Agenda item

The Board received a report informing the Board of NHS England’s plans to improve immunisation rates in Enfield. 

1.       Presentation of the Report

Maggie Luck from NHS England presented the report to the Board supported by Karen Keane, Senior Public Health Manager highlighting the following: 

• NHS England has plans to improve childhood immunisation rates within Enfield and across London to achieve the World Health Organisation’s recommended 95% of the population coverage. 

• NHS England is planning to deliver an MMR catch up campaign for 10-16 year olds and to instigate changes to the routine immunisation schedule. 

• The responsibility for commissioning immunisation lies with the NHS England.  In London this is generally done through GPs and schools in conjunction with local authorities. 

• In Enfield immunisation levels are below the level required for herd immunity and more work needs to be done to bring Enfield up to the 95% rate of coverage. 

• There are 5 areas of work including information management, GP performance, community services, training staff and raising public awareness.  

• Changes to the UK immunisation schedule include removal of the second priming dose of men C conjugate vaccine to be replaced by a booster given in adolescence, the introduction of rotavirus vaccine for infants at 2 and 3 months and the introduction of a pilot child flu vaccination scheme. 

• A temporary steering group has been set up to run an 6 months MMR catch up campaign, to immunise those who have missed being vaccinated and to help avoid a measles outbreak. 

• Only three practices in London have opted out of the campaign.

• Enfield has consistently lower rates of vaccination than other parts of North East London, London and England as a whole. 

• The new plans will provide more opportunities to develop local agency partnerships. 

2.       Questions/Comments

2.1           None of the surgeries who had opted out of the MMR Catch-Up Campaign were in Enfield.

2.2           A communications plan is being developed.  The possibility of targeting resources at those communities where there are the most problems was raised.  Communication through schools has been shown to capture the greatest numbers.  Posters and newsletters will be distributed among learning centres, libraries, community groups and the usual public places.

2.3           Figures of children not vaccinated are not available per primary school as this information is held by GPs, but it was possible that information on the number of children invited for vaccination, booked in and not attended could be gathered.  The scheme started on 2 June 2013. 

2.4           NHS England was working with GPs to deliver the programme overall. 

2.5           Links with school nurses were unclear.  Further details would be provided. 

2.6           Dr Mo Abedi said that he felt that there was a need for a more robust recall system for immunisations that had to be given over a period of time.  Where this had been implemented, immunisation rates had improved. 

2.7           It was felt that more robust data gathering was needed. 

2.8           NHS England is in negotiation with local providers to provide the necessary training for staff who are to implement the proposed changes. 

2.9           The CCG, local public health teams, NHS England and Public Health England are all working together, pooling their expertise and knowledge to improve the way immunisations are to be provided.  Improvements will be based on good evidence based practice. 

2.10       The figure of 85.7% of one year olds listed in the report which had been immunised would indicate that about 190 children had not been.  As these children would still be under the care of a health visitor, health visitors could be asked to follow up to ensure that these children are immunised. 

2.11       In quarter 1 (12/13) there had been an increase in the numbers vaccinated.  92.1% in Enfield closer to the 95% target.  This was thought to be because at this time there had been a big push on the issue and a large increase in focus. 

2.12       Ian Davis (Director of Environment) suggested that research was needed to find out why Enfield was so out of step with the rest of London to identify the root cause of the problem. 

2.13       Data has not been not collected on an ethnic basis.  Litsa Worrall suggested that more work should be done with the voluntary sector to enable them to be more proactive in encouraging different ethnic communities to make sure that their children were immunised. 

2.14       Liz Wise (CCG Chief Officer) welcomed the introduction of the rotavirus vaccine as this had caused a lot of sickness in the past. 

2.15       A national change was being made to the MenC vaccination programme so that one dose was given in early childhood and a booster at aged 12-13 which would provide more protection for young people of university age when they are more at risk from the disease. 

2.16       Immunisation had been a risk area during public health transition as there had been some ambiguity about where responsibility for the area lay but this had now been resolved.  Lead responsibility now lies with NHS England, but the CCG and the public health team have a key role to play.  

2.17       In Enfield there has historically been a problem with recording the data on immunisation, much of which had been inaccurate.  NHS England has recently agreed to pay for a new recording tool which will enable Enfield to capture immunisation rates more accurately.  This will give GP’s more confidence in the system and ensure that referrals are followed up more effectively. 

2.18       There was an opportunity to make sure children were immunised with the introduction of the new free school nursery places for two year olds.  The school admissions process could also be used to help ensure that children starting school were up to date with their immunisations. 

2.19       An update report will be provided to the next meeting of the Board including the action plan and more information on data analysis and why Enfield is different from the rest of London. 

AGREED to note the changes to the routine immunisation schedule and to endorse the plans to protect the community from the effects of vaccine preventable diseases.