Appendices

These appendices form part of the NHS England annual report and accounts 2022-23.

Appendix 1: how we delivered against the government’s mandate to the NHS

The government’s mandate to NHS England sets out the strategic direction of the organisation, describes the government’s healthcare priorities and the contribution NHS England and NHS Improvement are expected to make within the allocated budget, and helps ensure the NHS is accountable to both Parliament and the public.

The 2022/23 mandate was set as NHS services and functions continued to recover from the COVID-19 pandemic. NHS England was asked to prioritise 3 key missions over the course of 2022/23 and extending beyond: the continued COVID-19 response, recovery of the health system and taking forward reform.

In addition, this was a transition year as the Health and Care Act 2022 allowed for NHS England to become legally responsible for the functions carried out by NHS Improvement, NHS Digital and Health Education England. There was also an acceleration to the move to greater partnership working through ICS and ICBs.

This assessment of delivery against the 2022/23 mandate captures our broad assurance of performance as we continue to address the impact of the pandemic and look towards recovery. This follows assessments by policy teams at NHS England and DHSC.

Objective 1: continue to lead the NHS in managing the impact of COVID-19 on health and care

This objective focused on how NHS England should continue to lead in treating patients with COVID-19 or long COVID, delivering COVID-19 vaccinations to eligible patients and preparing for the forthcoming public inquiry into the pandemic.

In July 2022, NHS England published commissioning guidance for adult and children post-COVID-19 services (in accordance with NICE guidelines). Internal assurance returns in January 2023 demonstrated improved delivery against this guidance across all themes of care: access, assessments, rehabilitation and recovery, discharge and review, workforce and wider system support.

Since December 2021, community-based COVID-19 therapeutics have been made available for around 1.5-2.0 million highest risk patients through COVID Medicine Delivery Units (CMDUs). In addition, around 16,000 patients received a COVID-19 antiviral or nMAB treatment in hospital between October 2022 and end of March 2023

NHS England has maintained COVID-19 vaccination for millions of people in England through its booster programmes. Following the September 2022 to February 2023 launch for care homes, health and social care workers and severely immunosuppressed, 17.5 million booster vaccinations were recorded. As of March 2023, 11.5 million autumn booster COVID-19 vaccinations were recorded. A push towards co-administration has been successful, with flu and COVID co-administration significantly increased in the autumn 2023 programme.

The COVID-19 UK Public Inquiry is now ‘live’ and NHS England has been directly disclosing information to it. Preparatory work has largely concluded, with a year-end report provided to the Programme Board in February 2023.

Objective 2: recover, and maintain delivery of, wider NHS services and functions

This objective focused on addressing the impact of COVID-19 on levels of demand and access to NHS services, including elective care, primary and community care, cancer care, screening and vaccination services, mental health services, community support for people with a learning disability and autistic people and dentistry services.

The key targets in the NHS’s Delivery Plan for tackling the COVID-19 backlog of elective care have been met or are on track. The first milestone was met in July 2022 as we eliminated virtually all 104 week waits, while the number of people waiting over 18 months has reduced by more than 90%.

In October 2022, NHS England and DHSC published patient choice guidance to support those waiting for elective care. The My Planned Care platform was also broadened to include postcode search and waiting time information for independent sector provides to allow for easier comparison of local providers.

NHS England has addressed additional demand in primary and community care through recruiting for additional roles in general practice. As of March 2023, there were 29,103 more direct patient care roles in primary care which is 11% above target for March 2024. There are also now more GP appointments nationally than pre-pandemic.

Cancer services have continued to recover with significant progress in reducing the 62-day backlog, meeting the Faster Diagnosis Standard in February 2023 and improving the early diagnosis rate above 57%, our best proxy for clinical outcomes of improved survival.

Recovery is underway for NHS breast, bowel and screening services that were paused or had reduced uptake due to the pandemic. NHS Abdominal Aortic Aneurysm screening programmes and NHS Diabetic Eye Screening services have fully recovered from the pandemic and NHS antenatal and newborn services have remained unaffected.

In 2022/23 the NHS achieved the second highest flu vaccination rates on record, with
21.2 million people vaccinated, compared to a record 22.2 million in 2021/22.

Although there has been some recovery in mental health services, community support for people with a learning disability and autistic people and dentistry services, challenges remain with demand particularly high in these areas.

Objective 3: renew focus on delivering against the NHS Long Term Plan and broader commitments for the NHS

This objective focused on a return to delivering the commitments outlined in the NHS Long Term Plan. It also aimed to embed partnership working through the establishment of ICSs and support timely and safe hospital discharges.

NHS England has supported ICS partners to develop place arrangements and have worked with them to develop meaningful leadership, governance, local shared plans and build sustainable improvement capability.

Discharge delays remain a key issue driven largely by capacity challenges in adult social care. The 100-Day Challenge was launched to drive improvement in discharge, using the 10 best practice initiatives identified by the Discharge Taskforce, to improve in-hospital discharge processes, and has been rolled out to community and mental health trusts.

Objective 4: embed a population health management approach within local systems, stepping up action to prevent ill health and tackle health disparities

This objective focused on how NHS England should support NHS organisations working together with local government and others to identify and meet the needs of their communities through investment in evidence-based prevention programmes.

The NHS Digital Weight Management Programme has been successfully operational since 2021 and yielded 240,000 referrals by March 2023.

NHS England continues to ensure national and local plans are focused on health inequalities and wider determinants of health. Guidance on ICB Joint Forward Plans, published in December 2022, included a section on health inequalities, reinforcing related associated legal duties on health inequalities.

Objective 5: ensure effective NHS leadership, culture, and use of organisational resource to realise the benefits from future structural changes within health and care

This objective focused on the leadership NHS England should give to ICBs and systems to ensure effective use of resources and a positive culture.

The first-ever NHS Long Term Workforce Plan was published in July 2023 with support from the government. Extensive stakeholder engagement was undertaken with very positive feedback overall, including from think tanks, ICSs, Royal Colleges and trade unions. 

NHS England is implementing commitments in the Data Saves Lives strategy, which will increase transparency and ensure clearer public understanding of how data used across the health and care system.

The Children and Young People’s Transformation Board is now well established and published the Core20PLUS5 for children and young people in December 2022, providing a framework for how ICBs can reduce health inequalities.

Finally, the ‘Creating the New NHS England Programme’ established and delivered the successful merger with NHS Digital in January 2023 and Health Education England in April 2023. To support the smooth transition of the merger, partnership arrangements with Health Education England and NHS Digital were established to enable joint planning across the 3 organisations.

Appendix 2: meeting our Public Sector Equality Duty

The Public Sector Equality Duty (PSED)[1] is a duty of due regard. In meeting the PSED (the Equality Act 2010), NHS England hopes to drive strategic and demonstrable equality improvements by reference to the nine protected characteristics in the Equality Act 2010[2] for the people we serve, the people that we employ and in the exercise of our broader activities and functions. Detailed information on the purpose of the PSED and the Specific Equality Duties (SEDs) is provided in NHS England’s Specific Equality Duties Review Report[3] (see chapter 1.2 and Appendix 1).

2022/23 was a year of major change for the NHS with the passage and implementation of the Health and Care Act 2022, the establishment of ICBs, the creation of the new NHS England and the end of a number of separate NHS statutory bodies. There was significant complexity during 2022/23 which impacted on how NHS England addressed its responsibilities under the PSED and the specific equality duties (SEDs) because of the changes to the functions of NHS England.

The review report

In May 2023, NHS England’s Board considered a detailed report that assessed key progress made against the equality objectives and targets that we set for NHS England and NHS Improvement for 2022/23. The full review report 2022/23 is located on the NHS England’s website.[4] This review report provides wider equality information, as of March 2023, as required by the Specific Equality Duties (SEDs). It also addresses the SED reporting requirements placed on NHS Improvement between April and June 2022 before its dissolution. This review informed the revision of our equality objectives and targets for 2023/24 and 2024/25.

Part 1 of this report explains the changing context within which the new NHS England is now functioning and what reporting is covered by this report. Part 2 provides a summary assessment of our performance against our 8 equality objectives and the associated targets set for 2022/23.

Part 3 provides broader equality information looking at NHS England’s 2022/23 business plan priorities and key national equality programmes. Part 4 provides key employment statistics for 2022/23 for NHS England looking at the protected characteristics on which employment data is gathered on the NHS ESR and part 5 provides key employment statistics for April to June 2022 for NHS Improvement, prior to its merger with NHS England, again looking at the protected characteristics on which employment data is gathered on ESR.

The report has 3 supporting appendices. Appendix 1 provides information of the PSED and SEDs. Appendix 2 provides information on the health inequalities duties and appendix 3 provides a list of key acronyms.

The engagement work undertaken in 2022/23

In May 2023, NHS England’s Board also considered and approved the publication of an engagement report. The full engagement report 2022/23 is located on NHS England’s website.[5]

This engagement report reflects on the consultation and engagement carried out by NHS England during 2022/23 to inform the development of the equality objectives and targets for 2023/24 and 2024/25. Part 1 of this report, the overview, explains the purpose of the report, how this report builds on the last report to the Board on engagement and explains with whom NHS England engaged. Part 2 identifies key themes from the engagement and how we are addressing these.

There are 3 annexes to this report. Annex A identifies overall feedback on the equality objectives and targets and some wider issues and questions beyond the scope of the PSED/SED. Annex B analyses the feedback received via a questionnaire sent to Equalities and Health Inequalities Network, a network hosted on the NHS Future website. This also provides information on the respondents. Annex C provides a condensed version of the rich feedback we received from the NHS England patient and engagement forums.

Appendix 3: reducing health inequalities

Our work to reduce healthcare inequalities in 2022/23 sought to focus system efforts to narrow the gap and strengthen accountability and capability, building on learning from the pandemic.

Our strategic approach to reducing healthcare inequalities

The pandemic highlighted the urgent need to prevent and manage ill health, particularly in groups that experience the worst outcomes. To help achieve this, ICSs were asked to focus on 5 priority areas for tackling healthcare inequalities in the first half of 2021/22, continued into 2022/23:

  • priority 1: Restore NHS services inclusively
  • priority 2: Mitigate against digital exclusion
  • priority 3: Ensure datasets are complete and timely
  • priority 4: Accelerate preventative programmes that proactively engage those at greatest risk of poor health outcomes
  • priority 5: Strengthen leadership and accountability

Framework for action – Core20PLUS5 approach

Core20PLUS5[6] is our approach to help reduce healthcare inequalities at both national and system level. It defines a target population comprising the most deprived 20% of the population (the Core20) and other population groups identified by local health data such as ethnic minority communities (PLUS groups). It sets out 5 clinical areas of focus:

  • early cancer diagnosis (screening and early referral)
  • hypertension case finding
  • chronic respiratory disease (driving COVID-19 and flu vaccination uptake)
  • annual health checks for people with serious mental illness
  • continuity of maternity carer plans

We recruited 132 Core20PLUS ambassadors (people working in the NHS) to promote reduction of inequalities for all, particularly groups likely to experience health inequalities such as communities in deprived areas.

7 accelerator sites were launched by the Core20 PLUS Collaborative to progress the 5 clinical areas of focus with locally identified populations. The collaborative brings together strategic partners and experts to reduce and prevent health inequalities.

The Core20PLUS Connectors programme has 24 connector sites across the 7 NHS regions. We recruited 350 connectors with 50 Voluntary, Community and Social Enterprise (VCSE) or Healthwatch delivery partners to influence and engage local people on how to overcome barriers to accessing services.

Work continues to agree Core20PLUS5 indicators and improvement goals with national clinical programmes.

Governance

The programme continues to host governance and accountability mechanisms for engaging with national, regional and local stakeholders on healthcare inequalities. Systems are in place to receive updates on the Health Inequalities Plan and its alignment with wider ICS plans in development, tackling health inequalities in urgent and emergency care, national digital channels and reviews of the whole sickle cell disease pathway. We continue to engage senior responsible owners for healthcare inequalities in ICSs and trusts to share learning and innovation.

Priority 1: restore NHS services inclusively

We published case studies with practical actions that can be taken across the care pathway to help trusts deliver an inclusive recovery. We have published case studies[7] on board performance reporting, including waiting list data, to show how different trust types are presenting and using their data to address health inequalities. This was completed by April 2023 following a peer learning event with NHS providers and co-design with the provider public health network.

Priority 2: mitigate against digital exclusion

The framework for NHS action on digital inclusion sets the vision for digital participation in healthcare and reflects on opportunities and risks as the system undergoes major digital transformation.

Priority 3: ensure datasets are complete and timely

Robust data enables the NHS to understand more about the populations we serve, helping to ensure equitable access, excellent experience and optimal outcomes for all. The Health Inequalities Improvement Dashboard[8] provides insights for tackling health inequalities across our 5 priority areas in the 2023/24 planning guidance[9] and the 5 clinical areas of the Core20PLUS5 approach.

The dashboard is complemented by the priority neighbourhoods for unplanned hospitalisations dashboard, the actionable insights tool and the PCN dashboard. These are designed to drive improvement for populations with the poorest access, experiences and outcomes of healthcare.

During the year, our healthcare inequalities data tools and products were improved through quality assurance and user testing. This helped users interpret the dashboards and create strategies for improvement at ICS and PCN level for cancer and respiratory disease.

Priority 4: accelerate preventative programmes that proactively engage those at greatest risk of poor health outcomes

The Core20PLUS5 approach was adapted in November 2022 to apply to children and young people[10], defining a target population and identifying five clinical areas requiring accelerated improvement: asthma, diabetes, epilepsy, oral health and mental health.

Five new e-learning modules were launched to help implement Core20PLUS5, covering narrowing health inequalities in hypertension, early cancer diagnosis, chronic respiratory disease, maternity, and severe mental illness. The modules are available free on the Health Education England e-learning platform.[11]

A unique collaboration between the Accelerated Access Collaborative, our National Healthcare Inequalities Improvement team and academic health science networks working with their ICSs was developed to adopt and spread evidence-based innovations (medicines, medical devices, diagnostics and digital technologies) in the 5 clinical areas outlined in Core20PLUS5. 38 ICSs were selected and supported with funding to work on 39 innovation for health inequalities programme projects.

Priority 5: strengthen leadership and accountability

In 2022, we commissioned the University College London Institute of Health Equity to review accountability mechanisms for health inequalities, undertaking an evidence synthesis and interviews with 17 system leaders and academics to better understand barriers, challenges and opportunities for holding systems to account for measurable improvements in health outcomes. The research will inform the development of practical tools, approaches and resources for accountability mechanisms for health inequalities, in line with our operating framework.

With the NHS Confederation, we co-designed webinar master classes and a board assurance tool for non-executive directors and chairs in systems and trusts, to equip them to better understand the impact of health inequalities in service delivery. 

In response to the NAO report on managing NHS backlogs and waiting times[12], a draft health inequalities elective recovery data strategy was developed with the relevant data planned for publication by March 2023. The strategy includes a roadmap for engagement and routine reporting of health inequalities data across elective care workstreams.

The NHS Long Term Plan makes the case for stronger action on health inequalities to drive fairness and improved population health outcomes, and it outlined a more concerted and systematic approach to reducing health inequalities and addressing unwarranted variation in care.​ Our expectations for health inequalities set out in the planning guidance contribute towards a more systematic approach across the NHS. Our policy documents published in 2022 and early 2023 build on this aim, including the NHS Standard Contract[13], urgent and emergency care recovery plan[14] and PCN Direct Enhanced Service for tackling neighbourhood inequalities.[15]

We continued to support and hold leaders to account through quarterly regional stocktake meetings, influencing and driving national funding for targeted health inequalities improvement and developing collaborative networks such as the emerging leaders’ network. This network is aimed at clinical fellows, clinicians, allied health professionals and managers in training or developing their careers who have an interest in leadership and health inequalities.

As part of our commitment to provide strategic direction and influence action, we initiated a programme on the sickle cell disease clinical pathway to improve the quality of care and ultimately outcomes. A ‘Can you tell it’s sickle cell?’[16] campaign was part of a drive to improve sickle cell care across the NHS. A phase one review was completed with recommendations to improve the pathway grouped into 10 themes. A phase 2 review has begun.

We launched an e-learning course providing ‘An introduction to inclusion health’ with the Royal College of General Practitioners, to help people understand what inclusion health is, the factors driving social exclusion and the actions to improve access to services and care for people from inclusion health groups.

The Health Anchors Learning Network (HALN)[17], hosted with the Health Foundation and now in its second year, reached 1,600 members. We invested in 5 trusts through test and learn grants for HALN members.[18] HALN played a significant role in innovating and spreading practice, increasing the NHS’s contribution and impact on social and economic development and benefiting communities, particularly those that experience inequalities.

We developed a communications and engagement toolkit[19] to improve reach into socio-economically deprived areas and worked with stakeholders to publish guidance for NHS estates and facilities staff[20] on reducing health inequalities.

To build capability for action on health inequalities, we hosted 5 Core20PLUS5 webinars, jointly delivered the Royal Society of Medicine’s Tackling Inequalities Conference on 11 January 2023, made several educational films to raise the programme’s profile and supported 238 speaking engagements to embed action and share messages. 

Appendix 4: working in partnership with people and communities

In 2022/23, our work continued to focus on using the learning from the pandemic to support health and care services to take a more community-centred approach in how they work with people and communities.

In July 2022, we published new statutory guidance for ICBs, NHS trusts and foundation trusts on working with people and communities. This guidance aligns with the changes in the Health and Care Act 2022 and supports ICSs to develop effective approaches to working with people and communities. We set up a network of ICB engagement leads that met regularly in the year to help them embed the principles and approaches of the guidance in their systems, provide peer support and share effective practice. We worked with ICBs, Healthwatch England and other partners on the new assurance process for how ICBs apply the guidance, which forms part of the 2022/23 ICB annual assessment.

We finalised the review of the NHS England patient and public participation policy, undertaking extensive engagement with stakeholders throughout the year. The policy forms part of our established process for ensuring and assuring consideration of our duty to involve the public in commissioning (section 13Q of the NHS Act 2006 (as amended)). In March 2023, the Strategy Performance and Investment Committee considered the ‘public participation dashboard’, which offers an overview of practice including commentary on the section 13Q duty.

We supported and advised professionals working across health and care to ensure public participation is embedded into ways of working. This included delivery of 80 online training and learning sessions accessed by 2,900 individuals. Internally this included assuring NHS England’s duty to involve the public in commissioning (section 13Q of the NHS Act 2006). Additionally, we ran our bi-annual Engagement Practitioners Network event, #StartWithPeople. More than 3,000 people signed up to attend our 3 1-day virtual events held in April 2022, November 2022 and March 2023, covering more than 80 sessions.

In March 2023, we launched our new Working with People and Communities to Improve Health Outcomes course on FutureLearn. So far more than 900 people have taken part, and the course is now available on demand, so we expect many hundreds more to do so over the next 12 months.

We have worked with ICBs throughout the year to build a strong network of those leading work with people and communities. The group supports leads in their roles to embed the statutory guidance at ICB level as well as ensuring a regular flow of communication and insight.

We continue to build our internal network of engagement and equality champions and provide them with support and resources to fulfil their role. The champions are senior leaders who promote the benefits of our approach and embed the practice of working with people and communities in their directorates and regions.

Maximising the impact of NHS volunteers and the VCSE sector

We continue to support NHS volunteers and the wider VCSE sector to undertake activities which benefit our patients and staff. This year we have seen, for example, thousands of NHS Volunteer Responders and other volunteers contribute to the smooth-running of COVID-19 vaccination sites.

The NHS Volunteer Responders programme was originally established as a COVID-19 response, delivering more than 2.5 million tasks, and attracting many new volunteers. We commissioned a development of this programme to enable volunteers to support emerging priorities across both health and social care, as well as to retain a bank of volunteers who can be activated rapidly if required in potential future emergency situations.

The VCSE sector’s reach into diverse communities makes it a key partner in our drive to reduce health inequalities and we continue to work with our sector partners and with DHSC and UKHSA in the Health and Wellbeing Alliance. This enables health and care decision-makers to hear the views of communities which experience the greatest health inequalities, leading to inclusive policies and services. To strengthen the voice of VCSEs at system level we continue to support and develop the VCSE Alliances which are embedded within every ICS.

The sector’s impact was particularly clear this winter when we used our existing networks with charities that work with children and families to raise awareness of the unexpected national outbreak of Group A Streptococcus and influenza among children. This included the distribution of essential health information in a range of accessible and translated formats.

The added value that the sector can bring in supporting the NHS during times of additional pressure was amplified during the pandemic. We commissioned a multi-year ambulance auxiliary contract with St John Ambulance to provide additional emergency ambulance support at times of high demand and a consortium led by British Red Cross to support people who are medically fit for discharge to receive support to return home from hospital, and provide other practical assistance, thus reducing avoidable readmissions and reducing length of hospital stay. The success of this in demonstrating the role that voluntary sector organisations can play in supporting hospital discharge led to many local areas commissioning their own home-from-hospital provision.

Looking to the future, we drew on the experience of a wide range of VCSE sector and health leaders to make it easier for people from all groups and communities to volunteer within the NHS. This NHS Volunteering Taskforce made four strategic recommendations which we will publish during 2023/24, along with our initiatives to achieve them.

Supporting PCNs to work with people and communities

The PCN people and communities workstream continued to build on the previous years’ work to trial various involvement approaches through our test and learn sites. This included sharing the learning from those sites and building capacity and confidence around using community-centred approaches. We worked with an organisation, ‘Better Ways’, to explore how we can build a ‘connecting the connecters’ network. We also worked with New Local, which is undertaking research to explore the impact of using community-centred approaches to support and develop communities at a PCN level.

We continue to learn from the work at Central Liverpool PCN.[21] With the support of CoCreate[22], it set out to develop sustainable engagement approaches to tackle racial health inequalities. The evaluation of the project[23] shares its approach and reflections from some of the clinicians involved. Morecambe Bay has also looked into how it can address local health inequalities through community engagement.[24]

Working in partnership with the National Association for Patient Participation, the Patients Association, Co-create, Healthwatch England and the NHS Confederation, we continue to use the widening participation animation[25] and a FutureNHS[26] site to support and widen the reach of the patient participation groups (PPGs). There is a particular focus on encouraging practices to understand and reach out to their whole populations, including those people they are not connected with. We created a PPG Champions Group to support and influence PPG members towards community-led approaches and created an FutureNHS space for sharing good practice.

Access to employment – supporting people with experience of homelessness into healthcare support worker (HCSW) roles

Working with Pathway[27], Groundswell[28] and the Royal Society for Public Health[29], we are addressing some of the systematic and individual barriers to employment. To achieve this, we worked with trusts to examine culture, employment practices and readiness to adopt ‘trauma informed’ employment practice – which can help recruit people with a lived experience of homelessness into employment as HCSWs.

By early 2022/23, across 4 trusts, 11 people were offered HCSW roles, and another trust is in the application process.

The project was a success from the trusts’ perspective, with many changing their procedures. Pennine Care[30] developed a leaflet describing how it would support people and eliminated the need for complex application forms, helping people to apply with a short CV. These approaches have been shared across all the trusts involved.

Based on this success, the 3 organisations involved are developing a model which could be commissioned by trusts in the future; with commitment from at least 2 trusts to have a regular cycle of recruitment for people who have experienced homelessness.

Work with young people

Through the ongoing development of the NHS Cadets[31] programme we enabled more than 3,000 14 to 18-year-olds to volunteer in health and care. NHS Cadets aims to recruit young people from deprived communities and under-represented groups. The Cadets have been developing their first aid, mental health, leadership and communication skills, and volunteering with the aim of considering a career in health and care. The programme is run in partnership with St John Ambulance.

We continued to work with the Pears #IWill Fund to embed youth volunteering in 32 NHS trusts. In May 2022 IVAR published ‘The power of youth volunteering’[32] to share learning and best practice from this project with a wider audience.

We trialled a Young People’s Health Challenge to inspire 7- to 14-year-olds from deprived communities and underrepresented groups to consider NHS volunteering and act as a forerunner to NHS Cadets. We worked with 195 young people across 19 pilot sites to co-develop an open access Health Challenge toolkit. This will connect local youth organisations to the NHS and help to reduce health inequalities by supporting children and their families to gain a better understanding of the NHS and of self-care. The programme is run with Barnardo’s and the Royal College of Paediatrics and Child Health.

The long-established NHS Youth Forum continued to meet regularly, both online and through attending two weekend residentials. Run in partnership with the British Youth Council, the Forum consists of 25 young people from across the country. In 2022/23, it worked on 4 youth-led projects, exploring the following themes:

  • young people and health information: What do young people think of the NHS’s Instagram and wider social media output? Where do young people go to find health information? And what can be done to make that information more accessible?
  • barriers to accessing healthcare: How do health inequalities affect young people, and how easy is it for them to get information to help them access healthcare? What do young people think of waiting lists and their impact? And how could staff training help remove barriers to healthcare?
  • NHS App and digital services: How do young people use the NHS App? What about the design of it and the user interface? How could the app be used as an appointment booking service?
  • improving mental health services: How do young people’s experiences of mental health services differ across the country? Where are the examples of best practice? How can those services be used as models to improve mental health services across the country?

Through surveys, hundreds of other young people contributed their thoughts and ideas, culminating in further engagement at the NHS Youth Summit in February 2023. The findings and recommendations for each project will be produced as an end-report.

A Youth Advisory Network was established, advising on a wide range of topics with programme and policy leads, such as:

  • managing conflict in healthcare settings
  • stopping smoking and vaping
  • connecting care for children, the ‘Own it’ project – looking at young people having ownership of their healthcare

The Young Carers Health Champion programme was established in 2015 to enable young carers to participate in planning and developing young carer friendly services aiming to support service change through young carer voices. In 2022/23 the eighth cohort of 16 young carers focused on using social media to promote the top tips for GPs and the new cluster of Systematized Nomenclature of Medicine Clinical Terms codes for identifying unpaid carers of all ages.

Working in partnership with parents and carers of young people

The #Gettingthrough the First Few Days (published in 2021/22) set out important information family members need when their child or young person has been admitted to a Child and Adolescent Mental Health Service (CAMHS) inpatient unit.

These guides have been highlighted in our Tier 4 CAMHS service specifications and the Royal College of Psychiatrists’ quality network standards.

The guides were formally launched in June 2022 at the Royal College of Psychiatrists’ Quality Network for Inpatient CAMHS and have been distributed to all inpatient units, with webinars delivered in October to address any questions relating to implementation.

Working in partnership with carers

The Commitment to Carers programme worked towards formalising and improving carer data collection and coding, essential to track progress against NHS Long Term Plan deliverables. This will feed into system learning and transformation processes. The programme continues to gain insight and strength from the biannual System Maturity Matrix assessment which for quarter 4 2022/23 included 90% of all ICSs. This gives us a clear view of progress on the Commitment to Carers agenda across 8 component themes and is shared with our oversight group.  

Engagement with the carer agenda on hospital discharge encouraged conversations and collaborative working between health, social care and voluntary sector organisations to improve outcomes for carers. Progress is being maintained around introduction of quality markers and carer champion approaches alongside resource pack and staff training initiatives. Building on our success in 2022/23 in gaining access and providing assurance for the Better Care Fund (BCF) carer narrative plans, the latest BCF policy framework and planning guidance for 2023-25 provides further opportunities to improve transparency of spend and collaborative working for the benefit of carers. The impact and reach of our Mind the Gap projects continue to gain plaudits and is building evidence of sharing best practice. Use of our FutureNHS platform (open to NHS and other organisations) is growing for all our programmes, supported by our social media work.

Working with leading national charity Carers UK in 2022/23 we gave all unpaid carers in England free access to Carers UK Digital Resource for Carers, an online platform hosting information and advice for carers to help them build resilience in their caring role, including a contingency planning tool. This means that staff have practical support to offer carers once they have been identified. We co-produced guidance for professionals to help them make this support offer available.

‘This May Help’ films

Gary Lineker, Myleene Klass and Tanni Grey-Thompson are among the 16 presenters helping raise awareness for This May Help. This is a national initiative providing mental health advice to parents and carers, jointly launched by NHS England (Children and Young People’s Mental Health Quality Taskforce and Public Participation Team) and Bradford District and Craven Health and Care Partnership.

The website gives easy-to-follow advice to help families manage their child’s mental health. This advice has been developed by NHS professionals and parents who have been through their own child’s mental health journey. Parents and carers have shared advice that helped them and that may also help other families. Professionals who work with children are also encouraged to use the website.

Networks and forums

Across the organisation, we run a wide range of forums, advisory groups and sounding boards, involving people from different communities and health interests. These include the Learning Disability and Autism Advisory Group, the NHS Youth Forum, the Older People’s Sounding Board, the LGB Sounding Board, the Adult Mental Health Advisory Network and more.

A key forum is the NHS Citizen Advisory Group (detailed in the diagram below), which brings together patient and public voice partners from across the forums. It champions appropriate, effective and meaningful participation, including identifying good practice and opportunities for improvement.

Meeting bi-monthly throughout the year, the NHS Citizen Advisory Group provided constructive challenge and feedback on areas such as NHS England’s equality duties; the NHS Long Term Plan; the revised public participation policy; and engagement within mental health programmes.

Learning Disability and Autism Advisory Group and Forum

The Learning Disability and Autism Advisory Group continued to advise on changes which affect autistic people and people with a learning disability. In 2022/23 the group has advised on:

  • ways that GPs can support people with a learning disability and autistic people get the healthcare they need through development of autism registers and learning disability annual health checks
  • mental health services in the community and from GPs
  • crisis support in the in the community
  • NHS England’s equality objectives
  • making conversations in primary care more compassionate (to support the reducing violence work)
  • sharing GP records on the NHS App, after safeguarding issues had been raised
  • shaping work to improve quality of inpatient mental healthcare

The work with the wider Learning Disability and Autism Forum was mainly through social media with examples of great practice shared during Learning Disability Week – promoting lifesaving practice and reasonable adjustments in healthcare. In Autism Awareness Week we raised awareness of work to improve health outcomes for autistic people. Several consultations were shared, accessibly, with the Forum – including the special educational needs paper, the Down Syndrome paper and the public participation guidance for ICSs. Great feedback was received about the work to promote reasonable adjustments in cancer screening during cervical screening week. Through the forum we encouraged people to talk to health staff if they had worries about cancer screening and encouraged staff to make reasonable adjustments. We also encouraged people with a learning disability to access primary care services, post-COVID-19, with an easy read newsletter.

Learning Disability Employment Programme

The Learning Disability Employment Programme was launched in 2015. In 2019, the NHS Long Term Plan committed to improving the number of supported internship opportunities in the NHS workforce for young people with a learning disability and autistic people as a key route to employment. In quarter 1 of 2022/23, we continued to encourage the development of local and national solutions to improve the equality prospects and outcomes of these young people through meaningful employment in the NHS.

One important step towards achieving this ambition was the launch of the Pan-London Supported Employment Board in June 2022. This board is co-chaired by Jane Clegg, Chief Nurse for London, and Mayor Rokhsana Fiaz, London Borough of Newham. Consisting of senior leaders from across the capital and national bodies, the board’s aim is to develop a shared, ambitious vision for London for making employment a realistic opportunity for all young people with disabilities, with a particular focus on those with learning disabilities and autistic people. During 2022/23 and beyond, the board was tasked with agreeing and setting out a 3-year strategic plan to drive this ambition.

In relation to developing supported internship programmes, critical engagement work with trusts continued in quarter 1 through our delivery partner DFN Project SEARCH to secure agreement to begin up to 38 new supported internship programmes between the autumn 2023 and 2024. This will support rebuilding opportunities for young people with a learning disability and autistic people, following the devastating impact of the pandemic.

Appendix 5: sustainability

Scope

All reporting in this section covers NHS England, NHS Improvement and the CSUs. Each trust and ICS will have its own Green Plan and will report its sustainability performance separately. Sustainability across the wider NHS continues to be led by the Greener NHS.

Summary

We continue to be committed to the Greening Government Commitments and to the Greener NHS commitment to be a net zero health service by 2040. In May, the Board approved our 2022-25 Green Plan for NHS England, which outlines the carbon reduction milestones we aim to reach as we progress to net zero. Measured from a 2017/18 baseline, we aim to achieve the following reductions in greenhouse gas emissions:

  • 44% by 2025
  • 80% by 2028
  • net zero for the emissions we control by 2040
  • net zero for the emissions we influence by 2045

Each CSU will have its own Green Plan and while their targets may vary, they will continue to be included in the figures reported in this sustainability report.

Consumption and emissions related to energy use across our corporate estate reduced this year compared with last. Levels of business travel and related emissions have increased after two years of limited travel, which has resulted in higher emissions overall. Our greenhouse gas emissions are currently below the levels we’d hoped to have by 2025 and are at a similar level to the target we aim to achieve by 2028.

We are also making good progress with moving our salary sacrifice car fleet to zero-emissions at the tailpipe and with reduced water consumption.

Areas for focus in the future include removing consumer single use plastics (CSUP) from our estate, improving the recycling rate and better provision of good quality data. We plan to include more categories in future reporting, and we are considering the inclusion of homeworking emissions and those related to commuting.

Reporting for multi-occupancy buildings

We are reporting on the proportion of the NHS PS buildings occupied by NHS England and NHS Improvement and CSUs. Where we are a tenant of a government department, energy, waste and water information will be reported in its annual report and published on its respective websites.

Provision of data

NHS PS is the landlord for most NHS England and NHS Improvement and CSU offices, and we rely on it for the provision of utilities and waste data. The energy and water data provided for this financial year comes with the following guidance from NHS PS:

  • all waste costs for quarter 1 2022/23 were estimated based on average tariffs
  • all water usage and cost were estimated
  • all electricity, gas, water, and waste were apportioned by floor area by occupant
  • where utilities information was unavailable, it was estimated based on the averages for the rest of the estate

ICT waste data was unavailable for this report. Although we are unable to report on the amount of waste per category, we are confident that our processes align to the requirements of the Government’s ICT and Digital Services Strategy. The provision of this data for future reports remains a priority.

Mitigating climate change: working towards net zero by 2040

2021-25 GGCs headline target:

Reduce the overall greenhouse gas emissions from a 2017/18 baseline and reduce direct greenhouse gas emissions from the estate and operations from a 2017/18 baseline.

2021-25 GGC sub targets:

Reduce the emissions from domestic business flights by at least 30% from a 2017/18 baseline and report the distance travelled by international business flights.

Contextual information

 

 

2019/20

 

2020/21

 

2021/22

 

2022/23

Net internal area reported in m2

 

73,942

 

68,016

 

56,347

 

47,658

WTEs reported

 

15,408

 

15,801

 

16,318

 

18,575

Greenhouse gas emissions (figures have been rounded to the nearest whole number)

Scope 1 emissions tCO2e

 

2019/20

 

2020/21

 

2021/22

 

2022/23

 

Change from baseline

Emissions from organisation-owned fleet vehicles

 

243

 

57

 

14

 

53

 

 

Gas

 

2,034

 

936

 

1,005

 

823

 

 

Total Scope 1* (tCO2e)

 

2,277

 

993

 

1,018

 

876

 

-67%

* Scope 1 emissions arise from organisation owned and operated vehicles, plant and machinery.

Scope 2 emissions tCO2e

 

2019/20

 

2020/21

 

2021/22

 

2022/23

 

Change from baseline

Electricity

 

2,892

 

1,592

 

1,273

 

807

 

 

Total Scope 2* (tCO2e)

 

2,892

 

1,592

 

1,273

 

807

 

-88%

* Scope 2 emissions arise from the consumption of purchased electricity, heat, steam and cooling.

Scope 3 emissions tCO2e

 

2019/20

 

2020/21

 

2021/22

 

2022/23

 

Change from baseline

Road travel

 

2,851

 

465

 

375

 

863

 

 

Rail travel

 

1,418

 

50

 

162

 

626

 

 

Domestic air travel

 

32

 

1

 

2

 

16

 

 

International air travel

 

55

 

2

 

2

 

16

 

 

Total Scope 3* (tCO2e)  

 

4,356

 

519

 

541

 

1,522

 

-73%

Total (tCO2e) 

 

9,524

 

3,104

 

2,833

 

3,205

 

-79%

* Scope 3 emissions arise from official business travel by vehicles not owned by the organisation.

Scope 1 related use

 

2019/20

 

2020/21

 

2021/22

 

2022/23

 

Change from baseline

Scope 1 business travel (km)

 

1,346,591

 

364,503

 

83,520

 

301,497

 

-83%

Gas (kWh)

 

11,062,757

 

5,089,362

 

5,486,632

 

4,507,467

 

-59%

Scope 1 business travel (cost)

 

£367,840

 

£26,984

 

£24,044

 

£119,867

 

 

Gas (cost)

 

£410,829

 

£161,714

 

£192,395

 

£202,532

 

 

Air travel

Domestic air travel

 

 

2019/20

 

2020/21

 

2021/22

 

2022/23

Number of domestic flights

 

913

 

20

 

40

 

255

International air travel

 

 

2019/20 (km)

 

2020/21 (km)

 

2021/22 (km)

 

2022/23 (km)

Short Haul International Unknown

 

0

 

0

 

0

 

0

Short Haul International Economy

 

233,989

 

13,647

 

13,402

 

65,690

Short Haul International Business

 

444

 

0

 

0

 

0

Long Haul International Average

 

0

 

0

 

0

 

0

Long Haul International Economy

 

320,294

 

10,168

 

10,535

 

72,227

Long Haul International Premium Economy

 

0

 

0

 

0

 

0

Long Haul International Business

 

11,819

 

0

 

0

 

0

Long Haul International First

 

0

 

0

 

0

 

0

International (non-UK) Unknown

 

0

 

0

 

0

 

0

International (non-UK) Economy

 

0

 

0

 

0

 

0

International (non-UK) Premium Economy

 

0

 

0

 

0

 

0

International (non-UK) Business

 

0

 

0

 

0

 

0

International (non-UK) First

 

0

 

0

 

0

 

0

Car fleet

2021-25 GGC sub-target:

Meet the government fleet commitment for 25% of the government car fleet to be ultra-low emission vehicles232F[48] by 31 December 2022, and 100% of the government car and van fleet to be fully zero emission at the tailpipe by 31 December 2027. This commitment covers vehicles which are leased by employees through the employer’s salary sacrifice scheme.

Vehicle emissions

We have exceeded the target for 25% of fleet vehicles to be ultra-low emissions, having met the target before 2019, and are on track for 100% of fleet vehicles to be zero emissions at the exhaust pipe by 2027.

Minimising waste and promoting resource efficiency

2021-25 GGC headline target:

Reduce the overall amount of waste generated by 15% from the 2017/18 baseline.

Sub targets:

  • reduce the amount of waste going to landfill to less than 5% of overall waste
  • increase the proportion of waste which is recycled to at least 70% of overall waste
  • reduce government’s paper use by at least 50% from a 2017/18 baseline
  • remove CSUP from the central government office estate
  • report on the introduction and implementation of reuse schemes

Minimising waste and promoting resource efficiency

 

2019/20

 

2020/21

 

2021/22

 

2022/23

Total (tonnes)

 

1,440

 

291

 

173

 

263

Recycled (tonnes)

 

1,241

 

177

 

63

 

153

Incinerated with heat recovery (tonnes)

 

190

 

109

 

110

 

110

Incinerated without heat recovery*

 

0

 

0

 

0

 

0

Landfill (tonnes)

 

10

 

6

 

0

 

0

Waste to landfill (%)

 

1%

 

2%

 

0%

 

0%

Recycling (%)

 

86%

 

61%

 

36%

 

58%

Cost of recycling**

 

Not available

 

Not available

 

£31,276

 

£73,552

Cost of incineration with heat recovery***

 

Not available

 

Not available

 

£73,794

 

£70,325

Cost of incineration without heat recovery

 

£0

 

£0

 

£0

 

£0

Cost of waste to landfill****

 

Not available

 

Not available

 

£0

 

£0

Total cost of waste disposal

 

 £199,127

 

 £96,175

 

£105,070

 

£143,876

Paper use (reams)

 

91,153

 

9,826

 

6,035

 

5,106*****

Reduction in paper use from a 2017/18 baseline

 

-26%

 

-92%

 

-95%

 

-96%

Total (tonnes)

 

1,440

 

291

 

173

 

263

Recycled (tonnes)

 

1,241

 

177

 

63

 

153

* This is the first year we have distinguished between waste being incinerated with and without heat recovery.
** Cost of waste disposal for recycling was not provided by our supplier until 2021/22.
*** Cost of waste disposal for incineration with heat recovery was not provided by our supplier until 2021/22.
**** Cost of waste disposal for waste to landfill was not provided by our supplier until 2021/22.
***** This figure has been estimated. Where figures were available, the average was used to estimate missing figures.

Consumer single use plastics

We procured 106,562 items which are defined as consumer single use plastics, according to the Greening Government Commitment definition. This figure was used to estimate the number of items for CSUs; 50,882. This is the first time we have been able to report on CSUP and we will continue to report on this regularly, working with our suppliers to understand what items are being purchased and identify alternatives to reduce levels of CSUPs.

Reducing our water use

2021-25 GGC headline target:

Reduce water consumption by at least 8% from the 2017/18 baseline, with the following sub targets:

  • ensure all water consumption is measured
  • provide a qualitative assessment to show what is being done to encourage the efficient use of water

Reducing our water use

 

2019/20

 

2020/21

 

2021/22

 

2022/23

Water used (m3)

 

54,974

 

15,779

 

24,964

 

21,851

Cost of water used

 

£216,318

 

£33,518

 

£73,169

 

£63,054

Water use continues to be estimated by our head leaseholder, NHS Property Services. Over the last few years, it has worked hard to reduce the number of water suppliers from more than 25 to under 10 at the end of 2021. However, to further improve its ability to manage water supply and consumption across its estate, it is developing a procurement process to select a single national water supplier. This will provide enhanced cost and billing certainty, while improving the metering of water and developing mechanisms to reduce consumption. The selection criteria will also include key requirements around leak detection, usage reporting and net zero commitments strategy.

Based on the estimates we have been provided, water consumption has reduced by 87% from the 2017/18 baseline.

Sustainable procurement

Sustainable Procurement is championed by the Chief Sustainability Officer and the Chief Commercial Officer at a senior level. Oversight is provided by the NHS Sustainability Board.

We continue to follow the NHS Net Zero Supplier Roadmap and related guidance, applying a mandatory minimum weighting of 10% on net zero and social value in all NHS England procurements, as well as require suppliers bidding for contracts with a value of £5 million per annum and more to have a Carbon Reduction Plan, aligned to Procurement Policy Note (PPN 06/21).  Our procurement management system supports sustainability risk assessments and the implementation of the Social Value Model (PPN 06/20).

We continue to encourage suppliers to use the Evergreen Sustainable Supplier Assessment, which is an online tool for suppliers to engage with the NHS on their sustainability journey and understand how to align with the NHS net zero and sustainability ambitions, including those set out in the NHS net zero supplier roadmap.

Reviewing policy compliance informs ongoing training needs and identifies new areas for development. Training is also provided when policy changes are introduced. A review of practice in line with the Commercial Continuous Improvement Assessment Framework also provides support to determine training need.

Adapting to climate change

Business continuity planning is used to approach the management of risks and threats to our organisation. Business continuity management identifies our priorities and prepares solutions to address disruptive threats, including those which may be the result of climate change and extreme weather events.

Reducing environmental impacts from ICT and digital

We maintain the use of ICT equipment for as long as possible. When items become obsolete, we work with other organisations to process our ICT waste responsibly and sustainably. This may be through approved authorised treatment facilities, following waste electrical and electronic equipment regulations or using corporate recycling schemes. All partner organisations operate a zero-waste to landfill policy.

The Greener NHS national programme

The Greener NHS national programme was launched in 2020, alongside the world’s first commitment for a national health service to reach net zero. This programme is important because:

  • climate change threatens the public’s health and impacts on the NHS’s ability to deliver high quality care
  • the NHS’s response to climate change is set to deliver unprecedented health benefits through cleaner air, healthier diets, increased energy security and more liveable communities
  • reaching net zero provides opportunities to reduce long-term running costs for the NHS
  • there is staunch support from the system’s 1.3 million staff, with over 9 out of 10 supporting the NHS’s net zero ambitions.

The Greener NHS national programme is led by the NHS sustainability board. The programme is delivered in the way that is most appropriate and sensitive to each local context by working carefully through the NHS regions and systems.

NHS carbon footprint

The NHS has committed to reducing greenhouse gas emissions under our direct control (the NHS carbon footprint) from 6,100 ktCO2e in 2019/20 to 3,200 ktCO2e by 2028 to 2032 and to net zero by 2040. This trajectory implies a reduction to 5,000 ktCO2e in 2022/23.

Calculated emissions for 2022/23 are 4,550 ktCO2e as shown below. This data, combined with the evidence of action across the NHS as described below, suggests the NHS is on track to meet the target trajectories for the NHS carbon footprint in the coming years, giving confidence in our ability to meet the commitments in 2028 to 32 and 2040.

These figures are based on both actual and forecasted data as at end April 2023, and may be subject to revision as final input data is published. There is therefore some uncertainty in these estimates.

Provisional estimate of the NHS carbon footprint by emissions source

(ktCO2e, rounded to nearest 50kt)

2022/23 emissions

NHS carbon footprint

4,550

Of which:

Estates

2,850

Medicines

1,150

Fleet and business travel

550

This progress is supported by targeted action across the NHS, including the following areas:

Medicines

In recent years, desflurane use has fallen from 20% of all volatile anaesthetics by volume to 3%, and the January 2023 announcement to eliminate desflurane use across the NHS will bring the overall reduction in emissions from desflurane to 40 ktCO2e per year from 2024. Nitrous oxide emissions are estimated to have fallen by over 40 ktCO2e in 2022/23, driven by efforts to make more efficient use of nitrous oxide (improved supply and stock management, enhanced piping systems maintenance and audits and demand reductions where clinically appropriate).

Annual inhaler emissions have fallen by over 100 ktCO2e from 2019/20. The Impact and Investment Fund, the range of resources developed including by Asthma and Lung UK, and clinician engagement have successfully reduced the national average emissions per inhaler prescribed by more than 10% compared to last year. 

Fleet and business travel

Progress is being made across the NHS towards decarbonising travel and transport. 8 ambulance trusts are trialling 21 zero-emission vehicles, 6 of which are dedicated to support mental health response, cutting emergency response times, and reducing demand on traditional double-crewed ambulances. In addition, 5 electric trucks (Heavy Goods Vehicles) are being trialled across the NHS, while London Ambulance service has procured 35 fully electric Fast Response vehicles. For the first time drones have been used to deliver vital chemotherapy to the Isle of Wight, reducing a 4-hour journey time by road and sea to a 30-minute flight, minimising wastage and treatment delays while also reducing carbon.

Estates

More than £800 million funding has been secured by NHS trusts through the Public Sector Decarbonisation Scheme which is being invested in heat pumps, solar panels, LED lighting and other energy efficiency measures, reducing NHS energy bills as well as carbon emissions. Progress will be further supported by the NHS Net Zero Buildings Standard which was published in February 2023 to become operational in October 2023, and will ensure the development of sustainable, resilient, and energy efficient buildings that meet the needs of patients now and in the future.

NHS Carbon Footprint Plus

The NHS has also committed to reducing emissions from its Carbon Footprint Plus (greenhouse gas emissions under our direct control as well as the emissions we can influence) from 25,000 ktCO2e in 2019/20 to 6,800 ktCO2e by 2036 to 2039 and to net zero by 2045. This trajectory implies a reduction to 22,000 ktCO2e in 2022/23.

Estimated emissions in 2022/23 are 21,700 ktCO2e. This modelling, combined with the evidence of action across the NHS as described below, suggests that the NHS is on track to meet the target trajectories for the NHS Carbon Footprint Plus in 2022/23.

This total is reported on a target-consistent basis to allow a like-for-like* comparison with the Net Zero NHS trajectory. This modelling is based on both actual and forecasted data as at end-April 2023, and may be subject to revision as final input data is processed. Emissions for much of the Carbon Footprint Plus are modelled based on spend data and hence this estimate carries some uncertainty and should be interpreted with caution. More detail of the modelling approach can be found in the Delivering a Net Zero NHS report.

Progress has been supported by targeted action including in the following areas.

*This approach compares emissions with the trajectories based on carbon factors and budget assumptions for the Carbon Footprint Plus consistent with the modelling underpinning the NZ report.

Supply chain

Emission reductions in 2022/23 are realised principally through the adoption of a 10% weighting for net zero and social value into all tenders, work by NHS organisations to make more efficient use of supplies through local supply chains and the forthcoming requirement that suppliers of all new contracts over £5 million per annum provide a publicly available carbon reduction plan for their scope 1, 2 and a subset of scope 3 emissions, with a commitment to reach net zero by or before 2050. In 2024, this will go further, with the requirement of a carbon reduction plan being extended to all procurements, providing greater confidence in future emission savings at scale. 

Clinical transformation

Meeting our net zero emission targets requires carbon reductions across all patient pathways, achieved by adopting a clinical and patient-centred approach to delivering high-quality low carbon care. This approach has ensured that new models of care such as virtual wards, the GIRFT High Volume Low Complexity and elective surgical hub programmes are considering their carbon impact and harnessing their carbon reduction potential. As the NHS continues to offer patients greater flexibility in how they receive their care, increased access with fewer repeat trips will improve patient care while reducing travel emissions.

Supported by the NHS and respective Royal medical colleges specific net zero initiatives such as the Royal College of General Practitioners Net Zero learning hub and the Royal college of Emergency Medicine GreenED accreditation scheme are equipping the growing and engaged clinical communities to act on meeting our net zero targets.

Research

In 2022/23, the SBRI Healthcare programme, an Accelerated Access Collaborative, NHS England’s programme, allocated £6 million funding to 18 ground-breaking innovation projects to advance greener innovations and support their net zero evidence generation for implementation in the NHS. Sustainability criteria were integrated in some of NHS England’s wider research and innovation programmes to ensure net zero is strongly considered within all programmes and decision-making. Partnerships have now been forged with the Medical Research Council and National Institute for Health and care Research to advance environmentally sustainable research.

Workforce

In 2022/23, the NHS delivered a sharp rise in engagement in training at the intersection between climate change and health; from County Durham and Darlington NHS Trust training more than eight out of ten staff on the topic, to more 50,000 NHS staff engaging with the ‘Building a Net Zero NHS’ e-learning module.

Delivering a net zero NHS

The Health and Care Act 2022, introduced new legally binding duties on all NHS bodies, including NHS England, to have regard to contributing to the legally binding targets in the Climate Change Act and Environment Act.

The Greener NHS national programme was launched in 2020, alongside the appointment of a Chief Sustainability Officer, to deliver the world-leading commitment of a net zero national health service. During 2022/23, the Greener NHS team – with support from across the NHS – helped to: 

  • publish statutory guidance on how the NHS and NHS bodies should seek to meet their net zero targets
  • support all trusts and ICSs to develop their own sustainability strategies – Green Plans – to chart their course to net zero, with all trusts and ICBs appointing board-level leads to ensure they are achieved
  • secure just under £1 billion in additional funding for NHS through the Public Sector Decarbonisation Scheme and funding programmes focused on net zero clinical innovation and workforce training
  • implement the new NHS net zero hospital standard to encourage sustainable, resilient, and energy-efficient buildings that meet the needs of patients now and in future
  • launch new patient and clinical resources with Asthma and Lung UK, to help patients improve their lung health while supporting the environment by offering the choice to switch to less carbon-intensive inhalers; this along with other initiatives helped reduce national average emissions per inhaler prescribed by 16% compared to previous year
  • decommission desflurane by early 2024, with support from the Association of Anaesthetists and the Royal College of Anaesthetists, which will lead to a total reduction of 40 ktCO2e per year from 2024
  • implement new procurement guidance for suppliers bidding for NHS contracts above £5 million a year, requiring suppliers to produce and publish a Carbon Reduction Plan committing the supplier to achieving net zero by 2050 or sooner
  • share best practice on how to set up and deliver a net zero health service, following commitments from the government, and working with the World Health Organization. At COP27 an agreement was made with the US government to align healthcare procurement to the NHS net zero supplier roadmap
  • award £6 million through two phases of the Small Business Research Initiative to pioneer net zero MedTech and digital innovations for high quality, efficient and more accessible healthcare
  • deliver a Healthier Futures Action Fund, to kick-start innovative initiatives to improve health and patient care, reduce inequalities, deliver value and efficiencies while supporting a more sustainable health service
  • establish the Zero Emission Emergency Vehicle Pathfinder programme, resulting in a national specification for zero emission rapid response vehicles; eight ambulance trusts are trialing 21 zero-emission vehicles of several types including the new, rapid mental health community response vehicles
  • trial the use of drone technology to deliver vital supplies, such as chemotherapy drugs and pathology samples, as sustainable as possible; Portsmouth Hospitals University NHS Trust and Northumbria NHS Trust participated in the project

These milestones helped the NHS reduce its carbon footprint to an estimated 4.55Mt in 2022/23, keeping us on track with the trajectories set out in the Delivering a net zero NHS report.

Appendix 6: Key acronyms

Acronym

Definition

ALBs

Arm’s length bodies

ARAC

Audit and Risk Assurance Committee

CCG

Clinical commissioning group

CDF

Cancer Drugs Fund

CETV

Cash equivalent transfer values

CMD

Commercial Medicines Directorate

CRR

Corporate risk register

CSUP

Consumer single use plastics

CSU

Commissioning support unit

DHSC

Department of Health and Social Care

DSPT

Data Security and Protection Toolkit

EPR

Electronic Patient Record

ESM

Executive senior manager

ESR

Electronic Staff Record

FReM

Financial Reporting Manual

ICB

Integrated care board

ICO

Information Commissioner’s Office

ICS

Integrated care system

IFRS

International Financial Reporting Standards

IG

Information governance

KPI

Key performance indicator

NAO

National Audit Office

NHS BSA

NHS Business Services Authority

NHS PS

NHS Property Services

NHS TDA 

NHS Trust Development Authority

NICE

National Institute for Health and Care Excellence

NQB

National Quality Board

PCN

Primary care network

PCSE

Primary Care Support England

PRP

Performance-related pay

PSED

Public Sector Equality Duty

PUPOC

Previously unassessed periods of care

SARC

Sexual assault referral centre

SCCL

Supply Chain Coordination Limited

UEC

Urgent and emergency care

UKHSA

UK Health Security Agency

VCSE

Voluntary, Community and Social Enterprise

WGA

Whole of Government Accounts

WTE

Whole Time Equivalent

References

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[2] https://www.gov.uk/discrimination-your-rights

[3] https://www.england.nhs.uk/long-read/the-review-report-equality-objectives-and-information-review-as-at-31-march-2023/#appendix-1-introduction-to-the-general-and-specific-public-sector-equality-duties

[4] https://www.england.nhs.uk/wp-content/uploads/2022/05/B1588-nhsei-equality-objectives-for-2022-2023-2023-2024.pdf

[5] https://www.england.nhs.uk/wp-content/uploads/2023/05/board-18-may-23-item-8iii-sed-report-2-engage.pdf

[6] https://www.england.nhs.uk/about/equality/equality-hub/national-healthcare-inequalities-improvement-programme/core20plus5/

[7] https://www.strategyunitwm.nhs.uk/publications/inclusive-elective-care-recovery

[8] https://www.england.nhs.uk/about/equality/equality-hub/national-healthcare-inequalities-improvement-programme/data-and-insight/hi-improvement-dashboard/

[9] https://www.england.nhs.uk/wp-content/uploads/2022/12/PRN00021-23-24-priorities-and-operational-planning-guidance-v1.1.pdf

[10] https://www.england.nhs.uk/about/equality/equality-hub/national-healthcare-inequalities-improvement-programme/core20plus5/core20plus5-cyp/

[11] https://www.e-lfh.org.uk/programmes/health-inequalities/

[12] https://www.nao.org.uk/wp-content/uploads/2022/11/managing-NHS-backlogs-and-waiting-times-in-England-Report.pdf

[13] https://www.england.nhs.uk/nhs-standard-contract/

[14] https://www.england.nhs.uk/publication/delivery-plan-for-recovering-urgent-and-emergency-care-services/

[15] https://www.england.nhs.uk/wp-content/uploads/2022/02/B1366-tackling-neighbourhood-health-inequalities-supplementary-guidance-v1.1.pdf

[16] https://www.england.nhs.uk/blog/can-you-tell-its-sickle-cell/

[17] https://haln.org.uk/

[18] https://www.health.org.uk/sites/default/files/2021-09/haln_test_and_learn_grant_funding_guidance.pdf#:~:text=The%20Health%20Foundation%20and%20NHS%20England%20and%20NHS,participants%20and%20the%20wider%20health%20and%20care%20system.

[19] https://future.nhs.uk/connect.ti/EHIME/view?objectId=160802853

[20] https://www.england.nhs.uk/about/equality/equality-hub/national-healthcare-inequalities-improvement-programme/contacts-and-resources/building-for-health/#case-study-8

[21] https://clpcn.co.uk/tackling-racial-inequality-working-group/

[22] https://www.wearecocreate.com/

[23] https://www.wearecocreate.com/wp-content/uploads/Co-create-CLPCN-Tackling-Racial-Inequality-Engagement-Project-Evaluation-1.pdf

[24] https://www.wearecocreate.com/wp-content/uploads/Health-Inequalities-in-Morecambe-Bay-Final-Report.pdf

[25] https://www.youtube.com/watch?v=4_Y1FLMrdsw

[26] https://future.nhs.uk/PPGnetwork/grouphome

[27] https://www.pathway.org.uk/

[28] https://groundswell.org.uk/

[29] https://www.rsph.org.uk/

[30] https://www.penninecare.nhs.uk/

[31] https://www.sja.org.uk/get-involved/young-people/nhs-cadets/

[32] https://www.ivar.org.uk/publication/the-power-of-youth-volunteering/