In May 2020 there was serious concern within NHSE/I around the potential for a high prevalence of flu during the coronavirus pandemic. A solution was urgently needed to help increase immunisation uptake that would ensure that the nation didn’t face a health crisis with flu and COVID-19 in the same season.
There was an urgent requirement for a national call and recall service to drive uptake of flu vaccine. At the same time preparing to have a national service commissioned and mobilised for when the COVID-19 vaccine became available.
As an NHS leading provider of Child Health Information Services (CHIS), we had the relevant experience and were asked if we could deliver something similar at a national level for influenza. This was an urgent request. We were commissioned by NHSE/I to provide a national immunisation management service for flu within eight weeks (start date 1 September 2020). The service would support local systems and drive vaccination uptake, reach the most vulnerable in society and provide a fair and equitable process for inviting individuals for vaccination.
Most importantly we were asked to deliver a programme that could be a test and forerunner for COVID-19 when the vaccine became available.
The nation was relying upon an effective vaccination programme that would save lives and be a catalyst for economic recovery.
The challenge
- Procure and put in place, at speed, a national management system, hybrid mailer service and overall support service that could work with the existing complexities of local systems to call and recall eligible individuals and that would capture details from point of vaccination.
- Design an analytics capability that could report information to a detailed region and commissioning area level to support local intervention campaigns to drive immunisation uptake.
- Provide a national picture in real-time, and feed this cleansed data to a central database that was still being created as part of the COVID-19 response.
Our approach
The service drew on experience from our successful Child Health Information Services (CHIS) to rapidly assemble a multi-disciplinary team and provide a national solution.
The NHS Immunisation Management Service (IMS) was designed to be at the core of the national vaccination programme. IMS was successfully built around integration and collaboration. Strong working relationships, sharing 'blood, sweat and tears' with committed partners was critical to the success of the programme. It was also supported by ongoing robust contract management with partners.
SCW, along with two private-sector organisations System C (procured system provider) and Synertec (procured hybrid mailer), worked hand-in-glove alongside our commissioner NHSE/I, Public Health England, and NHSD/NHSX to design the system to drive uptake of vaccination.
Robust governance was established from the outset due to the size, scale and significant reputational impact of failure to deliver the service. An SCW executive programme board was set up to ensure all procurement documentation, business cases and contracts were rigorously scrutinised. The Board engaged closely with colleagues in NHSE/I to ensure appropriate sign off was achieved at all stages.
Maintaining a discipline of robust governance and assurance, with everyone working from home due to lockdown, and against a backdrop of political pressure to deliver at such a rapid pace, was incredibly challenging for SCW and its partners. We are proud that we managed to design and deliver on time, a brand new national service that has stood up to significant assurance and review.
IMS is an excellent example of multi-disciplinary team-working. Our workforce included colleagues from across the whole of SCW as well as partners working at national and regional level. The unique nature of this programme, required close working relationships, effective communication protocols and collaborative ways of (remote) working to deliver at pace through a pandemic. Our working and engagement with recruitment agencies to support the delivery of the recall centre have ensured mobilisation of a trained workforce, within budget, working from home and innovative ways of supporting IT.
Our team was designed to integrate closely with the commissioner’s teams in communications, information governance, tech and data, regional delivery and equality and diversity.
Key features of the service
- Identifying eligible people who are prioritised for vaccination.
- Sending letters or SMS messages to invite and remind individuals to book their vaccinations.
- An outbound call centre making follow-up calls to those who haven't been vaccinated. The service identifies perceived and actual barriers to vaccination uptake and seeks to mitigate this through answering queries or signposting, and supporting bookings through the national booking service.
- A regional Improving Immunisation Uptake Team that analyses data to provide evidence of areas and groups with low vaccination levels, enabling targeted national and local campaigns to increase vaccination uptake.
- A National Immunisation Management System (NIMS) providing a single data store for vaccination records, demographics and booking transactions for over 50m people, in near real-time, and generating reports and dashboards for analysis. This procured system, NIMS performs to the highest set standards and is the engine providing data for Public Health England, NHS England and at ministerial level.
- Geographical and population analysis identifying optimal locations and routes for vaccine delivery, saving valuable time and resources.
For the first time, 60M eligible individuals in England have a record on NIMS. It is the main system of record for NHSE/I immunisation programmes maintaining a list of citizens' demographics, clinical records, and vaccination status to inform cohort selection, planning and prioritisation. It integrates with numerous other NHS systems to send and receive data to enable vaccine delivery activities.
A real ‘first’ for the NHS, it was procured mid-pandemic and designed to be developed as the programme evolved from flu to COVID-19 vaccination. It integrates with several 3rd party national systems via its Application Programming Interface in real-time. It is successfully the core backbone scheduling service for call and recall of eligible individuals and continues to provide value to the national programme.
The outcome
The NHS delivered the most successful national flu immunisation management programme ever. Far exceeding the uptake targets that were set with over 80% of people aged 65+ years - resulting in zero flu cases since January 2021.
This led to the foundation for the COVID-19 programme and we were able to build on this success and drive uptake working at a regional and national level. The set-up of the NHS national flu and COVID-19 service took just six weeks.
Within the first seven days of issuing COVID-19 letters:
- 45% of people aged 85+ vaccinated
- Over 1 million invited to book their vaccination
We implemented a real-time, multi-system view of the NHS vaccination programme – from local neighbourhoods, to regions and up to national population level. It provided the ability to pinpoint factors contributing to immunisation uptake, target areas for improvement and inform local planning.
The service provides a rich source of data and intelligence to inform future vaccination programmes.
Official statistics from the government’s national flu and COVID-19 surveillance reports show substantial achievements in the priority groups of citizens targeted. The expectation from the commissioner was for us to enable an efficient and fast-moving vaccine programme that would be able to flex and adapt according to need. This was achieved and we supported the NHS to meet all the Government vaccination targets.
Without a doubt, the IMS service making telephone calls to the 2-to3-year-old cohort contributed to our best uptake performance - NHS local lead for flu immunisation covering the London area
We have been asking for something like this, which provides all the data including information around demographics and ethnicity in one place, for years. - Public health consultant West-Midlands
Results as of 23 June 2021
- We have invited 36 million individuals (73.6% of England population) to attend a mass vaccination centre by letter and text, and 3.5 million phone recalls made to non-attendees since the start of the COVID-19 programme.
- For COVID-19 we have sent 47 million letters and 32 million texts to date - and for flu, we mailed over 21 million letters and made 1 million outbound calls over 117 days.
- The NIMS infrastructure manages up to 3 million API calls per day. A total of 300 million since the start of the COVID-19 service.
- The recall centre has assisted 48.5k people with booking their vaccine appointments since the start of the COVID-19 programme.
- Individuals called by our recall service were twice as likely to go on to receive the vaccine compared to those that are not called (based on demographically matched sample size 90k).
Summary
The Flu/COVID-19 service has been the catalyst for change in immunisation. Learnings from the COVID-19 programme have been applied as planning starts for the next flu season, and also starting to inform service re-design of wider screening programmes. Indeed, the discipline and energy applied to the programme has been cited as a valuable lesson to inform other screening programmes such as for cardiovascular disease.
New software developed for IMS is now being made available to other programmes. These platforms are enabling rapid deployment of new technology into existing markets, for example, CHIS, which is now benefitting from the increased data flow and visibility, efficiency and speed of an enhanced service.
The service is also now being explored for catch-up campaigns such as MMR. The entire population is now benefitting from this national service and platform, enabling acceleration of changes and increased efficiency.
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