Imms Action Plan v9

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Imms Action Plan v9 Powered By Docstoc
					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’.

				
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