GOVERNING BOARD. Date of Meeting 15 May 2013 Agenda Item No 13. Title Immunisation and Vaccination Report 2012/13

Transcription

1 GOVERNING BOARD Date of Meeting 15 May 2013 Agenda Item No 13 Title Immunisation and Vaccination Report 2012/13 Purpose of Paper To update the CCG on the performance and quality of vaccination programmes in Portsmouth City and identify future work and challenges in relation to these programmes Recommendations/ Actions requested For information Author Matthew Pickerill, Development Manager (Health Protection), Public Health Portsmouth Sponsoring member Andrew Mortimore, Director of Public Health Date of Paper 4 April 2013

2 Immunisation and Vaccination Report 2012/13

3 Contents 1. Executive Summary Purpose Introduction The Vaccination Programmes The Childhood Vaccination Programme The Influenza and Pneumococcal Vaccination Programmes The Pertussis Vaccination Programme Performance Childhood Immunisation Programme Current Achievement Trends and Comparators Influenza and Pneumococcal Vaccination Programmes Current Achievement Trends and Comparators The Pertussis Vaccination Programme Improving Vaccination Uptake Childhood Vaccinations Influenza Future Work and Challenges Conclusion

4 1. Executive Summary 1.1 The purpose of this report is to provide an overview to Portsmouth CCG of the delivery and performance of NHS provided vaccination services in Portsmouth City. 1.2 This report will outline the routine vaccination programmes provided in the city and their performance. It will also outline work that has been undertaken to improve performance and highlight future work and challenges. 1.3 Vaccinations are a safe, effective and economical way of reducing the morbidity and mortality associated with infectious disease. They are widely considered to be the second most effective public health intervention behind the provision of clean water. 1.4 Vaccination programmes provided in the UK include the childhood, influenza and pneumococcal programmes, and in October 2012, a temporary programme of pertussis vaccination for pregnant women was introduced to combat a significant increase in pertussis cases, particularly in neonates. 1.5 In 2011/12, 1 out of 8 childhood vaccination targets was achieved in Portsmouth City. Of the 7 targets that were not achieved, 4 were missed by less than 5% and 2 missed by greater than 5%. 1.6 Trend data shows steady and sustained increase in childhood vaccination uptake rates. 1.7 Childhood vaccination rates for Portsmouth City compare favourably with England, with 3 rates higher than that for England, and 2 within 2% or less of the England rates, although they compare less favourably with those of South Central Strategic Health Authority (SCSHA), with only 1 rates higher than SCSHA, 4 within 2% of SCSHA rates and 2 more than 2% less than SCSHA rates. 3

5 1.8 Portsmouth City achieved the 75% influenza vaccination uptake target for the over 65s with a 75.2% uptake rate but only achieved 52.9% for the under 65s at risk groups and 43.1% for pregnant women, against a target of 70%. 1.9 In 2012/ % of NHS Portsmouth staff (against an SCSHA target of 50%) had their influenza vaccination, a significant decrease since last year and which reflects a national decrease in uptake In 2012/13 a survey of 26 out of 27 Portsmouth GP practices found that the uptake rate for pneumococcal vaccination in the over 65 year olds was 69.3%, a slight decrease from 72% in 2011/ To improve the quality and performance of the childhood vaccination programme, the Immunisation and Vaccination Umbrella Group for Portsmouth City develops, agrees and monitors the Childhood Vaccination Action Plan. In 2012/13 this work included: Commissioning an experienced practice nurse to work with GP practices to identify areas for improvement in relation to their childhood vaccination rates Improving data quality, reporting and monitoring Developing a vaccination communications campaign aimed at increasing awareness of vaccinations and improving uptake rates The influenza campaign was overseen by the Influenza Steering Group which reported to the Immunisation and Vaccination Umbrella Group. Work undertaken to improve uptake included a large and varied communications campaign aimed at both patients and staff, development of a Best Practice Pack to share best practice amongst GP practices, commissioning district nurses to vaccinate housebound patients and the development of a Local Enhanced Service (LES) to encourage GP practices to vaccinate patients living in residential and nursing homes On the 1 st April, commissioning of immunisations and vaccinations will transfer to the NHS Commissioning Board (NHSCB) Wessex Local Area Team (LAT). The public health team will still have a significant role to play in vaccination by providing advice, support and challenge related to vaccination 4

6 issues and targets to commissioners to ensure effective interventions are commissioned to increase vaccination uptake rates. Public health will also have responsibility for monitoring and achieving the targets in the Public Health Outcomes Framework (PHOF) Challenges for 2013/14 include resolving commissioning issues related to school leaver booster scheduling, the development of a contract with NHS Solent to provide Child Health Records services, leadership of the influenza vaccination programme and ensuring the safe transfer of commissioning responsibilities and current issues to the NHS Commissioning Board Wessex Local Area Team (LAT) Key areas to focus on in 2013/14 include the under 65s at risk group and pregnant women as part of the seasonal flu campaign and 5 year vaccination rates for the childhood vaccination campaign. 5

7 2. Purpose 2.1 The purpose of this report is to provide an overview to Portsmouth CCG of the delivery and performance of NHS provided vaccination services in Portsmouth City. 2.2 This report will outline the routine vaccination programmes provided in the city and their performance. It will also outline work that has been undertaken to improve performance and highlight future work and challenges. 2.3 This report will not report on vaccination programmes that are purely occupational or travel related. 3. Introduction 3.1 Vaccinations are a vital part of any successful national public health programme. They are a safe, effective and economical way of reducing the morbidity and mortality associated with potentially serious infectious disease and are widely considered to be the second most effective public health intervention behind the provision of clean water. 3.2 Aside from the protective effect of vaccinations in individuals, an indirect effect known as herd immunity is important in protecting populations from infectious disease. This occurs when a high proportion of a population have been vaccinated which reduces the opportunity for infections to circulate in that population. To ensure that this effect is significant, most vaccination programmes aim for at least a 95% uptake rate. 3.3 Vaccination programmes provided in the UK include the childhood, influenza and pneumococcal programmes, and in October 2012, a temporary programme of pertussis vaccination for pregnant women was introduced to combat a significant increase in pertussis cases, particularly in neonates. 6

8 3.4 Evidence for these programmes is regularly reviewed by the national Joint Committee on Vaccination and Immunisation (JCVI), who advise the DH on potential changes to UK vaccination programmes that may arise from the current evidence base. 3.5 In Portsmouth City, all vaccination programmes are overseen by the Immunisation and Vaccination Umbrella Group. This group is made up of multi-organisational and multi-professional representatives from Solent NHS Trust, Portsmouth City Council, HIOW Health Protection Unit, Portsmouth Hospitals Trust and Primary Care. The group s role is to monitor all vaccination programmes in the city and provide advice on improving and sustaining vaccination uptake rates. 3.6 An influenza steering group is also convened each year to plan and monitor the annual seasonal flu campaign, and this also consists of multiorganisational and multi-professional representatives from Solent NHS Trust, Occupational Health, Portsmouth Hospitals Trust, District Nursing, HIOW Health Protection Unit and Primary Care. This group feeds back to the main Immunisation and Vaccination Umbrella Group. 4. The Vaccination Programmes 4.1 The Childhood Vaccination Programme The childhood immunisation programme is offered to all children in the UK. It is the most complex vaccination programme provided and provides routine vaccination against 10 different infectious diseases. It also provides human papillomavirus (HPV) vaccination to year old girls and hepatitis B and BCG vaccination to selected children based on individual risk assessment Protection against each disease requires one or more doses given at specific intervals to establish initial immunity, with some diseases requiring further booster doses of vaccine to maintain immunity throughout life. The details of the childhood immunisation programme are provided in Table 1 below:- 7

9 Table 1 UK Childhood Vaccination Schedule (as at March 2013) Age Given 2 months 3 months 4 months months 3 years and 4 months to 5 years (Pre-school boosters) Girls aged years years (School Leaver s Boosters) Diseases Protected Against Diphtheria, tetanus, pertussis, HiB, polio (DTaP/IPV/HiB), pneumococcal disease (PCV) Diphtheria, tetanus, pertussis, HiB, polio (DTaP/IPV/HiB), meningitis C (MenC) Diphtheria, tetanus, pertussis, HiB, polio (DTaP/IPV/HiB), pneumococcal disease (PCV), meningitis C (MenC) HiB, meningitis C (HiB/MenC), pneumococcal disease (PCV), measles, mumps and rubella (MMR) Diphtheria, tetanus, pertussis, polio (dtap/ipv), measles, mumps and rubella (MMR) Human Papillomavirus (HPV) Tetanus, diphtheria and polio (Td/IPV) In Portsmouth City childhood vaccinations are provided by GP practices, except the HPV vaccination which is provided by the NHS Solent School Nursing Service Information on childhood immunisation status is recorded by the Child Health Records Department (CHRD). CHRD collate information on vaccinations given by practices and school nurses and provide vaccination scheduling and appointment services to most GP practices in the city. 4.2 The Influenza and Pneumococcal Vaccination Programmes These vaccinations are given to protect against the influenza virus and pneumococcal bacteria Influenza vaccination is given on a yearly basis due to changes in circulating influenza virus types. 8

10 4.2.3 Those who are eligible for influenza vaccination include: o o All those aged over 65 years Those aged less than 65 years who: Are at ANY stage of pregnancy Have chronic respiratory disease e.g. some asthmatics, COPD Have chronic heart disease e.g. chronic heart failure Have chronic kidney disease e.g. chronic kidney failure Have chronic liver disease e.g. cirrhosis, chronic hepatitis Have chronic neurological disease e.g. stroke, cerebral palsy Have diabetes Are immunosuppressed e.g. splenectomy, HIV, on high steroid doses Are carers Are living long-term in residential and nursing homes In addition, all PCT staff were offered influenza vaccination to protect themselves, their families and their patients and to help ensure business continuity through the pressures of winter. Commissioning of flu vaccination for local healthcare staff will need reviewing in 2013/14 due to the NHS organisational re-structure Those eligible for pneumococcal vaccination include:- o o o Children as per the childhood immunisation programme All those aged 65 years and over Those aged less than 65 years who: Have chronic respiratory disease e.g. some asthmatics, COPD Have chronic heart disease e.g. chronic heart failure Have chronic kidney disease e.g. chronic kidney failure Have chronic liver disease e.g. cirrhosis, chronic hepatitis Do not have a spleen or whose spleen is functioning incorrectly Have diabetes that is not controlled by diet alone Are immunosuppressed e.g. HIV, on high steroid doses Have a cochlear implant 9

11 4.2.6 Children under the age of one year are given 2 doses of pneumococcal vaccine (at 2 and 4 months) with a boosting dose at months. All other age groups are given one dose of vaccine, with patients with no spleen, a poorly functioning spleen or chronic kidney disease given a boosting dose every 5 years Most influenza and pneumococcal vaccinations are provided by GP practices. Influenza vaccination is also provided by the occupational health department to local healthcare staff, and in some services individual staff members have been trained to provide influenza vaccination to their colleagues. 4.3 The Pertussis Vaccination Programme This temporary programme was introduced in October 2012, in response to a significant increase in the cases of pertussis and mortality from it especially amongst neonates, who would not normally be vaccinated against pertussis until they were 2 months old Pertussis vaccination is offered to pregnant women between 28 and 38 weeks gestation and is provided by GP practices. The vaccine is given at this stage as it protects the baby from pertussis from birth until vaccination is given at 2, 3 and 4 months of age as part of the routine childhood vaccination programme. 5. Performance 5.1 Childhood Immunisation Programme Current Achievement There are a number of national targets for immunisation and vaccination, and performance against them is shown in Table 2 below. Performance data only looks at 2011/12 as this is that latest available full year s worth of data. Trend data includes the latest 2012/13 uptake data. 10

12 Table /12 Annual Vaccination Targets and Performance Targets 2011/12 Target 2011/12 Actual Immunisation rate for children aged 1 who have completed immunisation for diphtheria, tetanus, polio, pertussis, Haemophilus influenzae type b (Hib) - (i.e. all 3 95% 94.4% doses of DTaP/IPV/Hib) Immunisation rate for children aged 2 who have completed immunisation for pneumococcal infection (i.e. 95% 91.3% received pneumococcal booster) (PCV) Immunisation rate for children aged 2 who have completed immunisation for Haemophilus influenzae type b (Hib) and meningitis C (MenC) - (i.e. received 95% 93.2% Hib/MenC booster) Immunisation rate for children aged 2 who have completed immunisation for measles, mumps and rubella 95% 92.3% (MMR) - (i.e. 1 dose of MMR) Immunisation rate for children aged 5 who have completed immunisation for diphtheria, tetanus, polio, 95% 84.8% pertussis (DTaP/IPV) (i.e. all 4 doses) Immunisation rate for children aged 5 who have completed immunisation for measles, mumps and rubella 95% 83.8% (MMR) (i.e. 2 doses of MMR) Immunisation rate for girls aged around years who have completed immunisation for human papillomavirus vaccine (HPV) (i.e. all 3 doses) 90% 90.4% Source: COVER Key: - Red Target missed by more than 5% Amber Target missed by less than 5% Green Target achieved In 2011/12, 1 out of 8 childhood vaccination targets was achieved. Of the 7 targets that were not achieved, 4 were missed by less than 5% and 2 missed by greater than 5%. 11

13 Table 3 compares annual vaccination uptake rates between 2010/11 and 2011/12. This shows that there have been increases in 2 year old PCV and MMR rates and a significant increase in HPV uptake rates since 2010/11. However, there have been no changes in 2 year old Hib/MenC or 5 year old MMR rates and small decreases in 1 year old DTaP/IPV/Hib and 5 year old DTaP/IPV rates. Table /11 and 2011/12 Vaccination Target Performance and Trends Target 2010/11 Target 2010/11 Uptake 2011/12 Uptake 2010/11 to 2011/12 Trend 1 year olds (DTaP/IPV/Hib) 95% 94.5% 94.4% 2 year olds (PCV) 95% 88.6% 91.3% 2 year olds (Hib/MenC) 95% 93.2% 93.2% 2 year olds (MMR) 5 year olds (DTaP/IPV) 5 year olds (MMR) year girls (HPV) 95% 89.4% 92.3% 95% 85.4% 84.8% 95% 83.8% 83.8% 90% % Source: COVER Key: - Red Target missed by >5%, up to 1% decrease, up to 2% decrease etc Amber Target missed by <5% no change Green Target achieved up to 1% increase, up to 2% increase etc 12

14 Due to current data collection processes and reporting it is very difficult to provide reliable uptake rates for school leaver s boosters. Data collection for school leaver s boosters is currently being reviewed by the Department of Health Trends and Comparators Figures 1 to 3 show the quarterly vaccination uptake rates at 1, 2 and 5 years between 2007/08 and 2012/13. These have been portrayed on graphs with the same scale to highlight differences in uptake rates at 1, 2 and 5 years old Figure 1 shows the 1 year old vaccination uptake rates between 2007/08 and 2012/13 showing rates fluctuating between 92% and 96%. Figure 1 Vaccination Uptake Rates at 1 Year, Portsmouth City, 2007/08 to 2012/13 Source: COVER Figure 2 shows the 2 year old vaccination uptake rates between 2007/08 and 2012/13, highlighting the ongoing and sustained increase in uptake rates which are now close to target levels. 13

15 Figure 2 Vaccination Uptake Rates at 2 Years, Portsmouth City, 2007/08 to 2012/13 Source: COVER Figure 3 shows the 5 year old vaccination uptake rates between 2007/08 and 2012/13, highlighting the ongoing and sustained increase in uptake rates, although the increase is less marked than for the 2 year old uptake rates, and the rates are significantly below target levels. 14

16 Figure 3 Vaccination Uptake Rates at 5 Years, Portsmouth City, 2007/08 to 2012/13 Source: COVER Table 4 shows the Portsmouth uptake rates compared to South Central SHA and England. The vaccination rates for Portsmouth City show that 3 rates are higher, 2 are lower but within 2% and 2 are lower but within 5% of the England rates The vaccination rates for Portsmouth City show that 1 rate is higher, 4 are lower but within 2%, 1 is lower but within 5% and 1 is greater than 5% lower than South Central SHA rates. 15

17 Table 4 Comparative Vaccination Uptake Rates, Portsmouth City, South Central SHA and England, 2011/12 Vaccination VSB10_03 1 year DTaP/IPV/Hib VSB10_08 2 year PCV VSB10_09 2 year Hib/MenC VSB10_10 2 year MMR VSB10_14 5 year DTaP/IPV VSB10_15 5 year MMR VSB10_ years HPV Portsmouth City South Central SHA England 94.4% 95.6% 94.7% 91.3% 93.2% 91.5% 93.3% 93.4% 92.3% 92.3% 93.5% 91.2% 84.8% 89.8% 87.4% 83.8% 88.0% 86.0% 90.4% 88.1% 86.8% Source: COVER Key: - Red Portsmouth rate is lower and by 5% or more Amber Portsmouth rate is lower and by less than 5% Lime Portsmouth rate is lower and by less than 2% Green Portsmouth City rate is higher or equal Table 5 compares vaccination uptake rates between Portsmouth and a number of other UK cities, which are similar to Portsmouth in relation to children s services, demography and deprivation, and as can be seen Portsmouth has lower uptake rates in a number of areas than similar cities. 16

18 Table 5 Percentage of children immunised by 1st, 2nd and 5th Birthdays by PCT in PCT (in order of decreasing similarity) 1 year DTaP/IP V/Hib 2 year MMR 2 year Hib/Men C 2 year PCV 5 year DTaP/IP V 5 year MMR Portsmouth City Teaching PCT Plymouth Teaching PCT Southampton City PCT Peterborough PCT South East Essex PCT Bournemouth & Poole Teaching PCT* Torbay Care Trust Bristol PCT Telford & Wrekin PCT Sheffield PCT Derby City PCT Source: COVER Bournemouth & Poole Teaching PCT and Dorset PCT reported issues associated with IT systems which affected data quality in

19 5.2 Influenza and Pneumococcal Vaccination Programmes Current Achievement Influenza vaccination uptake rates for Portsmouth City for 2012/13 are highlighted in Table 6 below:- Table 6 Influenza Vaccination Uptake Rates, Portsmouth City 2012/13 Targets 2012/13 Target 2012/13 Actual Variance from Target Percentage of over 65s receiving seasonal flu vaccination 75% 75.2% +0.2% Percentage of under 65s at risk receiving seasonal flu vaccination 70% 52.9% -17.1% Percentage of pregnant women receiving seasonal flu vaccination 70% 43.1% -26.9% Source: ImmForm Portsmouth City achieved the over 65 influenza vaccination uptake target but failed to achieve targets for the under 65s and for pregnant women Pregnancy was included for the first time in 2010/11 as a risk group eligible for influenza vaccination. In 2012/13 the uptake rate for pregnant women was 43.1%, an increase from the 2011/12 uptake rate of 27.9% In 2012/13 the uptake rate for NHS Portsmouth staff was 36.1% a decrease since 2011/12, reflecting a national decrease in uptake in staff groups. Confusing commissioning arrangements may also have had an effect on uptake rates In 2012/13 a survey of 26 out of 27 Portsmouth GP practices found that the uptake rate for pneumococcal vaccination in the over 65 year olds was 69.3%, against a target of 75%. This ranged from 63.6% in the year olds to 80.4% in the 75+ year olds. This has decreased from a rate of 73.2% in a survey of 15 patients in 2011/12. 18

20 5.2.2 Trends and Comparators Figure 4 below highlights the over 65 year olds influenza immunisation uptake rates for Portsmouth City, SCSHA and England between 2004/05 and 2012/13. The Portsmouth uptake rate fluctuates between 74% and 76% and is consistently higher than both SCSHA and Portsmouth rates. Figure 4 Over 65 Year Old Influenza Vaccination Uptake Rates for Portsmouth City and England, 2004/05 to 2012/13 Source: ImmForm Figure 5 shows the under 65 flu vaccine uptake rates between 2006/07 and 2012/13 showing an overall increase in rates although these seem to be plateauing. Portsmouth rates are similar to SCSHA rates and are consistently higher than England rates. 19

21 Figure 5 Under 65 Year Old Influenza Vaccination Uptake Rates for Portsmouth City and England, 2006/07 to 2012/13 Source: ImmForm Figure 6 shows flu vaccine uptake rates for pregnant women between 2010/11 and 2012/13. The latest figures show that the uptake rate has increased since 2011/12 and is higher than England but lower than SCSHA. Figure 6 Pregnant Women Influenza Vaccination Uptake Rates for Portsmouth City and England, 2010/11 to 2012/13 Source: ImmForm 20

22 5.3 The Pertussis Vaccination Programme No targets have been set nationally for the pertussis in pregnant women programme and monthly uptake rates ranged from 35.8% in October 2012 to 64.1% in February Improving Vaccination Uptake 6.1 Childhood Vaccinations Towards the end of 2011/12 a Childhood Vaccination Action Plan was developed which detailed a programme of work for 2012/13 to improve the performance and quality of the childhood vaccination programme in Portsmouth City. This was agreed and monitored by the Immunisation and Vaccination Umbrella Group. Details of the workstreams undertaken are found in Table 7 below:- Table /13 Childhood Vaccination Workstreams Workstream Communications Progress A communications campaign has been planned and commissioned and will be running through March and April 2013 with the branding of Parents! Be a Hero and get your child vaccinated being used again. The campaign will include 3 road shows at popular sites across Portsmouth where staff will be promoting the campaign and offering branded balloons and doodle flags to children. Posters, leaflets and cardboard cut-outs of the superhero characters will be used in GP practices, children s centres and libraries and advertising will also be used on buses, billboards and telephone boxes across the city. A video will also be used in GP practices and the maternity department at Queen Alexandra Hospital and will also feature on Facebook, Healthy Pompey and Portsmouth City Council s website. All of these will be promoting vaccination and the web link 21

23 Data Quality and Reporting Practice Nurse Trainer Programme which directs parents to the vaccination section of the Healthy Pompey website. Adverts will also be placed in local publications such as Flagship, Term Time and Baby Hampshire. A data quality project has been commissioned from Enhanced Healthcare Services (EHS) who will undertake a data consolidation exercise between GP practices and CHRD vaccination records. This will help identify ghost patients and missing vaccination records which will improve vaccination uptake rates across the city, and identify reasons for these discrepancies so that actions can be put into place to prevent issues in the future. The project will also identify children who are missing vaccinations and EHS staff will then contact these patients directly and invite them in for vaccination. There have been a number of information governance issues that have delayed this project but it is hoped that this will be implemented during April and May A practice nurse trainer was commissioned to work with GP practices in Portsmouth to identify issues related to the vaccination programmes in their practice and to support them to identify solutions. The practice nurse has visited all practices in Portsmouth and has worked closely with CHRD. The main issue highlighted in the project is the lack of clarity related to the system of paperwork involved with the current child health system RiO. The practice nurse trainer has educated many of the practice nurses and practice managers around this and it is planned to produce some guidance for practices after the project Other areas of work undertaken during 2012/13 include the commissioning of vaccination awareness training for the Health Trainer service to ensure key messages about the safely, effectiveness and importance of vaccinations are more widely spread and the implementation of the pertussis vaccination for pregnant women provided by GP practices. 22

24 6.2 Influenza Work on the 2012/13 influenza vaccination programme was overseen by the Influenza Steering Group which reported to the Immunisation and Vaccination Umbrella Group. Details of the workstreams undertaken are found in Table 8 below:- Table /13 Influenza Vaccination Workstreams Workstream Communications Materials from the national campaigns FluSafe, aimed at the public and Flu Fighter aimed at staff, were used to promote flu vaccination. Flu leaflets were circulated with staff payslips and communications for staff flu vaccination were sent out via the intranet and . An article encouraging members of the public to get their flu jab was also published in Flagship magazine, a monthly magazine produced by Portsmouth City Council and sent to all Portsmouth residents. In an effort to boost under 16 flu vaccination rates a letter was sent to all parents of Portsmouth schoolchildren asking them to check their child s eligibility for flu vaccination and if required to book an appointment with their GP to be vaccinated. As in previous years SCSHA sent a monthly letter to GPs highlighting their performance and encouraging them to improve it further. At Risk Groups A residential and nursing home LES was developed to encourage vaccination in these at risk groups and district nurses were commissioned to provide vaccination to housebound patients. The service had been refined based on feedback from the 2011/12 season but capacity within the district nursing had been significantly decreased which meant that a number of flu vaccines were delayed. Primary Care Development of a Best Practice Pack for GP practices in order to share examples of best practice in managing 23

25 successful flu campaigns. Maternity Vaccination Maternity services were commissioned as a pilot to provide flu vaccination to pregnant women in antenatal clinics. However, not as many vaccinations were administered as anticipated as many mothers who attended their GP practice for pertussis vaccination were also given flu vaccination, meaning that many women who attended antenatal clinic were already vaccinated against flu. 7. Future Work and Challenges 7.1 As from the 1 st April, when public health is formally transferred to the Local Authority, commissioning of immunisations and vaccinations will transfer to the NHSCB Wessex LAT. 7.2 The public health team will still have a significant role to play in vaccination by providing advice, support and challenge related to vaccination issues and targets to commissioners to ensure effective interventions are commissioned to increase vaccination uptake rates. 7.3 Public health will also have responsibility for monitoring and achieving the targets in the Public Health Outcomes Framework (PHOF), which contains a broader range of vaccination targets than in previous years. These will be monitored by a newly formed Health Protection Committee which will provide assurance to the Director of Public Health and the Health and Wellbeing Board on issues related to the Health Protection workstream. 7.4 Table 9 below will highlight a number of areas of work that will need to be taken forward during 2013/14. 24

26 Table 9 Future Vaccination Workstreams Working Groups Childhood Vaccinations Seasonal Flu Review the terms of reference and workings of the Immunisation and Vaccination Umbrella and Flu Steering Groups Implement recommendations from the practice nurse trainer and data quality projects Develop a childhood vaccinations health equity audit Support the NHSCB Wessex LAT in implementing future changes to the childhood vaccination programme e.g. rotavirus vaccine in September 2013 and potentially meningitis B vaccine in the future Review the commissioning of staff flu vaccination Review the commissioning of the district nursing service provision of flu vaccine in housebound patients Re-commission maternity services to provide flu vaccination to pregnant women Investigate pharmacy provision of flu vaccination based on the NHS Hampshire model Investigate ways to increase under 16s flu vaccination rates 7.5 There are a number of challenges that need to be addressed in relation to vaccination programmes in the city. This includes the resolving the commissioning of school leaver booster scheduling to ensure all children are invited and offered a school leaver booster vaccination and the development of a robust contract with NHS Solent to provide Child Health Records services in the city. 7.6 It is vital that a robust handover process is implemented to ensure all issues are handed over to the NHSCB Wessex LAT, and that appropriate support is offered to them by the public health team in relation to vaccination programmes in the city. 25

27 8. Conclusion 8.1 Vaccinations are a vital part of any public health programme and are essential in protecting the health and wellbeing of those at risk of infectious disease. 8.2 Childhood vaccination rates in Portsmouth City are increasing gradually, and effective interventions must be commissioned to accelerate and sustain these increases. 8.3 Key areas to focus on include the under 65s at risk groups and pregnant women as part of the seasonal flu campaign and 5 year vaccination rates for the childhood vaccination campaign. 8.4 It is vital that effective work and partnerships continue and are further developed throughout the transition period as responsibility for commissioning of vaccination programmes moves to the NHSCB Wessex LAT. 26