Haringey. CCG Governing Body. Immunisation and Screening Update. Report. May 2015

Transcription

1 1 Haringey CCG Governing Body Immunisation and Screening Update Report May 2015

2 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

3 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. 3

4 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 4 38%, compared to Haringey s 37.6%. This was an increase on the 25% coverage rate in 2013/14.

5 Childhood immunisation Hepatitis B vaccinations HepB_da ta_type12 m FULL DATA Sum of HBpos_12m Sum of HepB 12m_H data_ty denominato epb_% pe24m r FULL DATA Sum of HBpos_24m _ denominator Sum of 24m_H epb_% 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. 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

6 Haringey 3 year childhood immunisation trend Quarterly COVER data 2011/ /15

7 Q3 14/15 versus Q3 13/14 childhood immunisation performance 7 National COVER data is still presented by PCT, and the borough reporting remains experimental.

8 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. Coverage by dose 2013/14 academic year cohort 11 Area (year 8) Dose 1 Dose 2 Dose 3 England London Haringey School Leavers booster School leavers booster is delivered in schools by the school nurses. Due to 8 the suspension of the national data collection (KC50), there are currently no figures for school leavers booster delivery.

9 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. 9

10 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. 10 The local immunisation group has been re-instated and met on 1 st June 2015.

11 What is NHS England doing to improve uptake Vision Empowering Londoners to eliminate vaccine-preventable diseases from London Objective One To improve uptake and coverage Objective Two To reduce inequalities Improving the information systems Data cleansing Data linkage Improving coverage through provider recovery plans People registered with GP People who struggle to access mainstream Contributing to the management of vaccinepreventable outbreaks Targeting specific communities 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 Measured using the following success criteria Nationally published vaccine uptake data Increased range of access points Reduced outbreaks and incidents Clinical audit of pathways Objective Three To improve patient choice and access Introducing new immunisation programmes with new technologies Roll out children s flu programme Improving patient choice and widening access Embedding immunisations in the maternity and neonatal care pathway High level risks to be mitigated Information governance and systems Stakeholder and user engagement Inadequately trained immunisation workforce Vaccine supply 11

12 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. 12

13 Antenatal and newborn screening KPI Q4 2013/14 Trust FA1 - completi on of Down's Request Form North Middlese 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 x 97.10% 99.60% 78.30% 99.60% 10.10% 83.20% Source: Published data UK NSC - North Midd Maternity Unit 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% % 97.4% (NCL) 86.5% (NCL) North Middlesex 3.05% Source: UK NSC - Haringey CHRD and NCL Hearing Programme 13

14 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. 14

15 15 Trends in screening uptake since 2006: Breast, cervical and bowel cancer screening

16 Cervical cancer screening actions for improvement 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 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. 16

17 Breast cancer screening actions for improvements 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. 17

18 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. 18

19 Diabetic eye screening Performance for the NCL Screening Service 19

20 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. 20