Organisation objective
- NHS Long Term Plan
Working with people and communities
What approaches have been used to ensure people and communities have informed this programme of work?
- consultation / engagement
- qualitative data and insight, for example, national surveys; complaints
- quantitative data and insight, for example national surveys
- partnership working with voluntary, community and social enterprise organisation
Work on vaccinations has been informed by extensive quantitative and qualitative data insight, including on communications that resonate with the public. In developing the Vaccination Strategy NHS England undertook extensive consultation and engagement, including a market engagement exercise and public CitizenSpace survey. Approaches to delivery have been tested extensively with NHS providers and systems, as well as external stakeholders including representative bodies and charities.
Action required
The Board is asked to note the information provided in this paper.
Background / Issue and context
1. This paper provides an update on progress of how the NHS Vaccination Strategy is being delivered going into Autumn 2024, a vaccination season which will include COVID-19, seasonal influenza (flu) and a new Respiratory Syncytial Virus (RSV) vaccination programme in England.
2. Seasonal vaccination programmes help protect those greatest at risk, reduce hospitalisation and death, keeping people well and reducing pressure on NHS services during Winter. However, NHS England is also aware that maintaining high uptake requires sustained effort to overcome structural barriers to uptake, including building trust with some communities and falling public salience around COVID-19.
3. NHS England, working closely with the UK Health and Security Agency (UKHSA) and the Department of Health and Social Care (DHSC) design, deliver and communicate vaccination offers, with programme eligibility informed by expert advice from the independent Joint Committee on Vaccination and Immunisation (JCVI).
4. In December 2023, NHS England, together with partners, published the NHS Vaccination Strategy to build on the lessons of the COVID-19 vaccination programme and set out a strategy for improving access and uptake of all NHS vaccines. Ahead of Autumn/Winter 2024 it is important to take stock and set out our plans for making sure the strategy delivers.
NHS Vaccination Strategy
5. England has historically performed well across both life-course and seasonal vaccinations and has responded to outbreaks of vaccine-preventable disease. England has some of the highest levels of flu vaccination coverage for over 65s compared to other OECD countries (OECD, influenza vaccination rates) and the NHS COVID-19 vaccination programme has delivered 165 million vaccinations to date.
6. The trends in some of our vaccination programmes have shown falling uptake rates, for example we have not met coverage targets for childhood immunisations and there is significant variation in uptake and coverage between different communities that can often reflect wider health inequalities.
7. At the end of last year, the NHS Vaccination Strategy was published, which incorporates what has been learned through the rollout of the COVID-19 vaccine and from years of delivering the flu and routine immunisation programmes. The strategy aims to improve uptake and the experience of users of vaccination programmes by:
- creating a high quality, convenient offer that is tailored to the needs of local people, but is primed to respond to outbreaks and future pandemics;
- supplementing this with targeted outreach services to increase uptake in underserved populations;
- joining-up services through integrated teams working across the NHS and other organisations to improve patient experience and deliver value for money
8. We will achieve this through a number of pragmatic changes, including:
- building on the National Booking Service established during COVID-19 to create a simple, convenient and efficient front door to access vaccination services;
- developing integrated, multidisciplinary teams that work across the NHS to deliver vaccinations in the place that people need them; and
- living local teams more power to decide how to deliver vaccination services to their local population
9. At the heart of all of these actions is a recognition that we need to do more to reach those communities that are currently underserved. During the pandemic, we developed services that reached out into communities, as well as working to build trust around vaccinations by addressing the “3 Cs”: confidence, complacency and convenience (WHO, 2014).
10. We saw the principles of this in action as NHS England rolled out the Mpox vaccination last year. Joined-up working across primary care and sexual health services meant we could deliver this vaccination to the populations most at-risk in settings that were convenient and trusted. This approach led to a successful Mpox vaccination campaign in 2023, which contributed towards the rapid decline in cases.
11. Following the publication of the NHS Vaccination Strategy, a detailed implementation plan is being developed, that specifies how the vision will be delivered. We have started to embed the principles of the strategy in our preparations for Autumn/Winter.
COVID-19
12. During the Spring campaign we delivered 4.28m vaccinations in 11 weeks. In line with JCVI recommendations, the NHS continues to focus on protecting those at greatest risk of severe disease and hospitalisation, including older age cohorts and those with underlying health conditions.
13. The COVID-19 programme is delivered by community pharmacy and GPs collaborating as primary care networks (PCNs); NHS hospitals, and a small number of high-volume vaccination centres (usually operated by NHS Trusts), in line with the needs of local communities.
14. This year we have put in place a new procurement process for COVID-19 vaccination, with contracts running from 1 September 2024 to 31 March 2026 to cover multiple campaigns. The procurement is being conducted under the new Provider Selection Regime and we will use our learning to inform future procurement exercises. Over time, and in line with the Vaccination Strategy, we expect to increasingly align our procurement processes across multiple vaccination programmes.
15. Working with ICBs, our regional teams will ensure the new procurement process helps secure sufficient capacity, coverage and a convenient offer for local communities, as well as supporting provider stability. It will also help local teams to commission tailored services for specific communities through a new outreach service specification. This new specification gives commissioners more flexibility in how they ask providers to deliver services where local population requirements are not being met by the existing arrangements.
16. We have not yet received JCVI advice on what will be required of a possible COVID-19 vaccination programme beyond 31 August 2024, and we await Government’s consideration of advice. However, for the purposes of the new procurement process and wider operational planning, we have asked providers to plan on the basis of any COVID-19 programme starting alongside the adult flu programme in early October.
17. The NHS importantly maintains the ability to surge outside of the main campaigns, providing vaccination to an expanded population or vaccinating at pace as the epidemiology of COVID-19 as a disease evolves.
Flu
18. Flu is an unpredictable but recurring Winter pressure, with a particular risk of severe illness for older people, the very young, pregnant women and those with underlying health conditions. Uptake of adult flu in England is one of the highest in the world and currently exceeds the World Health Organisation target of 75%. In autumn 2023, flu vaccination uptake was 78% for those 65 and over.
19. Informed by JCVI advice, this year’s programme includes those over 65, those in a clinical risk group, care home residents and carers, as well as children aged 2 to up to 17 years. There is also an offer for frontline health and social care workers, predominantly offered through occupational health provision.
20. The Annual Flu Letter 2024 was published in March and indicated the eligible groups for this year. Planning is well underway for a 1 September 2024 start for pregnant women and children and vaccination for all other adults from early October.
21. The adult flu programme is predominantly delivered by general practice and community pharmacy, with some vaccination also provided by NHS Trusts. The children’s flu vaccination programme continues to be delivered by GPs and school-aged immunisation teams in schools and community catch-up sessions.
22. Despite high uptake overall, variation in uptake between different groups, geographies and communities persist. Improvements to the National Booking Service, timings and eligibility of Covid and flu campaigns, together with proactive outreach and community engagement efforts, aim to improve address these challenges, as well as support co-administration, helping the NHS protect as many people as possible ahead of the winter months.
23. Central to the NHS Vaccination Strategy is streamlining, as far as possible, access to the different vaccinations for which a person may be eligible. For seasonal vaccinations this means enabling people to get COVID-19 and flu vaccinations together, should they wish. The National Booking Service has been expanded to allow individuals to book their COVID-19 vaccination and their flu vaccination together. As of this Spring, the National Booking Service now allows for people to group book vaccinations for themselves and a loved one at the same time.
RSV
24. RSV is a common respiratory virus that can cause serious lung infections. While RSV infection can occur at any age, the risk and severity of RSV and its complications are increased in older adults and in neonates and small babies, having a considerable impact on individuals and NHS services during the winter months.
25. Following guidance from the JCVI in September 2023, and successful completion of a competitive tender by UKHSA on 24 June 2024, NHS England and UKHSA wrote to systems to set out next steps for delivery of two new RSV vaccination programmes – for older adults and pregnant women.
26. We are the first nation in the world to be delivering both RSV programmes. This represents the biggest change to the NHS’ vaccination offer since the COVID-19 jab was rolled out.
27. All adults turning 75 years old on or after 1 September 2024 will be eligible for a routine RSV vaccination and should be offered a single dose on or after their 75th birthday by general practice who will be offering vaccination as an essential service. NHS England is also commissioning a small number community pharmacies in on region as early adopters of an approach to extend access for local communities.
28. Recognising RSV vaccination provides an opportunity to keep people well and alleviate winter pressures by protecting people at risk from morbidity and mortality, NHS England has asked systems to vaccinate as many people as possible during September and October, prior to the expected RSV winter season, in a one-off catch up campaign.
29. To protect newborns, those who are at least 28 weeks pregnant (the eligible cohort) on 1 September 2024, will be offered a single dose of the RSV vaccine. As part of the routine offer, vaccination will be offered at 28 weeks gestation, with eligibility up to birth.
30. Regionally, NHS England has commissioned trusts providing maternity services, supplemented by a small number of community trusts using an “in-reach” model to ensure a convenient and comprehensive offer. This aligns to our ambition in the NHS Vaccination Strategy to use a flexible vaccination workforce to deliver jabs in the most convenient way possible and aligned with existing services. General practice will also be contracted to offer vaccination opportunistically or if requested at 28 weeks pregnant.
31. For those who have home-births or who do not access NHS maternity services, additional services providing a follow up offer of missed doses in community settings, will also be in place. The exact mix of providers will be determined by regional NHS England teams and ICBs according to the local vaccination delivery network and needs of the community.
32. The current specialised commissioning provision to protect at-risk infants for whom RSV infection is likely to cause serious illness or death will continue.
Measles, Mumps and Rubella (MMR) vaccination
33. Alongside the seasonal vaccination programmes, there are also life-course vaccinations that require our urgent priority over the next few months. Since January, the NHS, together with partners, has been urging millions of parents and carers to book their children in for missed MMR vaccinations to protect children and young people from becoming seriously unwell.
34. More than a million parents and carers of six- to 11-year-olds were sent emails, letters and texts inviting them to book an appointment with their child’s GP practice for their missed MMR vaccine. Throughout February and March over a million children and young adults aged 11 to 25 years living in London, the West Midlands and Greater Manchester were also encouraged to book an appointment. This represents a big leap forward in how we use data to create a more targeted offer of vaccination to underserved communities.
35. Since April, the North West region has been piloting a community pharmacy offer, as part of helping us understand whether a more diverse service offering for childhood immunisations is desirable for underserved communities.
36. Between 1 Jan and 24 March 2024, there were a total of 360,964 MMR vaccinations delivered, up almost a quarter (23%) from 293,847 in 2023. This included 187,737 first doses and 171,635 second doses. The most significant increase in vaccinations was for those aged five to 25 years old, with four times as many vaccinations – 75,499 – in the first three months of 2024 than 18,433 in the same period last year.
Pertussis vaccination
37. UKHSA has reported an increase in cases of pertussis (whooping cough) in 2024 compared to last year. Getting vaccinated while pregnant is highly effective in protecting the baby from developing whooping cough/pertussis in the first few weeks of their life.
38. Pregnant women become eligible for their pertussis vaccination from 16 weeks and can receive the vaccine up until they go into labour, however the level of protection decreases the later the vaccine is administered.
39. GPs are currently commissioned to offer opportunistic vaccination or on request to pregnant women and 123 out of 128 NHS trusts also have a supplementary opportunistic offer.
40. NHS England is taking a number of actions, in line with the NHS Vaccination Strategy, to improve uptake including:
- improving professional and public vaccine knowledge and confidence with a vast range of communications activity
- improving access to vaccine services, including addressing health inequalities
- ensuring accurate, up-to-date and prompt recording of vaccinations by providers
- ensuring local system oversight of the commissioning and delivery of the programme, ensuring clinical leadership and coordination of local services
41. We continue to monitor the number of measles and pertussis cases with local systems taking appropriate action as required
Next steps
42. We continue to focus on maximising vaccine uptake, ensuring as many people as possible are protected ahead of the winter months. We are taking all necessary steps to prepare for a complex Autumn season, but challenges remain, such as uncertainty around the long-term future of COVID-19 vaccine eligibility and a tight operational timeline for RSV.
43. NHS England is working closely with DHSC and UKHSA on public facing communications, especially around the new RSV campaigns. We are also collaborating with stakeholders in local systems to ensure continuous community engagement across vaccinations to build vaccine confidence and ensure people have the information they need to help them stay well. It is vital that community engagement work continues all year-round and not just in the midst of the seasonal campaign.
44. We know that uptake in certain settings continues to be challenging across the vaccination programmes. We are taking further steps with NHS providers to address the lower uptake rates of seasonal vaccinations by health and social care workers and also some of the lower uptake trends we are seeing for pregnant women. These actions include understanding the attitudes of healthcare workers towards vaccination and developing co-located vaccination offers in maternity settings.
45. Later this year, NHS England will publish more detail on progress and next steps on implementation of the NHS Vaccination Strategy which will set out what is required over the longer term to deliver improved uptake and coverage.
Publication reference: Public Board paper (BM/24/28(Pu))