NHS Seasonal Influenza Immunisation Programme in Cheshire & Merseyside 2015/16: Final Report

NHS Seasonal Influenza Immunisation Programme in Cheshire & Merseyside 2015/16: Final Report Produced by the Cheshire & Merseyside Screening and Immunisation Team 1

NHS Seasonal Influenza Immunisation Programme in Cheshire & Merseyside 2015/16 Final Report for 2015/16 First published: May 2016 Accountable person: Dr Daniel Seddon FFPH, Screening and Immunisation Lead Prepared by: Pauline Jones, Screening & Immunisation Manager Lynn Simpson, Screening & Immunisation Manager Jennifer Piet, Screening & Immunisation Coordinator Stacy Evans, Screening & Immunisation Coordinator Neil Gaye, Public Health Programme Contracts Manager Acknowledgments of contributors: Abigail Phillips, Administrator Jackie Johnson, Data Analyst Ben Wellman, Administrative Assistant Members of the Flu Task Group 2

Contents Contents... 3 1 Executive summary... 4 2 A reminder of Department of Health, Public Health England and NHS England Strategic Objectives for the Flu Plan 2015/16... 5 3 National Initiatives... 5 3.1 National Pharmacy Specification (New for 2015)... 5 4 Local Initiatives... 6 4.1 Maternity... 6 4.1.1 Merseyside... 6 4.1.2 Cheshire, Warrington & Wirral area... 7 4.2 Bespoke services... 7 5 Healthy Child Programme (universal programme by age cohort)... 8 5.1 GP delivery model, for young children age two, three and four years (as of 01 September 2015)... 8 5.2 School based delivery model for young children age five and six years, (as of 01 September 2015)... 8 6 Flu illness during 2015/16 and vaccine effectiveness... 9 7 Performance... 9 8 Monitoring... 10 9 Learning from 2015/16 programme:... 10 10 Recommendations for 2016/17:... 11 Appendix A Performance for 2015/16... 12 Appendix B Cheshire and Merseyside Influenza Programme Contacts for 2016-2017... 21 Appendix C Sources... 21 3

1 Executive summary This final report summarises the outcomes from the 2015/16 seasonal influenza vaccine programme across Cheshire & Merseyside. It will support a debrief and forward planning for the next Flu immunisation season of 2016/17; identifying key challenges and objectives for the whole of the Cheshire & Merseyside area and supporting bespoke challenges and actions at a local level. The 2015/16 seasonal influenza vaccine programme has had its challenges both nationally and locally. Uptake rates are lower across the board nationally and locally, with the Cheshire & Merseyside area still managing to be within the top 5 area teams in the country for flu vaccine uptake, with Cheshire faring slightly higher than Merseyside. However immunisation activity remains high when comparing the increased numbers of the population, as demonstrated in the performance data. Nationally this lower uptake has been attributed to several factors: the mild weather during the peak immunisation time period of October/November 2015, the credibility of the vaccine being effective from the previous season, and perceptions of Flu due to very little Flu illness attention in the media in recent seasons. New for 2015/16 was the national pharmacy specification for adults to receive a free NHS vaccine (within the national criteria). This has not made an impact on increase of uptake figures, particularly for the under age 65 year cohort at risk groups. The total contribution of the pharmacy model is just under 4%. This season the universal healthy child nasal spray vaccine programme was extended to children up to age 6 years, (as of 01 September 2015), in school years 1 and 2. The school based model, a first for Cheshire & Merseyside, has been extremely successful and acknowledgement goes to all of the service providers and schools for this new programme. Approximately 750 schools were visited across Cheshire and Merseyside within a 6 week period with an average uptake of 60%. However the GP delivery model for younger children age 2 to 4 years is proving more of a challenge both locally and nationally with low uptake figures, on the whole an average of 30% and sadly some with very low uptake. The data indicates extreme variation. There are some examples of good uptake and sharing of best practice locally will be encouraged. When considering vaccine effectiveness for this season and rates of Flu illness, the 2015/16 vaccine has been a good match vaccine to the circulating flu strains of Flu A (H1N1) and Flu B. Flu illness emerged late and peaked mid-february with an impact on GP consultations and hospital admissions including patients requiring ICU treatment. The PHE Screening & Immunisation Team and NHS England Cheshire & Merseyside Team wish to thank and acknowledge the hard work and contribution to all those involved in the preparation, planning and delivery of this very busy and challenging time framed programme. Pauline Jones Screening & Immunisation Manager PHE Cheshire & Merseyside Team 4

2 A reminder of Department of Health, Public Health England and NHS England Strategic Objectives for the Flu Plan 2015/16 To actively offer the influenza vaccine to 100% of eligible clinical risk groups including all pregnant women, and to achieve 75% vaccination of those aged 65 years and over, and healthcare workers with direct patient contact. To deliver a healthy child influenza vaccine programme (live attenuated nasal spray vaccine). Providing a 100% offer to those children in the eligible age cohorts: to achieve uptake rates of 40 to 60%, to protect individual children receiving the vaccine and to reduce the spread of Flu illness in the community and vulnerable contacts. - Two, three and four year olds as of 01 September 2015: via General Practice - School Years 1 and 2 as of 01 September 2015: this has been the first season of extending the healthy child flu programme to this cohort nationally, it has been delivered by a school based delivery model for Cheshire & Merseyside. 3 National Initiatives 3.1 National Pharmacy Specification (New for 2015) During the 2015/16 flu season NHS England introduced a new programme in the form of a National Advanced Service for the delivery of flu vaccination in community pharmacies to all groups as set out in the tripartite flu letter. The national pharmacy scheme covers all eligible patients covered by the tripartite letter, but with a restriction for adults from age 18 years with the inactivated influenza vaccine. To help support the communication of the Flu vaccine programme in pharmacy to general practices, NHS England Cheshire and Merseyside agreed that all participating pharmacies use the PharmOutcomes software for payment and reporting purposes. Use of this software helped NHS England to have real time statistics relating to uptake. The Pharmacy based programme started on 16th September 2015. Unfortunately not all pharmacies were able to take advantage of the PharmOutcomes software which led to a discrepancy of vaccinations claimed and what was recorded on PharmOutcomes. While PharmOutcomes was able to provide a more in depth analysis of the data than the claims submitted to NHS England and was able to provide demographic and eligibility data, about 37% of the claims were not recorded on PharmOutcomes. It is expected that the eligibility criteria ratios would be in line with those that were recorded on PharmOutcomes. There have been challenges of the data transfer from pharmacy to the GP clinical system (from where the ultimate national data is drawn), therefore under reporting and inconsistency of data may be another factor. The total contribution of the pharmacy model to the national flu vaccine programme of those who were eligible and attended is just under 4% of the Cheshire & Merseyside population with a slightly higher population within Cheshire. 5

Pharmacy delivered Flu immunisations across Cheshire & Merseyside Eligibility Number % of total of pharmacy delivered immunisations Aged over 65 7635 58.7% Carer 636 4.9% Chronic heart disease 465 3.6% Chronic kidney disease 85 0.7% Chronic liver disease 116 0.9% Chronic neurological disease 148 1.1% Chronic respiratory disease 2029 15.6% Diabetes 1121 8.6% Household contact of immunocompromised individual 86 0.7% Immunosuppression 307 2.4% Person in long-stay residential or home 20 0.2% Pregnant woman 328 2.5% Splenic dysfunction 22 0.2% Total 12998 100.0% Source: PharmOutcomes 25/04/2016 4 Local Initiatives 4.1 Maternity We are working with maternity care providers to ensure midwives promote and deliver vaccination of pregnant women. There is variation amongst maternal providers and some excellent examples of models of delivery that have proven successful and improved each year of which we shall share for 2016/17. 4.1.1 Merseyside Of the four maternity provider organisations in Merseyside two agreed to deliver the influenza vaccination programme to pregnant women, these are the Liverpool Women s Hospital and Bridgewater Community NHS Trust. Liverpool Women s Hospital commenced vaccinating in late November and vaccinated over 146 women. Bridgewater Community Trust commenced vaccinating at the beginning of the programme and vaccinated over 214 pregnant women or sign posted back to General practice if required. The increase in uptake from the maternal provider will in part explain the higher uptake of the flu vaccination within Halton CCG as well as the GP practices proactively promoting the vaccine. 6

Organisation Name All pregnant women (combined) Patients registered No. vaccinated % uptake Halton CCG 1769 869 49.1 Knowsley CCG 1768 852 48.2 South Sefton CCG 1775 828 46.6 Southport & Formby CCG 1035 468 45.2 St Helens CCG 2282 1087 47.6 Liverpool CCG 6666 2904 43.6 Total 15295 7008 45.8 4.1.2 Cheshire, Warrington & Wirral area All Cheshire, Wirral and Warrington (CWW) maternity providers offer flu vaccination at antenatal appointments. Wirral also offers the vaccine via the maternity shop based in Birkenhead town centre. Macclesfield, Leighton, Warrington, Countess of Chester and Arrowe Park maternity services all commenced their programmes in mid-october which was a little later than they had hoped due to a delay in vaccine and PGD. CWW maternity services have vaccinated approximately 573 pregnant women. Organisation Name All pregnant women (combined) Patients registered No. vaccinated % uptake Eastern Cheshire CCG 2180 1141 52.3 South Cheshire CCG 1979 917 46.3 Vale Royal CCG 1088 538 49.4 Warrington CCG 2139 1040 48.6 West Cheshire CCG 2893 1337 46.2 Wirral CCG 4184 1867 44.6 Total 14463 6840 47.3 4.2 Bespoke services Three providers of Drug and Alcohol Services across Cheshire & Merseyside delivered an influenza vaccination programme for their service users as a small pilot. It is expected that for the year 2016/17 all providers will work with NHS England to provide flu vaccinations as there will be earlier engagement and more robust planning at an earlier stage to bring all providers of drug and alcohol services on board. We are still awaiting the formal evaluation of the programme delivered in the drug and alcohol services and a full debrief will be available to inform planning for the 2016/17 flu campaign. Wirral Drug and Alcohol service facilitated homeless community being immunised within their environment i.e. outreach workers immunising in hostels, YMCA s, drop in centres. In Wirral approximately 131 homeless individuals were vaccinated. Warrington CCG has also offered a similar scheme to their homeless community by using a local hostel and a community health provider. This is an area for development in 2016/17. 7

5 Healthy Child Programme (universal programme by age cohort) This is the third year of the national healthy child live attenuated intranasal spray vaccine (LAIV) programme. The aim is to reduce Flu illness in young children by offering individual protection and to reduce flu spreading to others. Young children are super spreaders of the Flu virus to contacts within their family and community who are at risk to complications of Flu. To reduce Flu illness activity in children and the community, a good equitable uptake of between 40 to 60% has been requested nationally. This season has seen the extension of the universal healthy child programme to older age cohorts of children. This age extension is to increase year on year under national direction; next season will include school year 3. 5.1 GP delivery model, for young children age two, three and four years (as of 01 September 2015) This is nationally commissioned via General Practice and is the third year of delivery. This is proving to be a challenge both locally and nationally with low uptake figures, on the whole an average of 30% and sadly some very low uptake figures with extreme variation. However we do have some excellent examples of high uptakes for this cohort and will be encouraging sharing of best practice. It is acknowledged that the children age 4 years are in reception class at school and are likely to have an improved uptake/access by a school based delivery model. However nationally for 2016/17 this is already in the GP service specification. We shall await decisions from national direction for the 2017/18 programme. 5.2 School based delivery model for young children age five and six years, (as of 01 September 2015) The delivery to this age cohort was commissioned by NHS England, we were fortunate to secure a school based model for all of the Cheshire and Merseyside area. This is the first time that immunisations have been delivered within a school setting to such a young age. It has been a positive experience with collaborative working, provider services opting to share and learn via meetings and telephone conferences as they prepared and progressed through the delivery timeframe. This was important as we had not been part of any national pilots. It has been extremely successful and acknowledgement goes to all of the service providers, schools and all who have supported this new programme. Approximately 750 schools were visited across Cheshire and Merseyside within a 6 week period with an average uptake of 60%. There are some excellent examples to learn and share from going forward for 2016/17. Likewise there were some challenges particularly in Liverpool city centre regarding concerns over the gelatin content of the vaccine leading to withdrawal of consent from some schools; this will be addressed earlier with national learning and support materials for 2016/17. 8

6 Flu illness during 2015/16 and vaccine effectiveness The 2015/16 vaccine has been a good match vaccine to the circulating flu strains of Flu A (H1N1) and Flu B. Flu illness emerged late and peaked mid-february 2016, with an impact on GP consultations and hospital admissions include patient requiring ICU treatment. 150 new ICU/HDU admissions with confirmed influenza (mostly H1N1) were reported across the country in week 9. Outbreaks were also reported, mainly from schools and care homes and a hospital. Excess mortality was seen in the 15-64 age groups. A full report will be produced nationally and will support planning for the 2016/17 season. 7 Performance The 2015/16 seasonal influenza vaccine programme has had its challenges both nationally and locally. Uptake rates are lower across the board nationally and locally, with the Cheshire & Merseyside area still managing to be within the top 5 Area Teams in the country for flu vaccine uptake. Uptake rates have either maintained or reduced slightly in Cheshire. Similar numbers of adults have been vaccinated in 2015/16 compared with the previous season, but with lower % uptake in most groups and local areas. A total of 524,323 vaccines were administered to the adult and at risk population across Cheshire & Merseyside (excluding the Healthy Child Programme). Nationally this has been attributed to several factors: the mild weather during the peak immunisation time period of October/November 2015, the credibility of the vaccine being effective from the previous season and perceptions of Flu due to very little Flu illness attention in the media in recent seasons. New for 2015/16 was the national pharmacy specification for adults to receive a free NHS vaccine (within the national criteria). This has not made an impact on increase of uptake figures, particularly for the under age 65 year cohort at risk groups. The total contribution of the pharmacy model is just under 4%. Key points (please see appendix A for data by cohort): Age 65 years For the Merseyside area, the decision to cease the sending of an independent letter to invite the over 65 year population was an acknowledged risk but it has not contributed significantly to a reduction in uptake rates. However variation by practice continues across both Cheshire & Merseyside. At risk groups under age 65 years Uptake remains plateaued and again with GP variation, with some examples of good practice to share. Pregnancy There was no real significant increase, figures are arbitrary as the pregnant denominator on GP system is not a true indicator. Some examples of good practice were noted, as discussed in the maternal section. This will be a priority for 2016/17. Children age 2, 3 and 4 years Uptake on average is low with huge variation. Children age 5 and 6 years This cohort was immunised in the school setting. There has been good uptake partly attributed to ease of access and a targeted provision. There were some challenges which will support the learning and preparation for next season. 9

Health Care Workers There are some excellent examples of good uptake rates. Some Trusts have maintained whilst others have a significant drop compared to the previous year. Individual Trusts are requested to reflect upon their strategy and plan ahead for next season. We appreciate that some Community Trusts have additional challenges with staff based on many sites. We encourage any Trust to share examples of good to practice via the Cheshire & Merseyside Flu Task Group. This is important as vaccination of healthcare workers with direct patient contact against flu has been shown to significantly lower rates of flu-like illness, hospitalisation and mortality in the elderly in long-term healthcare settings. Please refer to appendix A for detailed performance tables for 2015/16 and comparison to the 2014/15 season. 8 Monitoring Merseyside has an established Flu Task Group, which has met, before and during the Flu immunisation season. This has been supported by local flu groups within each CCG to address and support local challenges. Cheshire area also has local flu groups within each CCG. Here are some examples of the innovation at CCG level: Local communications, local newspaper, matrix traffic signs, taxi advertisements, local posters with a targeted approach, use of till receipts Bespoke issues addressed to ensure provision to all in the national programme, e.g. homeless people, clients registered to substance misuse support services In addition, there have been regular stakeholder reports, reporting on the data as it is collated nationally at the end of October, November and December with the final figures for the end of January within this report. This data was also scrutinised locally within the CCG Flu groups. On a wider footprint the Cheshire & Mersey Flu Leads link to: a North West flu group, national communication, telephone conferences and reports/bulletins. 9 Learning from 2015/16 programme: Vaccine coverage in healthy children aged two, three and four years of age remains low with extreme variations and some very low figures. There are some examples of good practice which will be shared. Pregnant women uptake remains plateaued at around 46% and again with extreme variation. Some good examples of mixed delivery models with some maternity providers having good success, to be shared as best practice. Maternity providers will be approached by NHS England regarding improvement plans to support the clinical delivery of both Flu vaccine and the pregnancy pertussis vaccine programme. 10

Uptake for at risk groups under age 65 has dropped slightly during 2015/16, and again with individual GP variation. However immunisation activity remains high when comparing the increased numbers of the population, as demonstrated in the performance data. The increased choice of access with the national pharmacy model appears to have had no impact on this cohort for Cheshire & Mersey. The school based delivery of the healthy child flu nasal vaccine was successful for 2015/16; this cohort is to increase to include new school year 3 children for 2016/17. There were some challenges with low uptake in individual Local Authorities; provider services are producing detailed evaluation to prepare for next season. Some local issues of bespoke delivery to groups, such as those residing in care homes or housebound. To be included in local preparation for next season. 10 Recommendations for 2016/17: Recommendation To begin planning for 2016/17 earlier as a Task Group and with local groups to anticipate and support previous or expected challenges. To share examples of good practice, particularly for: young children age 2, 3 and 4 years, pregnant women and at risk groups. To enhance further the number of bespoke services to vulnerable harder to reach groups. Ensure availability of update training for immunisers for 2016/17. To address wide variation and particularly low performing providers. Report practice level achievements and variation to CCGs for dissemination to Practice Managers. Enhancement of maternal clinical provision of flu vaccine. Report Health Care Worker (HCW) data back to Trust Chief Executive Officers. HCW: Any Trusts that require support with an action plan to improve further. Prisons: Ensure access to the vaccines is available for those meeting the NHS criteria. Roll out of bespoke services, to promote engagement with vulnerable groups/clients, such as homeless services and substance misuse team. By Whom Cheshire & Merseyside SI Team; Local Flu groups Cheshire & Merseyside SI Team; Local Flu groups NHS England with LA Cheshire & Merseyside SI Team to liaise with CCGs Cheshire & Merseyside SI Team to liaise with CCGs Via NHS England and CCGs Cheshire & Merseyside SI Team; Trust to endorse support Cheshire & Merseyside SI Team with individual Trust Cheshire & Merseyside SI Team with NHS England Cheshire & Merseyside SI Team with NHS England 11

Appendix A Performance for 2015/16 Organisation Name Halton CCG Knowsley CCG South Sefton CCG Southport & Formby CCG St Helens CCG Liverpool CCG Merseyside total: Table 1: Summary of influenza vaccine uptake across Merseyside to 31 January 2016 (Figures in dark grey show % uptake rate at same time last year, 2015) Year 65 and over Under 65 (atrisk only) Summary of Flu Vaccine Uptake % All Pregnant Women All Aged 2 All Aged 3 All Aged 4 2016 72.2 47.6 49.1 36.0 38.6 30.3 2016 Variation 63.6-78 39.9 59.7 41.7 63.9 15.8 61.3 13.2-69 13 63.8 2015 73.8 50.3 46.7 35.6 37.2 32.6 2016 74.4 49.5 48.2 27.9 33.7 21.8 2016 Variation 67.6 83.3 35.3 61.1 33.3 71.4 6.9 53.8 6.5 53.5 5.9 43.9 2015 76.9 57.6 51.7 40.5 41.7 36.1 2016 72.0 44.7 46.6 32.0 33.3 25.9 2016 Variation 53.1 81.8 27.2 63.3 30.2 68.3 0 63.1 11.1-75 2.5 48.7 2015 75.0 50.4 48.6 36.5 38.2 29.1 2016 75.1 49.2 45.2 39.9 41.6 34.4 2016 Variation 67.1 83.9 29.7 63.5 23.9-63 3.4 81.8 17.2 77.4 5.6-82.8 2015 77.0 52.6 45.9 43.7 48.5 38 2016 75.0 49.2 47.6 32.1 36.9 26.6 2016 Variation 64.2 86.4 32.4 84.6 26.7-70 6.3 67.3 12.8 61.7 7.1 60.9 2015 78.5 56.8 48.8 42.3 43.3 37.5 2016 73.3 48.7 43.6 27.8 29.6 23.9 2016 Variation 42.7 85.8 25.6 72.6 18.2-80 0-60 0 72.7 2.3 66.7 2015 76.5 54.2 45.4 31.2 32.1 26.3 2016 73.7 48.2 45.8 30.6 33.5 25.7 2016 Variation 42.7 86.4 25.6 84.6 18.2-80 0 81.8 0 77.4 2.3 82.8 2015 76.5 54 47.2 36.2 37.8 31.4 12

Table 2: Summary of influenza vaccine uptake across Merseyside to 31 January 2016 with figures by GP registered population (Including % uptake rate and figures at same time last year, 2015) Summary of Flu Vaccine Uptake % Organisation Name No. practices 65 and over Under 65 (at-risk only) All Pregnant Women Halton CCG 2015/16 72.2 47.6 49.1 Number registered: 17 21671 18473 1769 Number vaccinated: 15637 8789 869 Halton CCG 2014/15 73.8 50.3 46.7 Number registered: 17 21057 16099 1798 Number vaccinated: 15549 8104 839 Knowsley CCG 2015/16 74.4 49.5 48.2 Number registered: 31 25620 21484 1768 Number vaccinated: 19052 10626 852 Knowsley CCG 2014/15 76.9 57.6 51.7 Number registered: 33 25289 18214 1793 Number vaccinated: 19438 10486 927 South Sefton CCG 2015/16 72.0 44.7 46.6 Number registered: 32 29244 20873 1775 Number vaccinated: 21070 9881 828 South Sefton CCG 2014/15 75.0 50.4 48.6 Number registered: 33 29043 18280 1709 Number vaccinated: 21789 9212 830 Southport & Formby CCG 2015/16 75.1 49.2 45.2 19 Number registered: 31316 14031 1035 Number vaccinated: 23517 6901 468 13

Southport & Formby CCG 2014/15 77.0 52.6 45.9 Number registered: 20 31235 12601 1111 Number vaccinated: 24040 6630 510 St Helens CCG 2015/16 75.0 49.2 47.6 Number registered: 36 39038 26283 2282 Number vaccinated: 29297 12941 1087 St Helens CCG 2014/15 78.5 56.8 48.8 Number registered: 36 38334 22755 2262 Number vaccinated: 30076 12921 1103 Liverpool CCG 2015/16 73.3 48.7 43.6 Number registered: 93 74803 65357 6666 Number vaccinated: 54865 31812 2904 Liverpool CCG 2014/15 76.5 54.2 45.4 93 Number registered: 74181 58072 6509 Number vaccinated: 56783 31450 2956 Merseyside Total 2015/16 73.7 48.2 45.8 Number registered: 228 221692 166501 15295 Number vaccinated: 163438 80400 7008 Merseyside Total 2014/15 76.5 54 47.2 Number registered: 232 219139 146021 15182 Number vaccinated: 167675 78803 7165 14

Table 3: Summary of influenza vaccine uptake across Cheshire to 31 January 2016 (Figures in dark grey show % uptake rate at same time last year, 2015) Organisation Name Eastern Cheshire CCG South Cheshire CCG Vale Royal CCG Warrington CCG West Cheshire CCG Wirral CCG Cheshire, Warrington & Wirral (CWW) total: Year 65 and over Under 65 (atrisk only) Summary of Flu Vaccine Uptake % All Pregnant Women All Aged 2 All Aged 3 All Aged 4 2016 76.9 52.3 52.3 54.7 53.3 47.4 2016 Variation 69.9 82.9 41.2 62.7 39.4 87.5 34.6 68.9 36.1 66.7 28.9-68 2015 78.1 55.8 53.6 52.3 54.9 46.6 2016 74.7 49.2 46.3 38.8 43.6 33.0 2016 Variation 64.4 80.5 37.5 67.6 30.2 65.5 14.5 69.4 27.9 62.1 8.8 58.6 2015 76.7 55.4 52 43.6 46.6 37.8 2016 74.3 52.2 49.4 39.3 44.9 34.6 2016 Variation 71.9-80 52.6 59.2 47.1 60.8 36.1-67.3 41.3 61.4 21.1 53.8 2015 74.7 57.4 54.5 50.2 53.7 44.3 2016 70.5 39.8 48.6 37.9 39.9 30.6 2016 Variation 59.6 78.7 30.3 70.4 25.8 76.5 8.3-83 13.3 75.6 11.7-75 2015 71.4 45 52.2 39.5 44.6 31.5 2016 73.4 48.3 46.2 46.9 47.1 37.1 2016 Variation 64.6 89.2 38-63 35 69.1 13.6 73.9 25.2 71.4 13.7 70.6 2015 75.2 52.7 49.1 45.4 50.6 38.7 2016 73.6 49.6 44.6 36.6 40.5 30.1 2016 Variation 54 84.4 35.6 70.5 20 86.7 8.7 69.2 15 86.7 3.4 67.9 2015 74.7 50.1 47.9 38.6 44.9 33.4 2016 73.9 48.2 47.3 42.1 44.4 34.9 2016 Variation 54 89.2 30.3 70.5 20 87.5 8.3-83 13.3 86.7 3.4-75 2015 75.2 51.9 50.6 43.7 48.4 37.5 15

Table 4: Summary of influenza vaccine uptake across Cheshire to 31 January 2016 with figures by GP registered population (Including % uptake rate and figures at same time last year, 2015) Organisation Name No. practices 65 and over Summary of Flu Vaccine Uptake % Under 65 (at-risk only) All Pregnant Women Eastern Cheshire CCG 2015/16 76.9 52.3 52.3 Number registered: 22 46700 21874 2180 Number vaccinated: 35920 11448 1141 Eastern Cheshire CCG 2014/15 78.1 55.8 53.6 Number registered: 22 45879 20017 2004 Number vaccinated: 35816 11164 1074 South Cheshire CCG 2015/16 74.7 49.2 46.3 Number registered: 18 35955 28175 1979 Number vaccinated: 26858 10760 917 South Cheshire CCG 2014/15 76.7 55.4 52.0 Number registered: 18 35129 19217 1956 Number vaccinated: 26940 10645 1017 Vale Royal CCG 2015/16 74.3 52.2 49.4 Number registered: 12 18363 12613 1088 Number vaccinated: 13636 6585 538 Vale Royal CCG 2014/15 74.7 57.4 54.5 Number registered: 12 18799 11880 1150 Number vaccinated: 14041 6821 627 Warrington CCG 2015/16 70.5 39.8 48.6 Number registered: 26 37531 26723 2139 Number vaccinated: 26448 10633 1040 16

Warrington CCG 2014/15 71.4 45.0 52.2 Number registered: 26 36770 23680 1568 Number vaccinated: 26268 10653 819 West Cheshire CCG 2015/16 73.4 48.3 46.2 Number registered: 33 52071 30167 2893 Number vaccinated: 38228 14564 1337 West Cheshire CCG 2014/15 75.2 52.7 49.1 Number registered: 34 52124 27139 2901 Number vaccinated: 39193 14293 1423 Wirral CCG 2015/16 73.6 49.6 44.6 Number registered: 56 68184 43166 4184 Number vaccinated: 50161 21401 1867 Wirral CCG 2014/15 74.7 50.1 47.9 Number registered: 56 67209 40799 4135 Number vaccinated: 50227 20435 1981 CWW Total 2015/16 73.9 48.2 47.3 Number registered: 167 258804 156418 14463 Number vaccinated: 191251 75386 6840 CWW Total 2014/15 75.2 51.9 50.6 Number registered: 168 255910 142732 13714 Number vaccinated: 192485 74011 6941 17

Table 5: Summary of school age influenza vaccine uptake across Merseyside by Local Authority to 31 January 2016 Organisation Name Summary of Flu Vaccine Uptake % All Aged 5 All Aged 6 Halton Local Authority 53.0 54.1 Knowsley Local Authority 53.4 55.5 Sefton Local Authority 58.5 60.9 St Helens Local Authority 56.5 56.0 Liverpool Local Authority 53.2 51.8 Merseyside Total: 54.9 55.2 Table 6: Summary of school age influenza vaccine uptake across Cheshire by Local Authority to 31 January 2016 Organisation Name Summary of Flu Vaccine Uptake % All Aged 5 All Aged 6 Eastern Cheshire Local Authority 65.7 64.1 Warrington Local Authority 60.5 57.7 West Cheshire & Chester Local Authority 63.4 62.4 Wirral Local Authority 63.3 63.1 Cheshire, Warrington & Wirral Total: 63.5 62.3 18

Table 7: Influenza vaccine uptake in Health Care Workers in NHS Trusts across Merseyside to 31 January 2016 (Figures in grey show % uptake rate at END of 2015 season) Summary of Flu Vaccine Uptake % Organisation Name Merseyside Area Team Health Care Workers St Helens and Knowsley Hospitals NHS Trust Liverpool Heart and Chest NHS Foundation Trust Alder Hey Children s NHS Foundation Trust Aintree University Hospital NHS Foundation Trust Liverpool Women s NHS Foundation Trust The Walton Centre NHS Foundation Trust Royal Liverpool and Broadgreen University Hospitals NHS Trust Southport and Ormskirk Hospital NHS Trust Mersey Care NHS Trust Liverpool Community Health NHS Trust Merseyside Total: Year No. of HCWs with Direct Patient Care No. Seasonal flu doses given since 01 September 2015 % Seasonal flu doses given since 01 September 2015 2016 1580 1069 67.7 2015 2192 1453 66.3 2016 3429 2626 76.6 2015 3431 2864 83.5 2016 1408 901 64.0 2015 1179 885 75.1 2016 1670 1312 78.6 2015 1690 1358 80.4 2016 4058 2771 68.3 2015 3708 2850 76.9 2016 1234 928 75.2 2015 979 758 77.4 2016 994 700 70.4 2015 973 743 76.4 2016 4500 2922 64.9 2015 4190 3198 76.3 2016 2371 1873 79.0 2015 2337 1903 81.4 2016 2427 1711 70.5 2015 2432 1807 74.3 2016 2355 1303 55.3 2015 2008 1347 67.1 2016 27828 18135 65.2 2015 25119 19166 76.3 19

Table 8: Influenza vaccine uptake in Health Care Workers in NHS Trusts across Cheshire to 31 January 2016 (Figures in grey show % uptake rate at END of 2015 season) Organisation Name Cheshire, Warrington and Wirral Area Team Health Care Workers Wirral University Teaching Hospital NHS Foundation Trust Mid Cheshire Hospitals NHS Foundation Trust The Clatterbridge Cancer Centre NHS Foundation Trust East Cheshire NHS Trust Countess of Chester Hospital NHS Foundation Trust 5 Boroughs Partnership NHS Foundation Trust Warrington and Halton Hospitals NHS Foundation Trust Cheshire and Wirral Partnership NHS Foundation Trust Wirral Community NHS Trust Bridgewater Community NHS Trust Cheshire, Warrington and Wirral Total: Year No. of HCWs with DIRECT Patient Care Summary of Flu Vaccine Uptake % No. Seasonal flu doses given since 01 September 2015 % Seasonal flu doses given since 01 September 2015 2016 3920 2600 66.3 2015 3554 2446 68.8 2016 4543 3592 79.1 2015 4670 3567 76.4 2016 3162 2098 66.4 2015 3087 2350 76.1 2016 702 388 55.3 2015 690 398 57.7 2016 2966 1660 56.0 2015 0144 1599 50.9 2016 3733 2668 71.5 2015 3711 2895 78.0 2016 2554 1404 55.0 2015 2929 1302 44.5 2016 2544 2076 81.6 2015 2544 1996 78.5 2016 2519 944 37.5 2015 3516 1219 34.7 2016 1185 705 59.5 2015 1032 739 71.6 2016 1949 891 45.7 2015 2347 1240 52.8 2016 27828 18135 65.2 2015 28877 18511 64.1 20

Appendix B Cheshire and Merseyside Influenza Programme Contacts for 2016-2017 Lead Manager: Pauline Jones Screening & Immunisation Manager pauline.jones14@nhs.net Lead Coordinator: Stacy Evans Screening & Immunisation Coordinator stacy.evans@nhs.net Lead Administrator: Abigail Philips Administration Assistant (Public Health) abigail.phillips2@nhs.net Lead NHS England Commissioner Neil Gaye Public Health Programme Contracts Manager ngaye@nhs.net Appendix C Sources The national flu immunisation programme 2015/16 tripartite letter (Department of Health, Public Health England and NHS England) Published 27 March 2015 PHE Gateway Reference: 2014833 NHS England Gateway Reference: 03316 ImmForm website PHE North West Influenza Bulletins 2015/16 Community pharmacy seasonal influenza vaccination advanced service September 2015 Service specification NHS England Publications Gateway Reference: 04045 Immunisation against infectious disease (Green Book) on-line: Influenza, Chapter 19 21