Haringey
CCG Governing Body
Immunisation and Screening Update
Report
May 2015
1
Aim of the report
• This report is an update for the Haringey CCG Governing Body on the
section 7a Immunisation and Screening Programmes currently
commissioned by NHS England.
• Section 7a is the NHS Public Health Functions agreement of the NHS Act
2006 and amended in Health and Social Care Act in 2012 that outlines
responsibilities for NHS England to commission specific public health
services aimed at improving populations’ health.
• It describes recent performance of the programmes at the regional and
local level.
• It includes local challenges, NHS England plans to address those
challenges and support that the local Public Health team is taking to boost
local performance.
2
Immunisation borough summary
• Overall, there has been some good improvements in achieving increased
immunisation coverage. However, there are still great variations across the
borough within specific areas and across different vaccination schedules;
• Hepatitis B vaccination data indicates that there are robust procedures in place
with a high completion rate of the 12 and 24 month cohorts;
• Trends for childhood immunisation coverage over the last three years suggest
overall improvement. However, fluctuations in performance between the quarters
still exists and is mostly due to data collection and data returns;
• Flu vaccinations this year in Haringey are comparable to the London average.
Thirty eight pharmacies in Haringey have been commissioned to offer free flu
vaccinations and PPV to eligible patients;
• Whittington Child Health Information System (CHIS) department has been
reviewed by NHS England and an action plan has been drawn up for
improvements.
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Childhood and pregnancy immunisation
Child flu regional pilots
• London continues to be a national pilot site for the roll out of children’s flu vaccination in
primary school aged children in Havering and for the 2014/15 flu season the offer was
extended to Year 7 in secondary schools to maintain continuity.
• This winter NHS England also offered all special schools across London the opportunity to
take part to improve the uptake of flu in this cohort and to test the logistics for the flu
programme delivery moving forward into 2015/16.
• 2, 3 and 4 year olds
• GP practices are offering all 2, 3 and 4 year olds flu vaccines (using Fluenz nasal spray)
this year. Last year, where flu vaccines were offered to 2 and 3 year olds, uptake across
London was 33% and 30% respectively. Local data is not available yet.
Flu vaccinations in pregnancy
• Preliminary data for the London average coverage rate for flu vaccination in pregnancy was
38%, compared to Haringey’s 37.6%. This was an increase on the 25% coverage rate in
2013/14.
4
Childhood immunisation
Hepatitis B vaccinations
• NHSE has identified that the flow of information from some maternity units to CHIS is not
always accurate. NHSE is working with PHE and Maternity Units to establish what recording
and data flow systems exist with a view to issuing a simple directive to ensure data flows
happen. CCGs contract the maternity unit via the Maternity Pathway Payment (MPP).
NHSE performance manage and oversee service developments of immunisation and ANNB
(Antenatal Newborn) Screening Programmes.
BCG
• Haringey currently delivers universal BCG at birth at North Middlesex Hospital and
Whittington Health deliver vaccinations in the community. Due to national data collection
suspension (KC50), there are currently no figures for BCG delivery.
5
HepB_da
ta_type12
m
Sum of
HBpos_12m
_
denominato
r
Sum of
12m_H
epB_%
HepB_
data_ty
pe24m
Sum of
HBpos_24m
_
denominator
Sum of
24m_H
epB_%
FULL
DATA 24 95.8
FULL
DATA 18 100.0
• Q1 2014/15 data shows that 23/24 babies
born to Hep B positive women completed
vaccination course by 12 months. 18/18
babies completed vaccination by 24 months.
Haringey 3 year childhood immunisation trend
Quarterly COVER data 2011/12 - 2014/15
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Q3 14/15 versus Q3 13/14 childhood immunisation performance
National COVER data is still presented by PCT, and the borough reporting remains experimental.
School age vaccinations
HPV
• Achieving the 90% coverage target for HPV vaccinations remains a challenge
across London. 2013/14 data shows that HPV vaccination performance in
Haringey was lower than the England and London averages.
• From September 2014, only two doses of HPV are required to complete the
schedule, which should help to improve coverage rates. 2014/15 data is not
yet available.
School Leavers booster
• School leavers booster is delivered in schools by the school nurses. Due to
the suspension of the national data collection (KC50), there are currently no
figures for school leavers booster delivery.
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Area
Coverage by dose 2013/14 academic year cohort 11 (year 8)
Dose 1 Dose 2 Dose 3
England 91 90 87
London 85 84 80
Haringey 81 79 76
Adult vaccinations
Seasonal flu
• Provisional data for week 52 shows that 65.4% of over 65s have been
vaccinated in Haringey, compared to 66.7% vaccinated across London; and
45.6% in clinical risk groups received vaccination in Haringey, compared to
47% across London. This is an improvement in performance compared to
2013/14.
• Flu vaccination uptake for all staff in direct contact with patients at the
Whittington Hospital was 82.7%, 46.5% at the North Middlesex Hospital
and 29.5% at the BEH MHT.
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Challenges and next steps
• Some data quality issues with the Cover of Vaccination Evaluated Rapidly (COVER) reporting system
managed by Public Health England are reported across London. NHS England has secured COVER
reporting and the CHIS provider is submitting on time and passes through the internal NHSE quality
assurance process.
• Haringey CHIS (the Whittington) has been reviewed by NHS England and an action plan for the
Whittington CHIS has been drawn up to ensure the delivery of the agreed Service Specification.
• Flu vaccinations were lower at the beginning of the season and NHS England has worked with Haringey
CCG to increase uptake, particularly with the pregnant women cohort and offering access to flu
vaccination within pharmacies.
• Staff flu vaccination was lower at the NMH and BEH MHT. The CCG should request from the Trusts
action plans to improve the uptake for the next season.
• Training needs have been identified and fed into a national scoping exercise. Availability of training for
immunisers has been identified as a national barrier and workshops are taking place with PHE to resolve.
• Co-commissioning of school nursing team with local authority to deliver immunisations is taking place.
The local immunisation group has been re-instated and met on 1st June 2015.
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What is NHS England doing to improve uptake
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Objective One
To improve uptake and
coverage
Objective Two
To reduce inequalities
Objective Three
To improve patient
choice and access
Vision
Empowering Londoners to eliminate vaccine-preventable diseases from London
Improving the information systems
Data cleansing
Data linkage
Improving patient choice and widening access
Embedding immunisations in the maternity and
neonatal care pathway
Targeting specific communities
Introducing new immunisation programmes with new
technologies
Roll out children’s flu programme
Improving coverage through provider recovery plans
• People registered with GP
• People who struggle to access mainstream
Contributing to the management of vaccine-
preventable outbreaks
Measured using the following success
criteria Nationally published vaccine uptake data
Increased range of access points
Reduced outbreaks and incidents
Clinical audit of pathways
Overseen through the following governance
arrangements
Overseen by the London Immunisation Board
National Public Health Senior Oversight Group
Three patch Immunisation Quality Improvement
Boards
On-going engagement with Health and
Wellbeing
Boards
High level risks to be mitigated
Information governance and systems
Stakeholder and user engagement
Inadequately trained immunisation workforce
Vaccine supply
Screening borough summary
• Sickle cell and thalasemia screen at 10 weeks and completion of family origin
questionnaire is low;
• Cancer screening programmes coverage and uptake have increased over the
recent years but they are all still performing below the national standards in
Haringey;
• Bowel Cancer Screening uptake is lower in those who were never screened
(approximately 40%) compared to those who have been screened before (84%);
• Diabetic Eye Screening performance is currently not available for each borough -
data is still presented by the screening centre.
• NHS England has a number of actions in place to improve screening coverage and
uptake across all programmes.
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Antenatal and newborn screening
13
KPI Q4 2013/14
Trust FA1 -
completi
on of
Down's
Request
Form
ID1 - HIV
Coverage
ID2 - Hep
B
Referrals
ST1 -
Sickle
and Thal
Coverage
ST2 -
Sickle
and Thal
screen by
10 wks
ST3 -
Completi
on of
FOQ
North
Middlese
x 97.10% 99.60% 78.30% 99.60% 10.10% 83.20%
CHRD /
Hearing
Screening
Unit
NB1 -
Bloodspot
Coverage
NB2 -
Bloodspot
Avoidable
Repeat Rate
NB3 - Bloodspot
Timeliness of
Results (17 day)
NH1 - Newborn
Hearing
Screening
Coverage
(within 4 weeks)
NH2 - Newborn
Hearing Timely
assessment for
screen referrals (4
weeks)
Haringey 96.60% 100.00% 97.4% (NCL) 86.5% (NCL)
North
Middlesex 3.05%
Source: Published data UK NSC - North Midd Maternity Unit
Source: UK NSC - Haringey CHRD and NCL Hearing Programme
Antenatal and newborn screening
actions for improvements
• ST2 – Sickle Cell & Thalassemia - timeliness of test. The maternity
booking system is under review to facilitate earlier booking
appointments (10 weeks gestation).
• ST3 – Sickle Cell & Thalassemia – completion of Family Origin
Questionnaire (FOQ). The booking blood request form is under
review to improve completion of FOQ.
• NB2 – Newborn Bloodspot Screening – avoidable repeat tests.
New system implemented to triage all cards centrally for quality
and accuracy.
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Trends in screening uptake since 2006: Breast, cervical and
bowel cancer screening
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Cervical cancer screening actions for
improvement
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• The North Middlesex Hospital (NMH) cytology laboratory relocated to new premises in
November 2013 as part of planned reconfiguration of services to achieve a minimum
of 35,000 samples reported each year. This affected the 98% turnaround time
standard for delivery of results until September 2014. These issues have now been
resolved.
• There is an action plan in place to resolve waiting time issues for colposcopy at NMH.
This includes appointment of administrative staff , implementation of partial booking
and SMS text reminders.
• There are a number of specific actions targeting improving the coverage such as
Cancer Research UK primary care facilitators and the NHS England coverage and
uptake technical group that will critically appraise proposals for initiatives, produce
evidence of best practice and provide trajectories for improvement of screening
programmes to the London Screening Board. This work will inform NHS England
commissioning of coverage and uptake initiatives across London.
Breast cancer screening actions for improvements
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• An uptake CQUIN has been agreed with the North London Breast Screening
Service (NLBSS) for 2014/15; this aims to achieve 3% increase in the uptake by
year end through the implementation of an agreed evidence-based initiative.
Plans for the CQUIN are monitored through the performance board on a quarterly
basis.
• Barnet and Chase Farm Trusts have been acquired by the Royal Free Hospital
(RFH) Trust which has had an impact on the availability of the data.
• NLBSS report that the RFH Trust management is supportive and do not
anticipate a negative impact on the breast screening programme. Technical
Recall (TR) rates for NLBSS increased in May 2014 to 2.4% (national target
< 2%). The radiography department is conducting an audit and will be
considering purchasing equipment to reduce the 'blur' and improve on TR rates.
Bowel cancer screening issues and actions for
improvement
• The most significant factors affecting uptake for bowel cancer screening are age,
sex, deprivation and recent migration.
• Uptake is lowest for prevalent screens, i.e. those who have never ‘completed a
kit’ before (40.6%), while in incident screens, i.e. those who have previously
‘completed a kit’, uptake averages 81.3%.
• The London Hub contract for 2014/15 includes a CQUIN to improve uptake in the
NHS Bowel Cancer Screening Programme (NHSBCSP) in London by
• sending pre-notification lists (PNL) to GPs
• sending GP endorsement letters with screening invitations
• forwarding of reminder letters (at one month after invitation) to GP practices
to enable timely follow up of non-responders.
• Haringey’s Public Health Team has implemented a local enhanced service for
bowel cancer screening and 10 practices have taken up this service.
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Diabetic eye screening
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Performance for the NCL Screening Service
Diabetic eye screening
• The NCL Programme cited capacity issues in clinics as their main challenge and
they have introduced out of hours clinics where uptake is reported to be good.
• The programme has recently acquired a screening van to screen patients at GP
surgeries and other venues.
• The uptake in quarter one was 77% (3% lower than the previous quarter) because
23% of patients (15 out 66) referred with active R3 during the reporting period did
not attend the offered appointments.
• The programme is auditing the DNA rates at Hospital Eye Services across the five
main referral sites to ascertain if the problem is more prevalent at any particular site
in the patch and will then formulate targeted strategies to address issues that arise.
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