Executive summary
This paper is for the Board’s information only to provide an overview of the Delegation of NHS England Direct Commissioning Functions – Evaluation and Monitoring of Services Directions 2026 (Directions) issued to NHS England in March 2026 by the Secretary of State for Health and Social Care (SoS). These Directions have been issued under section 254 of the Health and Social Care Act 2012 (2012 Act) and section 13ZC and 272(7) and (8) of the National Health Service Act 2006 (the 2006 Act).
The purpose of the Directions is to require NHS England to collect and analyse information from relevant health and care bodies relating to services commissioned by Integrated Care Boards (ICBs), which are direct commissioning functions that have been delegated to ICBs by NHS England under section 65Z5 of the 2006 Act.
Action required
The Board is asked to note the new Directions and the information provided in this Paper regarding their purpose, effect, and requirements.
Background
1. Under section 254 of the 2012 Act, the SoS may direct NHS England to establish and operate a system for the collection or analysis of information. These are functions exercisable in relation to the development or operation of information systems in connection with the provision of health services or of adult social care in England. Under section 13ZC of the 2006 Act, the SoS may give NHS England directions as to the exercise of any of its functions. The Directions are issued by the SoS to NHS England under these provisions and are functions which were transferred to NHS England under the Health and Social Care Information Centre (Transfer of Functions, Abolition and Transitional Provisions) Regulations 2023.
Purpose of the direction
2. NHS England is responsible for making sure that the health services which ICBs commission are safe, effective, delivering value for money and are reducing health inequalities.
3. In May 2022, NHS England set out its plans and roadmap for the delegation of its direct commissioning functions to ICBs (delegated functions). This fulfils the NHS long-term policy ambition of giving ICBs responsibility for managing local population health needs, tackling inequalities and addressing fragmented pathways of care.
4. NHS England retains overall accountability for the discharge of these Delegated Functions and requires the necessary assurances from ICBs that its functions are being discharged safely and effectively. The purpose of the Directions is to require NHS England to undertake the necessary collection and analysis of information relating to the Delegated Functions that will enable NHS England to:
- monitor and evaluate national and local service performance against relevant service specifications to understand whether the commissioned services are achieving the desired aims and patient benefits.
- understand the impact these services have on the wider NHS.
- understand patient pathways and care outcomes to improve the quality and safety of services and reduce health inequalities.
- inform priority setting for the development of new clinical services.
- enable an integrated approach to population health management and facilitate health and care partnerships to design new models of care; and
- enable partnership working with ICBs and support them to monitor the delivery of Delegated Functions within their region, conduct benchmarking, inform decision making and target inefficiencies.
5. The Directions operate as framework directions. This means that they establish a broad purpose for which data is to be collected and analysed and provide for separate requirements specifications to be put in place under the Directions over time relating to different data collections. The requirements specifications contain the detail of individual collections that NHS England will be directed to collect and analyse. Each of the separate requirements specifications will be published alongside the Directions.
6. There are two initial requirements specifications establishing new data collections under the Directions:
a. The Community Pharmacy Clinical Services Dataset – this relates to services provided by community pharmacies such as Pharmacy First, or Blood Pressure Check Service. NHS England will collect and analyse data about the care given to patients when they access community pharmacy services, such as the nature of the consultation, reasons for patient visits, medicines prescribed and referrals to other NHS services such as the patient’s GP, 111 or to Accident and Emergency.
b. The Dental and Orthodontic Activity Dataset – NHS England will collect and analyse data about the care given to patients when they access NHS dental and orthodontics services, such as the type of dental treatment received.
Effect and requirements of the Direction
7. From the 3 March 2026, when the Directions were issued, NHS England has a legal duty to comply with the Directions, which require it to:
a. establish and operate such systems for the collection and analysis of information set out in the published Requirements Specifications to the Directions; and
b. analyse the information collected, including linkage to other data lawfully held by NHS England, as NHS England determines is necessary, to achieve the Purpose.
8. These functions are to be exercised in accordance with the Requirements Specifications. Also, in accordance with the service levels, support and monitoring requirements, and the reporting and governance requirements notified by the SoS in writing to NHS England. The exercise by NHS England of the functions set out in the Directions is also subject to the statutory guidance issued by the SoS to NHS England under section 274A of the 2012 Act: NHS England’s protection of patient data, 23 May 2023 which is guidance that NHS England has a duty to have regard to when discharging its functions under these Directions.
Approval of acceptance of Directions and publication
9. The National Medical Director and the Director of Privacy and Information Governance approved acceptance of the Directions on behalf of the Accounting Officer as set out in the NHS England Scheme of Delegation. The Directions have been published on the NHS England Digital website: Delegation of NHS England Direct Commissioning Functions Evaluation and Monitoring of Services Directions 2026 – NHS England Digital.