Immunisation Update Afua Nketia, Immunisation Coordinator Dr Agnes Marossy, Consultant in Public Health

Immunisation Immunisation is one of the most effective public health interventions. The World Health Organisation recommend that uptake for childhood immunisations should be at least 95%. We are not achieving this target.

Why are we not achieving the target? Not enough people being immunised We don’t always have a record even if someone has been immunised

Why are people not immunised? Lack of knowledge-  Schedule changes- second dose MMR, 12 mth baby immunisations  Misinformation - Wakefield  Misunderstanding of when immunisations are due - pre-school booster  Lack of access-hard to reach, language problems, migration, chaotic lifestyles  Cultural reasons

Why don’t we know who has been immunised? Good question!

Why don’t we know who has been immunised? Before Paper records not sent / never arrived in post 2. Child moved out of area and records sent away 3. Immunisations missed elsewhere not entered on child’s record After Immunisations on practice system not always entered on the correct template. Sometimes deleted by accident 2. Wrong date of birth, name or other demographic details 2 and 3 from “before 2010”.

Bromley position

Bromley position

Trends in uptake

What have we done to improve…… Knowledge  Awareness of the schedule, posters, leaflets  Nursery visits  Glades adverts Access Defaulter project Misinformation- national approach Cultural- gypsy traveller work Data quality work. (collection and training)

Defaulter project Better data- better analysis of individual practice data Training all practices to run timely searches Defaulter project introduced. Health visitors and practice working together in targeting defaulters. This exercise highlighted the health visitor role in childhood immunisations. Evaluation of defaulter project indicated a need to change the process- Improving immunisation uptake was piloted following the defaulter project evaluation.

Nursery Projects All Bromley nurseries asked to take part in survey about childhood immunisations 5 nurseries agreed to hold coffee mornings to raise awareness of childhood immunisations. Parents were invited to bring their children’s Red books, to the coffee mornings where a gift was offered to completely immunised children.

Nursery project findings Some parents were unsure what immunisations their children had. The extra MMR in 2008/9 was especially confusing to most parents. Most thought the pre-school booster meant just that.

Improving immunisation project 30 practices in Bromley were included in the improving immunisation project. A snapshot of defaulting children in these practices were targeted by the Public health team. Steps-  team member contacts practice to check if child has been immunised or has an appointment.  Where required team member contacted the guardian by phone.  When appointment booked, option of a text reminder was given.  Where no response to phone calls (9) a home visit was made  Active refusers had the immunisation record changed to reflect this.

Improving immunisation project evaluation The use of prewritten script and text message reminder successful. Home visits took up more time than expected and there was a lower response rate.

Improving immunisation project what next 37.84% of the defaulter children had previous immunisations but no record on the GP data base. ? Encourage practices to implement the processes used. Non medical staff could make the telephone call with the aid of the prewritten script. Encourage practices to use text reminders- many already do. Good practice findings to be circulated to practices.

Pathway for unregistered children with incomplete immunisation history

Commissioning for Quality and Innovation (CQUIN) payment

Bromley Immunisation uptake

Immunisation uptake at 5 years

Immunisation uptake at 2 years

Immunisations uptake at 1 year

Thank you for your attention. Any questions?