Organisation objective

• NHS mandate from government
• NHS Long Term Plan
• Governance

Working with people and communities

• Consultation/engagement
• Qualitative data and insight – for example, national surveys, complaints
• Partnership working with voluntary, community and social enterprise (VCSE) organisations

Stakeholders including the public were engaged during the development of the NHS Vaccination Strategy, the recommendations of which included delegation of commissioning responsibility. Further significant engagement, including with participant groups and communities, will take place in Q4 2024/25 and throughout 2025/26.

Action required

The Board is asked to approve the recommendation in this paper.

The proposals have been considered by the Vaccination and Screening Delivery and Transformation Board, Commissioning Development Programme Delivery Group, and the NHS Executive.

Issue

1. This paper asks the NHS England Board to approve proposals for the future commissioning of NHS vaccination and screening services and child health information services. It proposes to delegate the significant majority of these services to integrated care boards (ICBs) on 1 April 2026, to support ICBs’ role in population health and prevention, with a small number of functions retained to ensure efficiency and national consistency. Health and justice vaccination and screening responsibilities will be retained, reflecting previous NHS England Board decisions, and NHS England regions will continue to commission these.

Background

2. NHS vaccination, screening and child health information services (CHIS) (referred to as ‘V&S’ for the remainder of this paper) are population health programmes that are highly cost effective and a core part of prevention. They are delivered to healthy people and have the potential to cause harm, and therefore have specific considerations in relation to their commissioning arrangements to ensure they are delivered consistently and to national standards of quality and safety.

3. As a result, we have taken a cautious approach to the delegation of V&S. In May 2024 the Executive agreed that the commissioning of suitable components of these services will be delegated in April 2026 with associated staff transfers taking place at the same time. This was communicated via a system letter on 30 July 2024.

4. Since then, the national and regional V&S teams have been working together, bringing in wider expertise, to develop proposals for delegation based on the footprint of provision. In the case of vaccination, this has been in development for some time following the publication of the NHS vaccination strategy, which proposed delegation as a way of increasing flexibility for systems to determine their local vaccination delivery network.

Recommendation

5. Our proposal is for the vast majority of V&S services to be delegated to ICBs. In summary we recommend that:

1. commissioning of all vaccination services is delegated to ICBs, in line with the vaccination strategy
2. commissioning of most components of screening services is delegated to ICBs, with the exception of some functions which are delivered across large footprints and are more suitable to be retained and commissioned by NHS England (see paragraph 10)
3. commissioning of CHIS is retained by NHS England

6. This proposal means that, from April 2026, ICBs will have responsibility for a wider range of prevention services for their populations and greater levers to discharge their population health function. NHS England will have a role, and therefore require expertise in assurance, standard setting, co-ordinating and planning above ICB level, implementing new programmes and programme changes and incident management to support the requirement for national consistency in V&S programmes.

7. Annex A sets out the list of V&S service components and our specific recommendation for each. For screening and CHIS, the proposals are expressed as a functional analysis because screening and CHIS have a variety of significantly different service components already commissioned at different levels. Vaccination commissioning is less fragmented, and the assumption is that responsibility for commissioning vaccination services, including COVID, is delegated to ICBs as a whole. The vaccination functional analysis therefore focuses on roles and responsibilities at ICB, regional and national level.

Considerations

Principles

8. The following principles have guided the development of the delegation proposals:

1. V&S services must always be delivered in line with recommendations from the UK National Screening Committee (UKNSC) or Joint Committee on Vaccination and Immunisation (JCVI) and to nationally-consistent standards of quality and safety.
2. Delegation will deliver benefits by enabling ICBs to use their population health insight to design locally-tailored models of access that reach their whole eligible population, including under-served communities. Our assumption is therefore that, subject to point (a) above, services are delegated by default unless there is a good reason why they should not be.
3. ICBs are the strategic commissioners. Even where components of a programme pathway, such as lab services, are commissioned by others and their services made available to ICBs, ICBs retain the overall responsibility for the people living in their area.
4. By having oversight of the whole of a pathway, ICBs will be able to make decisions on how to use resources efficiently, for example between screening and symptomatic pathways. They will also be able to manage demand and capacity across the pathway; for example, by aligning abdominal aortic aneurysm screening with vascular treatment pathways.
5. Many of our services are subject to transformation, either now or in the future. In some cases, the act of delegation will help create the transformation; for example, by enabling ICBs to design innovative delivery networks. In other cases, the transformation will happen alongside or after delegation. In these cases, delegating the service should ideally facilitate transformation, or at the very least should not inhibit it.

Retained functions

9. The below 5 components of screening services are proposed to be retained by NHS England and commissioned once for the whole country. This is a very small proportion of the overall programme. They are:

1. bowel cancer screening hubs (n=5)
2. bowel cancer screening managed service provision (n=1)
3. Cervical Screening Administration Service, CSAS (n=1)
4. HPV cytology laboratories (n=8)
5. newborn bloodspot laboratory services (n=13)

10. This arrangement will make best use of resources, both in terms of commissioning budget and staff, and will help to align these services with other relevant areas of national commissioning, such as genomics laboratories. Retaining these service components will also enable us to deliver service transformation and programme changes rapidly, efficiently and consistently across the country. This is particularly important where public health commissioning budgets, along with other areas of NHS finances, are likely to be constrained; when change requirements that require additional funding are issued from UKNSC we will need to prioritise, plan and implement as one across the country.

11. Regions and ICBs have provided thorough feedback on the proposal, with a focus on the proposed retained functions. The feedback reflects a variety of positions and concerns which have been considered in their totality and in line with the points set out in paragraph 10.

12. In Q4 2024/25, NHS England will work with ICBs to set out roles and responsibilities across the whole pathway to ensure ICBs maintain oversight, even where services are commissioned elsewhere. For example, ensuring representative ICB involvement in commissioning NHS England’s retained functions and setting out governance and assurances processes between national, regional and ICB teams for incident and performance management.

13. Recommendations for the optimal commissioning, contracting and financial arrangements for the retained services is being developed and will be tested with regions and ICBs as part of the operating model development in Q4 2024/25.

14. While not technically a commissioned function, it is also proposed that quality assurance of screening services should be retained nationally. This is because, particularly in a delegated environment, a consistent quality assurance approach delivered through a single integrated function would be the best arrangement to safeguard against unwarranted variation.

15. CHIS are unlikely to benefit from delegation as many of the issues with the current service are because of the plurality of, and variation between, providers. Retaining responsibility for CHIS commissioning will help enable transformation activity including the digitisation of the personal child health record and the reduction in paper-based administration and data transfer.

Interdependencies and wider implications

ICB and regional operating models

16. Regional teams have begun working with their ICBs on readiness to receive delegated services and the development of coherent operating models; including learning from previous delegations, understanding existing resources in ICBs and what they will require to commission V&S services.

17. Clinical and public health expertise is best aligned with the critical mass of the commissioning function – that is, transferred to ICBs in support of delegation. Regions may also need to retain some public health expertise to support the NHS England role set out in paragraph 6.

18. Operating models should deliver the delegated commissioning functions and ultimately improve population health outcomes. We expect that this will lead ICBs to deploy a range of different models across the country and across the range of functions they are delivering. For instance, some larger ICBs may choose to deliver the majority of the functions themselves, whereas some of the smallest ICBs may need to create collaborative arrangements capable of delivering the functions delegated to them. For certain small and medium enterprises or other areas with very limited resource – for example, those providing public health expertise – a network arrangement may be required to allow expertise to be used across several ICBs.

ICB readiness

19. NHS England regional teams are putting in place closer working arrangements with their ICBs from April 2025. This will enable optimised ways of working which are safe and ambitious, ensure the right governance routes are in place and support learning between regions and ICBs. Arrangements include:

1. appropriate forum(s) established to support the region to consult with ICBs in decision making and arrangements in place to ensure wider integrated care system partners are involved as appropriate, in particular local authority public health representatives
2. appropriate sharing of information and data to inform delivery and target areas of concern; finance and performance data shared to enable ICBs to better understand the status of the service and the impact of delegation
3. where relevant, provider visits (for vaccinations and screening) are carried out jointly between NHS England and relevant ICBs, with action plans jointly agreed and monitored
4. relevant ICBs being involved in procurements and contracting for vaccination and screening services, using ICB local intelligence and provider relationships, focusing on areas of low uptake
5. each ICB having vaccination and screening senior responsible officers; each ICB has nominated a board level member
6. operational groups for vaccinations and screening have been established with appropriate ICB representation, and these groups meet regularly
7. during 2025/26 regional commissioning teams and public health expertise will increasingly work as integrated teams

20. In Q1 2025/26 we will be developing the V&S pre-delegation assessment framework ready for launch in July 2025 and assessment concluded in October 2025. This will include draft ICB allocations which will be based on 2025/26 financial flows in order to provide financial stability to ICBs and providers. Target needs-based ICB allocations will be developed in parallel and issued in shadow form in autumn 2025, together with the convergence policy and timeline.

Oversight and assurance

21. An oversight and assurance workstream, within the commissioning development programme, is currently developing the approach for this and will integrate V&S into the NHS Oversight and Assessment Framework and ICB capability assessments.

Engagement and next steps

22. The UK National Screening Committee, UK Health Security Agency and the Department of Health and Social Care have been engaged on the proposal and are supportive of the delegation proposal. NHS England internal teams (such as Primary Care, NHS Cancer Programme, NHS Diabetes Prevention Programme, Diagnostics and others) have been engaged and are also supportive.

23. ICBs have been engaged on the delegation proposal via their regions. They are supportive of what is set out and are keen to develop local operating models which embed vaccination and screening services as part of their wider prevention and population health responsibilities.

24. Next steps:

1. Regions and ICBs continue to develop their operating models, with approval of these by the Executive in April and approval of proposed staffing implications at the May 2025 Executive HR Group.
2. Establish the current spend distribution of regional budgets and contracts by ICB footprint in order to inform the baseline for ICB allocations and the basis of future contracting arrangements.
3. Develop an oversight and assurance framework for V&S, in alignment with other retained and delegated commissioning functions and the ICB capability assessment as part of the overall NHS Oversight and Assurance Framework
4. Further work with Department of Health and Social Care officials to prepare for ministerial clearance of delegations under the section 7a agreement in Autumn 2025, pending a final Board decision in December 2025 on the basis of an up to date assessment of ICB readiness to take on delegation.

Annex A: Functional analysis/delegation hypothesis

Screening

Abdominal aortic aneurysm (AAA) screening programme

AAA screening service

Breast screening programme

Breast screening service (BSO)

Diabetic eye screening (DES) programme

DES service

Bowel cancer screening programme (BCSP)

BCSP hubs

FIT kit provision (MSP)

BCSP centres

Cervical screening programme

Cervical Screening Administration Service (CSAS)

Sample-taking: primary care

Sample-taking: sexual health

Sample-taking: opportunistic

HPV cytology laboratories

Colposcopy

Antenatal and newborn (ANNB) screening programme

ANNB services provided through the maternity pathway

Newborn bloodspot laboratory services

Genomic procedures, testing and specialist appointments

Child Health Information System (CHIS)

Child health records departments

Service description

A workforce that supports, maintains and administers the IT system (below), providing data validation, failsafe and reporting functions

Proposed future arrangements and rationale

Proposed commissioner from 1 April 2026: NHS England

• increased consistency of service across the country
• opportunity to consolidate services and create efficiencies

CHIS IT

Service description

The Child Health Information System used by a provider to capture and record clinical activity.

Proposed future arrangements and rationale

Proposed commissioner from 1 April 2026: NHS England

• the responsibility for the IT system should lie with the commissioner of the respective CHIS service initially
• in the longer term, a discovery is planned to set out how CHIS IT can increase consistency, better enable interoperability with other systems, create efficiencies and resolve issues of local variation from IG standards

Red book

Service description

Parent-held paper-based personal child health record.

Proposed future arrangements and rationale

Proposed commissioner from 1 April 2026: NHS England

• as part of a strategy for CHIS, and in line with government commitments to move from analogue to digital we are reviewing how the Red Book is used and what it needs to look like in the future

Vaccination

Oversight and accountability

ICB role

• Secure and oversee provision of NHS vaccination programmes, in line with national guidance, that meet national performance expectations, address local population need, maximise uptake and reduce unwarranted variation.
• Ensure providers of vaccination services are meeting the expected programme offer or have an improvement plan, linked to effective contract management.
• Manage and respond to relevant public and parliamentary requests, and complaints, relating to delegated vaccination services.
• Collaborate with regional detained estates teams to incorporate those settings into local campaign planning and deployment.

Regional role

• Responsible to the NHS England CEO for ICB performance against agreed standards in that region.
• Agree tailored improvement targets with ICBs to support increased uptake in underserved communities, reducing inequalities and supporting collaboration across ICBs for certain groups.
• Support pan-region responses to public or parliamentary requests where required.
• Responsible for the performance management of providers.

National role

• Oversee national vaccination programme delivery and performance against standards agreed with DHSC, UKHSA and JCVI.
• Ensure that vaccination services are appropriately included in NHS England oversight and assurance frameworks.
• Monitor the overall coherence, stability and sustainability of the commissioning model for vaccination services.
• Manage and respond to relevant public and parliamentary requests, relating to national elements of vaccination services.

Governance

ICB role

• Identify a named executive director responsible for vaccination, including addressing inequalities and unwarranted variation.
• Identify specialist public health expertise that will support commissioning and oversight functions
  Integrate vaccination within appropriate governance structures.
• Support regional risk processes.

Regional role

• Participate in national-to-regional governance forums to discharge accountability for regional vaccination performance.
• Support ICB and national risk processes.

National role

• Build strong working relationship with DHSC, UKHSA, JCVI and other national partners.
• Co-ordinate internal NHSE national vaccination oversight.
• Ensure appropriate representation for vaccination services at relevant cross-NHS England forums.

Strategy

ICB role

• Lead implementation of the NHS Vaccination Strategy working across the NHS, local government (including directors of public health) and other key partners in collaboration with regional teams.
• Ensure vaccination is included in the ICP integrated care strategy and builds on evidence from local joint strategic needs assessments (JSNA) and insights work with patients and the public.

Regional role

•  Co-ordinate improvement activity within and across the region where this will be of benefit.

National role

• Set national strategy and priorities for vaccination deployment in line with DHSC policy directions, JCVI advice or recommendations, and UKHSA guidance.
• Develop national infrastructure to support system-led vaccination service improvement.

Service transformation and programme changes

ICB role

• Plan local service transformation activities to improve quality and access.
• Implement vaccination programme changes as required by NHS England following JCVI advice or recommendations, and DHSC policy, to agreed standards and within specified timescales, taking direction from regional or national teams where appropriate.
• Manage impact of programme changes and transformation on BaU vaccination delivery and wider NHS activity.
• Undertake local evaluation of the impact of innovation and outreach models, and ensure outcomes are widely shared and built into future planning.

Regional role

• Work in collaboration with NHS England national team in the planning of programme changes and new programmes.
• Support ICBs in safe operational implementation of programme changes, providing direction where necessary.
• Co-ordinate improvement activity within and across the region.

National role

• Maintain awareness of likely new vaccination programmes and future changes to current programmes.
• Agree vaccination programme policy changes with DHSC following JCVI advice.
• Develop and communicate an implementation plan for programme policy changes which may include piloting and evaluation.
• In partnership with UKHSA, evaluate the overall impact on uptake, cost effectiveness and patient experience of vaccination programme delivery to inform policy development.

Commissioning

ICB role

• Commission a vaccination delivery network that meets the objectives set out in the NHS vaccination strategy, working with local partners.
• Ensure compliance with patient engagement duties, consultation with local representative bodies (for example, LPC and LMC) and other relevant legislation in the delivery of commissioning responsibilities.
• Assess the impact of changes to the delivery network on provider sustainability.

Regional role

• Responsible to the NHS England CEO for the quality-of-service commissioning in that region.
• Co-ordinate engagement with regional UKHSA, local government and other relevant teams.
• Detained estates teams to continue to commission vaccination in detained estates, collaborating with ICBs in local programme planning.

National role

• Develop and maintain national service specifications for vaccination, including minimum service requirements.
• Lead national consultation with primary care representative bodies where required.
• Set commissioning policy and criteria, maximising local flexibility as far as possible to commission services on the basis of population need.
• Provide direction and support to ICB and regional teams to support the safe discharge of duties and delivery of strategic objectives.

Procurement and contracting

ICB role

• Where appropriate run legally and contractually compliant local provider selection and procurement processes for vaccination services.
• Engage with multi-ICB procurements where required.
• Undertake local provider impact assessment to manage implications for the wider market and the delivery of other services.
• Finalise all relevant contract documents and schedules for inclusion in provider contracts and carry out any local consultation/negotiation process as required.
• Manage and monitor contract end dates/extensions.
• Work with providers to localise and implement service specifications.
• Manage provider contracts including post payment verification and disputes.
• Work collaboratively with other ICBs to design and deliver arrangements across multiple ICBs and manage out-of-area provision.

Regional role

• Support coordination of procurement activity across ICB footprints where required.
• Provide dispute resolution between ICBs and providers where required.
• Perform all contracting duties required of an associate to an ICB contract for NHS England vaccination services.
• Provide advice to ICBs on schedules to be incorporated into local contracts.

National role

• Ensure vaccinations are included in national NHS England contracting and payment strategy – for example, the NHS standard contract and primary care contracts.
• Conduct overarching impact assessment of national procurements on sectors, such as primary care.
• Develop national templates for contracting processes where required.
• Provide support/advice to ICBs on schedules and primary care contracts to support delegated services.
• Produce and update best practice contract templates for adaptation and use.

Finance

ICB role

• Put in place robust financial governance for vaccination services.
• Discharge relevant financial management, oversight and assurance responsibilities of delegated vaccination services, including but not limited to financial planning, investment and commissioning decision-making including public health allocations, budgetary control within the resources issued and delivery of efficiency targets and cost-savings, financial reporting and accounting, whole system financial oversight.
• Record and report financial information on national financial systems in line with national guidance.

Regional role

• Assure ICB financial performance and delivery, escalating to national teams as relevant.
• Disseminate and translate national messages to ICBs including implications of policy and contractual changes for whole system financial performance.

National role

• Manage financial systems, including interface between primary care systems and ledgers.
• Set national financial framework for the commissioning of vaccination services, including payment terms and pricing.
• Set ICB financial allocations for vaccinations.
• Negotiate and agree the overall budget for vaccination services.
• Co-ordinate financial impact assessment for JCVI programme changes and new service specifications.
• Consolidate ICB financial plans and reporting and generate national financial reporting.

Clinical advice and quality

ICB role

• Hold providers to account for delivery of safe, high-quality care, continuous improvement and meeting national standards and guidance for safety and quality.
• Set up appropriate governance to oversee the quality of ICB vaccination services, including ensuring appropriate clinical and public health leadership, and supporting the DPH independent scrutiny function.
• Ensure processes are in place to identify, escalate and mitigate quality issues and report SUIs.
• Authorise PGDs.
• Respond to and record provider immunisation queries, escalating these appropriately as required.
• Support public health prioritisation of service delivery based on latest clinical and epidemiological expertise.
• Identify clinical expertise to support local responses to vaccination incidents and outbreaks.
• Manage vaccine-related incidents and cold chain breaches, escalating these appropriately as required.

Regional role

• Support response to vaccination SUIs and complex enquiries where required.
• Identify appropriate clinical governance where services are provided across ICBs.
• Share learning and advice.

National role

• In collaboration with UKHSA, define quality and safety standards for vaccination services ensuring these are updated and able to be applied operationally.
• Share learning with regional teams on issues identified nationally.
• Manage the relationship with external bodies including NICE, charities, MHRA, JCVI and royal colleges.

Digital services, data and analytics

ICB role

• Help providers manage transition to national digital services, including alignment of local and national booking services where appropriate.
• Ensure an effective and comprehensive call recall approach is in place linking with providers, regional and national teams to coordinate across all programmes.
• Use data and insight to identify population needs to inform commissioning approaches.
• Ensure providers use nationally commissioned point of care data recording systems to capture accurate vaccination data, and support improvements in the quality of data collected.

Regional role

• Engage in the national development of digital services to ensure that these meet and support the oversight and information required to discharge regional functions.

National role

• Develop a vaccination data record to provide timely, accurate data across all vaccs programmes and enable nationally-consistent invitations/bookings.
• Provide a ‘Record a Vaccination’ service for all vaccs, increasing automation and offline recording.
• Develop the NHS App to support vaccination services including booking.
• Develop a national data reporting system, including data receipt, processing, reporting and analytics.
• Include vaccination in wider NHS England and government data strategies.

Vaccine supply

ICB role

• Align commissioned vaccination service models with nationally procured vaccine supply using the relevant system.

Regional role

• Support direction of vaccine supply as required.

National role

• With DHSC and UKHSA co-design future models of procurement and supply of vaccines to support ICB commissioning and contracting.

Incidents, VPD outbreaks and surge

ICB role

• Develop a robust, multi-agency plan for vaccination delivery in outbreak/surge situations, aligned to wider EPRR processes and with clear leadership, clinical public health expertise and governance.
• Advise and co-ordinate providers in the effective management of incidents.

Regional role

• Ensure arrangements within the region enable ICBs to access public health expertise, technical advice and guidance where required in the management of outbreaks, surge, cold chain issues and incidents.
• Share learning from incidents.
• Lead the response to outbreaks or incidents where this is required.

National role

• Ensure service specifications and guidance set out requirements for outbreak response in collaboration with UKHSA.
• Maintain the ability to direct vaccination deployment where necessary.
• Provide IMT coordination where this is on a cross-regional or pandemic scale working within other EPRR processes, and collaborating with other organisations and government departments.

Communications

ICB role

• Plan and deliver system, neighbourhood or place-based communication campaigns, aligned with regional and national activity, to help local populations understand how they can access vaccination, and build trust and confidence.
• Cascade communications to ICB vaccination provider networks.

Regional role

• Co-ordinate region-wide communication campaigns where necessary, aligning with national activity and supporting ICBs to reach their populations.
• Cascade national communications and respond to ICB enquiries.

National role

• In partnership with DHSC and UKHSA, run national communication campaigns where required to support increases in uptake and coverage or address outbreaks.
• Cascade national communications and respond to enquiries from regions and ICBs.

Publication reference:  Public Board paper (BM/25/07(Pu)