immunisations schedule changes

In 2024 to 2025, NHS England will work on implementation and commissioning elements of the following changes to the childhood immunisation programme:

• offer a second dose of measles at the new immunisations visit at 18 months, instead of at 3 years 4 months (for delivery from December 2025)
• as part of the Hib programme, deliver an additional dose of Hib-containing multivalent (5-in-1 or 6-in-1) at a new visit at 18 months (from December 2025), and remove the MenC-containing vaccine at 12 months (from June 2025)

Screening

NHS diabetic eye screening programme

In 2024 to 2025, NHS England will continue to roll out the extension of 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 UK NSC.

NHS breast screening programme

In 2024 to 2025, NHSE will:

• publish an uptake plan and results of the reviews on uptake
• agree a trajectory on uptake improvements to accompany the plan

NHS bowel cancer screening programme

In 2024 to 2025, NHS England will:

• extend the starting age of the bowel cancer screening programme to 50 and 52 year olds and evaluate a reduction of the current threshold (120 micrograms of haemoglobin per gram of faeces) to a lower threshold (80 micrograms of haemoglobin per gram of faeces) in a number of early adopter sites in October 2024 to March 2025
• provide a trajectory to accompany the plan

NHS targeted lung screening

In 2024 to 2025, NHS England will continue to expand the targeted lung health check programme so that 38% of the eligible population have received an invitation by March 2025.

NHS newborn blood spot screening programme: tyrosinemia

In 2024 to 2025, NHS England will complete the implementation of tyrosinemia as part of the newborn bloodspot screening programme, including providing regular updates and a final report on verification and validation work. 

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 2024 to 2025, NHS England will conclude the delivery of the in-service evaluation and provide a formal report to UK NSC by January 2025.

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

In 2024 to 2025, NHS England will conclude the evaluative rollout of NIPT with the provision of a formal interim report to UK NSC by September 2024.

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

In 2024 to 2025, NHS England will:

• actively engage in the planning and design of the Health Technology Assessment commissioned in-service evaluation for the use of self-sampling in the cervical screening programme
• (in the event that UK NSC makes a positive recommendation for self-sampling as an option for non-responders to the programme) accelerate work already underway to support implementation as quickly and safely as possible

Spinal muscular atrophy (SMA) in-service evaluation (NHS newborn bloodspot programme)

In 2024 to 2025, NHS England will actively engage in the planning and design of the in-service evaluation for the addition of screening for SMA in the newborn bloodspot screening programme.

Child health information services (CHIS)

In 2024 to 2025, NHS England will continue a strategic review of CHIS, ensuring the outputs of this review take into account other strategic commitments to improve data and information sharing for children and young people. This will include (but is not limited to) work to digitise the Red Book record and the introduction of a single unique identifier for children.

Sexual assault referral centres (SARCs)

In 2024 to 2025, NHS England will implement and maintain provision of the Child Protection Information Sharing (CP-IS) service in SARCs.