Mother on phone holding a young child

Deprivation and ethnicity: Improving immunisation uptake across the UK

In July 2020, we were commissioned by NHS England to deliver the national Immunisation Management Service (IMS) for influenza. This service would be a keystone in the Government’s enhanced winter flu programme for the 2020/21 season.

The challenge

The primary objective of the programme was to optimise the uptake of the flu vaccine to key groups, or cohorts of citizens across the UK. The programme would provide a detailed breakdown and analysis on local uptake of the Flu vaccination identifying low levels of uptake requiring targeted interventions.

Additionally, it would pin-point high levels of uptake from which best practices lessons could potentially be learned and shared. 

This capability has especially highlighted the effects of deprivation and ethnicity on immunisation uptake. Deprivation and ethnicity are known to have a recurrent impact on the uptake of all immunisations including flu vaccinations. Both factors are major issues in themselves, but also sometimes work together in certain areas and communities and this was noticeable from SCW’s local immunisation figures. 

  • A 2020 poll conducted by the UK Household Longitudinal Study found that vaccine scepticism among Black, Asian and ethnic minority groups in the UK is high. And press coverage lately has seen high profile BAME celebrities supporting flu jabs and reassuring people from ethnic minority backgrounds of the safety and effectiveness of the vaccines themselves

Our approach 

We provided a National Immunisation Management System (‘NIMS’, an IT and infrastructure platform), supported by a comprehensive service into the national vaccination programme.

  • Letters were sent to offer and remind eligible individuals to book their flu vaccinations 
  • A regional support and Improving Immunisation Uptake Service was implemented across the seven NHS regions. Our team of specialists worked closely with the flu leads at CCG, STP, Public Health and PCN level. Using operational data to show uptake, and analysis using data such as age, geographical location, deprivation and ethnicity we were able to inform local planning and provide a focus on where uptake needed to be improved
  • An outbound call centre was set up to contact those citizens who had not taken up the offer of a flu vaccination. Analysing NIMS flu vaccination data, the regional Improving Immunisation Uptake team were able to schedule for calls to be made to citizens within areas of particularly poor flu vaccination uptake
  • This outbound call centre service identified the perceived and actual barriers people were experiencing in accessing the flu vaccination and looked to mitigate this by answering queries or showing contacts where they could get more information
  • Regional reports were produced to capture caller feedback as rich data. The information was shared with stakeholders to inform and improve delivery of the vaccination. The service was targeted to specific Clinical Commissioning Groups (CCGs), across Primary Care Networks and to individual GP practices
  • Building relationships with our NHS colleagues across the regions enabled us to add value and support where needed. The SCW team attended local flu boards, where our IMS dashboard and reporting analysis would pin-point immunisation uptake to a granular level such as by GP practice. This enabled the identification of differences in vaccination uptake by groups and demographics.

It was this collaborative capability in our service that enabled us to shine a light on the marked effect of deprivation and ethnicity on immunisation success and provide targeted support for improvement.

The impact

Our IMS solution has been central to the success of the national programme and this is borne out of the official figures in the national flu surveillance reports:

  • Over 1 million people invited to book their vaccination
  • Flu vaccine uptake was 80.8% in people aged 65+ years, which is the highest uptake ever achieved
  • Uptake in 2 and 3-year-old children was also the highest ever recorded
  • In clinical risk groups uptake was 52.5% and higher than the last seven seasons
  • In pregnant women uptake was at 43.7% which is higher than the same time last season

But it was our regional collaborative IMS support that provided the vital detail that led to improving immunisation uptake. 

Granular data reporting by geography and population groups

Our contribution to identifying and targeting vulnerable groups against the backdrop of deprivation and ethnicity has made a real difference. 

Using our NIMS platform, reporting and analysis in the field has provided a level of insight not seen before within a national flu programme. Our teams in the England regions have provided real-time reporting of vaccination performance by geography and by different population groups. 

Daniel Thorogood from the regional IMS team covering London, which is one of the most challenging areas with a history of low immunisation success, commented: ‘The feedback from our customer, the NHS Flu Vaccination Programme Lead for London, this year has been overwhelmingly positive.’ 

In the North West and the Midlands our insight support and provision of on-the-ground feedback has helped tackle persistent issues on uptake relating to deprivation and ethnicity.

Using data to shape uptake improvement activities

  • GP practice targeting - Using detailed breakdowns supplied by our regional team, CCGs in the Midlands have been able to drill down to GP surgery level. Best practices from successful surgeries in their local flu plan were identified and passed on to those struggling to improve their vaccination targets
  • Targeted communications campaigns - Our data provided the information needed to run effective communication campaigns in the region. Media channels that serve a mainly ethnic audience were used for messaging to these groups to provide more information and reassurance around the vaccine itself
  • Day-of-the-week analysis to shape opening times - Harry Canty-Davies part of the IMS team supporting the North West points to another example, ‘Another approach has been to help arrange or make the vaccination appointment itself easier. Our figures help drill-down to neighbourhood level. This makes it viable for the CCG to open Saturday clinics and actually make the bookings for people who struggle to find the time.’
  • Evaluation and strategy planning - The figures we provided emphasised the correlation between social deprivation and the lower levels of flu vaccination in many communities within Birmingham and Solihull and the Black Country and West Birmingham. Our team presented this to the NHSE Midlands Seasonal Flu and Pandemic Immunisation Board attended by representatives from all CCGs in the Midlands and Public Health officials.

Philippa Turner from our Midlands IMS team told us: ‘This level of detail had not been seen before so we were asked to produce further data for each STP in the region. This will be used as part of a wider evaluation to decide on strategies and campaigns to help poorer communities get better access to vaccinations next year.’ 

While future plans are being evaluated, some successes are apparent now and although deprivation and ethnicity are important considerations for low uptake, the Midlands has nevertheless presented its best Flu vaccination figures to date. 

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