Guidance

Annex B: performance indicators and key deliverables

Published 22 February 2023

Applies to England

Performance indicators

The indicators shown in the following list are to be used as evidence in relation to the achievement of the first objective. (The objectives are set out under the ‘NHS public health functions 2022 to 2023’ section of the main agreement document.)

Except where marked with footnotes, the indicators are drawn from the Public Health Outcomes Framework.

The origin of the performance standard assigned for each indicator is described alongside the indicator name.

Indicators 41 to 56 apply (where relevant) to prisons and the immigration removal centre estate. Achievement of indicator 53 is predicted on effective contributions from partner organisations where relevant.

A subset of indicators shown in the following list are additionally included as metrics in the government’s mandate to NHS England for measuring progress on the NHS Long Term Plan over time. A multi-year strategic planning exercise will separately consider goals and trajectories, where not already agreed, as part of the NHS Long Term Plan update, which is due to be published in due course following this agreement.

For each screening programme listed in List B1: performance indicators for services provided pursuant to this agreement (indicators 28 to 40), refer to the:

• NHS population screening: pathway requirements specifications
• NHS population screening programme standards

These are produced by the Department of Health and Social Care (DHSC) under the Office for Health Improvement and Disparities. They inform, but are distinct from, NHS Standard Contract service specifications.

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)[footnote 1]	UK Health Security Agency (UKHSA) – DHSC coverage target	50%	60%
2	D03e: 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 (aged 2 years old)	UKHSA – DHSC coverage target	90%	95%
11	Population vaccination coverage – Hib/Men C booster (5 years old)[footnote 1]	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)[footnote 1]	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)[footnote 1]	WHO/ – DHSC coverage target	80%	90%
17	D04e: HPV vaccination coverage – one dose (males, 12 to 13 years old)[footnote 1]	WHO – DHSC coverage target	80%	90%
18	D04f: HPV vaccination coverage – 2 doses (females, 13 to 14 years old)[footnote 1]	WHO – DHSC coverage target	80%	90%
19	D04f: HPV vaccination coverage – 2 doses (males, 13 to 14 years old)[footnote 1]	WHO – DHSC coverage target	80%	90%
20	D04g : MenACWY vaccination coverage (13 to 14 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, 70 years old)	UKHSA – DHSC coverage target	50%	60%
23	Shingles vaccination coverage (catch-up cohort, 78 years old)[footnote 1]	UKHSA – DHSC coverage target	50%	60%
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 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 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 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)[footnote 1]	DHSC – UKHSA targets	30%	50%
43	HIV testing uptake (as a proportion of the eligible population)[footnote 1]	DHSC – UKHSA targets	50%	75%
44	Hepatitis C testing uptake (as a proportion of the eligible population)[footnote 1]	DHSC – UKHSA targets	50%	75%
45	Hepatitis B testing uptake (as a proportion of the eligible population)[footnote 1]	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 as a proportion of the eligible population – the proportion of individuals in secure environments that engage in structured drug and alcohol treatment interventions who, at the point of departure from that establishment, either (see indicators 48, 49 or 50)[footnote 1]:	DHSC – UKHSA targets	To be confirmed	To be confirmed
48	– 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 – UKHSA targets	50%	75%
49	– successfully engaged in community-based drug and alcohol treatment interventions following release; or	DHSC – UKHSA 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 establishment within 3 weeks of arrival (from community or another custodial setting)[footnote 1]	DHSC targets	70%	90%
52	Proportion of the treatment population receiving clinical treatment who are also receiving concurrent psychosocial interventions to address substance misuse[footnote 1]	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[footnote 1]	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[footnote 1]	DHSC targets	80%	95%
55	Proportion of survivors in whom emergency contraception was indicated, who were prescribed or were given emergency contraception in the SARC or 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 from services provided in 2021 to 2022

Continue to recover services impacted by the COVID-19 pandemic

To continue to transform NHS public health services, in 2022 to 2023 NHS England will:

• continue efforts to restore NHS national public health services (including cancer and non-cancer screening services) that were paused or had reduced uptake due to the pandemic (DHSC acknowledges the work that has happened to date and recognises there are particular challenges for certain services – for example, detained estate settings)
• in particular, this includes working to ensure all those who missed or had a screening or immunisation appointment delayed during the pandemic are encouraged to take up the offer of an appointment if they have not already
• continue work to reduce health inequalities, improve equalities, and improve uptake and coverage across all screening and immunisation programmes, particularly in areas where uptake is historically lower (it is recognised that screening and immunisation programmes operate from different IT platforms with variable data collection that significantly affect their ability to analyse data to identify target groups)
• maximise efforts in secure and detained settings to recover services that were paused or had reduced uptake due to the COVID-19 pandemic, particularly cancer and non-cancer screening programmes and routine immunisations. Secure and detained settings should aim to meet equivalent community efficiency standards for these programmes

Further roll-out of COVID-19 vaccination

To continue to transform NHS public health services, in 2022 to 2023 NHS England will:

• continue to deliver COVID-19 vaccinations at pace consistent with government’s priorities (informed by advice from the JCVI), vaccine supply, operational and clinical safety, and work with government to achieve the highest possible uptake across communities, continuing to reduce vaccine inequalities
• ensure the deployment of COVID-19 vaccinations during 2022 to 2023 supports the development of a ‘steady-state’, sustainable COVID-19 vaccination operating model that learns from the pandemic and builds on what has gone well, and considers the interface with flu and wider routine immunisations to deliver a service which works for all and drives maximum uptake across society. (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.)

Flu vaccination

To continue to transform NHS public health services, in 2022 to 2023 NHS England will:

• arrange provision of the public flu vaccination programme to groups detailed in the annual flu letter for 2022 to 2023
• 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 2021 to 2022 flu season where co-promotion and co-administration with COVID-19 vaccinations was enabled
• ensure 100% offer to all eligible cohorts to maintain the upward trend in uptake for the last 2 years
• continue to use data to understand and support reduction in regional variation and health disparities, supported by improved technology, during programme delivery in 2022 to 2023 and in future years

Routine immunisations

To continue to transform NHS public health services, in 2022 to 2023 NHS England will:

• maximise efforts to improve uptake of all routine vaccinations. This includes routine childhood immunisations, such as MMR (with all areas taking meaningful action towards 95% MMR coverage), HPV and meningitis, and improving coverage of polio-containing vaccines to maintain polio transmission risk status, as well as the adult shingles programme. In doing this, regional and community disparities in the uptake of routine immunisations should be actively tackled, with regional NHS England teams working with their integrated care systems and local stakeholders towards a minimum 90% target for the appropriate routine immunisations in all areas, alongside the 95% national target
• operationalise the JCVI HPV sub-committee recommendation of a 2-dose HPV immunisation schedule for those aged 15 years and over primarily in schools, and for men who have sex with men in sexual health services
• deliver a targeted mpox (monkeypox) vaccination programme as agreed with DHSC

Planning for an integrated national vaccination service

To continue to transform NHS public health services, in 2022 to 2023 NHS England will work to plan future operational delivery of an integrated national vaccination service for all immunisations, including COVID-19, that:

• enables delivery of life-long routine and seasonal programmes
• supports opportunistic catch up and co-administration where clinically possible
• supports regional and/or local delivery model design

Screening programmes – recovery

To continue to transform NHS public health services, in 2022 to 2023 NHS England will:

• work to ensure all those who missed or had a screening appointment delayed during the pandemic will be encouraged to take up the offer of an appointment if they have not already
• focus on increasing take-up in deprived areas, so that the percentage of cancers detected returns to pre-pandemic levels and to prevent avoidable morbidity

All screening programmes – addressing disparities

To continue to transform NHS public health services, in 2022 to 2023 NHS England will:

• implement plans to improve uptake and coverage
• address inequalities and improve equalities in all screening programmes

NHS bowel cancer screening programme

To continue to transform NHS public health services, in 2022 to 2023 NHS England will continue to extend the starting age of the NHS bowel cancer screening programme, building on the roll-out of the faecal immunochemical test to 56-year-olds.

This will be supported by workforce development, including:

• the accelerated training of more colonoscopists
• additional training of existing colonoscopists to undertake screening colonoscopy
• further recruitment of specialist screening practitioners and endoscopy nurses

NHS breast screening programme

To continue to transform NHS public health services, in 2022 to 2023 NHS England will ensure restoration of a round length in breast screening invitations to:

• ensure more breast screening services are attaining and maintaining the 36-month round length
• improve uptake

NHS cervical screening programme

To continue to transform NHS public health services, in 2022 to 2023 NHS England will:

• continue to support work on the in-service evaluation of cervical self-sampling and undertake preparatory planning for the possibility that the UK National Screening Committee (UKNSC) in 2022 recommends the use of self-sampling for non or very late attenders
• ensure that providers involved in the HPValidate study of tests for self-sampling, which started in 2021 and is expected to report in 2022, continue their involvement through the transfer of the operational delivery aspects of the in-service evaluation to NHS England
• continue to prepare for the 5-year interval changes in the programme, including NHS Digital’s delivery of the new NHS Cervical Screening Management System and the development of a detailed communications plan

NHS diabetic eye screening programme

To continue to transform NHS public health services, in 2022 to 2023 NHS England will publish an implementation plan and communication plan for implementing a 2-year interval for low-risk patients (those with no retinopathy or maculopathy).

NHS fetal anomaly screening programme

To continue to transform NHS public health services, in 2022 to 2023 NHS England will continue to deliver the operational elements of the current in-service evaluation of non-invasive prenatal testing (NIPT).

NHS newborn blood spot screening programme

To continue to transform NHS public health services, in 2022 to 2023 NHS England will:

• continue to deliver the operational elements of the UKNSC’s current in-service evaluation of severe combined immunodeficiency (SCID)
• prepare for further UKNSC programme recommendations for change.

Sickle cell and thalassaemia screening programme

To continue to transform NHS public health services, in 2022 to 2023 NHS England will support work to assess the effectiveness and cost of NIPT and non-invasive prenatal diagnosis in the sickle cell and thalassaemia screening programme.

Digital transformation of screening programmes

To continue to transform NHS public health services, in 2022 to 2023 NHS England will:

• as business owner to the digital transformation of screening and immunisation services, ensure NHS screening and immunisation strategies and service requirements are made clear, which need digitally enabling, to the statutory bodies responsible for health and social care digital systems, and consequently prioritise investment in these systems
• ensure service requirements for a new breast screening IT system, with extendable technology, are made available to NHS Digital (pending merger into NHS England)
• be the statutory body responsible for the commissioning of live IT systems used by most screening programmes and consequently prioritise investment in them

Child health information services

To continue to transform NHS public health services, in 2022 to 2023 NHS England will:

• continue to work with other statutory bodies to review and refresh the child health information services technical specifications and service specification in parallel with the digital transformation process mentioned above
• ensure that the scope of developments covers (at a minimum) the requirements set out in the published 2012 and 2015 information requirements specifications

Sexual assault referral centres

To continue to transform NHS public health services, in 2022 to 2023 NHS England will support SARCs to improve quality of services, and completeness, validity and timeliness of data in biannual SARC indicators of performance (SARCIP) reports, working towards publication.

1. This indicator is not drawn from the Public Health Outcomes Framework. ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷ ↩⁸ ↩⁹ ↩¹⁰ ↩¹¹ ↩¹² ↩¹³ ↩¹⁴ ↩¹⁵ ↩¹⁶ ↩¹⁷