Agenda item

Report of the Consultant in Public Health and the ICB.

The Board received a Briefing Note and presentation of the Head of Immunisations, Coventry and Warwickshire Integrated Care Board regarding vaccination rates and project work to increase uptake in Coventry.

Immunisations protected people and communities from serious infectious diseases, enabling people to live healthier lives.  Improving uptake of vaccinations could help to reduce hospital admissions and demand on the NHS.

Responsibility for immunisation was fragmented with both NHS England (NHSE) and Coventry and Warwickshire Integrated Care Board (ICB), holding lead roles on NHS immunisation delivery.

The NHSE West Midlands Screening and Immunisations team provided system leadership, support and oversight of ICB commissioning and delivery of NHS vaccinations.  The ICB commissioned services including managing the introduction of new programmes, monitoring providers against national performance indicators, quality improvement and reduction in inequalities.  This included leading on the management of clinical queries and incidents.

The main providers of immunisations in Coventry were GP practices (including practice nurses).  Pharmacies, Maternity and School Age Immunisation Services (SAIS).  Coventry City Council public health team had an assurance function and influencing role in local commissioning and ensured that the plans, approach, communication and delivery mechanism were community focused to maximise uptake across the diverse populations within the city.

For Coventry and Warwickshire, assurance was provided through the Health Protection Committee.

The ICB held a regular immunisation board with local system partners to monitor uptake rates, review service delivery plans and ensure the programme was meeting the needs of the communities.  Monitoring of vaccine coverage was essential to identify possible drops in immunity and take action before levels of disease increased.

Immunisation was a key priority set out in the recently published Coventry and Warwickshire Health Protection Strategy 2025-2030.  The ambition was to improve coverage across the life course.  The ICB also had a local immunisation Strategy, setting out the future direction of work including key priorities, performance indicators and targeted actions.

Data showed that vaccine uptake in Coventry across all age groups could be improved.  Coventry consistently underperformed compared with the national averages for vaccination uptake, particularly for boosters and second does.  Rates reflected a broader UK-wide decline in vaccine coverage.

Inequalities in immunisation uptake still persisted.  In Coventry, low vaccination rates were linked to areas of higher deprivation.  GP practices with larger list sizes and practices located in areas with higher proportions of ethnic minority groups.

The most up to date published immunisation uptake data in Coventry had been circulated in the Appendix attached to the report.  The level of uptake needed for herd immunity depended on the vaccine – primarily due to differences in effectiveness and the disease’s transmissibility.

Childhood vaccine uptake fell below the recommended level of 95%

Pneumococcal (PPV) and respiratory syncytial virus (RSV) vaccines protected against infections that were both leading causes for hospital admission.  Vaccine uptake for PPV in adults had improved and met or exceeded England averages in all age groups.  A mixed picture was seen for the shingles vaccine with rates in those over 75 being higher than the England average but falling below in those aged 65-70 years.

Vaccination coverage for Flu for over 65s, at risk individuals and for children had been declining since 2021-22.  Data had shown a low uptake in frontline health and care workers.  This rate had been decreasing since the pandemic and was at concerning levels.

The rate of uptake in vaccines administered in pregnancy (flu, pertussis and RSV) was lower in UHCW than in other maternity services in the ICB.  For flu, the uptake among pregnant women in 2024-25 was 29% at UHCW compared to 61% and 53% at the South Warwickshire Foundation Trust (SWFT) and George Eliot Hospital (GEH) respectively.  The rate in Coventry was slightly lower than the UK average.  All three trusts saw significant increases in maternal pertussis vaccination rates compared to the previous year in 2024-25 with UHCW at 41% compared to 72% (SWFT) and 60% (GEH).  A similar trend was seen for RSV vaccination, with uptake ranging from 25% at UHCW to 56% at both SWFT and GEH.  Contributing factors to the lower rates at UHCW included its larger patient population, local demographic challenges, problems with the vaccination booking and tracking system and difficulties in recruiting dedicated vaccinators.

In response to the vaccination rates in Coventry, the ICB and Public Health team worked collaboratively with partners to deliver co-ordinated, community-focused interventions/approaches, designed to raise immunisation levels across the city.  These initiatives were based on the evidence of what works to improve uptake of vaccinations and take into account the needs of Coventry’s communities:

• Engaging schools to embed opportunities that promoted vaccinations
• Tailoring vaccination sessions in Coventry Family Hubs to respond to specific needs
• Co-ordinating Winter Plans to optimise uptake of seasonal vaccines
• Engaging grass roots organisations to increase local understanding of the importance of vaccination
• Collaborating with Warwickshire to increase vaccination in pregnancy
• Training professionals and community influencers to promote immunisations

Representatives from Settlement Support CIC and Coventry Asylum and Refugee Action Group (CARAG) relayed their communities’ concerns regarding the barriers to accessing health services and in particular, immunisations.  The barriers included language, cultural taboos and religious beliefs and the ways in which the communities were overcoming these barriers which included the use of translation services, bespoke videos/social media advising why immunisations were important and flyers placed in African markets in the city. A forthcoming sport for social integration event on 26 July was an opportunity to reach out to the community. 

The representatives also advised the Board that the asylum seekers and migrants with no recourse to public funds had a distrust of the health service and were reluctant to access services, resulting in some members of the communities not availing of TB and HIV medicines.

Members of the Board, having considered the content of the report and presentation asked questions and received information on the following matters:

-  Grant funding was only available as and when it was received.

-  Migrants with no recourse to public funding were still able to receive medication.

-  Funding continuity instead of one-off funding, would increase migrant communities use of health services.

-  Due to cultural and religious norms, some members of the migrant community held cultural beliefs meaning they only used alternative medicine, much of which was not available in Coventry.

-  Awareness campaigns which advised scientists helped patients with remedies would help members of the migrant community access health services.

-  Many organisations within the city accessed the Coventry Health Protection grant including a day centre for older adults.  Transportation was provided from home to the centre for vaccinations.

-  Officers worked closely with the digital inclusion team on inclusive projects however, work to be still to be done to reach the physically and digitally isolated member of the community.

-  A monthly immunisation board meeting took place where immunisation was a standing agenda item on the Health Protection Committee.  An offer to GP practices to contact Public Health to engage communities with vaccination uptake had been made.

The Board requested:

1.  Officers contact the Settlement Support CIC regarding provision of support for the sports for social integration day.

2.  The Chair and Director for Public Health and Wellbeing investigate future ways in which to support to the Coventry Asylum and Refugee Action Group (CARAG).

3.  A further report be brought back to The Health & Wellbeing Board to include data from statistical neighbours and immunisation success rates.

4.  Officers explore support and guidance regarding vaccinations to the physically and digitally isolated communities.

5.  Officers explore pathways for improved medication uptake in the migrant community including partnership work through the Care Collaborative.

RESOLVED that the Health and Wellbeing Board:

1)  Identify opportunities to support improved uptake across the partnership.

2)  Endorse and actively promote key immunisation messages, while challenging and countering anti-vaccination narratives.

3)  Support collaborative efforts with local partners to improve vaccination uptake, particularly through targeted engagement with communities that have historically lower access or uptake.