Agenda item

To follow

Jess Seal, Primary and Community Care Transformation Manager (Bromley) – SEL CCG (“Primary and Community Care Transformation Manager”), Dr Rob Grounds and Dr Gurprit Singh Mudhar attended the meeting to provide an update on the Borough’s non COVID immunisation programme.

The Primary and Community Care Transformation Manager highlighted that it had been an unusual year, with the need to take the pandemic into consideration alongside the delivery programme of the flu immunisation. A collaborative approach had been taken across practices, pharmacies, and community providers, such as Bromley Healthcare who provided flu vaccinations to those that were housebound.

Dr Rob Grounds highlighted that influenza was a highly contagious viral illness. In people who were otherwise healthy it was usually unpleasant, but self-limiting, however the risk of serious illness was higher in infants, older people, and those with underlying health conditions, including those who were pregnant. Influenza viruses changed their external characteristics (spike proteins) gradually from season to season which produced different strains. Influenza vaccines were prepared using strains in line with WHO recommendations and were tri or quadrivalent (acting against 3 or 4 strains). Influenza immunisation had been recommended since the 1960’s and were targeted predominantly at higher risk groups. Since 2005-06, the uptake of the Influenza vaccine in England had gradually reduced in adults and those at risk from 75.3% to 70.5% in 2016-17. In 2012 the Joint Committee on Vaccine and Immunisation (JCVI) recommended that the programme be extended to include children aged 2 to 17 years, and in December 2020 it was advised that the cohort for vaccination be further expanded to include 50-64 year olds.

The South East London vaccination data for 2020/21, as at the end of January 2021, indicated that Bromley was doing very well with its Influenza immunisation programme, with figures well above the London average and similar to the national average. Data was provided by practice regarding the uptake of the immunisation by both adults and children. An average of 82.9% of at-risk patients in the 65 and over cohort, and on average 50% of at-risk patients under 65, had been vaccinated. A comparison of data from 2019/20 and 2020/21 highlighted that most practices in Bromley had recorded an increase in uptake from this cohort of patients, with just one not having seen an improvement. The data for children demonstrated that there had been a good uptake across Bromley’s practices with an average of 59% of at risk 2 year olds and 62% of at risk 3 year olds having received their vaccination. A comparison of data from 2019/20 and 2020/21 showed an improvement at all practices in vaccination uptake across all ages recorded (2-11 year olds).

Dr Gurprit Singh Mudhar advised Board Members that when comparing the flu vaccine uptake across London Boroughs, Bromley was ranked top for the over 65’s, and top across South East London for the under 65’s at risk. The comparison between 2019 to 2021 indicated that there had been a significant improvement in the overall uptake of the flu vaccination, however, as previously mentioned, there had been a reduction seen at one surgery in Bromley. In general, vaccination uptake was lower in areas with higher levels of deprivation and there were a number of potential reasons for reduced uptake, including:

-  vaccine hesitancy, potentially caused by lack of information and cultural reasons;

-  language barriers;

-  false information on social media; and

-  access to vaccination.

It was noted that due to the impact of the pandemic, the workload pressures of the practices should also be considered.

With regards to what could be done to help improve flu vaccination uptake, it was considered that generally more public awareness of the benefits of receiving the flu vaccination was required; social media could be used to correct misinformation; and improving the access for all, such as delivering the vaccinations via satellite or pop-up clinics. In specific areas, more health promotions could be delivered on a local level with local community leaders involved and outreach to local faith leaders. Any further learning from the COVID-19 vaccination programme would also be kept in mind. Surveys targeted at certain groups could be used to gather the thoughts and opinions of these cohorts and follow up phone calls offered to discuss these in further detail. The benchmarking of practices would be used to look at those that had recorded high levels of uptake – work would be undertaken to consider the reasons why these improvements had been seen, learning from it, and sharing of good practice.

The Primary and Community Care Transformation Manager emphasised that it had been a challenging year and practices and providers had been required to work very differently. There had been a lot of organisational requirements to enable clinics to be delivered in different locations, maintaining social distancing, and there had been an additional challenge with regards to supply and demand following the extension of the age cohort to be vaccinated. It was noted that they would be proactively looking at the programme for delivering the flu programme in the autumn alongside the boosters of the COVID-19 vaccine. The Director of Public Health noted that Public Health England were investigating the possibility of providing both vaccines at the same time.

In response to a question from the Chairman, the Primary and Community Care Transformation Manager said that they were actively looking to build upon the good work achieved over the last year. Bromley had been ranked the top London borough for flu vaccine uptake by the over 65’s cohort, during what had been a challenging year, and it was important that this level was maintained. The Place Based Director suggested that plans for the coming vaccination season and next winter could be presented at a future meeting of the Health and Wellbeing Board.

The Director of Public Health said that due to a significant reduction in COVID-19 infection rates it was suggested that the weekly dashboard report provided to Health and Wellbeing Board Members be reduced from weekly to fortnightly. It was highlighted that if there were any changes to the level of infection rates this could then revert to weekly updates. A Member noted that the dashboard was provided to all Elected Members and considered that this proposal should be put to them too to gather their feedback. If a reduction in the distribution of the dashboard was agreed, a benchmark as to when Members should be alerted to an increase in numbers would be required. The Director of Public Health advised that as number of COVID-19 infections were now very low, small fluctuations were seen but if they were within the tolerances it was suggested that a report would not be sent – the surveillance programme was still in place to monitor figures on a daily basis and if there was a trend of an increase, a report would then be produced and circulated. Board Members were asked to provide any feedback to the Director of Public Health on whether there were any elements in the dashboard reports that they would like to see more, or less, of or if there was anything else that they would like to have included.

A Board Member noted that the information contained in the dashboard report was provided on a confidential basis and enquired if there were any elements within it that could be shared more widely. The Director of Public Health advised that the data was marked as sensitive as it data was obtained from Public Health England. In order to access it the Local Authority were required to sign a data sharing disclaimer that it would only be used internally, and for purposes of the Health and Wellbeing Board, and should not be shared publicly. Board Members could discuss the data with colleagues but it was emphasised that the charts and diagrams should not be presented or copied.

The Chairman thanked the Primary and Community Care Transformation Manager (Bromley) – SEL CCG, Dr Rob Grounds and Dr Gurprit Singh Mudhar for their presentation.

RESOLVED that the update on the Non COVID Immunisation Programme be noted.