Agenda item

This report provides details of the work that has been undertaken by NHS England, Public Health and Hammersmith & Fulham CCG, both jointly and independently, to increase vaccine uptake. In addition, future action plans are described. 

The committee received an update on the work undertaken by NHS England (NHSE), Public Health and Hammersmith & Fulham Clinical Commissioning Group (CCG), both jointly and independently, to increase vaccine uptake and future action plans.

Councillor Vaughan queried the availability of data and how it would be monitored.  Mr van Wijgerden responded that some preliminary data was available but this had not been validated. The early indications, compared with the previous year, were that performance was better in respect of the 65plus age group and pregnant women, but worse in respect of at risk groups and children (probably as a consequence of the temporary unavailability of the vaccine).

Councillor Vaughan queried the progress with the schools’ vaccination programme and with a children’s centre pilot. Mr van Wijgerden responded that Central North West London NHS Foundation Trust (CNWL), the provider for the immunisations for North West London, was liaising with all primary schools, in respect of years 1 and 2, and had started to organise sessions.

A national directive prevented CNWL from offering the vaccine to reception and nursery children. Mrs Andreae added that this group would be given the vaccine in GP surgeries and GPs would be expected to facilitate this by, for example, organising sessions after school.

Mrs Andreae stated that a children’s centre pilot was still being discussed. There were a number of issues such as: clinical waste management; storage of the vaccine at the correct temperature; consent given by people for whom English was not their first language; and the possibility of repeating the vaccine because of the absence of medical records. Dr Anya added that a meeting with Children’s Services had identified possible children’s centres.

Councillor Perez queried which schools had not engaged with CNWL (paragraph 4.4). Mr van Wijgerden responded that he was not aware of any, but there might be an issue in respect of some schools being too small for the vaccine to be efficiently organised. Alternative arrangements would be made and parents informed.

Councillor Brown queried the supply issue with the  children’s nasal spray flu vaccine. Mrs Andreae responded that a batch had been deemed to not be of sufficient quality. Mr van Wijgerden added that the vaccine was manufactured in Britain, but the replacement batch had been from America.

Councillor Carlebach was aware of two schools, which had not been contacted by CNWL. Mr van Wijgerden would follow up with providers.

It was stated that CNWL is the provider for the immunisations and school nurses.

Post meeting note: It was clarified after the meeting that CLCH is the school nurse provider.

Councillor Carlebach emphasised the importance of providing the vaccine to children with disabilities. Mr van Wijgerden responded that for special needs schools, the vaccine was being offered to children of all ages.

Councillor Carlebach stated that some letters sent to parents referred to an injection. Mrs Andreae responded that whilst a template letter from Public Health had been sent to all practices, they could chose to send their own letter. Mrs Andreae agreed to arrange for the CCG to contact all practices to re-enforce the message that there was a need for clear communication, referring to immunisation, not vaccination, and would forward this message to Kensington & Chelsea CCG.

Councillor Carlebach queried the number of at risk in-patients who had received the vaccination. Mrs Andreae responded that the vaccination was not given to patients whilst in hospital, but before admission or after discharge, either by their GP practice or CLCH for housebound patients. It was inappropriate to give to unwell patients in an acute hospital, which would not have access to GP records.

Councillor Lukey referred to the role of the Community Independence Service, which included both Imperial College Healthcare and Chelsea and Westminster Hospital. Mrs Bruce agreed to ensure that the service was aware of the target groups and to send information to the relevant Chief Executives. Mrs Andreae added that the Clinical Quality Groups would also be an appropriate forum.

Dr Anya stated that  letters had gone to local hospitals from public health as part of the action plan.

Mr Naylor stated that there was anecdotal evidence that older people were reluctant to have the vaccination because in the previous year, it was perceived not to work, to give people flu and to make people feel ill. The message that the current vaccination was effective had not reached people.

In addition to the publicity set out in the report, Mr Naylor suggested that there should be information in places where older people gathered such as lunch clubs. There needed to be a lot more advertising and persuasion. 

Members noted that the issue of some faith groups having difficulty in accepting the vaccine needed to be resolved. Dr Anya stated that Rabbi Abraham Adler from the Kashrus and Medicines Information Service, had issued a statement on the acceptability of the vaccine for Jewish people but there had not been a similar statement from a Muslim leader that had been published by Public Health England.

Mr van Wijgerden added that NHSE was engaging with all faith groups, and most appeared to be in favour of the vaccine. However, this was not always reflected at local level, where leaders were influential. Mr van Wijgerden considered that it would take longer than a year to change attitudes.

Mr van Wijgerden stated that the previous year’s vaccine was a good vaccine, but did not work for one strain of flu. It would not be known until February if the current vaccine was successful in working against the prevalent strain of flu.

Councillor Perez queried how the open access service, which would enable GPs to vaccinate unregistered patients, was being promoted and whether the practices provider hubs would register unregistered patients. Mr van Wijgerden responded that the open access Service Level Agreement had been created at the request of GPs. The initiative had been piloted in the previous year. Members suggested that the hubs could be promoted at Foodbanks.

Mrs Andreae stated that people would be welcome to register with a GP at the three hubs.

Councillor Holder stated that the Council sat on the Patient Reference Group, and she would ensure that flu immunisation was on the agenda.

Mr van Wijgerden responded to a query that community pharmacies did not currently offer children’s vaccinations.

Councillor Vaughan thanked officers for attending. The Committee welcomed and was encouraged by the work which had been undertaken, particularly the joint work, which could be a model for future co-operation. The three organisations had come together in a fragmented health system to work strategically.  The Committee however noted that the challenge around changing attitudes remained.

Actions:

1.    The schools contacted by CNWL to be confirmed.

2.    The flu vaccination to be advertised in lunch clubs.

Action: NHSE/Public Health

RESOLVED THAT:

1.    The report be noted.

2.    An item on vaccinations generally be added to the work programme.

3.    CNWL be invited to a future meeting.

4.    The performance monitoring data be provided to Members.

5.    An update report, at the end of the flu season be added to the work programme.

6.    It was recommended that:

(i)            joint working should be expanded to a wider range of vaccination programmes; and

(ii)           more work should be done with acute providers.