Agenda item

 

This item is to receive a joint update from NHS England, the ICB and Public Health in relation to changes to immunisation programme commissioning, and the work undertaken to encourage uptake and reduce health inequalities through vaccination in the borough.

 

 

The Chair welcomed Kathy Wakefield, Senior Programme and Commissioning Lead, North East and Yorkshire Office for Pan ICB Commissioning (OPIC), Laura Brown, Public Health Officer for Rotherham, North East and Yorkshire Office for Pan ICB Commissioning and Gilly Brenner, Public Health Consultant deputising in the absence of Denise Cornwall, Health Protection Principal to the meeting and invited them to introduce the presentation.

 

The Commission heard that to support the transition, a new Office for Pan-ICB Commissioning (OPIC) was being established. The role of OPIC would be to provide specialist commissioning support to Integrated Care Boards in fulfilling their responsibilities for national screening and immunisation programmes.

 

Members were advised that the North East and Yorkshire OPIC footprint would cover the North East and North Cumbria Integrated Care Board, Humber and North Yorkshire Integrated Care Board, West Yorkshire Integrated Care Board and South Yorkshire Integrated Care Board. It was explained that these arrangements aligned with the Government’s Ten-Year Health Plan and the wider objective of strengthening the role of Integrated Care Boards as strategic commissioners of health services. Officers reported that significant work was already underway to redesign operating models, strengthen governance arrangements and build closer working relationships with Integrated Care Board partners to ensure a smooth transition.

 

Members were informed that screening and immunisation represented only one component of OPIC’s responsibilities, but nevertheless constituted a substantial and complex programme of work. The Commission heard that responsibility covered a wide range of vaccination and screening programmes delivered across all age groups, from childhood immunisations through to adult vaccination programmes and cancer screening services. In addition to routine commissioning functions, officers advised that the team also played a key role in responding to outbreaks and public health incidents through multi-agency incident management arrangements involving the United Kingdom Health Security Agency (UKHSA), local authorities, Integrated Care Boards and healthcare providers.

 

The presentation highlighted the key commissioning priorities underpinning all immunisation and screening programmes. Members heard that improving uptake and coverage across vaccination and screening programmes remained a primary objective, alongside a strong focus on reducing health inequalities and narrowing the gap between areas, services and populations with the highest and lowest levels of uptake. These objectives informed both local and national commissioning plans and were central to the commissioning intentions for 2026/27.

 

The Commission was advised that a number of significant service developments were currently being implemented. These included the continued expansion of community pharmacy provision, which already delivered influenza (flu), Coronavirus Disease 2019 (COVID-19) and childhood flu vaccinations. Under proposals aligned to the Government’s Ten-Year Health Plan, community pharmacies would also become involved in the delivery of adolescent Human Papillomavirus (HPV) vaccinations, with planning and implementation work currently underway. Members also noted the successful rollout of what was described as the world’s first gonorrhoea vaccination programme, using the Meningococcal Group B (MenB) vaccine and targeting identified high-risk cohorts through sexual health services.

 

Further developments within screening programmes were outlined. The Commission heard that the threshold for bowel cancer screening had been lowered to support earlier detection, with positive early indications being reported. Members were also informed that Human Papillomavirus self-testing had recently been introduced at the end of August, representing an important step towards achieving cervical cancer elimination objectives by improving access and encouraging greater participation in screening. Additionally, several national workstreams were exploring the use of automated technologies and artificial intelligence (AI) within screening pathways, both to enhance service delivery and to support workforce capacity challenges.

 

In relation to pre-school immunisation programmes, officers reported that improving uptake among children aged under five remained a priority, particularly with regard to measles-containing vaccines. The Commission was advised that measles continued to present ongoing concerns nationally, with occasional outbreaks and clusters of cases still occurring. Members noted that changes introduced to the childhood vaccination schedule earlier in the year had incorporated chickenpox vaccination into the combined Measles, Mumps, Rubella and Varicella (MMRV) programme, which had been positively received. It was further reported that a targeted MMRV catch-up programme would commence in November and continue until March 2028, focusing on children aged over six years who had not previously received a chickenpox vaccination or contracted the disease.

 

The presentation also addressed school-aged and adolescent vaccination programmes. Members heard that efforts continued to restore uptake levels to those experienced prior to the COVID-19 pandemic, with a particular focus on Human Papillomavirus vaccination because of its role in preventing cervical cancer. School immunisation providers were increasingly using the national Mavis reporting system, which improved parental communication, consent processes, data management and information sharing with General Practitioner (GP) practices. The Commission was also advised of the recent implementation of a time-limited MenB catch-up vaccination programme for higher-risk groups, including university entrants and young people entering residential further education settings. Officers reported that this programme had been positively received by educational providers, vaccination services and the wider public. Members were additionally informed that the Joint Committee on Vaccination and Immunisation (JCVI) had recommended the introduction of a routine adolescent MenB vaccination programme following outbreaks earlier in the year, although ministerial approval was still awaited.

 

Updates were also provided regarding adult immunisation programmes. Particular emphasis was placed on the Respiratory Syncytial Virus (RSV) vaccination programme, which had been expanded to include all adults aged over 80 and residents of older persons’ care homes regardless of age. Further eligibility extensions had subsequently been introduced for people aged 65 to 74 with specified clinical risk factors, including respiratory conditions and immunosuppression. Members also heard that efforts continued to improve uptake of seasonal vaccination programmes such as flu and COVID-19 vaccines. A particular focus had been placed on increasing access for people experiencing homelessness, with close partnership working taking place between health services and local authority inclusion health teams. Vaccination against pneumococcal disease had also been extended to this cohort to maximise opportunities for co-administration alongside other vaccines.

 

The Commission noted additional expansion of community pharmacy delivery within the seasonal flu programme. From October, pharmacies would be able to vaccinate at-risk children up to the age of 17, whilst from December they would also be able to offer vaccination to school-aged children who had missed their school vaccination sessions and associated catch-up opportunities. This approach was intended to improve convenience and maximise overall uptake. Officers reported that a trajectory of improvement targets had been established over the next three years to support continued progress across all vaccination programmes.

 

Following the national update, the Public Health Consultant outlined the contribution of the Council’s Public Health Service to immunisation and screening efforts. Members heard that the authority’s health protection function played an important role in community outreach and engagement, utilising established relationships with local communities, faith groups and community leaders to promote accurate health information and improve trust in vaccination programmes. This approach had built upon successful methods developed during the COVID-19 pandemic, where trusted local messengers had been particularly effective in reaching communities that health services could otherwise find difficult to engage.

 

The Commission was informed that Public Health teams also routinely analysed immunisation data to identify areas of lower uptake and emerging concerns. Where gaps were identified, targeted interventions were developed to address local challenges. Examples included providing vaccination opportunities through schools or community settings in particular neighbourhoods where childhood vaccination rates were below expected levels. Public Health also supported practical delivery arrangements through communications campaigns, provision of venues and the establishment of temporary vaccination sites where appropriate.

 

Members further received an update on the Pathfinder Childhood Immunisation Pilot, an NHS England initiative designed to improve vaccination uptake among children aged 0 to 5 years. The pilot utilised health visiting services commissioned by Public Health to identify children who had missed vaccinations and offer alternative opportunities to receive them. Officers explained that the programme was particularly supporting families who had experienced barriers to accessing routine vaccination pathways, including General Practitioner registration issues, language barriers, childcare commitments and other practical obstacles. Vaccinations could therefore be offered during routine health visiting contacts, creating a more flexible and accessible route into the programme. Whilst the pilot remained at an early stage, Members were advised that it would continue for a further twelve months, allowing more comprehensive data and outcomes to be gathered.

 

In conclusion, officers reiterated the significant organisational changes that were taking place nationally, the ongoing focus on improving vaccination and screening uptake, and the extensive partnership work being undertaken locally to address inequalities, improve access and support population health through effective immunisation programmes.

 

The Chair thanked officer for the presentation and invited questions and comments from members.

 

Cllr Duncan opened the discussion by asking about the principal risks associated with the planned transfer of commissioning responsibilities to Integrated Care Boards and how local health needs would continue to influence commissioning decisions within the new Office for Pan-ICB Commissioning arrangements. Particular concern was expressed regarding whether local priorities, including efforts to improve uptake of the Measles, Mumps and Rubella (MMR) vaccine and Human Papillomavirus (HPV) vaccinations, might be diluted within a larger geographical footprint.

 

In response, The Senior Programme and Commissioning Lead advised that officers regarded the transition principally as an opportunity rather than a risk. It was explained that the new arrangements would strengthen relationships with Integrated Care Boards and primary care providers and would bring screening and immunisation commissioning into closer alignment with wider health system planning. Although the new commissioning footprint would cover a larger geographical area across the North East and Yorkshire, Members were assured that a strong local presence would be retained. Dedicated South Yorkshire screening and immunisation teams would continue to operate, supported by place-based leads maintaining local relationships with authorities and partners. Officers acknowledged that there were some short-term risks arising from reduced staffing capacity following a recent voluntary redundancy programme. However, recruitment activity was underway to address vacancies and officers stated that essential work, particularly around reducing inequalities and supporting priority programmes, continued to be delivered through close collaboration between local authorities, Integrated Care Boards and wider system partners. It was emphasised that the longer-term effect of the changes was expected to be beneficial because of the stronger integration with local health commissioning structures.

 

Cllr Duncan subsequently clarified that their concern had related primarily to the risks during the transfer process itself and noted the reassurance provided regarding recruitment and workforce planning.

 

Cllr Thorp questioned why uptake of influenza and Coronavirus Disease 2019 (COVID-19) vaccinations had declined amongst care home residents and those aged over 65 despite overall improvements in uptake.

 

The Senior Programme and Commissioning Lead advised that no single cause had been identified. Officers were working closely with local authority partners and infection prevention and control teams to improve understanding of eligibility criteria and increase awareness amongst care home residents, relatives, carers and managers. Members were informed that joint communications were issued by Integrated Care Boards and local authorities to reinforce programme eligibility and the importance of vaccination. Officers also highlighted practical challenges associated with obtaining consent for residents lacking mental capacity, which frequently involved discussions with family members and the application of best-interest decision-making processes. Additional work was taking place with hospital providers to ensure eligible patients were vaccinated prior to discharge into care home settings.

 

Cllr Thorp queried whether declining uptake might be linked to increasing public scepticism regarding vaccination following the COVID-19 pandemic.

 

The Senior Programme and Commissioning Lead advised that no evidence had emerged to support such a conclusion and therefore officers had not identified this as a significant contributory factor.

 

Cllr Harrison sought clarification regarding the effectiveness of community engagement campaigns and pop-up vaccination services, asking whether outreach activity generated sustained improvements in vaccination uptake or simply resulted in temporary increases in attendance.

 

The Senior Programme and Commissioning Lead explained that all outreach schemes were subject to comprehensive business cases and robust evaluation processes. Evidence gathered through projects funded during the COVID-19 pandemic, particularly those aimed at improving access and reducing inequalities, suggested that outreach activity could successfully vaccinate people who might not otherwise engage with services; however, overall increases in uptake were generally relatively modest compared with the scale of effort involved. Whilst the evidence did not demonstrate substantial increases in vaccination coverage attributable solely to outreach activity, officers remained committed to supporting community-based provision because of its value in reaching vulnerable populations and addressing barriers to access. Members heard that future work would continue to explore neighbourhood-based vaccination models targeted at communities with persistently low uptake.

 

Cllr Ahmed asked why vaccination uptake remained comparatively low within certain communities and sought assurances regarding actions being taken to tackle these disparities.

 

The Senior Programme and Commissioning Lead explained that the causes were multifactorial and varied between localities and population groups. Deprivation, cultural factors, language barriers and literacy levels all contributed to lower uptake in some communities. Members were advised that, in certain areas, perceptions of the National Health Service itself could also influence engagement. Officers described ongoing work with community leaders, faith leaders and local partners to better understand local concerns and tailor interventions accordingly. The importance of place-based intelligence and trusted relationships within communities was emphasised as a key mechanism for addressing inequalities and improving uptake.

 

Cllr Ahmed asked whether a large-scale public campaign similar to that adopted during the COVID-19 pandemic should be introduced to encourage greater uptake of routine vaccinations.

 

Officers explained that the pandemic response had been delivered under exceptional circumstances and had benefited from substantial resources and emergency arrangements that would not be sustainable within routine vaccination programmes. Whilst efforts were continuing to expand delivery routes through community pharmacies, health visiting services and healthcare providers, evidence suggested that increasing the number of providers principally improved accessibility and flexibility rather than significantly increasing uptake. Members heard that more targeted approaches would therefore continue to be used, with mass vaccination models deployed only where significant outbreaks or specific public health risks justified such action. Officers also suggested that public understanding of vaccine-preventable diseases had diminished because many of those diseases were now rarely encountered. Consequently, future communications would place greater emphasis on explaining the serious consequences of illnesses such as diphtheria and tetanus and highlighting the protections afforded by vaccination.

 

Cllr Harper questioned the rationale for the significant expansion of community pharmacy vaccination services and asked how the approach would support residents in rural or harder-to-reach areas.

 

In response, the Senior Programme and Commissioning Lead explained that community pharmacy provision was intended primarily to increase accessibility and convenience. Examples were provided of children who missed vaccinations through school-based programmes due to illness or practical difficulties and who could instead receive vaccinations through local pharmacies. Similarly, pharmacies provided additional opportunities for parents already accessing other healthcare services. Whilst expanded provision did not automatically result in significantly higher uptake rates, officers considered that offering residents greater flexibility and choice increased the likelihood of participation over time and therefore remained an important element of the overall strategy.

 

Cllr Thorp sought further detail regarding the Pathfinder Childhood Immunisation Pilot. Referring to the reported investment in the programme, he questioned whether the initial increase in vaccinations appeared proportionate to the resources committed and asked whether the programme had been targeted appropriately at areas of low uptake.

 

The Public Health Officer for Rotherham explained that the Pathfinder programme formed part of a national Government initiative designed to test how health visiting teams could support immunisation delivery in the future. The intention was not simply to count vaccinations delivered but to evaluate different service models and establish sustainable approaches for long-term implementation. Members were advised that extensive preparatory work had been required, including workforce training, record management systems, referral pathways and engagement with General Practitioner practices. Within Rotherham, the programme had initially been delivered through a single trained health visitor, with additional staff currently being trained. Officers reported that referrals had expanded beyond the first participating practice and that the programme was gathering momentum. Particular emphasis was placed on supporting highly vulnerable families who were unlikely to engage through conventional routes. Members also heard that the programme’s benefits extended beyond vaccination delivery itself. Health visitors undertaking home visits had identified additional health and welfare concerns, including unmet dental needs and safeguarding issues, demonstrating wider public health benefits beyond immunisation outcomes alone. Officers also highlighted engagement activity undertaken at community events, including the Rotherham Show, where thousands of residents had received information and positive conversations about vaccination.

 

Cllr Baum-Dixon observed that future reports would benefit from additional benchmarking information to provide greater national context and enable Members to assess the effectiveness of initiatives against national trends and comparable areas.

 

The Senior Programme and Commissioning Lead confirmed that officers routinely compared local performance against regional and national data, including published England averages, and agreed that the inclusion of additional contextual benchmarking information would assist Members in their scrutiny of performance.

 

Cllr Baum-Dixon reiterated the value of presenting such comparative information within future reports.

 

The Chair commented that it would be beneficial to consider the drivers of the significant improvement in vaccination uptake amongst pregnant women, noting that the increase appeared to provide valuable learning opportunities. They also sought assurance regarding local governance and accountability arrangements during the transfer of commissioning responsibilities.

 

In response, the Senior Programme and Commissioning Lead explained that extensive governance arrangements were already in place, including internal senior management oversight, monthly programme monitoring and the establishment of a dedicated Office for Pan-ICB Commissioning leadership group involving executive representatives from Integrated Care Boards. At the local level, Members were advised that assurance and oversight were provided through the Health Protection Board, which received regular updates and monitored progress and risks associated with the transition.

 

Resolved:-

 

That the Health Select Commission:

 

1. Noted the contents of the presentation received.

 

2. Requested that local performance reports in relation to vaccination uptake be provided to the Commission at appropriate intervals to facilitate ongoing monitoring of support offered to wards, schools and GP practices. These reports should include benchmarking against national vaccination uptake data to enable comparison of local performance with national trends. Delivery method and timeline TBC.

 

3. Requested an update at an appropriate stage on the overall impact of the Pathfinder programme in Rotherham. Delivery method and timeline TBC.