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NHS Manchester Strategic Plan for Improving Immunisation Coverage, 2010-2012: ACTION PLAN Contents All text in tialics are recommendations from the DH feedback. The text regarding those recommendations given by the DH feedback as priority actions is underlined. Area Lead Updated? 1 Commissioning, coordination and urgent actions Kevin Perrett X Rag status 2 Data issues Jeannette Beckett x definitions 3 Immunisation Promotion Project Bev Yarwood x R Target date passed 4 Comms and engagement Val Bayliss-Brideaux x A In progress 5 Access and vulnerable groups Bev Yarwood x Pending Pending Completed (some work 6 Training Helen Fabrizio x G may be ongoing) N/A Action no longer applies Specific Vaccination programmes or settings 7 Vaccination of younger children (Primary Care) Karen O'Brien x 8 Neonatal Hep B vaccination Nicola Jepson x 9 Neonatal BCG Sally Webster X 10 Prison Health Erika Duffel x Seasonal flu and pneumococcal vaccination for at-risk 11 Nicola Jepson x groups 12 Seasonal flu vaccination - healthcare workers Nicola Jepson x 13 HPV vaccination Eleanor Roaf x 14 Teenage boosters Bernadette Dean x Annex List of discarded recommendations Strategic plan for Improving Immunisation Coverage 2010 - 1012 - Action Plan 1. Commissioning, coordination and urgent actions Area Lead: Kevin Perrett Overall Aim: overall coordination of the action plan, particularly the commissioning elements; to ensure progress on urgent actions and to coordinate any actions not fitting clearly in to any other sections Additional resources Person Target needed - if Evidence of RAG Recommendation Action(s) needed Current situation (give dates) responsible date resource issues completion status are a significant barrier Strategic plan and accompanying action plan (this spreadsheet) developed. Perf Indicators are, consistently, Monitoring VS indicators, being monitored through new monitorinig spreadsheet, Final plan should have a supported performance spreadsheet but also other routes (PM Framework, new IPT Vital Signs Funding of IPT framework with performance indicators for progress on data monitoriing system). Also imms highlighted in the monitoring, 1A Kevin Perrett Final sections of plan need completing by Bev Y and Berni D Jul-10 relevant, for G actions by contributing organisations as well as outcome Director of Public Health’s Annual Report (2008), the Joint Failsafe data, Section 3 measures. Strategic Needs Assessment (2008-13) and the most recent Manchester PCT Annual Report (2010) and the 09/10 Operational Plan. standard, PM 2011 DPH report will focus on Health Protection and imms Framework will be the lead chapter. Imms issues are reflected in revised CSP. Board has Each component of the final Immunisation Action Plan supported strategic plan as part of the PCTs' commissioning Revisions of commissioning plans need to reflect imms strategic CSP. Strategic 1B should be explicit in all commissioning plans in line with Kevin Perrett Dec-10 None intentions and development of action plan. Action plan still A planning and action plan WCC needs one section completing (school leaver booster), otherwise now completed. (Commissioning arrangements should) include key service Manchester Manchester standard, and related work, is taking forward this specifications that set out key performance indicators, Detailed documentation being developed for IPT project, which Standard, MCH agenda for GP. Clearer KPIs being included in MCH 1C quality standards for service delivery and access, Kevin Perrett should address these issues for IPT (the key part of this Oct-10 IPT funding contract, IPT R contract. IPT documentation being developed (and this performance management arrangements, frequency of recommendation). documentation recommendation is mainly relevant to development of IPT). reporting and an agreed data set. (Prince II). Longstanding concerns about HV involvement in TCS transition process involves detailed review of MCH Relates to Limited capacity vaccination, particularly from GPs. HVs do have an HEALTH childrens services, because the move to CMFT involves a Results of TCS TCS of HVs because important role in advising parents on vaccination but no 1D VISITORS redesign. HV and SN issues will be part of that review and Bev Childrens A transition of Safeguarding longer involved in imms DNA follow-ups. HVs also deliver Bev Yarwood Y will feed in on the imms issues involved. The Childrens Board Services review process pressures neonatal BCG vaccination. HV role being reviewed in are involved in that review. The NST identified a gap in relation to maternal and child relation to TCS process. workforce capacity, e.g. health visiting and practice nurses and training and midwife awareness of MMR Results of TCS schedules. NST recommend that NHS and Hospital Trust TCS transition process involves detailed review of MCH Relates to Comments on action plan suggest useful to look at SNs role Childrens review workforce requirements in relation to: 1. defining SCHOOL childrens services, because the move to CMFT involves a TCS in vaccination, though not clear why. School nurse delivery Services establishment, 2. levels of training needed and NURSES redesign. HV and SN issues will be part of that review and Bev Unclear at present A transition of HPV and SLB vaccination is under review (see relevant review. See professional development, 3. clarifying roles and Bev Yarwood Y will feed in on the imms issues involved. The Childrens Board process sections). sections on responsibilities, 4. ensuring sufficient capacity to improve are involved in that review. HPV and SLB. and sustain immunisation rates, and 5. service specifications and key performance indicators for key groups e.g. midwifery. NST were informed that health visiting provide immunisation advice but don’t immunise children so the NST recommend NHS Manchester explore the role of nurses and other professionals in immunising children and work with GPs and hard to reach families and support these families to immunise their children. nurses and training and midwife awareness of MMR schedules. NST recommend that NHS and Hospital Trust review workforce requirements in relation to: 1. defining establishment, 2. levels of training needed and professional development, 3. clarifying roles and responsibilities, 4. ensuring sufficient capacity to improve and sustain immunisation rates, and 5. service specifications and key performance indicators for key groups e.g. midwifery. NST were informed that health Considerable work undertaken by Primary Care visiting provide immunisation advice but don’t immunise PRACTICE Yearly report Commissioning in this area, led by Liz Slater, with approx 15 children so the NST recommend NHS Manchester explore NURSES Liz Specific support work undertaken with practices to encourage Aug-10 None of 20 PN vacancies now filled. About five vacancies on PCC G the role of nurses and other professionals in immunising Slater employment of practice nurses. nursing team remained unfilled but these are in practices with broader children and work with GPs and hard to reach families and activity problems that need to be tackled in a more general way. support these families to immunise their children. Information regarding MIDWIVES For discussion with midwifery leads to ascertain if current Oct-10 None See row 1 I for further details. provision of G Kevin Perrett situation satisfactory (contacts via Sam Bradbury) MMR to rubella neg women V&I committee already has wide represenation and new Imms Action Plan group adds to representation of key groups/stakeholders. Action planning process is also Revised Tof R Review membership of Vac&Imm Committee. Also see Row widening stakeholder involvement eg presentation to Kevin Perrett n/a n/a for V&I Pending 1H, which adds to this recommendation. Children's board. V&I group happy that all relevant committee Clarify the lines of communication between staff involved in stakeholders closely involved in strategic process and immunisation, the infection control team and the therefore deferred updating V&I T of R, partly as a review will Immunisation and Vaccination Committee. Consider be needed next year due to reorganisation. 1E inviting key representatives (e.g. practice nurse lead, specialist paediatricians, health visitor leads) to meetings Nick Gomm See Note that comms work - see Section 4 - also relevant to this See Section 4 See Section 4 n/a N/A and including them in the committee. and Sandra S Section 4 recommendation Kevin Perrett See Row 1A n/a n/a See row 1A n/a N/A The NST recommend that a designated Immunisation V&I Committee membership to be reviewed - see Row 1E. Also The V&I Committee act as immunisation champions. 1F Champions with partners to facilitate the delivery of the Kevin Perrett nominated leads for general practices being considered - see n/a n/a n/a N/A Additional issue is discussion of GP champions. Action Plan eg GP champions Row 7D. VS reporting arrangements are to V&I committee (monitoring To ensure the vaccination programme forms part of the Agreed to submit report to C&YP board (or possibly Exec) on spreadsheet) and to board (PM Framework). There is a local child health strategy. Building on governance imms situation and planning. To include issue of providing clear commitment towards improving MMR and Human arrangements we recommend that two reporting streams: Report to C&YP 1G Kevin Perrett regular reports and also strengthening of imms planning in next Oct-10 n/a Papillomavirus (HPV) uptake in the Children and Young board (or exec). G to NHS Manchester and Children Trust arrangements and iteration of C&YP plan (though Coalition Government changes People’s Plan (CYPP) 2009-12 but stronger involvement of the newly developed Manchester Standard could be used mean that it is unclear if that plan will be revised??). Children's Trust is needed. Report presented to C&YP to facilitate this. board. Build on Immunisation and Vaccination Management Group. The NST recommended that we review members, terms of reference and reporting lines, e.g. - NHS Manchester Public Health Team - Manchester Community Health - Hospital Trusts 1H - Primary Care Kevin Perrett See Row 1E n/a n/a See Row 1E n/a N/A - GM Health Protection Unit - Child Health and school health departments - Third sector groups - Local people and service users (including Black minority ethnic group representation) Service provided by acute trusts to rubella negative is much stronger than thought by NST visitors with all three trusts now vaccinating post-partum women in hospital. Data from Information Ensure that eligible women who are rubella non immune Explore with midwifery services regarding details of current UHSM indicates a 100% rubella serology uptake and a 92% 1I Kevin Perrett Oct-10 None from midwifery G when pregnant, receive 2 doses of MMR post delivery. service. vaccination rate for the 3.9% who are screen negative. Data services from CMFT suggests vaccination post-partum MMR uptake is approaching 100%. PAT has only recently changed to vaccination in hospital post-partum. VESPA plan initiated. All practices aware of their VNN’s and have confirmed to us. All practices contacted by phone and NST made aware of the lack of clarity and ownership of NST Good Practice is available and DH launching VESPA are now aware/using ImmForm to order vaccines. CICT the cold chain strategy. In order to develop a safe cold initiative this year, which will provide authoritative best practice monitoring the spreadsheet and updating if any practices Results of chain process we recommend that Manchester review and guidance, and to which PCT will need to implement. Approach have any queries. Practices informed of the DH protocol on 1J Helen Fabrizio Dec-10 None audits and A clarify who has ultimate responsibility for this and a regular would be self-audits followed by targetted visits jointly management of vaccines, which is also available on DH web VESPA process system of audit is instituted. This needs communicating to developed between CICT and MM (perhaps combined with IPC site and ImmForm web site. Cold chain and management of all partners. visits?). CICT need to work jointly with MM. vaccines is a module in every Immunisation training session. Med Management emailed all practices with the cold chain audit to complete. DATIX (web-based software) reports are provided from across organisation and monitored via MCH safety group. Note that the new NW Imm Programme Standards A one-off report from Chris Garrett on recent incidents (MCH Incident reporting (all incidents, not just SUIs) is a recommend that local services ensure that "a robust only) for ~ last 12 months will be provided to V&I group (Chris to organisational policy requirement and not just imms Reports system is in place for the management of critical incidents liaise with Sally W). Report can also cover how imms incident 1K Chris Garrett Dec-10 None incidents. Applies to MCH primarily however. Primary care produced by G and that information on incidents is reviewed, reports reporting may work in 2011/12 and onwards, and how V&I reporting is a seperate mechanism (via Medical Directorate). Chirs Garrett. produced, actions taken and that regular reports group might receive summary reports from whatever incident CICT operational immunisation guidelines recommends all disseminated to all immunisers. reporting system is put in place. incidents are reported on DATIX and CICT support with clinical advice as indicated for reported incidents. 2. Data issues Area Lead: Jeannette Becket Overall Aim: To promote accurate exchange and receipt of Information re childhood Immunisations and registrations Additional resources needed Person Target Evidence of RAG Recommendation Action(s) needed - if resource issues are a Current Situation (Give dates) responsible date completion status significant barrier 1: Group set up - first meeting held July 21st includes Need to recruit to 1 WTE to rep from GP Practice work through the reconciliation 2: Ideas data checks 5th August for one of the data comparing data Monitor progress practice 3: Working on from GP Practices and CHIS during 3rd quarter electronic uploads 4: to check any missing 10/11 to evidence The NST supported the plans for data reconciliation that includes agreed 1: Prepare and implement a data improvement action plan M/cr choices team telephone plans will assist in information and update by end of 4th information exchange protocols and the development of an extensive data to check and clean data between GP systems and the following up DNAs relevant systems - this quarter - year end - reconciliation exercise, a Forward Plan on how this new data is to be Child Health System to improve and maintain childhood 5: Update report names on additional resource is not demonstrate what maintained and what action is to be taken in light of this data. The NST were immunisation records for Manchester children to enable reports to GP practice user friendly wording currently available. The made the made aware of issues identified surrounding data capture and data sharing best possible Vital Sign Submission and accurate data 6: Attend current recruitment process difference due to incomplete reconciliation of information systems across organisations. 2:Build on current relationship with Patient Data to Practice Managers forum to highlight CHIS system and Jeannette Oct - Dec runs a significant risk of . Previous 2A Need unified approach to data collection and management to minimise exchange information and seek electronic upload data queries Beckett 2010 delaying recruiting to this post lessons learnt associated risks. NST stressed maintaining commitment to data quality and programme capability 7: Assist system suppliers in PDS compliance to Partnership working with the result in assuring regular data cleaning and linking to GP data with CHIS. Protocols should 3.Recommend to the project team that all children within improve GP Registration information flow- Joint Health Unit hs led to Practices of all be in place to ensure prompt sharing of information between Patient Data and the specified target group checked at GP practice are 8:Electronic exchange of GP registration details admin support for two days per children registered Child Health. Arrangements should be made between Practices, Child Health checked for immunisation history to protect and maintain from the Data Warehouse team has been requested - week to assist in the project. with them and and SHA to ensure the same data is collected by each, according to NICE Practice relationship and confidence between GP practices pending progress due to time restraints of Data The person has been Child their immunistions guidance and the Child health Department Warehouse Team Health System trained to are acurately 9. The purchase of Business Objects has enabled a retrieve Practice information recorded on both more robust reporting mechanism to assist in the reports from the Child Health system system required for the project 10. The prior to GP practice visits for Data Warehouse is no longer utilised Data checking 12.Child Health System developments planned for early 1:Established methods of reminders of children waiting to 2011 will support the project and improve data sharing 1:monthly flow of information to GP's be immunised sent routinely to GP 's monthly- expand on 2: Arranging to join practice managers forum to summaries to measure and evaluate each month on highlight and discuss issues TBA progress made. 3: Rewriting routine 2: - all recorded on a daily letters to GP's with assistance from GP representative As good practice we recommend that NHS Manchester establishes numbers 4. Attendance at the turnaround from receipt in Child Health. - no significant Reduction in of children waiting to be immunised in order to develop strategies to address Jeannette Practice Nurse Forum in North District allowed 2B problems apart from January 2010 during the severe Ongoing None children awaiting this and regularly audits the time taken for data to be entered on CHIS and Beckett discussion on the flexibility of the Child Health weather following closely on from the new year break - appointments appropriate action is taken. Appointment system - attendance at future forums in caught up inside two weeks 3:- establish Central and South districts are planned 5.. Child new letter to GP's to accompany list of children awaiting HealthSystem upgrade due in January 2011 will enable appointments - deliver monthly counts of outstanding electronic distribution of the immunisation schedule and vaccines piloting of the return of results by spreadsheet is planned with a GP practice Encourage and enable private providers to give the relevant GP practice or 1:Determine who the private providers are to arrange letters to private providers to Jeannette Oct - Dec Information flow 2D PCT details of all vaccinations administered to children and young people, so communication. 2: Send letters to ask private ask to provide CHIS with Not clear that this is a significant problem in Manchester Beckett 2010 established they can be recorded in the appropriate information system. providers to inform CHIS of any imms given to children details of any imms given Check McKesson and IT Advertise and promote the uptake of remote access to the Child Health Jeannette GP Access to 2E Set pilot site for access to the child health system Jul-10 Services can allow 2 GP practices currently using CHIS training completed database in practices and clinics. Beckett CHIS permissions through firewalls Protocols in place at every practice to ensure Child Health is updated of any Jeannette 7F Data issues considered as part of Data Improvement Plan - see row 7 N/A relevant changes of information. Beckett There should be a level of minimum IT training for all practice staff involved in data recording. Standardisation of Read Codes used for recoding Jeannette 7G Data issues considered as part of Data Improvement Plan - see row 7 N/A immunisation will improve the quality of the data. Consider standardising data Beckett coding if not already in place. 3. Immunisation Promotion Project Area Lead: Bev Yarwood Overall Aim:---To secure agreed improvements to uptake and, once increased levels of immunisation coverage are reached, to keep levels high. Additional resources needed - if resource Recommendation Person responsible Action(s) needed Target date Current Situation (Give dates) Evidence of completion RAG status issues are a significant barrier • This is very much new work that fits with making the role of the • Establishment of Failsafe current (HPV and schools) immunisation team broader. Urgent Team. September 2010: Two proposal needed (based on Salford system). members of staff now in post to • An established project management method will guide this project pursue and consolidate 'failsafe' through a controlled, well managed, visible set of activities to achieve action planning process the desired results. This project will be managed using the principles • Immunisation Promotion of the Prince 2 methodology Project lead with a strategic Failsafe team'. A quarterly target list of children outstanding immunisation generated enabling overview of the whole contact with parents to clarify if they have been vaccinated, whether they have perhaps moved Resources are needed for a programme, and Immunisation away, or to encourage attendance at the GP for vaccination. Staff individually contact the new system to be Promotion Nurse to focus on parents of those children who have outstanding vaccination to encourage them to go to their GP. established. There is a • A restricted access information folder has been set up on the PCT Partial impact operational management and The very small proportion of patients who can’t be contacted or who are unable to attend their VaccImm reporting tool main server to ensure that all members of the project are able to Q4 10/11 and delivery. Both staff members on 3A Bev Yarwood GP need to be visited at home and vaccinated by a domiciliary vaccination service. HoB and which has been created by access, save and update relevant information off site; and ensure that full impact Q1 secondment from substantive Salford experience suggest that team might consist of perhaps a band 6 project manager, two Central Lancashire PCT. all facts and data are easily and speedily accessible. 11/12 post until March 2011. To be band 5 nurses and two band 2/3 admin. Funding may be required to • To improve vaccination coverage, our initial two key target groups reviewed and reconsidered as further develop this tool to are for Vital Signs indicators One and Four. Recommendations relating to access issues. Commission a ‘Failsafe Team’ necessary in response to other suit our requirements. • Visits x two to Central Lancs for information sharing and gathering by (which could be funded through non-recurrent budgets in year 1 and changes involved with the TCS mainstreamed if successful). IPT agenda. Appropriate actions [ • For information sharing and gathering by IPT. see other sections of Action • JHU support – another colleague x 3 day’s week allocated to IPT. Plan] as agreed; increase in • See section 5 - Access and vulnerable group for further information. percentage uptake to be Proposal to begin parental contact process; to clarify immunisation demonstrated by Quarter 4. status of child, and reasons for same Quarter 3. Immunisation project plan There is a need for a well functioning CHIS and regular and frequent information exchanges between GPs, other information providers, and Child Health to ensure that data held is up to Jeannette Beckett See Section 3 date and robust. This information, once available, will be used by and for the Immunisation Promotion Team to manage and focus their activity. Data on domiciliary immunisation Domiciliary vaccinations to be offered only in specific circumstances, i.e. for 3B persistent non-attendees of appointments. The very specific use of this Bev Yarwood See comment in first column Q1 11/12? Via IPP No decision yet made on need for domiciliary immunisation service must be made clear to all involved in immunisations 4. Comms and engagement Area Lead: Val Bayliss-Brideaux Overall Aim: The long term goal of this strategy is improve vaccination uptake across the city using a variety of communications methods Additional resources Person Target needed - if RAG Recommendation Action(s) needed Current Situation (Give dates) Evidence of completion responsible date resource status issues are a significant Need to strengthen communications across and between organisations and to communicate with communities. The NST endorse Related comms and the planned development of an integrated internal and external communications strategy as part of the final action plan for engagement strategy and Val Bayliss- 4A improving immunisation uptake. NST recommend we communicate changes in services, service configurations, policies and See communications and engagement strategy associated actions and A Brideaux pathways to professionals and the public. NST also recommended we adopt a cross agency organisational development approach resulting to communications and increase the profile of immunisation uptake – the idea that this is ‘Everyone’s Business’. documents/papers etc Related comms and Regularly identify and target areas where uptakes of vaccinations are poor as 'places of concern'. Target these areas as priorities engagement strategy and Val Bayliss- 4B to, for example, improve information available to patients, and work alongside community groups to ensure the importance. NST See communications and engagement strategy associated actions and A Brideaux recommends we develop deeper understanding of local population including the reasons for not immunising. resulting documents/papers etc Related comms and engagement strategy and Develop links with agencies that work with specific community groups. For example Connexions, Youth Offending Team, Asylum Val Bayliss- 4C See communications and engagement strategy associated actions and A Seekers Centres, The Welcome Centre. Brideaux resulting documents/papers etc Produce /provide and disseminate information for the public of Manchester – in line with national communications campaigns as Related comms and appropriate - in various media (e.g. leaflets, posters, newspaper adverts, radio adverts) about immunisations. The information engagement strategy and should be tailored to target audiences and also available on the NHS Manchester website. Provide information in a user friendly Val Bayliss- 4D See communications and engagement strategy associated actions and A format for different audiences (particularly the seldom seen, seldom heard). Provide regular communications to local populations, Brideaux resulting especially families and service providers to increase awareness of the importance of immunisation and risks associated with the documents/papers etc failure / delay to an immunisation course. Related comms and engagement strategy and Information should be easy to understand and to the point. Information should be available in all recognised languages when Val Bayliss- 4E See communications and engagement strategy associated actions and A possible. NHS Manchester website to include links to information services on immunisations Brideaux resulting documents/papers etc Related comms and engagement strategy and Carry out an awareness raising campaign (using results from social marketing campaigns carried out elsewhere) about Val Bayliss- 4F See communications and engagement strategy associated actions and A immunisations, and promoting their importance. Brideaux resulting documents/papers etc Related comms and engagement strategy and Work with the communication lead at NHS Manchester to develop communications campaigns when there are infectious disease Val Bayliss- 4G See communications and engagement strategy associated actions and A outbreaks, government campaigns etc. Brideaux resulting documents/papers etc Related comms and engagement strategy and Consider using pharmacies, retail outlets, libraries, and local community venues to promote and disseminate accurate, up-to-date Val Bayliss- 4H See communications and engagement strategy associated actions and A information on childhood immunisation. Brideaux resulting documents/papers etc Related comms and Produce leaflets/posters for families who may consider taking their young children away for an extended period of time, advising engagement strategy and Val Bayliss- 4I them to ensure that the child is fully immunised against the appropriate infections before they travel. These should be distributed to See communications and engagement strategy associated actions and A Brideaux key locations within local communities, to reach the target group. resulting documents/papers etc 5. Access and Vulnerable Groups Area Lead: Bev Yarwood To review care pathways from a vulnerable group perspective; to ensure that barriers and blocks to access are identified and removed. Additional resources Person Target needed - if resource Evidence of RAG Recommendation Action(s) needed Current Situation (Give dates) responsible date issues are a completion status significant barrier The action plan needs a supported clear, integrated pathway, which identifies Bev Yarwood. Partnership working Ongoing. n/a Involvement of Communications Team - Scoping exercises in progress Imms Project Plan / and describes the entry points and routes through services depending on the Comms Team. Work to Strategic Plan/Action Plan Plus Imms Action Plan. needs of individuals and population groups longer term developm ent Ongoing. n/a MCH Homeless Families Team contact made 8.9.10 - Crude count IMMS Action Plan / Plus made of Immunisation status of C & Y P. Consideration as marginal Imms Project Plan longer group term developm ent 5A Ongoing. n/a Liaising with Voluntary Sector (BOAZ) 1.12.10 re asylum seekers - IMMS Action Plan Plus Consideration given as marginal group longer term developm ent Ongoing. n/a Information requested from Manchester CC re travelling families - Plus Consideration given as marginal group. longer Full engagement via Public Health co-ordinators. Meeting held to term discuss Sure Start commission. 15/11/10. developm ent Ensure enough immunisation appointments are available so that all local PCC IPT Child Strategic Action Plan/Action Plan – • Letter sent to all practice managers and nurses explaining ethos of Strategic Plan/ Action children and young people can receive the recommended vaccinations on time. Health Engagement and pilot work with targeted GP practices. IPT Plan McNesson Full engagement with and co-operation of Child Health Department. • Work ongoing re targeted GP practices • Contact made by IPT/Child Health/Liz Slater • Appointments made and data cleanse in progress • Practice visits by IPT to view perceived operational difficulties to IMMS delivery 5B n/a Bev Yarwood – IPT lead not engaged as accredited clinician with Immunisation Project McNesson care plus system. Plan Data cleanse between systems and reports to ensure accuracy. Training with connecting for Health 17th-18th November 2010 – Warwick (McNesson) for clinical safety workshop. IPT Child Health Proposal for Opportunity. IMMS in n/a • Meeting arranged with GP Surgery 22/12/10 GP Surgery • Paediatric Out-Patient Department. • Meeting arranged with Community Paediatricians December 2010 • City Centre Medical Pratice. Develop a protocol agreed across all agencies working with asylum seekers MCC JHU Liaison with MCC and voluntary sector. Ongoing n/a Not current vital signs requirement considered in more detail at later whereby their immunisation history is gathered as accurately as possible and Comms date as marginal group. ensuring appropriate appointments are made and given for outstanding immunisations to be administered 5C Health care professionals who work closely with asylum seekers and refugees IPT, ICT, MCC Liaison with MCC/ Voluntarty Sector Ongoing n/a to improve services in relation to immunisations, and facilitate communication between all groups involved in their care (with support from the infection control 5D team). (Identify areas of) low immunisation uptake to inform redesign routes into PCC, IPT, Child Scope capacity/necessity for drop-in clinic Meeting arranged with City Centre Practice to discuss 22.12.10 Action Plan / services – e.g. appropriate flexible hours, use of a wider range of settings – Health McKesson • Consider pilot with City Centre GP Practice Drop in clinics require a risk assessment and availability of accurate Immunisation Project use of children’s centres . Set up a number of drop-in clinics across the city, to • IMMS and delivery is a primary care responsibility and real time data. Paln which patients can be referred to by any health care professional. Consider • Consider pilot with Paediatric community clinicians locations which will suit the local needs such as in Sure Start centres, or Meeting held with KP /HV / IPT / Public HealthCo-ordinator's to Action Plan / 5E discuss Sure Start involment/engagement. Immunisation Project Plan n/a Child Health colleagues involved re compliance with data management McKesson – Business objects work in progress (NST recommend as good practice the) opportunistic childhood vaccinations Royal Free Hampstead NHS Trust – opportunistic childhood vaccinations in its n/a Meeting arranged with Acute / Primary Care colleageues to scope. paediatric outpatients department from February – March 09 See 5E 5F See 5E Note that the new NW Imm Programme Standards recommend that Strategic Plan / Action Plan n/a Child Health - Data group - Section 2. Cover data regularly. Received IMMS Action Plan / "Immunisation uptake by those at risk of not being fully immunised is reported treatment centre queries information received. IMMS Project Plan and closely scrutinised on regular basis, and that immunisation uptake rates of those at risk of not being fully immunised are fed back to all immunisation services and discussed with the view to improving access and overcome 5G barriers". n/a Care Plus / McKesson Planning n/a Working with Liz Slater and Commissioning Health visitors to become more involved with immunising in the community and Bev Yarwood Revisiting the debate about HVs delivering vaccination is unlikely to be productive - By end Advising parents on IPT involved in HV S=standards / structure re-design. Evidence that review targeting the non -attendees. The role of the HV in the immunisation agenda given capacity of HVs in the city - but their role in encouraging vaccination with new 2010 benefits of vaccination HVs already advising parents at new parent visit has taken place. needs reviewing. parents should be reviewed is already part of HV Scoping exercise due with Public Health co-ordinators (Justine IMMS Action Plan IPT role Baines) to establish what training is received by Sure Start Centre Project Plan Proforma 5H staff in regard to IMMS delivery for paeds admissions. Results of a pilot project. Check the immunisation status of children and young people at every Lisa Redfern / Lisa Redfern to explore options, particularly for developing a proforma for paeds Oct-10 None Imms status of children is currently checked when admitted, but not in Proforma for paeds appropriate opportunity including hospital in – or outpatient and accident and Kevin Perrett admissions. Will discuss with Rosemary McCann, who has an interest in this issue. particular detail. Issue is whether to vaccinate in acute setting, which admissions. Results emergency departments, walk-in centres or minor injuries units. The NST Possibly a pilot project to vaccinate in an acute setting can be developed? is difficult as requires access to CHIS data, vaccine supply, and of a pilot project. recommend that NHS Manchester use all opportunities to review children and considerable training and organisation. Alternative to that young people’s immunisation history and fully utilise every opportunity to considerable undertaking is to improve the discussion with parents immunise in the following situations: attendances at A&E and Walk In centres, about missing imms by raising awareness amongst paeds staff and outstanding immunisation in schools, statutory reviews for children in care, improving their attempts to encourage GP attendance for vaccination. 5I children known to child and adolescent Mental Health services, children who Providing vaccination in A&E and similar settings seems very are hospitalised ambitious for the likely benefits. Provision of vaccination in one WIC is being pursued (but provision in all WICs also seems overly ambitious). Audit of IMMS stands in progress - Crude numbers by Health Care assistants (working for MCH, but placed in A&E at CMMC). Will be discussed as progressive initiative as above. Ensure all locations providing immunisations are recording any identified Giving out general information, perhaps n/a Work up IPT / Child Health contact / liaison / database management As in 5H reason for non vaccination e.g. parental concerns, contraindications, needle Around the launch of a campaign with practice ongoing. 5J phobia etc. Results to be audited and findings to be used to improve service. Team brief (monthly information given HPV Spreadsheet (work in progress) out by team managers) To capture identified reasons for default can be utilised for delivery to under 5’s once accredited. The Healthy Child Team, led by a health visitor working with other practitioners, Representation at LMC – Essential that n/a Healthy Child HV role does not exist in Manchester. Different roles IMMS Project Plan / should check the immunisation record (including the personal child health Lead attends and gets support and responsibilities considered as part of re-design work with HV IMMS Action Plan record) of each child up to 5 years. They should carry out this check when the perhaps on specific campaign, or standard group. IPT involved. 5K child joins a day nursery, nursery school, playgroup, Sure Start children’s certain area of communication e.g. centre or when they start primary school. The check should be carried out in checking vaccination status if at the conjunction with childcare or education staff and the parents. doctors for something else/or writing to parents to remind them Offer vaccinations in locations that are more tailored to the needs of looked NST Good Practice is available – Leeds – Children in Care Immunisation increased n/a Meeting held with LAC team. Progress further with Child Health / LAC 7A after children, such as drop in centres at local clinics (see recommendation 5). from 51% in 06/07 to 84% 08/09 through opportunistic immunisation at regular health team. (moved assessments. from Section 7) 6. Training Area Lead: Helen Fabrizio Overall Aim: To provide accountable, targeted and inclusive multi-disciplinery immunisation training which conforms to Health Protection Agency standards Additional resources Person Target needed - if RAG Recommendation Action(s) needed Current Situation (Give dates) Evidence of completion responsible date resource issues status are a significant barrier All immunisation training and updates to be properly audited and 06.05.10 Meeting held with Maura Moss. Maura confirms that evaluated. Attendance on training to be fed back to managers. Meeting arranged with Maura Moss, cancelled by all Imms training is evaluated, the attendance is fed back to 6A Maura Moss n/a Further meeting to be arranged G Note that the new NW Imm Programme Standards recommend Maura, new date to be arranged. manager and a data base of immunisation training attended is that "An up-to-date immunisation training database available". maintained. Meeting at Wythenshawe offices 25.03.10 with Sally Webster, Leasa Benson, Liz 01.07.10 Training has been commenced as outlined. 1. Slater, Helen Fabrizio. Cate Riley and Muara Moss unable to attend. Training to use Introduction and Update to Immunisation to cover all age HPA curriculum. To be for all immunisations, not just Childhood Imms. Training to be 1 groups, for all professional groups (excluding HCA's and other day Introduction to Immunisation and a half day Update for Immunisers, four times a support staff) 2. A 3 hr course for non-immunising support staff If the PCT is year each course. To be available to all immunisers ( inc Prison Staff, HCA's giving flu has been introduced and the first session is 16.07.10. (we are required to provide vaccines). Flu and Pneumococcal training to be part Intro and Update courses, rather currently awaiting HPA guidance regarding the structure of Provide tailored training for non-immunising staff, particularly 3 day training for than separate. Separate training for support staff giving advice on imms e.g Sure Start courses needed for HCA's giving Influenza and Pneumococcal 6B GPs, practice reception and admin staff, carers, nursery staff, Helen Fabrizio Meeting arranged 25.03.10 n/a HCA's this will / Social Services. ?Three times yearly half-day depending on demand (will need to be Pending vaccinations. The current proposal is a 2/3 day course). midwives, social workers. impact on staff monitored and evaluated when started). New training programmes to be developed 04.01.11 No further information has yet been received regarding resource, and by end of April. Intro Imms and Update already completed. Further flyers to be sent training proposals. The Immunisation traning packages have training costs. out with changed course titles and content etc. Agreed actions needed to increase each evaluated well throughout 2010 . At present there is only course uptake among Practice Nurses, Liz Slater to discuss Imms training being part one further training course for non -immunisers planned in Feb of QOF with Jane Jackson. Infection Control to add Imms training to Infection Control 20111 due to changes to L&D with PCT re-organisation. No audit form for General Practice. Liz to review training records she has of PN's and further Imms traning is planned for 2011 promote course to them. 06.05.10 Meeting with Maura Moss Head of Learning and Meeting arranged with Maura Moss 19.04.10 - Development, Sally Webster, Head of Health Protection, and 6C Maura Moss unfortunately this has been cancelled by Maura. n/a None Further meeting to be arranged G Leasa Benson, Clinical Lead Health Protection. NHS New date to be arranged Manchester has robust training evaluation protocol. Carry out a review of the NHS Manchester/Manchester 01.07.10 All staff who immunise have to attend an Introductory Community Health training evaluation protocol. Note that the PCT recognised course. This may be provided by the local new NW Imm Programme Standards recommend that "all Universities, or by Dr David Baxter at Stockport, or through the current immunisers have received core-training (basic training) PCT Introduction to Immunisation Course. The corporate followed by an annual update as set out in the HPA national position regarding annual updates is still 3 yearly attendance at minimum standards for immunisation training" If the PCT is a recognised immunisation update course. Change regarding required to provide A proposal document of the relevant leads/ key this will be approached via a proposal document of the relevant annual updates Helen Fabrizio stakeholders regaring whether PCT has to provide Sep-10 See next cell leads/ key stakeholders in the next few months planned for @ A this will impact on yearly updates. Sept. 2010. Ideally an E-learning package would have been one staff resource, and solution but all e-learning is currently on hold with the re- training costs. organisation process in place. Staff can attend an Update annually if they feel they need this or a need is identified by a manager. A further option is to use the PCT /HPA competency framework annually. 04.01.11 The HPA are planning to release an immunisation e-learning package in Jan 2011. Vaccine Update newsletter supplied by the DH. Email contact All immunising staff should be signed up to receive Vaccine address for Vaccine Update has been circulated at Imms Update, which provides general updates on the immunisation Vaccine update – detailed and specific information training events, to Practice Nurses/ Practice Manager's and programme, including Green book changes. These staff must regarding vaccines. GP's via Elizabeth Slater, the PN Lead (Commisssioning). The 6D Helen Fabrizio n/a None See next cell G make time to make sure they are up to date with changes and if GP update – monthly newsletter sent by Primary link is also on the Infection Control web site, Immunisation training is required, that they attend training. Details on links to Care Commissioning to all GP’s Section. Immunisation information can also be added as needed update etc to be advertised on NHS Manchester intranet site. to the Practice Nurse Newsletter sent by Liz Slater or the Practice manager newsletter circulated by Joyce Thorley. 01.07.10 The infection control team have access to contribute to newsletters provided by the HPA to care homes, co-ordinated The infection control team to produce and disseminate regular NHS Manchester needs to ensure they are targeting by the CICT Administrators. This would enable any current newsletters to all involved in immunisations, and beyond. Helen and communicating the right people in the correct relelvant advice on immunisation to be added as needed. The 6E Consider having a role for a surveillance and communication Fabrizio / area when we are running campaigns or generally n/a None See next cell G General practices and Provider services have access to the person within the infection control team to produce the Fiona Smith promoting vaccination. vaccine update newsletter from the DH. There is access, links newsletter. and information on the Infection Control web site regarding immunisations for all staff and the public. 7. Vaccination of younger children (Primary Care) Area Lead: Karen O'Brien Overall Aim: To improve delivery of vaccination through primary care in Manchester Additional resources needed - if resource Evidence of Recommendation Person responsible Action(s) needed Target date Current situation (Give dates) RAG status issues are a significant completion barrier Improving the performance of general practices, particularly those performing less well, via No new resources needed, Manchester Standard. This work involves engaging this is primarily a with practices and negotiating better performance Quarterly Key contractual issue being Manchester Standard launched 23rd June 2010. Practices will against a series of indicators, including for Performance Karen O'Brien Jun-10 taken forward through receive quarterly updates on the key performance indicators immunisation. Being overseen by the PC indicators in the Manchester Standard relating to childhood imms & vac, etc - starting with October 2010 programme board. Communication with general Manchester Standard practice visits that begin in practices on increasing uptake including the quality January 2011 and accuracy of data and solid working Those not meeting minimum standards should have their contracts reviewed, 7C relationships, e.g. GP champions. with the possibility of remedial action. Payment data already available from finance and COVER data requested from Jeannett B. Payment data and COVER data to be Analysis of data by practice, from both COVER data analaysed to identify mis-matches. Then practices will be Spreadsheet Kevin Perrett and from payment data. To inform targetting of May-10 n/a approached to explain discrepancies. Decided not to undertake analysing uptake by N/A further work analysis as discrepancies in COVER reporting to be investigated practice by other means (and difficulties in underaking this work, particularly validity). Strengthen and formalise work with individual Work already underway with practices, this is a more formal practices, led by Primary Care Commissioning, and approach to current work with practices as part of Manchester supported by Community Infection Control Team as From within current PCC Standard work. Manchester Standard data for 09/10 baseline is Karen O'Brien specailist advisors. Agree process to select 2010//11 ? and CICT resources already with practices who have been banded A, B or C practices that require visits, based on performance depending on achievement. PCC will work with the Band C against Manchester standard, and to develop action practices as a priority. plans for individual practices that are monitored Have a team in place to target poorly performing practices and assist them in making steps towards improving performance in immunisation services. This 7D will result in jointly producing an action plan for the practice (based on guidance and best practice from elsewhere) against which they can be assessed. All All practices should be asked to identify a lead for practices should be encouraged to identify a lead for immunisations. immunisations with whom the CICT can make Contact to be made with practices, focusing on those with low contact regarding immunisation issues. Note that immunisation coverage. Contact already made with all practice the new NW Imm Programme Standards From within current CICT Listing of Kevin Perrett By end 2010 to provide information. Discussed at Manchester standard group - N/A recommends that "all immunisation services (GP resources immunisation leads not clear that an identified lead is needed for all practices - many practices / immunisation clinics) to have a named are performing well without having such link persons. individual for cold chain". Could this be the same person? See above, row 6 in particular. Focus is on working with all That commissioners provide regular feedback of performance in relation to practices but focusing on poor performers (no plan for 'GP immunisations to the providers (GP practices), including targets and No new resources needed, champions' as different methodology being used) Process for Manchester Standard comparisons between practices and localities. This should be made publicly See row 6 above - The key performance indicators this is primarily a working with under-performing has been developed. Quarterly process for working available and use data held on the Child Health database. DH endorsed NHS in the Manchester Standard will be reported back to 7E Karen O'Brien Feb-11 contractual issue being notification of under-performance is being under-taken. Cluster with under-performing Manchester’s proposed development of Manchester Standards and GP Cluster practice quarterly. Those Banded C will be priority taken forward through managers idea is more to do with acute services, not primary practices. Practice Managers to identify and target support to practices of concern. practices. Manchester Standard care performance. Action plans will be developed as part of visit programme. Communication with general practices on increasing uptake including the practice visiting process - starts in February 2011 - and that will quality and accuracy of data and solid working relationships, e.g. GP champions. include imms. Protocols in place at every practice to ensure Child Health is updated of any 7F Jeannette Beckett Data issues considered as part of Data Improvement Plan in Section 2 N/A relevant changes of information. There should be a level of minimum IT training for all practice staff involved in data recording. Standardisation of Read Codes used for recoding immunisation 7G Jeannette Beckett Data issues considered as part of Data Improvement Plan in Section 2 N/A will improve the quality of the data. Consider standardising data coding if not already in place. 8. Neonatal Hep B vaccination Area Lead: Nicola Jepson Overall Aim: To improve uptake of local neonatal hepatitis B vaccination and screening to reduce transmission of hepatitis B in Manchester Additional resources needed - if Person Target Evidence of RAG Recommendation Action(s) needed resource Current Situation (Give dates) responsible date completion status issues are a significant barrier PCTs should have an identified person responsible for coordinating Operational the local Hepatitis B vaccination programme for babies at risk of procedures and Hepatitis B infection. The person should also be responsible for Joint co-ordination by Nicola Jepson (CICT) and Amanda Allocated coordination hours located in Community Infection 8A NJ/AW Jul-10 None database kept G scheduling and follow-up to ensure babies at risk are vaccinated at Wynne (CHS). Clinical overview by LB/SW Control Team in infection the right time. This may involve working within and across several control folder PCT areas. Draft revised operational procedure and database developed. Develop joint CICT/CHS operational procedures and Jul-10 None Current guidelines include movement out section on who and G database to monitor procedure with assurance measures. what to inform A clear process for the local infant Hepatitis B vaccination Operational programme should be developed and implemented. Antenatal, procedures and postnatal, neonatal, paediatric, primary care and community NJ/AW list kept in support teams should communicate effectively and share infection control information so that the children and families affected can be folder contacted and followed up. Work in progress to ensure a contact list of out of area immunisation co-ordinators and infection control nurses are Need to strengthen communication links between virology, kept by up to date. Visits to be planned by Hepatitis B Co- 8B trust screening co-ordinators, border PCT Hepb B co- Jul-10 None G ordinators to meet with acute trusts to ensure communication ordinator and CICT. flows and that all relevant information is passed onto the relevant bodies. Babies born to Hepatitis B-positive mothers should be given the Revised draft procedure includes 1st dose given by hospital, Operational first dose of vaccine promptly, whether they are delivered in Ensure neonatal hepatitis B schedule and serology follow up subsequent doses and blood tests arranged as per DH procedures and hospital or at home. They should then receive all other 8C NJ/AW implemented as per national guidelines embedded within Jul-10 None guidance. Access database queries written to flag up any database kept G recommended doses, a blood test to check for infection and, where draft revised operational procedure and database outstanding vaccinations appointments, telephone calls to GP in infection appropriate, Hepatitis B immunoglobulin, in line with the Green or serology referrals control folder book. Health professionals should provide parents with information, Current draft procedure includes HPA Hepatitis B information advice and support on how to prevent the transmission of Hepatitis leaflet sent to parents with reminder letter for 2nd, 3rd and 4th Operational 8D B. They should emphasise the importance of ensuring babies Review information sent to parent from PCT and acute trust. None immunisation. Visits arranged for Hepatitis B Co-ordinators to procedures and complete the recommended vaccination course at the right time. In NJ/AW Sep-10 meet with acute trusts to check what advice/information is database kept A addition, they should assess whether or not the baby’s siblings given to parents at hospital prior to admission. in infection need to be immunised against Hepatitis B or tested for infection control folder Infant Hepatitis B vaccine included in immunisation training and should offer them vaccinations and blood tests if necessary. Ensure Hepatitis B included in staff training programme None programme. Health professionals should ensure administered doses of Hepatitis Review instructions sent to GP who administer the Hep B Revised letter developed for HV and GP to ensure records are Copy of letter in 8E B vaccination are recorded in the patient records and the personal NJ/AW Jul-10 None G vaccine of need to maintain patient records updated accordingly CICT folder child health record. Database and All the above actions should be integrated into the local care Review and merge Child Health and Infection Control Operational Joint Child Health/CICT Hep B database, procedures and 8F pathway for infant Hepatitis B. Disseminate recently developed antenatal hepatitis B database and procedures to develop a Jul-10 None procedures kept G pathway developed. neonatal hepatitis B care pathway and cycle of audit and review to NJ/AW Hep B pathway. in infection ensure all eligible babies are fully immunised and serology is taken control folder at year 1. Draft audit pro forma in place. New process to be audited Develop Hep B audit programme Oct-10 None Results of audit A October 2010 9. Neonatal BCG Area Lead: Sally Webster Overall Aim: To increase BCG vaccine access and uptake to achieve the agreed KPI for neonatal BCG vaccination Additional resources needed - if Person Evidence of RAG Recommendation Action(s) needed Target date resource Current Situation (Give dates) responsible completion status issues are a significant barrier Copies of notes from meetings We recommend NHS Manchester builds on current work around Citywide review of BCG coordination complete. Formal review of service held on CICT Service and chair ongoing citywide BCG provision meeting. neonatal BCG uptake and endorse plans to do a city-wide review of delivery meeting in progress. This has identified need for following subgroups files. Final 9A Sally Webster Subgroups in place. Overall aim to aceive BCG KPI of 85% by age Mar-10 None A this programme and where and who provides neonatal BCG in order - operational service/access issues and communications. Next citywide BCG working one. to plan a pan Manchester Service. review meeting to be arranged documents will be uploaded as available. BCG model in place .BCG pathway and operational procedures in draft. Develop routine BCG pathway with operational procedures that South BCG coordinator piloting model in central area . BCG poster available follow up those who DNA and improve service delivery. Need to and for distribution. LAC pathway that encompassess BCG reviewed and for 9B review where services are provided from in relation to service need Aug-10 None As above A distribution via LAC network. All developments excluding LAC pathway in and recommendation to deliver services collaboratively from Sally Webster. conjunction with comms and engagement team.Operational procedures will childrens centres. Ann need to be reviewed via PAG. Review and develop pan Manchester care pathways for targeted McDermott. immunisation programme including neonatal BCG Bev Yarwood. Karen Moore. Need to develop BCG uptake monitoring for completion at 12 85% uptake of BCG by 2 years of age to be included in service specification Sam Bradbury months of age against KPI target Mar-10 None from April 2011 for childrens services.statistics requested from child health to as above A demonstrate BCG uptake according to the 2year COVER cohort. 10. Prison Health Area Lead: Erika Duffell Overall Aim: To improve vaccination status of all prisoners in line with DH guidance Additional resources Person Target needed - if resource Evidence of RAG Recommendation Action(s) needed Current Situation (Give dates) responsible date issues are a significant completion status barrier Awaiting employment of nurse immuniser. Full implementation of Some progress made in terms of Dedicated nurse Notes from immunisation interim implementation improving End of immuniser at HMP Health plan and subsequent revision of this hepatitis B vaccination uptake through A 2010 HMP Manchester Protection plan. training of prison staff, review and Committee awareness raising among prisoners Interim plan actions: 1. Provide Hepatitis A, B, Diphtheria, Notes from Additional funding Discussions held around lack of hepatitis Tetanus, Polio boosters, MMR and Men C vaccines as per HPA, HMP Health Jul-11 needed for hepatitis A A vaccine. No further work around this A Schedule of Vaccination of Prisoners. Sept 2009 for new Protection vaccine until resource improve. receptions and long term prisoners. Committee Notes from Additional funding Discussions held around lack of hepatitis Ensure appropriate equipment/vaccines available for each HMP Health Jul-11 needed for hepatitis A A vaccine. No further work around this A session. Protection vaccine until resource improve. Committee Already being addressed but further work Notes from Update medical records and provide around improving data quality including HMP Health End 2010 None A data to provide assurance. cross-referencing with vaccines Protection dispensed. Meeting on 21.12.10 to discuss Committee Notes from HMP Develop plans to provide immunization Already being addressed through plans Immunisation service provision in HMP Manchester needs to HMP Health Manchester opportunistically and across remaining End 2010 None but should see further improvements once A be increased such that all prisoners are checked for their Protection 10A Health wings and workplace. nurse immuniser in place. immunisation needs upon first health assessments, and key Committee Protection vaccinations are offered, in accordance to DH guidance. Support induction of new nurse Current staff supported through training Notes from Committee immuniser until confident to provided through attendance on PCT HMP Health End 2010 None A undertake work plan unsupervised. courses and directly from ICT. New nurse Protection immuniser will have to attend training. Committee Monitor and review programme. Notes from Analyze and provide data as HMP Health End 2010 None Ongoing G assurance. Report via HMP Protection Health Protection Committee. Committee Notes from Training programme in place. Target of Training of key prison staff to HMP Health Jul-11 None 60% healthcare staff to be trained. New A support role of new nurse immuniser. Protection staff have been trained. Committee Notes from Work with Health Promotion Work commenced further materials being HMP Health End 2010 None A Officer to promote vaccinations. developed. Protection Committee Notes from Assessment around introduction HMP Health of prisoner vaccination cards. Jul-11 To be determined Link nurse undertaking assessment. A Protection Committee 11. Seasonal flu and pneumococcal vaccination for at- risk groups Area Lead: Nicola Jepson Overall Aim: to meet national target(s) for seaonal flu vaccination Additional resources needed - if Evidence of Recommendation Person responsible Action(s) needed Target date Current Stiuation (Give dates) RAG status resource issues completion are a significant barrier Nicola Jepson Meeting held 4 June 2010. Further meeting to be A st set up by NJ after 1 data collection to review data Organise meetings and act as seasonal flu co-ordinator End April and measure progress by practice Practices to order vaccine as necessary Andrew Bidolak confirmed system in place for A supply and delivery of vaccine Andrew Bidolak/Nicola Jepson/Judy Jones Supply and delivery of Pandemrix vaccine Ongoing A All practices should have by now ordered their General Practice Supply of trivalent vaccine vaccine Kevin Perrett Uptake target set by WHO for over 65’s as 75% A Chair planning group and oversee campaign and 60% for at risk groups Letter, flowchart Letter sent out to practices on 15 July 2010, and uptake table 11A n/a G Write to all practices offering information and guidance – to included the NHS Dudley flowchart and uptake in flu folder in General Practice cover various issues highlighted in this action plan chart by practice CICT office Completed as part of swine flu debrief and at 4 June meeting Seasonal Flu Vaccine Campaign 2009/10, data to end December 2009 (1 Sep 09 to 31 Jan 2010) uptake on HPI G 65 and over - 69.3% website Under 65 (at-risk patients only) - 52.3% Review 2009/10 practice uptake and compare to national Nicola Jepson average uptake. Flu graphs End April 3 June 2010 NJ has commenced visiting and contacting high uptake practices. Of the top 10 practices visited 4 practices, contact made with 1 over the phone. NJ and LS to meet w/c 9 August to analyse good flu practice and arrange visits to A the bottom 10 low uptake practices screening out any new practices and for those who in previous Targeting lower performers. Closer relationships with years had high uptake NJ will contact these by Nicola Jepson/Liz Slater practices early to improve uptake May/June phone Full listing required of: • What system each practice are on • Which primis facilitator covers which practice A • If there is an allocated flu person who can upload data Training practice staff to upload their own data Steven Norman/Bernie Ward During campaign Suggested to have a dedicated flu page. Highlighting top 10 high uptake practices. To also congratulate highest practice as visited by A Autumn to NJ and it was clear this practice work together Communications Action Plan to include promotion in areas coincide with as a team and very hard to achieve their Fiona Smith where uptake is low. campaign uptake. Email sent to Paul McGarry in April 2010 at JHU to 11B n/a put flu info in their leaflets/magazine. Further A Nicola Jepson Liaison with final poverty/keep warm work contact made in August 2010 11B n/a Provision of celvapan to those with contraindications Continuing from G Kevin Perrett to investigate particularly those with severe egg allergy current provision Payments for administration of the monovalent H1N1 Swine A flu influenza vaccine should continue to be made in JT to check date on existing DES and feedback to Joyce Thorley/Kevin Perrett accordance with the existing DES KP if DES expires before end March 2011 CICT NJ and CICT to continue to immunise poultry A Identify and immunise all poultry workers During campaign workers as done in previous years Kevin Perrett Mar-11 Meeting to be set up at the end of campaign A Review campaign based on final data overall and by practice Feb/March 12. Seasonal flu vaccination - healthcare workers Area Lead: Nicola Jepson Overall Aim: to achieve higher seaonal flu vaccination coverage in HCWs than in previous seasonal flu vaccination programmes Additional resources needed - if Evidence of Recommendation Person responsible Action(s) needed Target date Current Situation (Give dates) RAG status resource issues completion are a significant barrier Meeting held on 21 May 2010 Meeting held on 15 October Nicola Jepson G NJ to arrange final review meeting end of march to review 2010/11 and plan for 2011/12 campaign Organise meetings and act as seasonal flu co-ordinator End April Kevin Perrett Ongoing G Chair planning group and oversee campaign CMO letter has been sent out (twice, due to the error in the first version) and there will also be the regional comms campaign to back that up. Employers also Kevin Perrett Ongoing alerted through national guidance, but also specific letter sent to dentists and G Contact relevant health and social care employers to inform of responsibilities and offering training support pharmacists (in case not alerted through national channels). Review best approach for vaccination of staff HCW vaccination – feedback from National Conference on what works 1. Flexibility and accessibility 2. Peer to peer vaccination 3. Training for vaccinators At first meeting G 4. OOH access 5. Contact point for enquiries 6. Staff having to take conscious decision not to be vaccinated 7. Senior support 8. Creative comms campaigns Meeting accepted this feedback was helpful – to share as ‘best practice At first meeting guidance’ with employers. Write to employers early for next year 12A n/a North West Staff Seasonal Flu Vaccination Campaign have a range of materials available to use at www.attishoo.com. Theme is "Become a Flu Fighter" Suggested using local user friendly 12A n/a message for next year. Need to look at local comms ie new Manchester message jointly with Acute trust and city council for 2011/12 campaign Occupational Health are providing vaccination to MCH staff at Wythenshawe Hospital and NMGH. The service has been Comms At time of campaign advertised in Monday Messenger and will be repeated weekly and A also promoted to staff at the imms training that CICT provide. Data recorded by NJ and uploaded onto the DoH ImmForm Website monthly. Comms Tema have sent copies of staff flu magazines and postcards have been sent to Health Centres and to the TCS event. Also information in next Talking Health email bulletin and information via our Facebook and Twitter pages and will continue to To educate staff about staff benefits of flu vaccination. As send information out to voluntary sector newsletters determined by communications Categorisation problem, need to individually assess to be completely robust but this is impractial. Submit data to DoH as required Data reporting Nicola Jepson/ Managers At time of campaign New data reporting form designed and sent to all employers to be G form in CICT folder responsible for returned to NJ to upload data onto ImmForm wesbite Occupational Health Curent Nov uptake is 19.2% KP to write again to independant vaccination contactors Training package complete, training arranged in Septemebr and December Training material Helen Fabrizio Sept Managers need to identify staff and book on training course, available on CICT G advertised on L & D web page network drive Immunisation Training Managers responsible for Check previous immunisers are still able to immunise Occupational Health N/A and remain competent vaccination Employer responsibility. Judy Jones confirmed they are currently storing 19 boxes of 50x10 dose vials of Pandemrix Nicola expiry date 9/2011. Agreed that swine flu specific vaccine supply a G Jepson/Pharmacy/ relatively small issue. Check vaccine supply re swine flu specific vaccines MCH vaccine supply is taken from the Occupational Health supply. Supply is based on demand for last year. Issues regarding supply of new seasonal flu vaccine Ann to update Bethan on vaccine and consumable supply and N/A Consumables will also need ordering especially delivery issues anaphylaxis packs as they need ordering in advance Also cover in employers letter. Designated Leads / pharmacy Identifying overall leads. Planning for provision of suitable G vaccination service for: Access to vaccination is the key issue to be considered again next year. 12B n/a 12B n/a Suggested the designated vaccine lead to be Bethan Abbott-Jones? Two new staff groups will be targeted this year: Consultants and HVs A District Nurses Due to operational capacity in MCH all MCH staff will be vaccinated via Occupational Health in UHSM and PAT Trusts. HCW staff uptake is still very low. Special clinics finished but staff can still have the vaccine by appointment only at occ health. Acute trust staff have done peer to peer Bethan Abbott-Jones MCH and have had a good response to this. General Practices Letter sent to empolyers in October, letter provides general briefing information about seasonal flu vaccination and as NHS Manchester is Copy of data required to inform the Department of Health of the number of seasonal flu reporting form in G immunisations given to all healthcare workers employers are to provide CICT folder the necessary data GPs HCS staff uptake also low, staff are vaccinated via occ health in the LA, G Nathan Atkinson (Manchester City Council) Aug-10 not collecting data however (no requirement to do so) 13. HPV vaccination Area Lead: Eleanor Roaf Overall Aim: to meet Vital Signs target for HPV vaccination Additional resources needed - if resource Current Situation Recommendation Person responsible Action(s) needed Target date Evidence of completion RAG status issues are a (Give dates) significant barrier Confirmed by Child JM Send out and finalise school schedules Jul-10 None Confirmed G Health Confirmed by Child JB Send out consents Aug-10 None Completed G Health Collate response and put together information for school Confirmed by Child JB Aug-10 None Completed G nurses Health Confirmed by school BY Commence immunisation programme Sep-10 None To start Sept G nurses n/a BY Provide update on first dose uptake End Oct 10 None n/a First dose coverage data A Consider uptake and make recommendations for any Action plan; minutes of HPV group Early Nov 10 None n/a A remedial actions HPV group Second dose coverage BY Provide update on second dose uptake End Nov 10 None n/a A data Consider uptake and make recommendations for any Action plan; minutes of HPV group Early Dec 10 None n/a A remedial actions HPV group Futher actions to be described in the light of the December Progress against action HPVgroup Unclear None n/a Pending remedial actions required. plan; coverage data 14. Teenage booster vaccination Area Lead: Bernadette Dean Overall Aim: to meet Vital Signs target for school leaver booster vaccination Additional resources needed Person Evidence of RAG Recommendation Action(s) needed Target date - if resource issues are a Current Situation responsible completion status significant barrier School Planning n/a BD Book dates for Year 10 vaccinations 17.12.10 (number) schools have dates booked A data base 14A Imms team N n/a PW Development of "catch up" database Mid november Ongoing A Drive Ongoing Confirmed by n/a JB Send out consents dependant on Ongoing A Child Health date of session Ongoing Confirmed by n/a JB Collate response and put together information for school nurses dependant on None Completed G Child Health date of session Confirmed by n/a BD Commence immunisation programme 18.11.10 Ongoing G Immunsiation team Ongoing Admin support for Confirm by 14B n/a BD Inputting of uptake into "catch up" database to generate action plan dependant on Ongoing A immunisation team immuniation team date of session Arrange meetings with appropriate School Personnel for Whalley Range High School and Appointments Withington Girls School regarding pilot of "pupil post" for delivery and return of consent n/a BD to be organised Appointments made for 10th and 21st January G forms for SLB sessions in order to encourage higher return of consent forms prior to for new year immunisation sessions. n/a BD Arrange with 2 pilot schools dates for SLB End Jan 2011 Dates will be arranged at meetings A Confirmed by n/a BD Provide coverage data for those schools completed Mar-11 Not available as yet A Child Health Discarded recommendations Recommendation HCNA or NICE or DH? Number of times chosen Number of times discarded Rationale for discarding If children and young people are not up-to-date with their vaccinations, school nursing teams, in conjunction with nurseries and schools, should explain to parents why immunisation is important. Information should be 41. NICE 5 1 Already routine practice provided in an appropriate format (for example, as part of a question and answer session). School nursing teams should offer vaccinations to help them catch up, or refer them to other immunisation services. Monitor the age composition of the practice population so that there is This is work already undertaken by 39. NICE 2 5 enough capacity to provide timely immunisations. general practices. Develop a Failsafe team modelled on the Failsafe team in the Heart of Birmingham. The team will regularly identify specific groups who are Considerable funding required which is outstanding for a certain immunisation, and then seek to resolve their 11. HCNA 4 4 unlikely to be available. status by data reconciliation, arranging appointments and possibly domiciliary immunisation. Health professionals should record the mother’s Hepatitis B status in the personal child health record as soon as possible after the birth, Felt to be clinically inappropriate because before the midwife hands over care of the baby to the health visitor. The 47. NICE 0 4 of issues regarding confidentiality of mother’s Hepatitis B status should also be entered on the child’s record mothers' medical status. in the local Child Health Information System. Ensure young people fully understand what is involved in immunisation This is already being undertaken by so that those aged under 16, but considered sufficiently capable, can 36. NICE 0 4 school health. give their consent to vaccinations, as advised in the ‘Green Book’.
"Imms Action Plan v9"