Lessons from the Vaccination and Immunisation National Support Team

1. Lessons from the Vaccination and Immunisation National Support Team Fiona Print, NHS Central Lancashire Michelle Falconer, NHS Halton and St Helens

2. Public Health National Support Teams • Established by the Department of Health in 2006 to support local areas (including L/A, PCTs and partners) • Undertook ‘diagnostic’ visits to provide informed support, expertise and to challenge areas to achieve better public health outcomes • interviews • small group discussions • intelligence gained from publicly available information and documents sent by the participating PCT • 10 subject specific teams – Sexual Health, Tobacco Control, Health Inequalities, Teenage Pregnancy, Childhood Obesity, Alcohol Harm Reduction, Infant Mortality, Response to Sexual Violence, Vaccination and Immunisation and Children and Young People’s Emotional Wellbeing and Mental Health

3. NST approach NST used a consultancy approach NST was not an inspection or an audit The emphasis was on ‘positive potential’ rather than a ‘problem to fix’ This allowed the team to look beyond the original perceived problem and to bring back genuinely fresh insights to the clients

4. Vaccination and Immunisation National Support Team Commissioned by Immunisation branch of Department of Health in 2009 By February 2011, the team had undertaken a total of 16 visits, incorporating each region of England Visits are based on a systematic investigation of local context VINST offered and promoted the implementation of an evidence-based approach to tackling the Government’s key deliverables in relation to improving immunisation uptake

5. PCT selection Selection was from those PCTs that at the time had the lowest levels of MMR and HPV uptake but would include at least one visit to each of the SHA regions Once identified the CEO of each PCT was contacted and offered a visit from the team

6. Visit process Agreement with PCT to visit Meeting with DPH to discuss any issues prior to visit PCT send any relevant documents to the lead Associate Delivery Manager (ADM) for the visit ADM identifies and reviews any other information that is within the public domain Team undertake the visit. Typically Tuesday – Thursday One day of One-to-One interviews and small group discussions with representatives from all stakeholders invited One day of preparing report Report given back to PCT at a closing plenary on Thursday Follow up visit and support offered 6 weeks after visit

7. NHS London 3 London Learning and Dissemination Days Improving uptake, Data and Targeted programmes Presentations of good/innovative practice from London PCTs and speakers from around England Networking opportunity

9. Key strategic messages • strong local leadership is vital to an effective cross agency approach to improving immunisation uptake and sustainable delivery systems • clear governance arrangements are required to ensure local services work together to deliver increased vaccine uptake • real time data recording and reporting will strengthen local performance management and commissioning • integrated commissioning will ensure a whole systems approach developing sustainable delivery systems and increasing immunisation uptake rates

10. Key strategic messages • a strategic lead will provide oversight of individual programmes, and needs to be backed by a strategic approach to workforce issues • better understanding of the role and responsibilities of different agencies and staff will promote greater effectiveness and improved service delivery • community engagement and understanding the preferences and needs of local population will help develop flexible, responsive, acceptable services for the use of those who need them

11. Top 10 recommendations • Develop a vision, overarching strategy and action plan that’s SMART • Improve strategic and operational leadership • Active contract / performance management • Develop a communications strategy • Improve both internal and external communications

12. Top 10 recommendations • Know your population e.g. Mosaic / social marketing • Audit care pathways for targeted immunisations • Use data more effectively and share it • Link data where possible e.g. COVER and payment • Review staff capacity ensuring clear roles and responsibilities with appropriate training

13. All opportunities to review a child or young person’s immunisation history should be fully utilised and ensure that no opportunity is missed to immunise Increasing immunisation uptake is ‘everybody’s business’

14. Evaluation of VINST • 86% of stakeholders would recommend a visit by the VINST • 86% of stakeholders feel that the VINST has supported them in making progress on a number of important issues relating to immunisation uptake • 83% consider VINST to have adopted a robust evidence-based approach to immunisation

15. There have been a lot of different views across the city regarding vaccine uptake but VINST helped provide an objective look at it and I now feel the real issues are known. PCT assumptions were not evidence based” PCT Chief Executive The VINST provided a lever to drive up quality in other services” PCT Chief Executive A very positive experience from a very supportive team” Senior Public Health Nurse It’s a pity the team is disappearing just as it got into its stride. Feel the team increased the focus on immunisation.” PCT Chief Executive VINST “The data showing uptake against deprivation score was very good and gave a sense of what could be achieved. VINST did help to highlight a significant issue.” PCT Chief Executive

16. Change in MMR uptake at age 2 years

17. Change in MMR uptake at age 5 years

18. Refocusing • Smarter ways of working • If you always do what you’ve always done, you always get what you always got • Cost neutral • There are ways of doing things that don’t cost money – identify locally and share • Rationalise • Don’t duplicate work