In its report published today, the NAO finds NHS England has missed
the Department of Health and Social Care’s (DHSC) performance
standard for the uptake of nearly all pre-school vaccinations in
England in 2018-19. Uptake of nearly all pre-school vaccinations
has declined since 2012-13 and in 2019 the World Health
Organization withdrew the UK’s measles elimination
status.1 NHS England data shows regional variations in uptake
of vaccinations, with particularly low levels in London.
NHS England and Public Health England (PHE) have
identified several potential causes for the decline in pre-school
vaccination rates but cannot say which are having the greatest
impact, according to the National Audit Office
(NAO).
In July 2019, PHE estimated that around 90,000
children in England (1 in 7) had not had both doses of MMR at the
age of five. Current levels of uptake of the second dose of the
Measles, Mumps and Rubella vaccination (MMR) are 86.4%, below the
95% recommended by the World Health Organization (WHO) to give
herd immunity.
Most parents have confidence in vaccines. PHE
conducts an annual survey into the wider public’s and parents’
attitudes to vaccinations. This survey in 2019 found that 95% of
parents said they had confidence in vaccinations and only 3% had
refused one or more vaccine. NHS England and PHE are alert to the
need to emphasise the positive case for
vaccination.
Of the potential causes identified by NHS England and
PHE, no factor on its own explains the decline in pre-school
vaccination rates since 2012-13. NHS England and PHE do not know
the relative impact of each potential
cause. There is evidence that the 2013 health
system reorganisation in England resulted in fragmentation in the
way the vaccination programme has been delivered.
The way healthcare professionals remind parents to
vaccinate their children is inconsistent. Parents are contacted
to book an appointment through being called and recalled by
healthcare professionals. When primary care trusts were abolished
in 2013, NHS England took responsibility for commissioning
call/recall, but has not set out the requirements of GPs for
call/recall under the new arrangements. This has led to
inconsistencies in how the system works in different parts of the
country.
Some parents have reported finding it difficult to
access vaccination services due to the timing and availability of
appointments. There are also communities which are “under-served”
when it comes to healthcare, such as travellers, which may also
affect their vaccination rates.
Since 2018, NHS England and Public Health England
have been developing a plan to improve uptake of vaccinations.
NHS England is creating an MMR catch-up programme for children
aged 10-11 and published guidance in August 2019 for regional
teams on how to improve uptake of MMR vaccination. In July 2019,
DHSC announced that it would launch a new strategy on vaccination
by spring 2020 and the Prime Minister has since
requested it be brought forward to Autumn 2019.
- ENDS -
Notes for
Editors
-
Measles elimination status is awarded when there
have been no endemic cases for 12 months – that is the original
source of infection for reported cases was outside the UK and
then spread through the population in the UK.
