Executive summary

This annex provides a more comprehensive summary of operational performance based on published data and work to restore services.

Primary care and community health services                  

1. The Primary Care Access Recovery Plan (PCARP) launched in May 2023 makes it easier and quicker for patients to see their GP and members of the primary care team. Nearly 12 months into PCARP implementation, good progress has been made. Key achievements include:

i. Over 363 million GP appointments, excluding those for covid vaccinations, have been delivered in the 12 months to March 2024. This is an additional 56.3 million appointments than before the pandemic. This includes 3 in 5 GP appointments delivered face-to-face, over half booked and attended on the same or next day, and nearly 9 in 10 appointments attended within 2 weeks of booking (for appointments not usually booked in advance).

ii. An expansion of services in community pharmacy to make it easier for patients to access treatment for common conditions through their local pharmacy. Pharmacy First was officially launched on 31 January with 98% of pharmacies signed up. Community Pharmacy Contraception Service and Community Pharmacy Blood Pressure Check services were successfully expanded on 1 December 2023.  Uptake for these expanded services has been positive and a Pharmacy First Service public campaign commenced in February.

iii. More than 36,500 additional direct patient care roles in place now compared to 2019.  

iv. 90% of practices enabling patients to use the NHS App to send messages, book appointments and order repeat prescriptions. 

2. Working with integrated care boards through regions, we have developed delivery actions for year 2 to build off the strong foundation of year 1, embed changes and deliver the benefits for patients and staff.  This will include making more progress on primary and secondary care interface, embedding digital telephony, and increasing prospective records access >90%.

3. Following conclusion of the contract consultation process, documents have been published to support the implementation of changes to the 2024/25 GP contract. These include the Statement of Financial Entitlements, 2024/25 Network Contract Directed Enhanced Service Specification and supporting guidance, 2024/25 Weight Management Enhanced Service Specification, and updated guidance on the 2024/25 Quality and Outcomes Framework. Amendments to the GP contract regulations were laid in Parliament at the end of April to underpin the changes to the core GP contract. 

4. The Dental recovery plan was published 7 February 2024 to deliver up to 2.5 million additional NHS dental appointments for patients over the next 12 months, including up to 1.5 million extra treatments. It sets out how the NHS and Government will drive a major new focus on prevention and good oral health in young children and deliver an expanded dental workforce. We have already implemented the new patient premium and the revised minimum unit of dental activity value of £28. We continue to progress other elements including mobile dental services in the identified areas. 

Mental health

5. Mental health continues to be one of the NHS’s top priorities and we remain committed to improve services and address the long-standing treatment gap. The NHS continues to deliver at pace against public commitments despite pressures across the sector through increased demand and prevalence, and capacity constraints. Key progress against commitments include:

• As at March, talking therapies referral to treatment times are being met with 92.3% of patients seen within the 75% 6-weeks target, and 98.7% within the 95% 18-weeks target. In the rolling quarter to March 2024, NHS talking therapies services delivered access for 326,227 people.
• The proportion of early intervention in psychosis referrals entering treatment within 2 weeks was 70.9% in February 2024, against the 60% standard.
• Access to community mental health services continues to increase with 592,258 people receiving 2 or more contacts in the 12 months to February 2024, up from 583,731 in the 12 months to January 2024.
• There has been significant improvement for access to individual placement and support (IPS) services, with 34,872 people reported to have accessed an IPS service in the 12 months to February 2024, an increase from 32,193 in the 12 months to January 2024.
• The dementia diagnosis rate is 64.5% as of February 2024 against the national ambition of 66.7%, demonstrating improvement over January 2024.
• In Q4 2023/24 361,210 full physical health checks were delivered to people living with severe mental illness (SMI) a 23% increase on the previous quarter. These checks are an important way of contributing to the reduction of health inequalities given the higher mortality rate among people with SMI.
• There are now 37 established sites for specialist mental health provision for rough sleepers in high need areas, exceeding public commitments.
• Mental health support teams (MHSTs) in schools have become established, from having no operational teams in 2019, to 398 teams covering 35% of the pupil population as of Spring 2023. MHSTs are on track to cover at least 50% of pupils and learners with almost 500 MHSTs by March 2025.
• All 15 gambling clinics committed are now in operation, with the final 3 clinics in Liverpool, Preston and Sheffield opening during Q4 2023/24. As of the end of 2023/24, 8 regional gambling services are operational, with the capacity to treat up to 3,000 patients per year, including provision for children and young people (CYP).

6. There continues to be extremely high demand for mental health services. As a result, several areas remain challenged and work continues with regions and systems to prioritise recovery. The mental health urgent and emergency care pathway bed occupancy remains high and the proportion of adult length of stay over 60 days or 90 days for older adults was 24.5% in February 2024, in line with the previous month. There continue to be challenges with flow through the system, caused in part by challenges securing social care and housing support for patients, meaning that out of area placements (OAPs) remain high with 760 active OAPs in January 2024. Clear targets have been set to improve patient flow and work towards eliminating inappropriate out of area placements. Key support actions include encouraging use the Mental Health Investment Standard to support improved flow, increased regional oversight with enhanced data, establishing a taskforce on workforce, and alignment with wider programmes that enhance community and crisis care.

7. In the 12 months to February 2024 the number of children and young people (CYP) accessing services increased to 780,963, from 758,85 in the 12 months to January 2024. Whilst positive, performance is still behind trajectory, and monitoring is required to ensure this upward trend is sustained. CYP eating disorder pathways continue to be pressured – for the rolling 3 months to February 2024, 67.5% of CYP started urgent treatment within 1 week, an increase from 60.8% in the rolling 3 months to January 2024. 79.3% CYP started routine treatment within 4 weeks, an increase from 78.2% in the rolling 3 months to January 2023, both against a 95% target.

8. Access to specialist community perinatal mental health and maternal mental health services has been increasing since July 2023. In the 12 months to February 2024 57,170 women accessed these services, an increase from 55,873 in the 12 months to January 2024. This represents the largest monthly increase in access numbers since July 2021. The national team continue to provide support through regions and clinical networks on access and data quality issues including through sharing best practice from high performing systems, and working to improve links with maternity and primary care services.

9. Ensuring we have sufficient additional workforce available to meet increased demand remains the biggest risk to service delivery and transformation. However, progress is being made, with the mental health workforce growing by over 36% (39,800 full-time equivalent) between March 2016 and December 2023. Workforce expansion remains a priority, as does addressing significantly high vacancy rates, which in mental health nursing stand at around 16% in December 2023.

10. A full definition of ‘Parity of Esteem’ was published on parliament.uk in February 2024. This is a significant milestone for the mental health sector and acknowledges the importance of achieving parity with physical health, to ensure mental health remains at the forefront of policy and decision making.

11. Work continues at pace to create a vision that will unite the sector behind future priorities for further transformation over the next 5 to 10 years. Providing timely access for everyone who needs it and implementing the most therapeutic and least coercive models of care are at the core of the vision, supported by a strong focus on reducing inequalities for people with mental health needs. This follows significant and ongoing engagement with key stakeholders.

Learning disabilities and autism

12. At the end of March 2024, there were 1,820 adults and 220 under 18s with a learning disability or who are autistic, in a mental health inpatient setting. Since March 2017, there has been a 52% reduction in the number of adults with a learning disability (who are not autistic) in a mental health hospital, exceeding the Long Term Plan commitment, but a 78% increase in the number of autistic adults who do not have a learning disability.

13. We have published resources so that children and young people are added to a dynamic risk register if they are at risk of going into mental health hospital; we have commissioned the Local Government Association to support improvement in 6 local systems; £13 million capital has supported people to leave hospital for their own homes.

14. There has been strong delivery of annual health checks so that, as of February 2024, 69% of eligible people had received a health check (against public commitment of 75%) and 95% of people who had a check had an accompanying health action plan (66% of the eligible registered population).

15. Reasonable Adjustment Digital Flag is now mandated for use by all publicly funded health and social care organisations to identify, flag and record reasonable adjustment needs for disabled people. From April 2024 information will start to be shared across providers via the NHS Spine. We have published an implementation checklist for organisations and launched Digital Flag e-learning training for health and care staff; we continue to support the technical on-boarding of IT suppliers.

16. We are working with the Vaccinations and Immunisations team on the spring booster flu and covid campaign to increase access to, and improve uptake of, these vaccinations, and ensure accessible information is readily available to people with a learning disability and their carers. This will be supported by an updated communication toolkit

17. 41 Integrated care boards (ICBs) are actively working on their project plans for PINS (national project to support children with neurodevelopmental needs in schools). One additional ICB was an early adopter of PINS. Keyworkers to support children and young people at risk of admission to, or in a mental health hospital, continue to operate in all ICB areas. We continue to work with Government departments, regulators and via our regional teams to support the delivery of ICBs’ statutory responsibilities for children with special educational needs and disabilities.

18. In December 2023, there were 172,022 patients with an open referral for suspected autism. Of these, 147,042 patients had a referral that had been open for at least 13 weeks. We continue to work with local systems to implement the All-Age Autism Assessment Framework and Operational Guidance as well as supporting waiting list improvement initiatives.

19. We continue to support and build on the delivery of Oliver McGowan mandatory training on learning disability and autism for the health and social care workforce. At April 2024, over 1.7 million people had completed the e-learning component.

Children and young people

20. The national inpatient paediatric early warning score (PEWS) continues to be rolled-out in all paediatric in-patient settings to track potential deterioration in children. An electronic audit tool has recently been published for use by sites using the paper PEWS chart. This will allow for immediate and ongoing evaluation of the impact of PEWS. Work also continues for phase 2 of the PEWS including the development of an emergency department prototype chart.

21. The Children and Young People (CYP) Transformation Programme continues to deliver its Long Term Plan commitments, including treating 1,000 children and young people a year for severe complications related to their obesity. The complications of excess weight clinics have also started to use new medical technology which will provide further support for these CYP outside of the clinics.

22. On 27 March 2024, NHS England set out priorities and operational planning guidance for 2024/25. The guidance highlights several priorities around babies, children and young people, including:

• Recovery of services: the planning guidance highlights that system plans should reflect the needs of all age groups, including children and young people.
• Planning for the future: it noted that systems’ inaugural 5-year joint forward plans should expand evidenced-based approaches to population health, focusing on a healthy start to life, prevention, self-care and better management of long-term conditions.
• Urgent and emergency care and urgent community services: it asks systems to ensure that patients with mental health needs and children and young people are explicitly included in the plans to recover services. For CYP, this includes paediatric virtual wards, paediatric same day emergency care and implementation of the standardised PEWS across inpatient settings.
• Primary care and community services: to support recovery of primary care and community services, systems are asked to develop a comprehensive plan by June 2024 to reduce the overall waiting times for community services, including reducing waits over 52 weeks for children’s community services.
• Embedding measures to improve health and reduce inequalities, with an ask to put in place plans to maximise uptake of childhood vaccinations and flu vaccinations for CYP, increasing vaccination uptake for children and young people year on year towards WHO recommended levels. Other key actions for systems include collaborating with local authorities and family hubs to support the Healthy Child Programme framework and stronger parent–infant relationships, as well as reducing inequalities in access and outcomes from NHS services among the most deprived communities, delivering on the Core20PLUS5 approach which should include specific initiatives to address inequalities experienced by CYP.

Prevention and long-term conditions

23. Thrombectomy and thrombolysis activity continues to track towards trajectory, with greater adherence to the National Optimal Stroke Imaging Pathway and 99% of units using artificial intelligence decision support (April 2024). Video triage used in ambulances to help with rapid diagnosis is being increased. We have published a General Medical Council thrombectomy training standard and developed training academies to increase the number of doctors who can carry out the procedure. The Integrated Community Stroke Service model is being implemented with an increase of over 20% in the past five years of patients discharged from hospital who receive home-based stroke rehabilitation.

24. Over 1.5 million referrals have been made into the NHS Diabetes Prevention Programme to date. Independent evaluation, carried out by the University of Manchester, shows that people who complete the programme reduce their risk of developing type 2 diabetes by 37%, and that the programme resulted in a 7% reduction in population level incidence in areas where the programme was delivered between 2016 – 2018. In November 2023, the University of Birmingham published international research that showed that the programme also reduced the risk of complications from cardiovascular events.

25. The NHS Type 2 Diabetes Path to Remission Programme is now available across the whole of England. To date over 20,600 referrals have been made. Early data indicates participants each lose 7.2kg (over 1 stone) on average after one month, and 13.4kg (over 2 stone) after 3 months. This is in line with the outcomes seen in the trials where participants were able to improve their diabetes control, reduce diabetes-related medication and, in around 50% of cases, put their type 2 diabetes into remission.

26. NHS England has now received a full set of data from the National Respiratory Audit Programme, showing that the number of people completing pulmonary rehabilitation (PR) in 2022/23 had nearly returned to the pre pandemic levels of 2019/20. Data from the first ten months suggests PR completion rates could reach pre-pandemic levels in 2023/24. At the same time, the proportion of people having an initial assessment and completing PR remains in line with the trend over the past four years (60% in January 2024). 

27. The 2024/25 operational planning guidance continues to highlight hypertension and lipid management as key targets for improvement. In September 2023, 59.7% of people with a high-risk score were being treated with lipid lowering therapy meaning the 2023/24 operational priorities and planning guidance target has been met. Up to September 2023, 66.9% of the hypertension patients in England are managed to target. This is over 7 percentage points improvement compared to June 2022, although there is variation across the integrated care boards. The updated 2024/25 planning guidance goal for hypertension is 80% and for lipid management is 65% of people at high risk of cardiovascular disease (CVD) to be treated with lipid lowering therapies. CVDPREVENT audit data up to December 2023 will be published on 30 April 2024.

Screening and vaccinations

28. The NHS Bowel Cancer Screening Programme continues to exceed the 65% national coverage target. Age extension is in progress to delivery testing to 50 to 74-year-olds by end March 2025. Roll out to 54-year-olds on track for completion by the end of March 2024, with plans to extend to 52- and 50-year-olds by end March 2025. From July 2023, people with Lynch syndrome have been introduced into the surveillance arm of the Bowel Cancer Screening Programme.

29. The NHS Breast Screening Programme commitment to improving uptake continues with national interventions and initiatives to support regional and local plans. With a 2.3% increase on the previous year to 64.6% for the year ending 2023 (source: National Statistics Breast Screening Programme – NHS Digital). Uptake and coverage remain below the 70% efficiency standards although are improving steadily. Uptake improvement plan was approved in December 2023 and work is now underway to implement.

30. The NHS Cervical Screening Programme coverage is below the 80% programme standard for both older and younger cohorts. At the end of Q2 2023/24, 5-year coverage in those over 50 remained steady at 74.8%, whereas 3-year coverage for those under 50 fell to 66.6%, continuing a declining trend. National and regional initiatives continue to be developed and implemented to support improvements in coverage. Work continues at pace to plan for the implementation of the new NHS Cervical Screening Management System.

31. Uptake of initial ultrasound screens in the Abdominal Aortic Aneurysm Screening Programme is exceeding the achievable standard but below the optimal standard.

32. NHS Diabetic Eye Screening Programme has commenced moving participants who are assessed as lower risk (expected to be 70% of the cohort) to biannual screening. This will be phased in over a two-year period to ensure activity continues to be broadly balanced between years. Phase 1 of the project has now been successfully delivered. The programme has begun to plan for the implementation of optical coherence tomography within the digital surveillance pathway and R2 grading refinement from October 2024. Both initiatives will reduce the number of referrals to hospital eye services.

33. NHS antenatal and newborn screening programmes continue to achieve continuous coverage levels close to 100%.

34. Seasonal flu and COVID-19 vaccinations programmes 2023/24 achieved 11.8 million COVID-19, and 18.2 million flu vaccinations. The covid-19 vaccination programme concluded 31 January 2024; the flu vaccination programme concluded on 31 March 2024. The Spring covid-19 vaccination campaign began 15 April for care home residents, and the National Booking Service opened to the public for bookings on this date. Vaccination of all other eligible cohorts in the Spring campaign began on 22 April 2024. The covid-19 Spring seasonal campaign will finish 30 June 2024.

35. NHS England continues to implement the national measles, mumps and rubella (MMR) Improvement plan. Initiatives implemented include further call and recall, increased community engagement and scoping alternative models of delivery to improved access. Following an outbreak of measles in the West Midlands local action plans were developed and implemented. A nationally led call and recall campaign had been delivered inviting children aged 6-11 who are unvaccinated or partially vaccinated to come forward for vaccination. This has extended into London, the West Midlands and Greater Manchester to cover those up to 25 who are not fully vaccinated. Between 1 Jan and 24 March 2024, there were a total of 360,964 MMR vaccinations delivered, up almost a quarter (23%) from 293,847 in 2023.

36. Following Joint Committee on Vaccination and Immunisation guidance, NHS England continue to plan for implementation of both an RSV infant and RSV adult programme for eligible cohorts subject to approval by Ministers.

Recovery Support Programme

37. The Recovery Support Programme (RSP) provides national mandated intensive support to trusts and integrated care boards (ICBs) in NHS Oversight Framework segment 4 and have complex, deep-seated concerns around leadership, governance, finance, patient safety, quality, or performance. 

38. The programme now has 22 trusts (5 legacy special measures) and 3 ICBs enrolled. Since the last update in March 2024, there have been 2 new entries and no exits from the from the RSP, as set out below:

• On Tuesday 9 April, it was agreed by the Quality Performance Committee that King’s College Hospital NHS Foundation Trust and Mid and South Essex NHS Foundation Trust should transition from segment 3 into segment 4 of the NHS Oversight Framework and receive mandated support from the RSP.

Genomics

39. The NHS continues to provide the NHS Genomic Medicine Service (NHS GMS) through a consolidated laboratory network made up of 7 NHS Genomic Laboratory Hubs. There are 7 NHS GMS Alliances working together to support clinical leadership and embedding of genomic medicine in end-to-end pathways; and clinical genomic services that diagnose and manage complex rare and inherited disease. The NHS GMS is on track to deliver nearly 850,000 genomic tests, an increase of over 10% in the last year.

40. In line with the NHS Long Term Plan, we have continued to see growth in the number of patients accessing the whole genome sequencing service and an increase in the number of extensive genomic tests offered to patients diagnosed with cancer, during 2023/24. In total, over 92,000 whole genome equivalents have been sequenced, including more than 15,000 cancer genomes and more than 77,000 rare disease genomes.

41. In line with the commitment in the NHS genomics strategy, patient level contract monitoring data from the NHS GMS was made publicly available for the first time in December 2023. Activity data will continue to be published on a quarterly basis, with the second publication occurring in March 2024, and turnaround times added in time.

42. NHS England is continuing to support the Generation Study, which is delivered by Genomics England and supported by the NHS GMS, to sequence the genomes of 100,000 newborn babies. Colleagues from Genomics England and NHS England have been working with clinicians to agree the genes or conditions to be included in the programme and map downstream care pathways. The initial list of genes and conditions was published in October 2023 to enable public consultation on inclusion into the research study. The first site began recruitment to the study in March 2024.

43. April and May have seen the 8 approved NHS genomic networks of excellence begin to deliver work packages. The NHS genomic networks of excellence, announced in the NHS Genomics strategy, will play a key role in bringing together the NHS GMS, National Institute for Health and Care Research, Biomedical Research Centres, Academic Health Science Networks and other partners across industry and academia to accelerate genomic research. This will support the generation of evidence and models of adoption for new technology and testing, and clinical and laboratory practice, for example rapid whole genome sequencing, in defined areas of strategic importance.

Publication reference:  Public Board paper (BM/24/17(Pu))