Agenda item

Attending for this Item were:

NHS England and NHS Improvement (NHSE&I)

Dr Ash Banerjee, Screening and Immunisation Lead (Public Health Consultant)

Dr Alex Cockburn, Public Health Speciality Registrar

NHS Herefordshire and Worcestershire Clinical Commissioning Group (CCG)

Jo-anne Alner, Managing Director (ICS Development)

Worcestershire County Council (the Council)

Dr Kathryn Cobain, Director of Public Health

Hayley Durnall, Public Health Consultant

Dr Banerjee talked through the Agenda report which, for this meeting, had focussed on childhood and flu vaccinations. 

Although NHSE&I was responsible for commissioning vaccinations, the CCG had a role to play in ensuring the primary care provision.  In addition, the Council had a role in promoting uptake, especially through the commissioning of school nurses and health visitors.

Childhood immunisations for pre-school children were delivered by GP practices at five scheduled appointments and further immunisations were offered in secondary school years 8 and 9.  In addition, the flu immunisation was offered in school in certain year groups.

Achieving 95% uptake in the childhood immunisation programme would achieve ‘herd immunity’ ensuring that the level of any outbreak was reduced.  This was particularly important for those who were not able to receive a vaccination.

Uptake in Worcestershire was consistently higher than both the West Midlands region and England and generally achieved the 95% target at age 1, but not at 2 or 5 years of age.  However, there had been a sustained slight drop in uptake nationally in recent years, especially as children grew older.  The reasons for this five year decline were unknown, however, could be related to the ease of access.

The seasonal flu vaccination was traditionally delivered between September and March through GP practices, NHS Trusts, community pharmacies and schools.  Eligible groups included those aged 65+ and under 65 years with an at-risk condition.  In recent years, the eligible group had expanded to include all children from school Reception year to Year 7.  For 2020/21 the Government had announced that those aged 50-64 were to be invited for the first time, however final details were awaited.  In addition, health and social care workers were eligible, however, that responsibility lay with the employer. 

Uptake in Worcestershire for 2019/2020 across all eligible groups was higher than England, with the 65+ cohort achieving a 74.8% uptake.  Early indications for 2020/2021 suggested that across all eligible groups there was a 10% increase in uptake.  National targets for uptake in 2020/21 had also increased to 75% in each eligible group.

The COVID-19 pandemic had impacted the school programme of activity since March 2020, when schools were closed to the vast majority of pupils.  It was anticipated that the backlog would be completed during the current academic year.  Other childhood immunisations had continued to be offered through GP practices, however, there were fewer attendances, which may result in overall uptake being lower than in previous years.

NHSE&I had several initiatives to increase uptake, such as schemes where GP practices were paid to telephone families whose children had missed appointments to encourage uptake, or to explain the benefits of essential vaccinations to the most vulnerable groups, such as those with sickle-cell disease.  Further initiatives included targeted flu vaccination letters for vulnerable groups and an advice service for clinicians when patient queries were more complex.       

The Council, for 2020/2021, had introduced an initiative whereby all staff, including those in both maintained schools and academies, were offered a flu vaccination.

Dr Banerjee concluded by reiterating the key message that everyone must continue to have their scheduled vaccinations, including the flu vaccination for those in an eligible group.

In the ensuing discussion, the following main points were raised:

·         The effectiveness of the Pilot Scheme for flu vaccination for County Council staff was discussed and whether it was likely to be rolled out for all local government staff, nationally. Although this was unknown, it was noted that the Council’s Scheme would be evaluated and the findings  shared

·         In response to a question about the uptake of the shingles vaccine, it was noted that this was not as good as it should be, which may be as it was an opportunistic vaccine, i.e. people were not invited to have the vaccine but offered it by the GP when attending for other reasons

·         Although anti-vaccine groups existed, it was less prevalent in England and there was generally a positive attitude towards vaccinations in Worcestershire.  Survey results showed surprisingly high levels of support by parents and teenagers, with a good level of understanding that the NHS website, for example, was more trusted than other websites or social media

·         Strategies were in place to dismantle some of the arguments and the negative impact of publicity, such as the Public Health England campaign on the value of vaccines.  The Director of Public Health added that for Worcestershire, it was also important to engage with residents

·         Concern over the combined MMR (measles, mumps and rubella) vaccine 15 years ago had resulted in some more affluent parents paying for single vaccines, however, there was significantly more trust now.  Uptake of the MMR vaccine needed to rise. A recorded dip in 2018/2019 of the uptake at 2 years of age could not be explained, it was suggested that it could be as a result of a data error

·         The human papillomavirus (HPV) vaccine was delivered in two doses through the school programme. Girls, and more recently boys, were invited twice, in Year 8 and Year 9

·         As very little was known about the upcoming COVID-19 vaccine, people were forming their own opinions.  The CCG was anticipating more information from central Government by the end of November.

The Chairman of Healthwatch Worcestershire was invited to comment on the discussion and reported that Healthwatch had received no concerns from families about childhood immunisations.  He referred to a 2019 Healthwatch report on screening and immunisations which would be shared with the Committee. 

Healthwatch was aware of residents aged 50+ asking when they would be able to receive the flu vaccination.  A national decision was awaited, however, it was understood that the programme would be delivered through GP practices and community pharmacies, from early December.  Depending on demand, it may need to be delivered on a cohort basis.