Agenda item

To provide the current arrangements for childhood and school aged immunisations, including responsibilities for commissioning, delivery and quality assurance.

Dr Melanie Smith (Director of Public Health, Brent Council) introduced the report, which described the current arrangements for childhood and school aged immunisations. She advised the Board that the scope of the report had been deliberately limited due to the complex nature of childhood immunisations. NHSE were responsible for the commissioning of routine immunisations and had been able to provide figures for the Board. In Brent, the school age programme was commissioned through CNWL. She concluded that there were longstanding challenges with raising childhood immunisation rates in Brent.

The Chair thanked Dr Melanie Smith for introducing the report and invited NHSE colleagues Susan Elden (Public Health Consultant, NHSE) and Anne Tunbridge (Immunisation Commissioning Manager, NHSE) to speak. The following issues were raised:

• The Board’s attention was drawn to section 6 and 7 of the report, which detailed the headline figures for Brent. Generally, London coverage of childhood immunisations was lower than the national average. In Brent, the figures were slightly lower than the regional London average, but were on par with other boroughs in NWL.
• During the pandemic, coverage figures fell to their lowest ever across Brent, which were now showing signs of recovery but still not back to the 2018 baseline. As NHSE attempted to close that gap, new children fell into the age category of requiring vaccinations ie the numbers of children now needing immunisations is increasing.
• Section 7 detailed the collective efforts happening across agencies to improve vaccination rates in Brent. A focus going forward was around reducing inequalities and catching up on missed groups, listening to communities and building trust with providers and people.

In considering the presentation, the Board raised the following points:

• The Board asked if there was any demographic data on the groups where vaccination uptake was particularly low and if there was anything the Council could do to work more closely with those groups. Dr Melanie Smith advised the Board that she was looking to improve data quality, and a big achievement of the work done during Covid-19 was the ability to track vaccination rates alongside deprivation which was not currently possible for childhood immunisations. Immunisation data was held on a national system, and, until Covid-19, NHS data collection did not prioritise ethnicity or deprivation. She felt there was a need to supplement the very well-established national database with other initiatives to improve that data quality. In terms of working closely with groups who had low vaccination rates, Dr Melanie Smith highlighted that there was targeted outreach and a variety of offers from primary care to encourage uptake of vaccinations and make access easier, acknowledging, that for some families, attending their GP surgery was not always convenient. School aged immunisations had been offered outside of school settings and in December 2022 79 children had been vaccinated in 1 day in Brent Civic Centre. She commended children and young people services, public health, and NHSE colleagues who had been flexible in their approach to immunisation since Covid-19. Going forward, she wanted the universal offer through primary care to be as efficient as possible in order to free up time and resource for more targeted outreach for those communities who had not accessed the traditional offer.
• VershaVarsani (Head of Primary Care (Brent), NWL NHS)) highlighted that a large proportion of clinics had signed up to the extra health inequalities clinics held on weekends, and a number of children had been coming in for vaccinations on those days. As there was higher deprivation in the south of the borough, a focused clinic had been held there with at least ten children vaccinated in the short session held and information given out to other attendees. The ICB team worked closely with the regular immunisation working group, meeting every 2-4 weeks to look at challenges and improving rates for immunisation.
• Dr Haidar felt that another approach to improving vaccination uptake was to hold education workshops about the impact of illnesses and the importance of protection against them, and steer away from words like vaccination and immunisation which may discourage engagement due to stigma. In response to what was being done about the perception that immunisations caused autism, Dr Haidar informed the Board that health providers could only reinforce the fact that the initial theory spread by the media was not correct and the clinician whose research was published had been discredited. Primary care colleagues were still communicating this with patients and reassuring them that immunisations did not cause autism.
• As to whether there was any practice guidance and peer support across NHSE and other Local Authorities, Anne Tunbridge advised that part of her job as commissioning manager was to liaise closely with ICB colleagues to disseminate and share information. As a team within NHSE, they were aware of the patterns across London and this was shared directly with local ICBs and the NHSE team. In addition, immunisation co-ordinators were employed to work on the ground with GP practices and help NHSE understand the specific issues within the GP setting around vaccination. Dr Haidar highlighted the importance of working together to address the challenges faced by GPs. There were many other different ways NHSE linked in and worked closely with the local authority and ICB to target specific areas with issues. As of April 2024, a lot of the functions around vaccination would be delegated to ICBs so NHSE felt it was important to take steps to get closer to local communities.
• The Board asked when they would see another report on this topic. Susan Elden advised that if there was anything concerning or positive to report they would be able to provide that information as requested, but in regular business felt that the most appropriate timings for a report of this nature would be annually in order to see directions of trends.

RESOLVED: to note the information provided in the paper.