31
Examination of witnesses
Sharon Hodgson, Catherine Frances and Caroline Temmink.
Q224 The Chair: Welcome to today’s meeting. This is the 19th oral evidence session as part of the committee’s inquiry into childhood vaccination rates in England. It is our last oral evidence session. Thank you to Sharon Hodgson MP, the Minister in charge of these issues, for joining us today, and Catherine Frances and Caroline Temmink for attending.
The session is open to the public. It is broadcast live and will subsequently be available on the parliamentary website. A verbatim transcript will be taken of the evidence and published on the parliamentary website. A few days after the session you will be sent a copy of the transcript to check for accuracy. It would be very helpful to us if you could advise us of any changes and send it back as soon as possible. If, after this evidence session, you want to clarify or amplify any points made during our evidence, or anything that we have asked you for in addition, perhaps you would send it back to us as soon as you can. I would be most grateful.
The first question is pretty obvious. I remind you to introduce yourselves when you answer it. Are the Government and the NHS doing enough to reverse the decline in childhood vaccination rates and to tackle and reduce inequalities? How do you measure the success of the Government’s action to improve childhood vaccination coverage and reduce inequalities, including progress against the 2023 NHS vaccination strategy? Will you commit to reporting on progress against the strategy to Parliament periodically?
Sharon Hodgson: Good afternoon, everyone. It is a pleasure to come along and give evidence to your committee, thank you, Baroness Walmsley. I am the Minister for Public Health and Prevention. This is a major issue and a major priority for the Government. Newly coming into this role just four months ago now, I had to sit down. Everything is a priority, but my team told me I had to focus and prioritise, and come up with a list of a few things. I got that list to nine, so then we had to put them into tiers, and immunisation came under tier 1 priority for me. This is something that I really want to focus on during my time in this role, because it is so important.
It is a challenge. There has been a decline globally, not just in the UK, but specifically here over the last 10 years. The rates of immunisation and vaccinations, when you look at all the graphs and the tables, and everything that officials show me, show that that decline is worst in some of our most deprived areas, as I am sure you are aware. You will have had the evidence on this and seen it for yourselves also. That drove me to make this one of my key priority areas.
The health inequalities we see in some of our poorer communities are still shocking. It is something the Government are determined to turn around. There is the manifesto commitment to have the healthiest generation of children ever and there are so many parts of that. I know that we do so much work on food, obesity, healthy food and the access to that healthy food. Another part of it is helping keep children healthy and, in the case of immunisations, not just healthy but alive in some cases also. Immunisations are so important, so we really are doing everything we can to turn that around.
There is huge investment. I will hand over to officials to give you the drill-down and some of that information. There is huge investment, working with GPs and community pharmacies, to shift that dial. I am going to make it a huge focus. There is no one thing. There is no silver bullet. It has to be around access and awareness in the system. There are digital issues to drive up vaccination coverage and stuff around data. I know that we are going to come on to all that, but, for some of the detail, I will hand over to Catherine.
The Chair: Catherine, we are very particularly interested in how you measure progress.
Catherine Frances: I am the director-general of public health, global health and emergencies in DHSC. I also head up our vaccination function as part of that. On your question about how you measure success, ultimately success has to be in the numbers. Success has to be us achieving a level of vaccine uptake. For those areas of vaccination where we are trying to achieve herd immunity and the protection that that implies, we want to get up to those requisite levels. In other areas, and we will drill down into this maybe a little further on, we are vaccinating for slightly different reasons, maybe to slightly reduce the exposure to other members of the population. For example, flu for children is more focused on that.
Your question was whether we are doing enough. We will cover this over the course of today, I hope. We are focusing on four key areas. The first area that we are focusing on is the issue of access. Time and again we have a lot of evidence that parents of children tell us that accessing services, whether via GPs or via schools, is absolutely critical, and so investing in those big universal services is central to our strategy. We think it will help with inequality. You will have heard that we are also diversifying on top of that and trialling some other ways of getting vaccines to people.
The second big piece of work for us is around improving accountability. As we go through system change, particularly in the NHS, it is very important to us that everybody knows exactly what they are doing and why they are doing it. We can cover some of that today.
The third big piece of work for us, if I might take the liberty of covering it, is to improve our digital and data systems. We operate in a relatively fragmented context when we think about vaccination, but we have been making a huge amount of progress right now modernising our digital and data systems, which is fundamental to improving access to information for both practitioners and parents.
Lastly, we are focusing on communication. That is universal communication, but also that which works for different communities, some of which needs to happen quite locally.
Caroline Temmink: On the measuring point, we have the target set to us by the WHO and we are committed to going back up and hitting those levels. We will continue to publish the data and our progress, working with UKHSA to make sure we monitor that, particularly thinking about health inequalities. As the Minister has said, a lot of that uptake has dropped predominantly in the most deprived populations. Therefore, rather than just measuring the overall uptake, we are also focusing on narrowing that gap to make sure that we improve uptake not only for some people but for everybody.
The Chair: If you are trying to improve the numbers, do you think it is helpful to have removed the target?
Sharon Hodgson: We have not removed the target. We definitely still have targets. We have the international target and our own.
The Chair: I mean the MMR target.
Caroline Temmink: I think that you are referring to the NHS planning guidance. The NHS planning guidance has been streamlined so there are fewer points in there, but it does not mean that we have removed the target. We are still committed and the Secretary of State sets out each year the targets we have to achieve as an NHS in terms of uptake. That remains, for the preschool programmes, at 95%. We have also included for the first time an MMR metric in the NHS outcome framework. That is the first time that that will be a scoring metric to make sure that ICBs are measured going forward on their performance.
The Chair: Thank you. I think that we will have more questions about that as the afternoon progresses.
Q225 Lord Randall of Uxbridge: The NHS Alliance suggested to us that there is not always a clear and consistent message from the department, NHS England and UKHSA about how to improve vaccination coverage. Do you think that there is a need for a unified cross-governmental strategy?
Sharon Hodgson: The messaging can often be fragmented with all the different parts of the NHS, as you are aware. We are trying, especially with bringing NHS England back into the department, to ensure that we are all joined up, are all working together and all have a united message and mission. That work is under way. I do not know whether there is something in particular you are trying to drill down to.
Lord Randall of Uxbridge: No, I am just wondering. We have been told that there seem to be slightly different strategies or something. I am wondering whether you should be working together on it. You say you are doing it and I am wondering how far you have got with that.
Catherine Frances: The previous Government had a vaccination strategy that was largely produced by NHS England and focused largely on that system. We know that, when we look at vaccinations, you need a lot of agencies working together, and we will cover it later. We need schools, NHS and local government all partnering together. The focus for the department at the moment is what I tried to set out at the start, which is, “What are we actually doing?”, where we are seeing the work in a set of really important buckets, with early priorities that we are very clear on and later ones. Whether you write that down in a strategy is a question of presentation, but we are really clear on what we are doing, and we are hoping to talk about that today.
Lord Randall of Uxbridge: You are confident that that will be sufficient.
Catherine Frances: That comes back to our earlier question. The most recently published rates in 2024-25 are definitely still showing vaccination rates falling, particularly for the preschool vaccinations, and we are seeing that deprivation gap continue to open up. We would like to talk about it today, but there are steps that we are taking, particularly the quite strong movement on our work with schools over the course of this year, which is coming through right now, where we are changing our systems, and investment into GPs and other innovations that we have going. We will only know whether they have been effective as the numbers come through. It is in the nature of things, but we will be watching them really closely and adjusting course as we go.
Lord Randall of Uxbridge: You mentioned that, although you have not removed the targets, you have removed the targets from the NHS planning guidance. What impact, if any, has that had? Do you have any levers that you will be able to use to incentivise and support ICBs to make improving childhood vaccination coverage as much of a priority as other targets, such as elective care?
Sharon Hodgson: One thing we have done is to change the GP contract with regard to incentives and to give extra funding to ICBs and GPs. Last year, we ploughed over £1 billion into the system and this year it is £601 million directly to GPs to incentivise them to increase the rates, not to hit an arbitrary target, but just to have an improvement, especially targeting that at the underserved and most deprived areas. We are actively seeking to improve that coverage. We think that the devolution to the ICBs, as part of the reorganisation, will make the key difference.
Catherine Frances: It is a really good question. The national planning framework is a slimmed-back document from its predecessors, quite deliberately. You will see in there that it describes what happens to vaccination services structurally, but it does not set out the detail of the targets. Our public health agreements with the NHS set out the detail that was previously set out elsewhere. The new national outcomes framework, which is the way by which we cascade out through the NHS the key outcomes that we are looking for, includes MMR in there as a key indicator. Removing it from the national planning framework might be a little bit of a red herring in the sense of the importance that we are placing on it.
In terms of what ICBs can do, from 2027 ICBs will be the commissioners for vaccination. Currently, the NHS regional teams will commission, for example, schools immunisation services. From the start of 2027, they will be responsible for doing all that commissioning. They will have the budgets and the choice. Will they have the levers to do so? Yes, I think they will. They will also be able to hold their GPs to account and to work closely with other community groups and neighbourhood health operations. We are giving them the tools. As we go through today we should come on to how we are strengthening some of those tools, both the digital systems and other guidance and things with the system. Yes, we are definitely giving them the tools.
Q226 Baroness Nye: To come back to Lord Randall’s first question about the differences in messaging, one of your four key points, Catherine, was digital and data systems. In the course of our committee hearing evidence, we have heard that NHS England talks about digital interfaces and apps, but UKHSA talks about parents wanting GP-led text messages and plain email. You are then getting into the digital inequalities, because not everybody has smartphones. They cannot be part of that digital breakout that is fantastic but is going to exclude a lot of people. We have heard that one group of people want to do digital, and that is great because it is certainly needed, but another group of people want to have the old-fashioned red book and the text messages and emails. How are you joining all that up?
Catherine Frances: I do not think that it is an either/or and I do not think that we are in a different perspective. On my list of four things, one was access. The last one was communication and that communication can be very local or national and can take different forms.
Maybe it is helpful to bring to life a bit of what we are doing on digital, because I think that would help to bottom out what we are talking about here. At the moment, to give you an example with schools, for most schools, if somebody goes and has their vaccine at that school, the record is not automatically fed back to the child’s GP. We are right now introducing a new system across schools, which will contact the parents and say, “Would you like your child to be vaccinated?”, and then, should they want to be vaccinated and get the vaccination, that will be fed back to the central system.
That is not so much an issue of, if I can put it this way, massively innovative ways of interacting with the population. It is just integrating and prompting our data systems. The number of schools that are on that system will move from, I think, 5,000 or so back in February up to almost 14,000 by this September. That is a huge digital rollout.
If people do not engage with that, or if they engage and decide, as of course they are totally entitled to, that they are not sure about vaccination, we are really clear that schools immunisation services need to be following up face-to-face. In fact, that is all hardwired into some guidance that DfE has just issued to schools immunisations and schools. It is a mixture of messages sort of approach. That is just the schools service. You can have the same conversation about preschool.
The Chair: Before we move on to the next question, I do not think you answered my question about whether you will commit to reporting on progress against the strategy to Parliament. There is a lot going on. Is there any reason why you should not do this? I am sure Parliament would be interested.
Sharon Hodgson: I cannot see a reason why we could not do that, because it is one of my key priority areas. The department is focusing a lot of resources on this. If that is something the committee recommends that we do, I think we will take the advice of the committee and do so.
The Chair: Thank you very much for that reassurance that, if we were to recommend that, it would be well received.
Q227 Baroness Ritchie of Downpatrick: Minister and your team, you are very welcome. We have worked together in the past in the Commons and in a Joint Committee. Many witnesses have told us that NHS reforms risk fragmenting responsibility and accountability for childhood vaccinations. Therefore, what are you doing to ensure that responsibility and accountability for improving childhood vaccination coverage and reducing inequalities are not fragmented but are strengthened at all levels in the system?
Secondly, have you mapped out where responsibility for all aspects of the childhood vaccination programme will move to when NHS England is abolished and commissioning responsibility is delegated to the ICBs, including how they will be held accountable? Can you confirm that you will provide the committee with a map of roles and responsibilities at all levels in the system? I realise, Minister, that that is quite a tall order, but to try to address this issue we need some answers.
Sharon Hodgson: Thank you, Baroness Ritchie. It is lovely to see you again. We have to recognise that we have a very fragmented system at the moment. As you acknowledge, NHS England has been brought back in under the DHSC. We will be devolving, from April 2027, the leadership for this work locally to ICBs. Who is going to monitor that that work takes place is going to be mapped. Before I hand over to Catherine on that, one key thing that I will want to monitor is not only that the system is now doing what we want it to do, but that we are closing those inequality gaps, and that not only are the immunisation rates going up, but they are going up in the right areas as well.
If the committee is interested, Catherine and I did a visit just a couple of weeks ago to look at the situation in Enfield. You will all be very aware of the outbreak that we have had of measles in Enfield. We saw a tale of two cities, to use that phrase. Over Enfield in total, it is about 64%. In my neck of the woods, up in my constituency, that is as high as the mid-90s. It is where we want it to be. I am struck that my constituency has lots of deprivation and Enfield has deprivation. When we drilled down under those figures in Enfield, the less deprived part of Enfield was up in the 80s and the more deprived part was down in the 40s. The 64% hid the level of disparity and the inequality.
When we are seeing those rates go up, I will also be wanting to see the detail to ensure that we are getting the rates in the most deprived areas up equally. That would be one of the measures or levers and I would want to see that mapped out. On who and how that is going to be reported and work, I will hand over to Catherine.
Catherine Frances: In answer to your question about mapping the roles, yes, we can certainly map the roles. One of the most important things that we are doing at the moment in the movement to the new system is making sure that, where there is ambiguity, or felt ambiguity, which is as important as ambiguity, we are clarifying that. Right now, we have written to all schools and said, “This is the school role and this is the school immunisation team’s role”, just so it is absolutely clear and people feel confident in that.
In future, we are devolving accountability down to the ICB, and the individual ICB will then be accountable for commissioning of all the services. There will be commissioning from GPs, community pharmacy top-up and schools immunisations providers.
It is important to understand that GPs will remain the real central part of this system, in the sense that, for children, they hold the vaccination record, and they are the person who follows the child through their life. It is important also to note that we are not giving the core role of core children’s immunisation to community pharmacies, but are using them for certain top-up services. At the moment we are innovating and seeing, if we give them some pilot roles, for example in two to three year-olds flu, what the effect of that will be. They will have that role. Schools, as I have said, will carry on being critical.
We can provide a diagram of that as it is all sorted through. In terms of how the national and the ICB relationship works, we may not have all of the answers on that yet. We have the national outcomes framework and we can give you supplementary information as it comes.
Q228 The Chair: The ICBs may be accountable for commissioning, but that is not quite the same thing as really pushing the rates up and doing whatever it takes to do that. Who is going to do that? Are we putting pressure on the GPs themselves to do that, or is there going to be somebody in between?
Sharon Hodgson: We have incentivised the GPs.
The Chair: We do not know how well that works yet though, do we?
Sharon Hodgson: I hope that it will be quite successful. There is quite a fair amount of money that is being offered. We have changed the system. I will get Catherine to explain how it used to work, but we have changed it. There is this new incentive. I am trying not to say—you know, a “show me the money” type of thing—that it will get the results, but we are hoping that, with that new incentive in the system, the proof of the pudding will be in the eating, as they say. Catherine, how exactly have we changed that incentive?
Catherine Frances: Part of what you are describing is, as you move accountability to ICBs, whether somebody else will be checking what they do. In a sense, they will have to report on what they do. The exact arrangements that we make with ICBs will need to be finalised, but they will be accountable. The accountability sits with them. For the data and the performance, the national outcomes framework, which we have set out, goes down to ICB level for that reason.
The Chair: Who holds them to account in achieving that?
Catherine Frances: The department. We currently have regional teams that sit in NHS England. As we merge the organisations, we need to merge those things together into one body. You asked a really important question though about GPs and what it is that makes somebody who is a busy general practitioner deliver on this. I suppose that here there will be a range of levers.
We annually negotiate the general practice contract. The Government have put an awful lot more resource into general practice, so over £1 billion more in the first year of the Parliament and £600 million more this year. As the Minister says, we have tweaked some of the incentives there on GPs. We put in, quite deliberately, an extra payment level for the item of service fee. If you deliver a vaccine, that has increased from about £10 to about £12.
In addition, this year we are also rewarding GPs if they have an improvement level that is over a certain amount. That was for the very practical reason that, if you were sitting in an area where your attainment rates on vaccines were lower than the targets we were trying to get them to, we wanted to put in an incentive for them to improve, none the less.
You are absolutely right that we do not know what the effect of those incentives will be. We could have waited. We could have watched the first one come through before we appraised it and then did the second. We decided that it was a bit more urgent than that, so we went more quickly. We will know: the proof will be in the pudding.
The Chair: A bit more money may very well help a busy GP to do a bit more outreach. The fact is that we have had a reduction in the number of GPs and an increase in the size of their lists. Do you think that that is a factor?
Sharon Hodgson: It probably is. That is probably why we have seen such a decline over the last 10 years. If you laid the maps over each other, I am sure that the decline in GPs will follow the decline in vaccination rates. We need to turn the GP numbers around as well, which we have done. Is it 2,000 extra GPs we have now? We have more GPs and we are incentivising them and changing the system. As long as I am in this role, and who knows how long that will be—things are changing—I will be monitoring this. As I say, it is one of my main areas of focus.
The Chair: It is obviously one factor. Let us hope it is moving in the right direction.
Q229 Baroness Neuberger: Welcome. It is lovely to see you here. The Health Bill would remove the duty for ICBs to have representatives of GPs, local authorities and NHS trusts on their boards. I speak as somebody who was an NHS trust representative on an ICB board. In that context, how will you ensure that ICBs work closely with partners at the local level to respond effectively to local needs?
I absolutely take the point you have already made that there will be, within the department, regional teams that will be monitoring. We are thinking about a much more local accountability. Not having the GPs, to whom you have given the extra money, there on the ICB, seeing that they have to up the game, seems to be a problem. Can you tell us how you are going to make that work?
Sharon Hodgson: That is a really good question and I am going to hand it straight over to Catherine.
Catherine Frances: It is a really good question about cross-institutional working. A lot of what we are talking about in vaccination—and it may or may not be what you are driving at—may have to happen on at very local basis. There it seems that the ICB relationship with neighbourhood health organisations, which are typically operating on a 50,000-people kind of footprint, and the connection to the local system is critically important. There, of course, you can bring together a range of different organisations.
We have set out a strategy for how places might do that. Whenever I talk to any place across the country, they are really motoring on this. They are thinking about it in a hugely cross-institutional way. In general, we are talking about a devolutionary sort of approach. You are trying to balance that, giving people the tools but being clear where the accountability sits, and there will be some variation.
Baroness Neuberger: What we are really trying to get at is that, if you have an ICB with a board that does not have on it some of the players on whom you are relying to actually up the game and improve the service, it makes it more difficult. They are not being told, “Can you talk to your colleagues? Can you get out there and see what you can do?” I wondered whether you might even think about going back and looking at that, because we find that really quite concerning.
Sharon Hodgson: Absolutely, we would take that back if that is one of your recommendations as well. We want to make sure that there are no unintended consequences of these changes. The NHS has been through enough of that and we are trying to fix things as we move forward, so, yes, we would be happy to.
Baroness Neuberger: I have another one you might not like. The UKHSA representatives told us that there is very little assurance that commissioners and providers are actually meeting NICE guidelines on improving vaccination uptake. What are you going to do to make sure those guidelines are met? Again, it is this, “How will you monitor this? How will you get into the service enough?” That is partly an ICB point and partly an UKHSA point. How will you get into the service enough to see that this is happening?
Sharon Hodgson: I do not know whether Caroline wants to come in on this, but these are key questions. When we are changing everything for the better, which we hope it is, we must not let that oversight and accountability slip. Otherwise we are just wishing that it is going to be better without actually checking that it is.
Caroline Temmink: A lot of what is in the NICE guidelines is mirrored in the vaccination strategy and the things that we have already set out and described today. As our data becomes more accurate and timely, that will help us measure in terms of meeting those NICE guidelines, and particularly around access and making sure we can look at progress. A lot of the work will be about helping provide commissioners with that information, and more granular information, on which they can monitor progress. As Catherine has already set out, the exact process for that is still being worked through at the moment as we move to the shift away from NHS England regions to the department taking over that responsibility.
Baroness Neuberger: It would be very helpful to us, depending on how quickly that piece of work is going, to, if you like, look at the direction of travel. If you can let us have that, that might help us quite a lot.
Sharon Hodgson: Yes, I am happy to.
Q230 Baroness Andrews: Good afternoon. It is very nice to see you, Minister and officials. My question is very detailed, compared with some of the high-level stuff we have been talking about. It relates entirely to access. Catherine, you put access top of your list, although I do not think it was a hierarchical list, but access means different things. If you are a parent who cannot get into the booking system, who is waiting in a queue and is told to come back, the booking system is the thing that really frustrates and distresses people.
We have had a lot of information and witnesses who have recorded that and given us some examples of problems that have been solved. Is there a national awareness that this is an issue, and how can you help resolve it? You talked about incentivising GPs, but I doubt very much whether that is going to solve the booking issue. Is there anything that can be done nationally, or does it have to be done locally and in the surgery itself?
Sharon Hodgson: Thank you so much for your question, Baroness Andrews. It is lovely to see you also. As you have highlighted, the booking system and GPs are the front door for most families, especially for the preschool programme. Schools form the access during the programme for when children are at school. We have heard this a lot.
One thing in train—and I will bring in Catherine in a moment—is the NHS app and something that is going to be called the “my vaccines” hub that parents will have access to. It has not been launched yet. This is all still work in progress. The conversation earlier around digital exclusion will play into this, because, even though we might develop it as a department and think this is going to be the great solution, for lots of families still, it will just be another barrier if they do not have a smartphone or already feel digitally excluded. For a lot of families, that might be the solution that would help.
There will always be those who will want to turn up at the GP surgery and make their appointment. If that becomes a smaller number than it is at present and you have the majority of people using the NHS app and the “my vaccines” hub, we think that that will be a real improvement to solve this issue that we hear from parents around access. I will bring in Catherine, or do you have a follow-up question, Baroness Andrews?
Baroness Andrews: It will be a question for Catherine as well, actually. Does the “my vaccines” hub cover both the GP and the schools vaccination service? When would you expect to see it online? Are you going to pilot it, or are you going to roll it out across the country at the same time?
Catherine Frances: I feel like there are quite a lot of layers to that set of questions. We are in wholehearted agreement that people need to be able to access their GPs and appointments. We all know what that feels like when that is hard. A lot of that has to happen in the practice.
There is evidence that we are seeing coming through because of the investment that this Government have put into GPs practices, so that really substantial first-year investment of over £1 billion, followed by the £600 million. As the Minister said, the numbers of GPs are going up, but so too are some of the indicators about the public’s ability to access their GP. We have some survey data that shows that people are reporting contacting the GP now to be substantially easier than in 2024, which surely is the starting place. If you have a young child and you need a vaccine, you need to know that you can reach the GP and go in there. Those are signs of improvement. From the centre you need the investment, but then locally the practice-based stuff really needs to pull that through.
On access digitally and in other ways, I agree with the points that we made earlier that digital access is a very important piece, but is not everything. The big bet for schools this year is the rollout of this new system for managing vaccines booking. That means that, as a parent, you will get an email prompt saying, “Your child is due a vaccine”. It then takes you into a service—Caroline has been involved in developing it and knows a lot about it—that talks you through, “Do you want to consent?” If you want to, it makes it easier with the schools. The immunisation providers receive that data and can respond.
Many people will not say yes to that, and that is absolutely fine, or they will not respond to that email at all, which is also absolutely fine. The school immunisations teams’ contracts ask them to check who has not responded, to go through and find people and to follow up face-to-face. Caroline can talk further about how that works.
There was a third tier to your question about NHS apps. We will, in due course, want to bring vaccination for children on to the NHS app. We are currently piloting some ways of doing this. You are absolutely right that you have to pilot it carefully. It needs more work for some technical reasons because of the proxy access that is required for parents. We need to make sure that that is done appropriately before we roll it out.
Baroness Andrews: I think that we are going to follow up on some of the data questions. The reality for many parents with more than one child is getting to the surgery and finding that there is only one nurse appointment a week. We have had examples of the clinic only being open once a week. Drop-in is very important. Do the NICE guidelines cover this sort of a requirement? I know that a huge amount rests with the quality and organisation of the GP practice itself. Is there a steer from the NICE guidelines that says, “Be aware that there are families in your patch who do not have digital access and have disorganised lives, inevitably. Build what you offer around those eventualities as well”? Does NICE say anything at all to that effect?
Caroline Temmink: NICE very much talks about the convenience of appointments, so it really emphasises the need to think about your practice’s specific population and therefore what works for them. That answer will be different depending on who they are. It encourages that convenience point.
We, and our commissioners, do a lot of work with practices to help support them. Our child health information services—the CHIS—are often enabling the invites on behalf of GP practices. They monitor some of those waiting lists as well. We will have conversations and support practices where they can see that perhaps the practice does not have enough appointments available for the number of children becoming eligible. Working with the commissioner as well, we will work with that practice to increase the number of appointments available so we do not see backlogs building up. It is all those different elements together: helping support the practice, thinking about how many appointments a week they need, when they are, and what suits their population.
Baroness Andrews: I have two more very quick questions. How do you spread good practice, whether it is through the use of CHIS or whether it is the individual practices that have cracked this? How do you hold GPs and CHIS providers accountable when it comes to this? There is a lot going on, but it is working, according to our evidence, better in some places than others. Where is the accountability, particularly in relation to the NICE guidelines themselves?
Caroline Temmink: In terms of accountability, so that is a commissioner-provider responsibility. That is something that is monitored.
Baroness Andrews: That is going to rest with the ICB.
Caroline Temmink: In future, that is correct.
The Chair: For clarity, the app will be a record of the children’s vaccination status right up to 18 and a way of booking appointments. Is that correct?
Catherine Frances: I do not have the full details on every bit of spec that the app will have at this point because it is still in development and in testing. Clearly, that would be a comprehensive system. I do not have the answer to that yet.
The Chair: Is that the intention?
Sharon Hodgson: I believe so, yes, 0 to 18.
Baroness Andrews: Could I ask about the timeline on the app? Could we look forward to seeing it rolled out at the end of the year or the middle of next year? Do you have any sense of timescale?
Catherine Frances: Our current expectation, but this is absolutely subject to testing and working out whether everything is in place, is in the year 2027-28, not in the 2026-27 year. That is subject to all those testing protocols and making sure it works in a way that is safe and appropriate.
Q231 Baroness Nye: Thank you, Minister. On MAVIS, which we have talked a bit about, we have been told as a committee that the NHS England MAVIS system for school-aged vaccination consent lacks flexibility and cuts schools and pupils out of the consent process. You are shaking your head, so you do not agree with that. That is good; that is a good starting point. How will you monitor the impact of MAVIS on coverage and inequalities? Will you ensure that the school-aged immunisation teams can adapt call and recall and consent processes to local needs?
Sharon Hodgson: Caroline is our MAVIS expert.
Caroline Temmink: The intent is very much to support the relationship between schools, the school-aged immunisation provider and parents as we roll out MAVIS. A lot of this has been built on the feedback that we have had from schools, as well as parents and providers themselves. Some of this process was an incredible administrative burden on the schools themselves. With MAVIS we are aiming to take some of that burden off schools, but not to completely take away their role. We are doing joint work at the moment across the department, NHS England, UKHSA and the Department for Education, making sure we set out expectations for providers and schools, including information about running assemblies and helping promote vaccinations in schools, and taking some of that burden away in terms of the actual having to send out the invites themselves.
So far, we have seen a really positive impact of MAVIS where it has been rolled out. We are going to be at just under 14,000 schools by September, so in time for the flu programme. We are constantly monitoring the uptake and impact, including, as we can see in far more granular detail, the information around why parents might not be consenting, or if they do not respond. So far, we have seen that, where MAVIS has been rolled out, the response rate from parents has gone up. We had a huge number of non-responders previously, and that has shifted now, so we get a far more detail and a far higher response rate from parents. That also helps free up our schools team, as we have heard, to follow up with the parents who are not sure. It is a more efficient system, which allows them to spend less time chasing responses and more time having a conversation about vaccination.
Baroness Nye: To carry on with schools for a bit, we have heard from school nurses and other people in the school sector who say that there is a resistance in schools to get involved in vaccinations. Some schools do not want to welcome in the MAVIS teams or the school-aged immunisation teams.
NICE guidelines say that vaccination status should be checked at specific educational stages, such as school entry. If we are really serious about trying to drive up and catch all those children who have missed vaccinations for one reason or another, is there not a case of working with the Department for Education to ensure that checks happen as standard? Those entry points are crucial moments. I do not mean mandating it at school entry, but there are moments where you could do a catch-up programme. Is this something that you are working on?
Sharon Hodgson: Yes, absolutely. We are working very closely with DfE on this. As you say, it is not to go down a mandatory route, but to use those key opportunities, so when the children start reception and when they go into secondary school. It is to use all those opportunities.
One thing I want to say as well is around the core offer. If we get the core offer, be it at GP or at school, right and are initially, at the earliest opportunity, getting the child immunised, there is less follow-up. There is less chasing and it is far more efficient. Yes, we are doing a lot. I think that there has been a recent letter between our department and DfE, has there not?
Catherine Frances: You are absolutely right about the need to support schools through this. DfE, the department, NHSE and UKHSA, all of us together, have a joint programme at the moment, which is much more intense than it has been in recent years. It is about strengthening the guidance to schools. DfE recently did a big omnibus survey, including of parents. By the way, the feedback from parents was that parents were confused about vaccination. As Caroline has said, seeing this MAVIS new digital thing as a way of unlocking that conversation and improving consent is the way to think about it.
Schools said that they were unclear about what their role was and felt sometimes that they were being asked to do things that were not quite within the protocol of what the school should be doing. Maybe the immunisation provider should be doing it. This guidance sets out to them what the school should be doing. They are very practical things, such as a place for vaccination. Please make sure you do an assembly. Please make sure you call the children. Please facilitate the immunisation provider’s requests for information. It is that sort of thing.
We think that there might be a small minority of schools that are not participating as positively. They should be participating positively, and that is what the guidance says. One benefit of this new data system is that we can start to see where those problems are emerging. We have put in place a new regional system, which combines the regional teams of NHS England with the regional teams of DfE, and they are looking together. They are going to see where we need to support individual schools or academy trusts. I hope that conveys to you that it is quite a hands-on approach at the moment. We are trying to invest in this time and capacity.
The Chair: We have heard that some schools are not unwilling but unable to co-operate with a rather inflexible SAIS local service. That can be an issue in some places.
Q232 Baroness Hodgson of Abinger: Welcome and thank you very much for coming to speak to us today. Witnesses have told us that there is little assurance that healthcare staff involved in vaccinations are trained to UKHSA minimum standards. We have also heard in some areas that training hubs are being disbanded and that training budgets have not come through in advance of the delegation of commissioning to ICBs. How will you make sure that there is clear responsibility, accountability and funding to ensure that staff are trained to the minimum standards and training providers are accredited?
Sharon Hodgson: That is a very important question. You are probably aware that we are waiting—I am told that it is imminent—for the 10-year NHS workforce plan. A huge and important part of that will be not just working out exactly how many nurses, doctors, health visitors et cetera we need, but also around the skill levels and training requirements. I do not know whether what you speak of is caused by waiting for this NHS workforce plan, because it is going to be a huge part of what is going to be in that workforce plan. I will be particularly looking closely at the training offer that is included within that around immunisation, but also, particularly with my hat on with regard to babies, food and early years, the numbers of health visitors and how they fit into the whole wider workforce.
Parents need to have confident conversations when they are considering and taking up the offer. My kids are 30 and 32, and I am a nana for the first time to five-and-a-half-month-old Clara. When my daughter is going through this process of having her daughter immunised, the offer now is so comprehensive. It seems a much greater offer and, from talking to the team, I am aware that it is, with the timing of it and everything.
We have this really great offer that will help save children’s lives and improve their health, but it is only good if the take-up is there. We do not get the herd immunity, as we are seeing with measles, if the take-up is not there. Those conversations that we need parents to have can be had in a confident way only if the health professionals feel fully confident and fully trained, so it is both sides of it.
We need to encourage the parents and make sure that they can get the appointments with their GP, that the appointments are there and that the schools can get the consent forms. In order for the other side of it to work, we need the number of GPs, the number of appointments and the training and the skills. All that needs to come together to ensure we get this uptake. It is probably because it has all gone wrong that we have seen the decline that we have spoken about over the last 10 years. The training is so key.
Catherine Frances: I suspect that you already know that the accountability for making sure staff are trained is with the provider, but I do not think that that is really your question. What lies behind it is whether we are assured that they are doing that. UKHSA sets the standards here, which it has recently improved, and has issued a huge amount of training material, including for staff to aid their communication of vaccine rationale as well as their technical knowledge, which is part of their training. That all has the clinical input there and it needs to be delivered to that standard.
The only other point I would make is that this year, not directly relating to children’s vaccines, we are having a big push on vaccination among staff in hospital settings. The chief executive of NHS England has just written out to providers and other key partners in the NHS more widely and set a benchmark: “Can everybody reach a higher level of vaccination among those professionals than we have achieved in recent years?” We have seen some improvement, but that is to really step the change up. For us, having professionals who themselves are experienced, have been vaccinated, feel confident and are trained, there is something about creating a whole environment in which people feel more confident to deliver the messages that we need them to deliver.
Q233 Baroness Freeman of Steventon: Following up on that, you are talking about the importance of these conversations and we know how important they are to parents, particularly before their first vaccination appointment even. What are you doing to make sure that all healthcare professionals who might be able to influence that decision have the time to have those conversations, and that those conversations can be culturally appropriate and can be had before that first vaccination appointment?
Sharon Hodgson: This comes to the training, but also the numbers. We have more GPs now, which is great, and I hope therefore that there will be more appointments. One of the first people who a new parent will see is the health visitor. I am finding that the caseloads for health visitors are too great. They are too big. You can look at the disparity across the country. The average should be—it is not even an average. I think that the caseload should be around 250. That can vary massively.
It is not even just linked to deprivation. When I have looked at the list of the average that a health visitor will have on their caseload, there is not an obvious common denominator. You would have a more affluent area with a high caseload and another one with a small caseload, and equally in deprived areas. That means, as a health visitor with a really high caseload, that you do not have time to have those conversations. You are dashing to a family, checking the baby and saying, “Are you okay?” Then you are out the door to go to your next one.
In building in the time for those conversations, you want it to be a quality conversation. Can any of us have a quality conversation if it has to be rushed? You are going, “Vaccines are very important. Just have them. You’ll be sent an invite and just go”. You need to sit, and people will have questions and say, “I have heard this”. There is all the mis and disinformation that we have to deal with that is out there on the internet. We want trusted sources to be the message carriers.
You are right and absolutely spot on that that will take time. This is part of what I am wanting. I am so passionate about trying to fix this. There is not one solution, but health visitors and the numbers of health visitors is a massive part of that. That is why I am also eagerly awaiting the 10-year workforce plan so I can start to look at that and work towards the next spending review. I know that I cannot fix it in this spending review, so I will be looking for the next spending review to look at the numbers of health visitors.
Also, we have invested over £900 million in family hubs and healthy baby units. They are the key message carriers as well. That workforce also equals health visitors, who will be in and out of the family hubs. There are lots of opportunities for health professionals to have those conversations.
Teachers are also part of it. We need to ensure teachers feel confident to have those conversations in lessons with students, during their studies, including in PSHE and in science lessons. Years ago, when I was shadow Children and Families Minister, I became very keen on teaching children about attachment theory, age appropriately, from a very young age, and it is still an obsession. That is so children understand the importance of picking the baby up when the baby is crying, feeding the baby well and giving the baby lots of love, but equally understand the science of that. That is the same, I believe, with what we are talking about today: immunisation. If young people are taught about the importance of that, one day they will become parents, so you are not starting from scratch when they are a parent. I can see the Chair is agreeing with me. We agree on a lot of this. It is the earliest of early intervention.
Baroness Freeman of Steventon: What about midwives?
Sharon Hodgson: Absolutely, yes. Midwives are there in the antenatal period and can start those conversations. Yes, it is all of those health professionals.
Baroness Freeman of Steventon: Are you waiting for the workforce plan to work out how to give these people more time?
Sharon Hodgson: We hope that it will give us an insight into where there are shortages and where we need to improve things for the workforce. We cannot just wait for the workforce plan. I take the inference and your point on board. We have to be doing it now.
Catherine Frances: It takes time to train people and all those issues, such as the capacity, are really significant, as the Minister said. In vaccination in particular, as a subset of all this deep professional contact with people in very early life, we are running a series of pilots at the moment. You probably know about them. There are 12 across the country, using health visitors to deliver early vaccines. We want to see whether that leads to channel switching or an improved uptake. You might expect that direct contact in the family to be very productive, but we do not yet know until we see the outcomes of those. I think that seven of the 12 have started their vaccinations and the others are being set up still.
Baroness Freeman of Steventon: When are you expecting to have the results from those?
Catherine Frances: It will be the middle of next year. I am sure the committee knows this, but one legacy of Covid learning is that you have to have the national, but also the local. It depends on the local population. We have invested some resource from national government, but so too can local commissioners in working with voluntary and community sector groups, and with groups that are culturally in the best position to communicate and alleviate people’s fears and listen to their needs. We will be building on that going forward, and the devolution of accountability does potentially help more with that, although I agree that some of it is very local.
Q234 The Chair: Can I just take you back now to something that I hinted at a little earlier? I was rushing to get Baroness Hodgson’s question in before she had to leave. We have been hearing in our evidence that, in some areas, the school-aged immunisation service is very flexible and very well commissioned to do all the work that is needed. In some areas, it is much less flexible. We want as many schools as possible to be able to co-operate and let those teams into the school to vaccinate the children, but we have heard in some of our evidence that, in some cases, the schools are not unwilling but unable to co-operate.
For example, they get very little notice that they are coming in, which means that they cannot do parent drop-ins, or do lessons or assemblies about immunisation before the team comes in; or they want to come in during exam period when all the big areas in the school are occupied by desks with people writing and their heads down; or they will not come before or after school time. They are really very inflexible.
We heard from a couple of head teachers who said, “We are not unwilling, although we don’t see it as our primary responsibility. In some cases, we are not easily able to do it as well as we would like to”. I wonder what levers the department has to identify where this is happening and what you can do about making sure that the SAIS has the flexibility, the funding and the understanding of schools’ problems to be able to work closely together.
Sharon Hodgson: I will hand over to Catherine, but thank you for bringing this to our attention. Catherine might be aware of it, but it had not come to my attention yet.
The Chair: I know that there are a few schools that just do not want the vaccination, perhaps for cultural reasons. The vast majority do, but there are issues.
Catherine Frances: We do know about these sorts of issues. It is not schools’ primary responsibility and role to vaccinate. They are there to educate children and to give them safe environments, and all those things that schools are for, but they are a critical player. What we know is that some schools want more clarity about what they should be doing, and I hope that the guidance that DfE has issued to them will really help. but there are two sides to this partnership.
There is the immunisation service that goes in and has to deliver a quality service. I am going to hand over to Caroline in a second, because the basic answer to your question is that SAIS providers are commissioned from NHS England. They are quite long-term contracts that run for five or six years at a time. We are just coming through a period of renewing them at the moment. There is something about working with those providers to make sure that they are, as in any commissioning arrangement, all performing at the highest possible level that you would hope for. We use both together.
Just before I hand over to Caroline, I will say that, because we are doing this regional work this year, on both the education side and the health side of the piece, we can look at where there are problems, using the delivery structures from both systems. That is the first time that we have brought them together like that, because it is just a way of getting into an area where there is a problem. If the data is showing you that something is not right, we can go in and work out whether it is six of one and a half a dozen of the other, or slightly more eight of one and four of the other.
The Chair: It may well be.
Catherine Frances: We can help work out what it is.
The Chair: I just cannot understand why an organisation that has to plan its work over a period of time could give just a week’s notice to a school, given the amount of reorganisation that the school needs to do to enable it to do its work.
Caroline Temmink: I can absolutely appreciate how frustrating that would be for a school. Generally, SAIS teams do try to plan ahead. As well as the expectation on schools, we have set out the expectation on our school providers. There are occasionally operational issues where another school session has to be cancelled at short notice because of illness or some issue, so they will try to rejig some of those appointments. Obviously, that is not ideal, but the reality is that it does happen.
However, we are working to make sure, based on the feedback from schools that it can be disruptive, that we plan ahead as much as possible. For example, we have written out for the flu season coming and asked that all the dates for the autumn term are pre-agreed by the end of this summer term, so that both the school and the SAIS provider can plan ahead. That, alongside the regional forums that we are setting up, will, I hope, help alleviate that problem. If there are problems during term time, that local conversation can happen. There is always going to be the odd operational challenge for unforeseen circumstances, but we are definitely keen to make sure that that does not happen.
Q235 Baroness Andrews: Minister and officials, you are clearly exercised about inequalities in terms of vaccination take-up, and so are we. We have had a lot of evidence from witnesses across the patch telling us that a high vaccination uptake is more challenging and expensive in deprived areas—and we can all see why anyway—but that funding does not match that. Funding through primary care and SAIS is not equitable. What can you do to change this? Are there plans afoot to do this?
Secondly, in terms of schools, we have had the pleasure of hearing that, in some NHS England contracts for school services, they have included dedicated funding to reduce inequalities. Do you think that that could be rolled out? Is there something that we can build on there in terms of good practice?
Sharon Hodgson: As I mentioned earlier, we have put in funding to ICBs and GPs, building in the incentives and changing the system, to encourage higher allocations of funding towards areas of deprivation and low vaccine and immunisation uptake. I hope that we have already put in train solutions that will start to see this turned around.
I will also reiterate what I said about trying to get the core offer right in the first place. As I was just talking about with Baroness Freeman, if we are having the earliest conversations with GPs, midwives, health visitors and the family hubs, all the way through, we should start to tackle some of that low uptake, and there will be less targeted chase-up needed.
We have already put those things in train, and we should see the devolution to the ICBs. Also, they know the areas and what those issues are. Sometimes, it is access, although, when we were in Enfield, they told us it was not. There were other issues such as cultural sensitivities and conversations that needed to be had with key leaders in those communities, rather than it being that they could not get the GP appointment. They can be different in different areas, so we really need that focus to be drilled down to be area specific. I do not know whether Catherine or Caroline have anything to add.
Catherine Frances: I can say a little more, and I might hand over to Caroline about the SAIS providers example that you gave. As a general rule, although, of course, there is some work, community outreach work is often an area, for example, that is relatively light resource-wise, and pays dividends in terms of the returns. We invest nationally in some community outreach programmes, but we always hear that there is a need and a desire for more there, and some are commissioned locally.
More widely across the system, it is perfectly legitimate to say that, in general, if you are having to flex your systems more, or maybe put more services on to accommodate for the fact that somebody has three jobs and can get to you only at a certain point of the day, or is juggling lots of kids, and it is really hard to get in because they have other responsibilities, providing services in that way is, of course, often more expensive than it is in other contexts.
I would say two things about that. For primary care, the Government have said and we have acknowledged that the allocation process for primary care is based on the very old Carr-Hill formula. That is from back in 2004, and the department has commissioned research into that from NIHR to enable us and, ultimately, Ministers to consider what to do next. We recognise that that is an issue.
In the GP contract itself, when we came to revise the incentives this year, we did think long and hard about the ways in which we could reward practices not only for attaining a certain level of vaccination, but also for their efforts to improve, which might be quite costly. That is why we put this new incentive in place there to offer resource for people who are able to give a bit of an uplift—more than 5%—on their vaccination rates for children.
Baroness Andrews: Is that the increase in the item of service payment?
Catherine Frances: No, it is not.
Baroness Andrews: Could you tell us, just for the record, what exactly you have been talking about that is not the item of service payment?
Catherine Frances: Yes, I will try to have a go. Essentially, GPs will be paid for the item of service, which I would describe as the payment that you get to put a vaccine in somebody’s arm. That was increased from £10 to £12 last year. That was to help reflect GPs’ costs and needs—and they are very stretched—as well as to make sure that vaccine was given a real priority in there.
The new intervention that we have made this year is that we have said that they get a QOF points reward. Rather than setting it at a level where you reach a certain level of vaccination, which would be one way of doing it, we have said that you either reach that target level of vaccination or you are simply showing significant improvement. If you are showing more than a five percentage point improvement, we are saying that you get that reward as well. You are rewarding people who are trying very hard in a very challenging context, as well as people who are maybe hitting very high levels of attainment in a perhaps less challenging context to deliver the vaccine.
Baroness Andrews: That is really helpful, and we are following up in a moment on that.
The Chair: Before I move to Baroness Browning, can I just ask whether the Minister will have a little extra time at the end? We have been very ambitious with our questions and are running a little short of time. If we went on for an extra 10 minutes, would that be a disaster?
Sharon Hodgson: I have been so focused on this that I cannot remember what is in my diary next. Unless somebody jumps up and drags me out of here, I am fine. I have a hard stop around 4.15 pm; I am due somewhere at 4.20 pm.
The Chair: We are fine in that case. We will not keep you that long. Perhaps from now on, could we just ask one person to answer the question, whoever is most appropriate, and for everybody to keep things as short as possible? If there is something we have already covered, please just say so.
Q236 Baroness Browning: Thank you for the extra time. Following on from Baroness Andrews, and the question of GPs and money involved with vaccination, what is your assessment of the impact of the GP contract on childhood vaccines? How will you evaluate the impact of recent changes in the quality and outcomes framework and the item of service payment? When will those results be available?
We have taken evidence from the BMA, when I think it was £10, not £12. The BMA told us that, as far as GPs are concerned, the payment pays for the jab, not the job. You have now increased that to £12, because what they were indicating was that they have paid for the jab, but there is no incentive, because it costs them money, to increase the throughput. What does the £12 deliver in terms of increasing vaccination take-up?
Sharon Hodgson: For brevity, I will hand straight over to Catherine.
Catherine Frances: The answer to your question is that we are going to examine that and appraise the effects of it. We do not know yet, and will not know until we do the review, what the effect has been. I am looking through my briefing pack, and I am afraid that I do not know the exact date of when we will have finished that by, but, if you would like, we can follow up on that with you.
Baroness Browning: Thank you very much. Clearly, we expect GPs to have some sort of incentive to encourage take-up.
Catherine Frances: Yes, of course.
Baroness Browning: Will you take into account vaccination coverage and disparities in the review of the Carr-Hill formula for core GP funding? If so, how will you do that? We know that Minister Kinnock indicated that the Carr-Hill formula review would be implemented on 1 April 2027. If that is still the target for implementation, how is that review going? Is it complete? Is it still on track?
Catherine Frances: I am sorry, but I do not have his comments right in front of me. The stage that we are at is that the NIHR has done the evidence review that it was due to do and has returned that to the department, and we are now looking at it. We will need to work up a set of proposals, and then Ministers will need to take decisions. Exactly how that is designed, like most funding formula design, will need quite a rigorous process of testing and scrutiny. I do not have the detailed timelines in front of me, I am afraid—that is just because I am not the lead for primary care funding allocation—but we will go through a process on that now, and then Ministers will want to take decisions from there. I do not have any further answers to that at this point.
Baroness Browning: Who is the lead, by the way?
Catherine Frances: I think you would be looking at my colleague Elizabeth O’Mahony, who is our finance director-general, on that, but we can get you the exact answers if you want.
Q237 Baroness Nye: My question is about the role of neighbourhood health services, which, Minister, you have already referenced. What role will they play in childhood vaccination delivery, and how will you ensure that moving towards a more flexible, integrated delivery model does not compromise consistency, continuity of care, and recording?
Sharon Hodgson: Do you have a specific answer on neighbourhood health, Caroline or Catherine?
Catherine Frances: This is a combination of the answers that we have given you so far. It is not really an either/or, because what we are saying is that we want to strengthen the core systems—GPs, community pharmacies for some offers, and schools, but GPs and schools being the main thing. Neighbourhood health sits in addition to that, if you like, because I would expect people to augment, restructure and do things that are appropriate for their area.
I do understand the fear that one might be at the detriment of the other, but, given that some of the levers in this system are inevitably set nationally—national contracts for GPs, for example, as we just talked about—there is a strong thread there, and the work with schools is also being done nationally and then down through both regional systems.
Baroness Nye: What we have heard from some of our witnesses is that there is a fear that it is more to do with reducing hospital admissions than a concentration on preventive care, if you see what I mean. It is whether they are going to be given defined responsibilities for childhood vaccinations or stopping the decline.
Catherine Frances: The accountabilities will sit, as we have talked about, with ICBs. My observation on the discussion about vaccination is that it often merges these two things. Vaccination does have an impact on hospitalisation, but the value of vaccination, particularly for children, far outweighs simply the hospitalisation benefit. We are looking at whole-life effects, which are really considerable.
Baroness Nye: You have already mentioned the pilot of the supplementary offer for health visitors to improve the role, first for communication, and secondly because they can reach parts that others cannot. If that pilot is successful, do you foresee rolling that out nationally? How do you see rolling it out nationally when there is such a dire lack, as you have acknowledged, Minister, of health visitors to do the job, as well as keeping their workload manageable?
Sharon Hodgson: That will be about priorities. It is one of my current priorities. I am sure that the pilots cannot pre-empt what they may find, but I imagine that they are going to be proven to be successful at achieving the increase in take-up.
Regardless of that, we definitely need more health visitors. Their caseloads are just too high. I have seen the numbers. That is a piece of work that I will definitely be wanting to take forward, given the good work that we know health visitors do. If we want them to take more of a leading role with regard to having the conversations around childhood immunisations, they need to have the time, and they are going to have the time only if there are more of them. It will not happen overnight. It will have to be for the next spending review. If I am in post, it will be something I will be driving forward.
Q238 Baroness Cass: It is good to see you, and I am sorry that I cannot be there in person. My question is about community pharmacy. Some pharmacy groups have called for a national framework enabling community pharmacy to be commissioned to deliver vaccines where uptake is low. The recent evaluation of the pilot offer of RSV vaccination in community pharmacy suggested that it improved choice rather than reducing equity. I was wondering how you will develop the role of community pharmacy in childhood vaccination and ensure a clear national approach. Also, given the context, how might that fit in as a priority, given the pressures that we have and a bit of a crisis in community pharmacy as it is?
Catherine Frances: I will try to answer that, Baroness Cass, and then colleagues might want to come in. Community pharmacy has been a strained sector, as you allude to, and the Government have put a lot of additional resource in, as you will know, over the last two years.
The critical point on community pharmacy is that we do not currently want to use it as the core offer for children, the reason being that it has a lot of other things to do, but also because we do not yet know whether the evidence might suggest that it is really effective or might suggest channel switching. For example, at the moment, the two to three year-olds flu programme is being rolled out nationally on a pilot with community pharmacy. We will evaluate that to look at whether we are seeing switching or whether we are seeing simply an enhanced offer, which might be a good thing but is not the same kind of benefit as increasing the uptake overall. We need to watch that very carefully.
Where community pharmacy is particularly good is in reaching groups of people when we think there might be catch-up, for example, among adults or teenagers. We are using the community pharmacy model for the accelerated rollout of the MenB vaccine for young people who are just in the final year of the sixth form age group. That is partly because of the versatility of the sector and partly because they have proved themselves very willing to participate in that, and are being very flexible and proactive. It is also the sort of cohort in which they are likely to understand the offer and seek it out, but we are learning as we go on community pharmacy.
Baroness Cass: You have partially covered my second question, but some hospital doctors have shared their frustration that they cannot check children’s vaccination records when they might want to do a pick-up on a child. You have talked a bit about information systems. How do you ensure that all providers who could offer vaccinations can check a child’s vaccination status and record new vaccinations?
Caroline Temmink: That is a lot of the work that we are doing at the moment to improve the data systems and data flows that we have talked about previously. This is a fix forward. We know that some of the historic data, and data in GP records, is tricky to access, partly because of how it is coded or recorded, so we are doing a lot of work to improve that data quality going forward and ensure that that is available to all providers who are involved in a child’s care. Some of that work will also feed into the single patient record going forward.
RAVS, our record a vaccination service, is already used in all trusts, so trusts have the ability to record and check status. We are rolling that out to more vaccination types over the coming year as well. That is something that we are definitely working towards to make sure that people can both view the vaccination record and record vaccines in all settings.
Baroness Cass: Broadly, what might the timeframe be for that rollout when most places will be able to access and record?
Caroline Temmink: In terms of recording, that is already available, so we do have, as I say, that rollout in every trust, covering some of the adult vaccinations as well. Now we have the data flows and the FHIR imms API up and running for a lot of our vaccinations, that will be available across all of our childhood vaccinations over the course of this year, so we are moving rapidly to make sure that that is available.
The Chair: Thank you. That is very good news.
Q239 Lord Dholakia: My question relates to under-vaccinated communities. NHS England may commission and fund vaccination outreach and community engagement, but the basis is always short-term. What I wanted to find out is how you would support and incentivise ICBs to prioritise, commission and fund sustainable, evidence-based outreach, including through multiyear funding settlements.
Two questions arise from this particular problem. A lot of witnesses have told us that there are many barriers in their work with local authorities and the NHS. What could you do to alleviate these barriers? Secondly, how will you ensure that outreach initiatives are evaluated for cost-effectiveness, and good practice disseminated across the country?
Sharon Hodgson: You mentioned multiyear settlements. We have given a three-year settlement to ICBs to try to stop the short-termism and to ensure that there is serious, long-term planning going into this work.
With regard to barriers and underserved communities, that was what was so interesting about the conversations that we had in Enfield. We were told about how 90 languages are spoken in that one borough, with so many different and diverse communities, and about the part that that played in ensuring that the right message carriers are being reached in all of them. The issues will be different for each community and group of people, so it is really important. That is why we are devolving some of this down to that ICB level, because it is only people in those communities who will know how to best reach those people to try to turn this work around. That answers some parts of your questions. Catherine has written lots down, so I will hand over to her.
The Chair: Our main concern is the sustainability of the funding, rather than people having to just apply for some money, getting it or not getting it, and then having two months’ notice to put it in place if they get it.
Catherine Frances: Yes, exactly. One of the answers that I could give you in this committee is, “Don’t worry. We are putting in some money this year on community outreach”, but that is precisely the problem that you are worried about—that it is this year on community outreach. Valuable though it is, the point that the Minister makes is almost more fundamental than that. We have put in place three-year settlements for ICBs. The combination of that three-year planning scenario on the NHS side with the three-year planning scenario that has been issued to local authorities starts to see local practitioners across two massive systems able to plan and think about the best use of their resources. I absolutely agree with what you say, Minister, about how many of these solutions are best framed locally.
The thing that I do not have an answer for you on—and it is a very good question—is how you bottle the best practice and spread the learning. We are going to take that away. UKHSA colleagues do a lot of thinking about that, but that is a fair challenge and one that we should think further about.
Q240 Baroness Ritchie of Downpatrick: This is a question around the issue that the share of parents who have seen concerning information about vaccinations has increased in recent years. That is more to do with people being told, for example through social media, that there is a connection with autism. Will you commit, therefore, to developing a communications strategy to make sure that everyone has the information that they need about childhood vaccination?
UKHSA has told us that it aims to share accurate information about vaccines in its public-facing resources, but some witnesses have shared evidence with us that “pre-bunking” false information can also help build confidence. Therefore, how do you plan to monitor the spread of false information in real time, adapt your communications strategy in response, and evaluate the efficacy of different interventions?
Sharon Hodgson: Thank you for raising this. It is such an important area, and one that I am massively concerned about. I am pleased that you used the word “pre-bunking”, because we keep using it in the department. I do not know whether it has reached the Oxford English Dictionary yet, but it is what we need to do.
We need to invest in a national communications programme around this to counteract the mis and disinformation, and to work with platforms such as Google, even. Whenever you google something, you are not given all the sources any more and have to decide. There is the little AI Google bot thing that does some of that work for you. What I realise now is that more and more people do not even look down any more. They just google, “Is this vaccination safe?” and look at what the little summary at the top says.
We are working to ensure that the NHS and these trusted information sources are coming up in that initial summary that you get. One of the conversations that I had in the department just last week was about how we make sure that the right information is in that, because you or I will probably scroll down and look, or we will read leaflets or do our own research. What is happening more and more is that people talk to their friends. They look on social media. It is on Instagram, TikTok and all of that. We are doing so much in this space around access for young people to social media, because of how damaging and prevalent it is.
This is a really important piece of work, but, as politicians, all of us in this room and in the other place, we have such a huge responsibility that all politicians need to take seriously when they are spreading mis or disinformation in this space as well. Immunisations will save children’s lives. This is about the lives of children in this country. There needs to be a level of responsibility that politicians of all parties have to be cognisant of when they are talking about this. I am sure that everyone in this room has shown their passion for this subject matter, but there are some people who we are fighting against who do not believe what we believe, so we need to say that loud and clear, and to challenge that.
Baroness Ritchie of Downpatrick: Will you be able to send us details, Minister, when that piece of work is complete?
Sharon Hodgson: Yes, absolutely. We would be very happy to.
Q241 The Chair: Can I ask a mischievous question? How big is your communications team and how many of them are under 25? Do they know the right platforms and the right people to give those positive communications about the importance and safety of vaccines?
Catherine Frances: I do not know how big the communications teams are.
The Chair: I did not think that you would.
Catherine Frances: They sit across three organisations that work together, so NHS England, DHSC and UKHSA. It is absolutely right, though, that we do have people who can do proper online communication. It is a different skill from your traditional national campaigns or, indeed, your hyperlocal campaigns through local radio. I am confident in saying that it is none of the people on this panel, but we do have some people who do that very well and proactively, and who do all the things that the Minister has talked about, such as thinking about how search histories work and everything else.
Baroness Neuberger: I am going to follow Baroness Walmsley’s mischievousness, if that is all right, because I am really interested in what the communications teams are doing in government more generally. I wonder whether, as you are thinking about it—and you are clearly thinking about it quite hard—you are looking at having groups of younger people than under-25s, so the teenagers who are the most active users, and thinking about how you engage not directly but indirectly with them and whether that is part of the thinking that you are doing right now.
Sharon Hodgson: This is why the work that we are doing in schools, which I spoke of earlier, so educating young people in their science and PHSE lessons, in school time, and not just relying upon social media or message carriers, is so important.
Baroness Neuberger: I am asking about something else, which is bringing them back in to help spread the message in a way that they would appreciate and would appeal to them.
Sharon Hodgson: Yes, peer to peer. We have a health board in the Department of Health, which I have met. That is something that I will take up with the health board. What is it called? What is the exact title—the youth board? They exist and I have met with them. I will take up with them how they will help us ensure that we are getting that information at the right level. The point that you are making is well made. We might think that we know how to get that information out there but—
Baroness Neuberger: We do not have a clue.
Sharon Hodgson: We are the wrong generation.
Baroness Neuberger: Yes, exactly.
The Chair: Whatever they are called, we are very glad that you have them.
Sharon Hodgson: There is a youth board in NHS England.
Q242 Baroness Freeman of Steventon: I just wanted to pick up on a couple of the things that you spoke about there, one of which is pre-bunking. It is great to hear that it is all the talk of the area where you are. Several witnesses spoke to us about the difficulties that they are having in trying to produce local information that, essentially, pre-bunks some of the misinformation that affects their communities. They have been told that there is a national campaign and we should not mention X, Y and Z, because that brings things to the forefront of people’s minds, where it would not otherwise have been. Do you think that there is a role for more flexibility between local and national communications?
Sharon Hodgson: Yes. We have to make sure that we have joined-up communications and that we are singing from the same hymn sheet, which I suppose is the phrase. Can you think of a good example of how we are showing that we are doing that?
Catherine Frances: I think you may have asked a similar question to UKHSA colleagues, who observed that there are standard communications that are very helpful, because you know that they are factually rock solid and everybody can rely on them. We were talking about schools earlier. We are changing some of the language that they can use, so they can do it in a culturally confident way wherever they are. There is no problem at all with people augmenting messages in a way that works in whatever culture, language or context. Ultimately, we need to reach people, and we need people to be able to have informed and high-quality decisions and processes of consent. That needs to happen through many different voices. It is not an either/or.
Baroness Freeman of Steventon: My other question is about social media. The House of Commons Science, Innovation and Technology Committee recommended that the Government impose duties on social media companies to deprioritise content that is found to be misleading by fact-checkers, where that content could cause significant harm. Obviously, vaccines are very much in that category. Have you assessed the impact that doing that could have on vaccination uptake and public health?
Catherine Frances: We have focused entirely on the issue. Rather than assessing that removed content point, we have focused instead on getting the right messaging out there through, in a sense, a less combative approach. What we think people need to hear from are trusted voices, with appropriate and accurate information, through whatever form we can do. I am not sure that we have done the work that you describe there in that way, because our focus has been very much the other way. We know that different people trust different voices. We know that some people trust school teachers. Some trust the BBC. Some trust their GPs or other practitioners. That is our focus.
Baroness Freeman of Steventon: Social media companies are allowing misinformation to continue to be on their platforms. Do you not worry about that?
Catherine Frances: Misinformation comes in many forms. We are just aligned with the wider strategy across government on that. Our focus is absolutely on getting the right content out there. That is our primary aim.
Q243 The Chair: We are nearly there, Minister, you will be pleased to hear. We have just a couple more things. You have talked a lot about the various data gathering and sharing systems, and the work that has been going on to improve them all. Will you set out a plan to ensure that all partners involved in childhood vaccination data systems work together so that system leaders, providers and patients all have the data that they need when they need it?
Sharon Hodgson: We are aware that the current data systems are very fragmented, so we have made a conscious decision to fix forward rather than trying to fix what went wrong. We have spoken about the NHS app and the vaccine hub within that. We have a package of work that is under way across the whole department, as well as with GPs, to bring about a system that will work together and not be as fragmented.
Catherine Frances: Perhaps it is not universally understood, although this committee has probably got a sense of it today, that there is a lot of work going on across NHS and health systems to uplift and improve, of course, the digital and data offer. What we would like to convey to you today is that, in vaccines, it is happening right now. What tends to happen is that, as people find that they can suddenly access a system better, they think, “I didn’t know that was fixed”.
As Caroline was talking about earlier, the record a vaccination system is there. We are doing the schools rollout right now. We have created the front end that links these different systems together, and we are in final negotiation to switch that on. It may be more immediate than people fully appreciate. Yes, I would acknowledge that the NHS app and things will come a little down the line. Rather than setting out a big plan, we are doing it now.
The Chair: We are delighted to hear that. There is just one more point that we have not covered yet, so I will hand over to Baroness Freeman for that one.
Q244 Baroness Freeman of Steventon: Some witnesses have told us that schools can be unwilling to share some pupil data with the school-aged immunisation service teams, because of concerns about data protection. How will you work with the Department for Education to ensure that schools are clear on what data they can share and how?
Caroline Temmink: The Department for Education has already set out guidance on the expectation, and we are very clear that there is a legal and lawful basis on which schools should share that information with the providers. That has been reiterated again with schools, and we are taking the opportunity. There are now only a very small number of schools that are not willing to do that at the moment, but we are working through our regional forums that we have set up this month to identify where that is still an issue and to arrange conversations to give the schools the assurance that they are following the guidance and that it is okay for them to share that information.
The Chair: That is very helpful and very necessary, by the sounds of it. Thank you very much. I would like to thank you all very much for a very intense afternoon’s questions and answers. We are sorry that we have kept you a little past the designated time.
Sharon Hodgson: No, do not worry.
The Chair: We are most grateful to you, Minister, and to both Catherine and Caroline. Thank you.
