Quality & Safety Committee

SUMMARY REPORT Quality & Safety Committee Subject Influenza Immunisation Update ABM University Date: 7 December 2016 AGENDA ITEM: 3.1 Prepared, approved and presented by Sara Hayes, Executive Director of Public Health Purpose To inform the Quality and Safety Committee of the approach we are taking to increase flu vaccination uptake and to report progress for the 2016/17 influenza season. Corporate Objectives Excellent Population Health Excellent Patient Outcomes Sustainable Services Excellent People Decision Approval Information X Other Good Governance X X X X X Executive Summary Influenza vaccination uptake levels in 2015/16 season were above the required levels for pregnant women and for frontline staff but for all other groups were well below target. This paper presents the flu vaccination action plan for the 2016/17 vaccination season to try to increase coverage and so protect the population, particularly vulnerable people from the dangers of influenza. Key Recommendations The Quality and Safety Committee note the contents of this report. Assurance Framework This paper describes how vaccination uptake rates are monitored regularly and where poor performance is identified, the efforts made to increase coverage. Next Steps Flu vaccination will continue as planned to the end of March. 1

MAIN REPORT ABM University Quality & Safety Committee Date: 7 December 2016 AGENDA ITEM: 3.1 Subject Prepared, approved and presented by Influenza immunisation uptake Sara Hayes, Executive Director of Public Health 1. PURPOSE To inform the Quality and Safety Committee of the approach we are taking to increase flu vaccination uptake and to report progress for the 2016/17 influenza season. 2. INTRODUCTION Influenza vaccination uptake levels in 2015/16 season were above the required levels for pregnant women and for frontline staff but for all other groups were well below target. The Strategic Immunisation Group (SIG) has developed an action plan for the 2016/17 vaccination season to try to increase coverage and so protect the population, particularly vulnerable people from the dangers of influenza. 3. KEY ISSUES SIG developed strategic intentions for the 2016/17 flu vaccination action plan (Appendix 1) following a review of our own performance last year, advice from Public Health Wales and learning from recent experience elsewhere in the UK. These are: To increase immunisation uptake rates for all eligible children, aiming to maximise uptake and to raise the performance in the lowest performing areas. Increased flu immunisation uptake rates in the eligible children s cohorts should result in reduced transmission of influenza across all age groups, lessening levels of flu overall, and reducing the burden of flu across the population. In order to achieve this, a collaborative approach should be maintained between key professionals namely Health Visitors, GP s, School Health Nursing, Midwives, Pharmacy and Child Health Department. To continue to offer flu immunisation to all who are eligible, and to seek an increase in vaccine uptake amongst those in a clinical risk group, in particular those who are at highest risk of mortality from flu, but have the lowest uptake rates of the vaccine. To continue to improve uptake rates amongst ABM staff, in particular those with direct patient contact. In order to build upon the success of the previous season under the leadership of out Flu Ambassador, we expect to reach at least 60% uptake rates for front line staff in all Service Delivery Units, which is achievable. To promote accurate and timely information on flu vaccination that has been administered, this to be recorded and shared appropriately. 2

There is an active communication programme included in the action plan and several videos have been shared on social media, including a patient story of someone who contracted flu last year, which received much media attention. Immunisation activity for most aspects of the campaign tends to be highest between September and December but vaccination will continue to be offered until the end of March, which is appropriate given the flu infection season peaked relatively late last season, in March and April 2016. The most recent figures are attached (Appendix 2 and 3). With 118 trained flu champions across the the staff campaign has progressed well. We have vaccinated 53% of front line staff during the first 8 weeks of the campaign, following an initial intensive 6 week campaign and we are still offering vaccines in our Occupational Health Departments and carrying out ad hoc mobile sessions across the. We also support Swansea, Bridgend and Neath Port Talbot Local Authorities to vaccinate their front line staff who work closely with our community staff. The school campaign has also gone well this year with all year groups achieving uptake above 70%. It is too early to know how well the vaccination in pregnancy has been going as local data collection is underway. Other aspects of the campaign are still below the level we would like and efforts are continuing to try to improve uptake. A new system is being used to report uptake at practice level this year and the practices with low uptake are being visited to see how they can be supported. Vaccinations administered in pharmacies are being collated and reported monthly this year. There is no egg-free vaccine available this year so we are making arrangements for a small number of people with severe egg allergy in the at-risk groups to receive vaccination in hospital. PHW advise the risk of anaphylaxis is extremely small for these people. 4. WAY FORWARD Flu vaccination will continue to be promoted to the at-risk groups and frontline staff until the end of March. Efforts will continue, as outlined in the action plan, to encourage and support GP practices, based on their activity data. 5. RECOMMENDATIONS The Quality and Safety Committee note the contents of this report. 3

ABMU Flu Plan Winter 2016/17

ABMU Seasonal Flu Vaccination Plan for 2016-17 Flu occurs every winter and is a key factor in winter pressures across the organisation. An organisational priority of ABM is the seasonal influenza vaccination campaign which aims to minimise flu related morbidity, mortality, GP consultations, hospital admissions and pressures on A and E departments. This plan describes the processes in place and the actions required to deliver seasonal flu vaccination as effectively and efficiently as possible. It will be updated as required to reflect changing circumstances. The table below outlines ABM performance during the 2015/16 season compared to the Welsh average. WG ABM Wales Target Patients aged 65 yrs and older 75% 64.6% 66.6% Patients aged 6m to 64yrs at risk 75% 43.4% 46.8% Uptake of influenza vaccine in children No target 33.6% 44.5% aged 2+3yrs Uptake of influenza vaccine in children aged 4-6yrs in school No target 60.5% 63.4% Uptake of staff influenza immunisation Total staff immunised Staff with direct patient contact 50% 52.1% 54.6% 45.9% 47.2% Number of pregnant mums vaccinated (as taken from Point of Delivery survey 2015/16) 75% 80.5% 75.6% In response to these outcomes and the information within the WHC (2016) 039, the flu plan has been revised along with our strategic intentions for the 2016/17 season which are listed as follows: 2

To increase immunisation uptake rates for all eligible children, aiming to maximise uptake and to raise the performance in the lowest performing areas. Increased flu immunisation uptake rates in the eligible children s cohorts should result in reduced transmission of influenza across all age groups, lessening levels of flu overall, and reducing the burden of flu across the population. In order to achieve this, a collaborative approach should be maintained between key professionals namely Health Visitors, GP s, School Health Nursing, Midwives, Pharmacy and Child Health Department. To continue to offer flu immunisation to all who are eligible, and to seek an increase in vaccine uptake amongst those in a clinical risk group, in particular those who are at highest risk of mortality from flu, but have the lowest uptake rates of the vaccine. To continue to improve uptake rates amongst ABM staff, in particular those with direct patient contact. In order to build upon the success of the previous season under the leadership of out Flu Ambassador, we expect to reach at least 60% uptake rates for front line staff in all Service Delivery Units, which is achievable. To promote accurate and timely information on flu vaccination that has administered, this to be recorded and shared appropriately. 3

Objective 1 To achieve Welsh Government target (75%) for individuals aged 65 yrs and over To achieve Welsh Government target (75%) for those aged 6months to 64 yrs in an at risk group (This includes pregnant women) No Action Lead Progress RAG 1.1 Continue Primary Care Flu Planning Sub-Group meetings LD (PC) Dates set 1.2 Review of GP practice plans prior to roll out for forthcoming season. Identify practices with high uptake rates and plan to visit PCFPG Dyfed Rd surgery visited by IC and PHT 24.6.16 1.3 GP Practice plans to be sent to practices and returned by the end of July 2016 Primary care leads to review submitted GP plans and discuss with own primary care manager any concerns highlighted from these. PCFPG Majority of practice plans completed and returned (significant increase from 2015/16). Arrangements made for following up with practices 1.4 Circulate WHC for Influenza letter when received to ABM IG CW Circulated 3.8.16 1.5 Liaise with pharmacy re completion and sign off of relevant PGD s CW Plans in place 1.6 Distribute flu resources to participating pharmacies PHT/PC FPG Resources distributed via Lowri Hartson 1.7 Promote access to elearning and encourage greater use of the module All Information cascaded within ABM 1.8 Offer support to individual practices to review and plan flu campaigns PHT Offer sent by Primary Care Managers 1.9 Liaise with locality councils for voluntary service, i.e. Swansea CVS, Neath Port Talbot CVS and Bridgend Association for Voluntary Organisations, (BAVO) to support flu season PHT CVS Leads supporting PHT staff with community 4

awareness raising sessions. 1.10 Liaise with Healthy Working Wales and Local Authorities to offer flu immunisation resources/materials, social media guidance, and encourage them to promote via organisations/partners/staff PHT Partners contacted and distributing messages/resources 1.11 Prepare articles to promote flu immunisation in local free publications PHT Free articles placed in SA2 Times and Bay Magazines 1.12 Provide flu Information display Boards for loan to GP Practices and other agencies/ organisations PHT Flu boards/banners distributed widely to PC 1.13 Support Community/Workplace events to promote flu immunisation, i.e. Teddy bears picnic PHT/HV/SHN -Attended Teddy Bears Picnic 21 st 1.14 Ensure practices are actively encouraging attendance for flu vaccination to all eligible patients at start of season (100% offer) PCFPG/PC Managers July -Seminars with British Lung Foundation attended Patient call and recall included in practice flu plans 1.15 Forward annual flu report to practices IC Within local resource pack 1.16 Review the number of pharmacies in ABMU who will be commissioned to vaccinate SJ 1.17 Circulate flow chart for the management of egg allergy patients to primary care CW / PC Managers This is included in the back of the PGD 1.18 Ensure that primary care staff are informed of the recommended Read codes to be used, to support searching patient data systems to identify at risk patients. PCFPG Within WHC included in resource pack 1.19 Review, improve, update resource pack developed in 2015/16 and disseminate via GP Portal PCFPG Resource pack updated and sent out/uploaded to GP Portal 1.20 Monitor flu information on practice websites and provide up to date information PCFPG Information within 5

resource pack can be used to update practice websites. 1.21 Refresh myth buster training package and offer to non- clinical practice and pharmacy staff PHT Training updated, offer sent-4 sessions completed 1.22 Ensure review of GP uptake data routinely at cluster meeting agendas throughout flu season PHT Ongoing 1.23 Midwives /GP s to promote vaccine uptake as a routine, promoting the service and allaying fears of vaccination from client group 1.24 GP surgeries to code all pregnant mums from September onwards to be invited for their flu vaccine (from lists received from midwives). Midwives to update GP s throughout flu season of their current caseload. Midwifery database to be updated with regular reports to the DoPH Midwifery leads Midwifery leads 1.25 Participate in Point of Delivery survey guided by PHW. Midwifery leads 1.26 GP s to provide Community Nursing teams names of housebound patients who require vaccination Primary care Ongoing throughout season 1.27 Support Nurses who vaccinate vulnerable homeless individuals during flu season PC 1.28 Identify from the data, and follow up, practices with low uptake, or no data reported PCFPG Process in place for PC to follow up throughout the season Objective 2 To reduce the risk of ILI in patients and staff across ABMU HB by achieving at last 60% uptake of the flu vaccine in front line staff across all Service Delivery Units. No Action Lead Progress RAG 2.1 Identify returning and new Flu Champions. Delivery Units to nominate Champions in high risk areas Aim to increase number of flu champions across all Delivery Units 2.2 Prepare training presentations for Flu Champions CW / DW Completed SDU Increased number of flu champions for 2016/17 campaign 117 Trained 6

2.3 Circulate dates for training for Flu champions DW/Comms All existing flu champions have been contacted via e-mail. Meeting on 27/07/16 with Communications who will promote the role of a flu champion, advertising training sessions for new and existing champions on intranet system 2.4 Confirm venues in each Delivery Unit for staff flu vaccination DW Managers contacted from each site awaiting final confirmation from 3 sites 2.5 Pharmacy to confirm sufficient influenza vaccine has been ordered for staff/ patients DW Confirmed 18.5.16 11,000 doses ordered 2.6 Order flu leaflets for forthcoming season and circulate once received CW Completed 4.5.16 2.7 Additional resources to be ordered (pens/ stickers/ posters) from PHW CW All received from PHW 2.8.16 2.8 Liaise with Unit Directors re pending flu seasons plans for staff and patients Plans to consider immunising long term patients during flu season to commence UND / ML / IC Meeting 17.6.16. Consent form for OH to reviewed Flu champion training dates to be circulated with new dates for sept Each service delivery unit in attendance expect more flu champions to be nominated Long term inpatient flu vaccination discussed ML to seek confirmation re.funding for flu campaign 2.9 DoPH to liaise with Medical Director for medical staff to highlight on patient discharge letters their advice to receive flu vaccine in General Practice SH SH in discussion with HL over options to promote vaccination for patients identified as being in an at risk category 2.10 New and returning flu champions to be trained across the localities X 2 sessions planned in the main hospital sites DW/CW July training completed. Dates and venues arranged for further training dates in August and September 2.11 OHD to consider 8 week intense immunisation schedule, following confirmation of flu champions. ML/DW Consent form adapted with CW. Awaiting directorate 7

Consent forms to be finalised 2.12 Communications - Agree comms strategy Weekly Communications campaign supported by ABM Comms team Publication of Staff Flu Clinics, FAQ, Consent forms on intranet throughout campaign 2.13 Information of planned meetings/training events for staff across ABMU HB to made available for OH in order to target and include in their schedule 2.14 Flu leaflets / posters to be distributed. Key areas to include : Hospital entrances OPD/ Ante natal clinics/ day assessment units Children s centres All wards if possible (can be done via flu champions) Occupational Health 2.15 Staff flu vaccination programme to commence 26.9.16. Vaccine to be offered to new members of staff up until the end of March 2016 2.16 Close partnership working between OH/IC and pharmacy to ensure sufficient vaccine supply for staff and patients. SOP updated 2015/16 Comms All areas OH Flu champions OHD information to be amended. Completed consent form by early August 21.7.16 WG advise posters/ leaflets with printers. Expect delivery of same within 2-3/52 Target met within 6 weeks of the intensive programme. Vaccine will continue to be offered to staff up until March 2017 in order to reach 60% HB target 2.17 OH to write to staff on long term sick and maternity leave to promote flu vaccine uptake OHD 2.18 Report denominator information to WG September 2015 ML 2.19 Meet with ESR and Information colleagues to agree data collection and reporting process ML Collaborative work with informatics dept dashboard created 2.20 Identify and Train staff to input data and provide reports throughout the campaign ML 8

2.21 Provide accurate staff uptake reports to managers to enable them to monitor and improve uptake ML amongst their teams 2.22 Provide performance reports to the Executive Team, Service Directors and other Senior Managers on a monthly basis ML 2.23 Submit accurate monthly reports to Welsh Government and Public Health Wales ML Weekly reports forwarded Objective 3 To achieve 45% uptake rate of the flu vaccine in children aged 2 + 3 years in Primary Care. No Action Lead Progress RAG 3.1 Health Visitors to discuss / promote flu vaccination at every contact Jo K 3.2 ABM to accept offer from PHW to fund letters to each eligible 2+3 yr old. CHD CHD confirm capacity/ resources 3.3 Promotional event to promote vaccine at Teddy bear s picnic. Comms to attend with representatives from HV/ SHN/ PHT. Confirmed with PHW 13.6.16. AE d/w mailing room Confirmed 19.5.16. Press release w/c 25.7.16 3.4 PHT to scope offer of fluenz parties at cluster lever PHT Proposal circulated to cluster leads/ network meetings 3.5 PHW Flu e learning module to be promoted to all staff involved in this cohort ALL Awaiting confirmation o f updated modules. Ongoing 3.6 Utilise social media to promote uptake of fluenz in eligible cohorts Comms/ HV 3.7 Await instruction from PHW to release invitation letters to children from CHD IC/CHD Letters sent 5.9.16 3.8 Advise Primary care when vaccine is available to order following discussions with WG IC completed 3.9 Liaise with practices in respect of their ordering requirements to meet target IC 9

3.10 Circulate to practices and HV weekly uptake rates of the vaccine in this age group IC In progress 3.11 Support movement of vaccine (if required) to reduce wastage, updating WG as needed. IC Not required to as yet Objective 4 To achieve 65% uptake rates in school aged children in Reception to Year 3 in Schools. Aim to complete before 31.12.16 No Action Lead Progress RAG 4.1 Review previous year s flu campaign and amend plans for forthcoming season SAJ Completed 4.2 PHW Flu e learning module to be promoted to all staff ALL Completed 4.3 Consent forms to be finalised / printed CHD Confirmed 4.4 Leaflets for schools campaign ordered CW Completed 4.5 PHW resources to be ordered (stickers and posters) IC Completed 4.6 Liaise with WG and pharmacy on ordering requirements of vaccine required by schools IC / Pharmacy Weekly 4.7 Utilise existing social media platforms in schools and pre-school, by supporting schools to disseminate flu immunisation messages via their accounts 4.8 SHN to finalise plans for schools campaign, liaising with pharmacy, Child Health Dept, transport and schools as per SOP PHT SAJ & SHNs Established process in place Cohort sizes confirmed and school dates booked with final sessions being held on December 15 th meeting completion by 31/12/16 expectation. School visits to engage parents to commence before summer holidays begin. CH arranging leaflet order and distribution of same with consents via schools at start of September term. Dates and cohort sizes to be shared with Cefn Coed & POW pharmacies by July 1 st to inform weekly vaccine order and they will liaise with transport to co-ordinate delivery of vaccine to schools. 4.9 Promotional event to promote vaccine at Teddy bear s picnic. Comms to attend with representatives from HV/ SHN/ PHT. Confirmed 19.5.16 4.10 Include flu immunisation information in Healthy Schools and Pre-Schools e-bulletins across ABM PHT Established process in 10

place 4.11 Parent s of children that had consented but absent on day of vaccination to be signposted to GP for vaccination SHN/ Primary care Commence when programme starts October 4.12 Provisional date to start children s vaccination programme in schools 3/10/16 SAJ Dependent on vaccine availability 4.13 Recruit staff to Band 5 fixed term, term time only immunisation posts SAJ Interviews w/c 18/7/16 Objective 5 To protect vulnerable patients/clients in care home settings from Influenza. Reduce the risk of outbreaks of flu in care homes by promoting staff uptake and vaccinating clients No Action Lead Progress RAG 5.0 Nursing home staff to be trained annually highlighting importance of staff and client vaccination IC Dates circulated 5.1 Promote uptake of vaccine to health and social care workers with direct patient/client contact PCSDU 5.2 Circulate good practice guide for care homes from PHW IC Forwarded to interface nurses 5.3 E learning module to be promoted to all health and social care staff to complete PCSDU advised 5.4 Nursing Home staff to vaccinate patients/ clients from the end of September onwards by working in partnership PC SDU with clients GP s Objective 6 Communications No Action Lead Progress RAG 6.1 ABMU comms team to liaise with new flu comms lead in VPDP @ PHW when person starts post. Will then plan ABMU comms to support national campaign locally ensuring no duplication and effective use of available resources. Staff flu campaign communications will be led by ABMU comms along a similar line to last year staff supporting and encouraging each other to have flu vaccination. Will also include patient stories to help staff understand the importance of the flu vaccination to patients. AP On going 11

Objective 7 To ensure robust governance arrangements are in place during flu season No Action Lead Progress RAG 7.1 All ABM Immunisation Group members to attend flu planning meetings as planned or to nominate a representative ALL who will provide feedback to the group and actions as required. 7.2 ABM representative to dial in to National Flu Action Team meetings (usually fortnightly) IC/PHT IC and PHT representation 7.3 Flu plan to be amended/ updated by Immunisation group members ALL 12

02/10/2016 09/10/2016 16/10/2016 23/10/2016 30/10/2016 06/11/2016 13/11/2016 20/11/2016 27/11/2016 04/12/2016 11/12/2016 18/12/2016 25/12/2016 01/01/2017 08/01/2017 15/01/2017 22/01/2017 29/01/2017 05/02/2017 12/02/2017 19/02/2017 26/02/2017 05/03/2017 12/03/2017 19/03/2017 26/03/2017 02/04/2017 09/04/2017 Update 5 on Progress in Influenza Immunisation Campaign 2016-17 Analysis carried out by Public Health Wales Vaccine Preventable Disease Programme and Communicable Disease Surveillance Centre Data for this season are currently undergoing quality assurance and may be subject to revision in the future Table 1. Uptake of influenza immunisation in patients aged 65y and older and in those aged 6m to 64y at clinical risk, data correct as at 22/11/2016. Patients aged 65y and older Uptake Figure 1. Weekly trends in uptake of influenza immunisation in 2016-17 compared to 2015-16. Patients aged 6m to 64y at risk Uptake Abertawe Bro Morgannwg UHB 63,438 111,389 57.0 22,061 61,967 35.6 Aneurin Bevan UHB 72,551 118,221 61.4 28,126 67,001 42.0 Betsi Cadwaladr UHB 97,438 158,998 61.3 30,870 76,108 40.6 Cardiff and Vale UHB 48,442 80,129 60.5 20,534 52,404 39.2 Cwm Taf UHB 33,707 58,216 57.9 12,913 34,200 37.8 Hywel Dda UHB 52,227 93,137 56.1 14,482 41,514 34.9 Powys Teaching HB 20,955 36,412 57.5 5,421 14,281 38.0 Wales 388758 656502 59.2 134407 347475 38.7 75.0 50.0 25.0 0.0 18.7 59.2 56.7 53.2 47.8 42.4 38.7 36.4 33.5 31.9 29.6 25.5 2016-17 65y and older 2015-16 65y and older 2016-17 6m to 64y at risk 2015-16 6m to 64y at risk Target Week ending Data source: General Practice data collected through Audit+ Data Quality System

Table 2. Uptake of influenza immunisation broken down by risk group, data correct as at 22/11/2016. Risk Group Uptake 65y and older 388,758 656,502 59.2% At clinical risk 6m to 64y 134,407 347,475 38.7% Diabetes 6m to 64y 41,640 81,702 51.0% Chronic heart disease 6m to 64y 23,394 60,245 38.8% Chronic kidney disease 6m to 64y 6,273 14,501 43.3% Chronic liver disease 6m to 64y 3,001 8,586 35.0% Chronic respiratory disease 6m to 64y 66,686 174,978 38.1% Immune-suppression 6m to 64y 10,047 20,876 48.1% Mobidly obese 6m to 64y 18,522 73,093 25.3% Neurological conditions 6m to 64y 12,743 34,507 36.9% Asplenia aged 6m to 64y 3,068 9,808 31.3% Data source: General Practice data collected through Audit+ Data Quality System Table 3. Numbers of pregnant women immunised in s, data correct as at 22/11/2016. Pregnant women immunised Abertawe Bro Morgannwg UHB 1188 Aneurin Bevan UHB 1572 Betsi Cadwaladr UHB 2329 Cardiff and Vale UHB 1702 Cwm Taf UHB 641 Hywel Dda UHB 722 Powys Teaching HB 395 Wales 8549

Table 4. Uptake of influenza immunisation in patients aged 65y and older and in those aged 6m to 64y at clinical risk, data correct as at 22/11/2016, by Local Authority. Local Authority Patients aged 65y and older Patients aged 6m to 64y at risk Data submission rate Uptake Data source: General Practice data collected through Audit+ Data Quality System Uptake Practices submitted Total Practices Submission rate Abertawe Bro Morgannwg UHB Bridgend LA 19,120 32,045 59.7 6,563 18,432 35.6 18 18 100.0 Neath Port Talbot LA 16,656 29,255 56.9 6,141 16,377 37.5 21 21 100.0 Swansea LA 27,662 50,089 55.2 9,357 27,158 34.5 34 34 100.0 Total 63,438 111,389 57.0 22,061 61,967 35.6 73 73 100.0 Aneurin Bevan UHB Blaenau Gwent LA 8,053 14,447 55.7 3,313 8,599 38.5 11 11 100.0 Caerphilly LA 20,417 33,854 60.3 8,541 20,178 42.3 25 25 100.0 Monmouthshire LA 15,655 23,892 65.5 4,563 10,292 44.3 13 13 100.0 Newport LA 16,456 26,931 61.1 6,685 16,381 40.8 18 18 100.0 Torfaen LA 11,970 19,097 62.7 5,024 11,551 43.5 13 13 100.0 Total 72,551 118,221 61.4 28,126 67,001 42.0 80 80 100.0 Betsi Cadwaladr UHB Anglesey LA 10,237 16,523 62.0 3,186 7,498 42.5 11 11 100.0 Conwy LA 18,418 30,490 60.4 4,752 12,108 39.2 19 19 100.0 Denbighshire LA 13,893 24,144 57.5 4,165 11,500 36.2 14 14 100.0 Flintshire LA 19,737 31,375 62.9 7,134 16,547 43.1 22 22 100.0 Gwynedd LA 16,154 27,676 58.4 4,707 12,667 37.2 22 22 100.0 Wrexham LA 18,999 28,790 66.0 6,926 15,788 43.9 21 21 100.0 Total 97,438 158,998 61.3 30,870 76,108 40.6 109 109 100.0 Cardiff and Vale UHB Cardiff LA 32,263 54,068 59.7 15,432 39,136 39.4 50 50 100.0 Vale of Glamorgan LA 16,179 26,061 62.1 5,102 13,268 38.5 16 16 100.0 Total 48,442 80,129 60.5 20,534 52,404 39.2 66 66 100.0 Cwm Taf UHB Merthyr Tydfil LA 6,319 11,066 57.1 2,496 6,918 36.1 9 9 100.0 Rhondda Cynon Taff LA 27,388 47,150 58.1 10,417 27,282 38.2 33 33 100.0 Total 33,707 58,216 57.9 12,913 34,200 37.8 42 42 100.0 Hywel Dda UHB Carmarthenshire LA 24,071 41,080 58.6 6,956 19,388 35.9 25 25 100.0 Ceredigion LA 11,487 22,388 51.3 2,874 8,875 32.4 14 14 100.0 Pembrokeshire LA 16,669 29,669 56.2 4,652 13,251 35.1 14 14 100.0 Total 52,227 93,137 56.1 14,482 41,514 34.9 53 53 100.0 Powys Teaching HB 20,955 36,412 57.5 5,421 14,281 38.0 17 17 100.0 Wales Total 388,758 656,502 59.2 134,407 347,475 38.7 440 440 100.0

Table 5a. Uptake of influenza immunisation in children age 2 & 3 years, by, as at 22/11/2016. Uptake Abertawe Bro Morgannwg UHB 3894 11756 33.1 Aneurin Bevan UHB 4309 13736 31.4 Betsi Cadwaladr UHB 5855 15220 38.5 Cardiff and Vale UHB 3912 11962 32.7 Cwm Taf UHB* 1813 7022 25.8 Hywel Dda UHB 2160 7757 27.8 Powys Teaching HB 1005 2623 38.3 Wales 22948 70076 32.7 * Cwm Taf UHB are piloting delivery of live attenuated influenza vaccine through nursery school sessions during 2016/17, see table 6a for current uptake Table 5b. Uptake of influenza immunisation in children age 2 years, by, as at 22/11/2016. Children aged 2 & 3 years Uptake Abertawe Bro Morgannwg UHB 2013 5769 34.9 Aneurin Bevan UHB 2136 6737 31.7 Betsi Cadwaladr UHB 2854 7416 38.5 Cardiff and Vale UHB 1917 5963 32.1 Cwm Taf UHB 1172 3484 33.6 Hywel Dda UHB 1120 3839 29.2 Powys Teaching HB 532 1331 40.0 Wales 11744 34539 34.0 Table 5c. Uptake of influenza immunisation in children age 3 years, by, as at 22/11/2016. Children aged 2 years Children aged 3 years Uptake Abertawe Bro Morgannwg UHB 1881 5987 31.4 Aneurin Bevan UHB 2173 6999 31.0 Betsi Cadwaladr UHB 3001 7804 38.5 Cardiff and Vale UHB 1995 5999 33.3 Cwm Taf UHB* 641 3538 18.1 Hywel Dda UHB 1040 3918 26.5 Powys Teaching HB 473 1292 36.6 Wales 11204 35537 31.5 * Cwm Taf UHB are piloting delivery of live attenuated influenza vaccine through nursery school sessions during 2016/17, see table 6a for current uptake

Table 6a. Uptake of influenza immunisation in nursery school children aged 3y in Cwm Taf UHB (data provided by up to 22/11/2016) Nurseries Children aged 3 (Nursery classes) visited Uptake Cwm Taf UHB 80 1422 2110 67.4% Table 6b. Uptake of influenza immunisation in primary school children aged 4y in school immunisation sessions (data provided by s up to 22/11/2016) Schools visited Children aged 4 (Reception classes) Uptake Abertawe Bro Morgannwg UHB 55 2292 3150 72.8% Aneurin Bevan UHB 94 2336 3329 70.2% Betsi Cadwaladr 158 2022 3009 67.2% Cardiff and Vale 27 745 1149 64.8% Cwm Taf 80 1684 2214 76.1% Hywel Dda 119 1517 2261 67.1% Powys 45 398 537 74.1% Wales 578 10994 15649 70.3% Table 6c. Uptake of influenza immunisation in primary school children aged 5y in school immunisation sessions (data provided by s up to 22/11/2016) Schools visited Children aged 5 (Year 1 classes) Uptake Abertawe Bro Morgannwg UHB 55 2336 3191 73.2% Aneurin Bevan UHB 94 2317 3357 69.0% Betsi Cadwaladr 158 2048 3039 67.4% Cardiff and Vale 27 713 1204 59.2% Cwm Taf 80 1835 2369 77.5% Hywel Dda 119 1507 2333 64.6% Powys 45 438 653 67.1% Wales 578 11194 16146 69.3% Table 6d. Uptake of influenza immunisation in primary school children aged 6y in school immunisation sessions (data provided by s up to 22/11/2016) Schools Children aged 6 (Year 2 classes) visited Uptake Abertawe Bro Morgannwg UHB 55 2318 3165 73.2% Aneurin Bevan UHB 94 2324 3395 68.5% Betsi Cadwaladr 158 1882 2987 63.0% Cardiff and Vale 27 635 1130 56.2% Cwm Taf 80 1673 2245 74.5% Hywel Dda 119 1515 2288 66.2% Powys 45 379 596 63.6% Wales 578 10726 15806 67.9%

Table 6e. Uptake of influenza immunisation in primary school children aged 7y in school immunisation sessions (data provided by s up to 22/11/2016) Schools visited Children aged 7 (Year 3 classes) Uptake Abertawe Bro Morgannwg UHB 55 2056 2911 70.6% Aneurin Bevan UHB 94 2230 3363 66.3% Betsi Cadwaladr 158 1974 3032 65.1% Cardiff and Vale 27 667 1166 57.2% Cwm Taf 80 1655 2231 74.2% Hywel Dda 119 1503 2310 65.1% Powys 45 452 659 68.6% Wales 578 10537 15672 67.2% Table 7a. Uptake of influenza immunisation in Welsh & NHS Trust staff until the end of October 2016 1 Combined figures for: Additional Prof Scientific and Technical, Additional Clinical Services, Allied Health Professionals, Medical and Dental, Nursing & Midwifery Registered staff groups. 2 Staff with direct patient contact uptake is not yet available for Public Health Wales NHS Trust. Total Staff Staff with direct patient contact 1 Uptake Uptake Aneurin Bevan UHB 3836 13145 29.2 2579 9127 28.3 Abertawe Bro Morgannwg UHB 7549 15908 47.5 5492 11123 49.4 Betsi Cadwaladr UHB 6292 16534 38.1 4402 11695 37.6 Cardiff and Vale UHB 3714 14645 25.4 2748 10498 26.2 Cwm Taf UHB 2477 7952 31.1 1687 5286 31.9 Hywel Dda UHB 3065 9902 31.0 2275 7033 32.3 Powys Teaching HB 640 1758 36.4 446 1141 39.1 Velindre NHS Trust 416 737 56.4 220 452 48.7 Welsh Ambulance Service NHS Trust 651 3147 20.7 519 2061 25.2 Public Health Wales NHS Trust 2 704 1714 41.1 - - - Wales 29344 85442 34.3 20368 58416 34.9 Table 7b. Uptake of influenza immunisation in NHS staff groups up to October 2016. ESR staff group Staff Uptake Additional Clinical Services 5328 15806 33.7 Additional Prof Scientific and Technical 1067 3014 35.4 Administrative and Clerical 5325 13956 38.2 Allied Health Professionals 2046 4966 41.2 Estates and Ancillary 2308 8554 27.0 Healthcare Scientists 507 1716 29.5 Medical and Dental 2556 7360 34.7 Nursing & Midwifery Registered 8852 25209 35.1 Data source: Occupational Health Departments in s and NHS Trusts in Wales

Table 8. Numbers of patients immunised by community pharmacies in Wales (data correct as 9/11/2016). Aged 65y and older 6m to 64y at risk Abertawe Bro Morgannwg University 2576 1326 Aneurin Bevan 1414 693 Betsi Cadwaladr University 3315 1307 Cardiff and Vale University 1522 1091 Cwm Taf 867 454 Hywel Dda 1799 690 Powys Teaching 483 183 Total 11976 5744

SummarybyHealthBoardandLocalAuthority(22nov2016) 65yandolder Clinicalrisk<65y Children2to3years Pop Imm'd Uptake Pop Imm'd Uptake Pop Imm'd Uptake ABM UHB Wales Bridgend NeathPortTalbot Swansea ABM Total Wales 32,045 19,120 59.7% 18,432 6,563 35.6% 29,255 16,656 56.9% 16,377 6,141 37.5% 50,089 27,662 55.2% 27,158 9,357 34.5% 111,389 63,438 57.0% 61,967 22,061 35.6% 3,531 1,199 34.0% 2,893 888 30.7% 5,332 1,807 33.9% 11,756 3,894 33.1% 656,502 388,758 59.2% 347,475 134,407 38.7% 70,076 22,948 32.7% Chooseareaforriskgroupbreakdown ABM Total Bridgend NeathPortTalbot Swansea Wales Colourkey 25% to<50% uptake 50% to<60% uptake ABMTotalriskgroupbreakdown Patientgroup Uptake 65yandolder 111,389 63,438 57.0% Asplenicpatients(<65y) Chronicdiabetespatients(<65y) Chronicheartpatients(<65y) Chronickidneypatients(<65y) Chronicliverpatients(<65y) Chronicrespiratorypatients(<65y) Immunosuppression(<65y) Morbidlyobesepatients(<65y) Neurological/strokepatients(<65y) 2yearolds 3yearolds 1,549 14,855 11,328 2,979 1,576 30,877 3,128 13,319 6,360 5,769 5,987 445 7,040 4,135 1,194 528 10,883 1,256 3,084 2,187 2,013 1,881 28.7% 47.4% 36.5% 40.1% 33.5% 35.2% 40.2% 23.2% 34.4% 34.9% 31.4%