The Health Overview and Scrutiny Committee met to discuss routine immunisation in Worcestershire, and to review their work programme. The committee heard that Worcestershire has a high level of population protection against vaccine preventable diseases, but it is important that uptake is maintained or improved, and that vaccinations are a key part of NHS winter planning and resilience. The committee agreed to send a letter thanking the presenters for their attendance, requesting comparable data around similar councils, and setting objectives to be achieved in the next 12 months.

Routine Immunisation

The committee received an overview of routine immunisation from Ash Banerjee from NHS England, Matthew Fung, Consultant in Public Health at Worcestershire County Council, and Will Taylor.

Mr. Banerjee explained that vaccinations are a way of protecting people from getting vaccine-preventable diseases, and are considered to be the second most effective public health intervention after clean water. He noted that during the pandemic, there was very little mixing of individuals, which meant that most vaccine-preventable disease case numbers fell dramatically. However, protection is going, and people are asking more questions about vaccinations, which is causing concern that vaccination rates will fall.

Mr. Banerjee outlined the routine programmes offered to children, pregnant women, and older adults, some of which are seasonal, and some of which are offered all year round. He noted that Worcestershire has been quite well protected from the decline in vaccination rates seen in other areas of the country, and that the level of recovery in Worcestershire is higher than most other areas.

Mr. Banerjee explained the concept of herd immunity, and the importance of getting high uptake to protect not only yourself, but also others, especially those who are immunosuppressed and cannot have live vaccines themselves. He also spoke about vaccine hesitancy, and the three 'C's of hesitancy: confidence, complacency, and access.

Mr. Fung spoke about reaching areas of unmet need, and facilitating those populations to obtain vaccinations and to remove any barriers that may exist. He noted that last year, the council ran an MMR pop-up campaign in local libraries, which resulted in around 160 children being vaccinated, and that they plan to repeat that program of work this year.

Mr. Taylor noted that Worcestershire is one of the best performing counties in the country in terms of vaccination rates, and that one of the factors that helps is that Worcestershire has some of the highest satisfaction with GP services in the country. He also spoke about widening access, widening hours, and widening the availability of vaccinations, especially in some of the underserved communities.

Dr Lisa McNally, Director of Public Health, stated that while Worcestershire is doing well, relatively speaking, it is important to keep pushing the ambition higher, and that it is important to work with community groups and schools to advocate for vaccination.

Councillor Karen May, Chair of the Health Overview and Scrutiny Committee, asked how Worcestershire is going to influence the surrounding areas to get their immunisation rates up, and what actions are proposed to make sure that more people go and have their flu vaccination and COVID vaccination in the coming autumn.

Dr McNally responded that the council is working with specific communities on a range of public health matters, including vaccination, and that they are working with schools, the Gypsy Roma Traveller community, and other communities to get the right messaging out and make it as easy as possible for people to uptake vaccinations.

Councillor Tom Wells, Chair of the Overview and Scrutiny Performance Board, asked whether it might be possible in future to create a suite of data that compares Worcestershire with comparable councils and counties, and how the council is actually going to work collaboratively to get out to the hard-to-reach groups to encourage and improve immunisation in those areas, and what targets they may set.

Dr McNally responded that the council has a clear ambition to push the percentage up, and that they are not being complacent. She noted that the council is working with schools, setting up pop-up clinics, working with prisons, working with universities, and working with gypsy, roman, traveller groups to get people vaccinated.

Mr. Fung added that the council also has Your Health, Your Wellbeing vans that take vaccination and other health care directly into deprived neighbourhoods and communities.

Councillor Christine Wilde raised the issue of social media and the spread of misinformation about vaccines, and asked whether this is considered a barrier to messaging.

Dr McNally responded that the council faces an everyday battle against people who will take advantage of people's fear to boost their own profile or just generate some attention for themselves, but that the council is up for that battle.

Councillor Mel Fordington asked how the council is going to be bringing the catch-up plan into scheduling, and what they are going to be targeting as in schools and things like that.

Mr. Banerjee responded that the council has developed improvement plans in the areas of school age immunization teams, and delivery through GP practices, and that they are going to review the consenting process and go through the whole process from when you are invited, have schools work with you, and understand how different teams across the region do that.

Councillor Bakul Kumar asked about the Your Health bus, and whether all the councils need to know when they are coming in their areas, and whether that can be publicized further. He also asked about the role of public health in showing that COVID vaccines are important for vulnerable groups, and how they can promote it rather than say it's okay if you want to take it or not.

Mr. Fung responded that Your Health provides a wide range of different services, vaccinations and health checks and blood pressures and point of care testing lots of different things, and that they use different ways of promoting when they're going to different areas, including an online calendar for professional organizations to access and to request as well on the internet for them to come to certain areas.

Mr. Taylor added that a vaccination event shouldn't be an event in isolation, and that it's really important that the council offers value, so when people come to have their vaccination they are also talking about what's happening with your blood pressure or you need to put in for that health check.

Councillor Andy Fry asked to see the numbers for Redditch, and whether this district is lower than that, and what is being done about it.

Mr. Banerjee responded that unfortunately, that is actually quite difficult because of the national systems for collecting vaccination data, but that they are getting better, and that they will hopefully soon have much better MMR data.

Councillor Peter Turner asked how the council can reach religious groups that are very apprehensive about injections and various other things.

Mr. Banerjee responded that it's not about necessarily scaring people, it's about what we know is that if you don't want a vaccine and you feel very kind of hassled and pressurised to have it, and the facts that you're given you feel aren't honest, then actually that messaging doesn't work.

Councillor Wilde asked how the council deals with the fact that there are a lot of practitioners in the complementary medicine area that are very anti-vaccine and they promote it very strongly and they're very convincing.

Dr McNally responded that a lot of those who put a lot of effort into telling people that vaccines are dangerous usually have an alternative to sell, and that she would always say a lot of this is about following the money.

Councillor Fordington asked why it cannot be advertised more that you are actually sort of putting, you know, whatever you're putting out as a message across whenever you're actually opening up social media they can actually see that the next MMR is actually available.

Councillor May stated that she would like to invite the presenters back in 12 months and ask them if they could have some comparable data around similar councils, county councils and the West Midlands where Worcestershire sits within the West Midlands, and also the objectives that have been achieved in this coming 12 months.

Simon Adams from Healthwatch stated that he would have been interested to talk to them about the take-up of the flu and COVID vaccination and particularly the COVID vaccination within the NHS last year, and whether or not that presents an opportunity to do some research around why people with a captive audience, if you like, a controllable audience as to why people might not take the vaccine.

Councillor Wells suggested that Councillor May send a note on behalf of the board thanking the presenters but also making the point about wanting Worcestershire figures compared with like for like rather than the West Midlands, and asking what they are going to do differently to get to the sort of benchmark they're looking for.

Councillor Turner suggested comparing Worcestershire with international figures rather than just within the UK itself.

Councillor Fry stated that he would like to bring Abbeydale and Lakeside and Batchley and Woodrow up to the Worcestershire average, and asked how to do that.

Councillor Kumar stated that the council needs to learn from public health to say comparative data of exactly what they have in Redditch, vulnerable groups, and how they are being targeted and how they are being educated in Birmingham, and take that as an example and put it towards Redditch quite rightly for the disparity.

Work Programme

The committee then discussed the work programme for 2025/26.

Councillor Turner stated that access to GP appointments should be at the top of the list, because that's going to affect the vast majority of people.

Councillor Kumar stated that GP access and appointment systems is a major issue, and that same day access, digital versus in person balance, and patient satisfaction on that should be discussed. He also stated that emergency care pressures, out of hours and urgent care, and delayed discharge and hospital flow should be discussed.

Mr. Adams stated that Healthwatch is planning to talk to GPs through their patient participation groups about how they see the access at their public participation groups and how they've actually achieved those improvements, and that they are also looking at the rehabilitation pathway in Worcestershire.

Councillor Wilde stated that the administrative side of things impacts on people, and that she would like to know how they're handling it and how they're going to improve it. She also stated that the power of the lived experience should be heard, and that the committee should find a way to let that voice be heard.

Councillor Wells suggested that Councillor May have a discussion with Mr. Adams because in terms of Health Watch he comes to the meetings, he's always incisive and helpful in terms of his contribution, but he wondered whether they're getting the best out of him, whether there's more that he can deliver for them if they only were to ask, and in that zone he's thinking about articulating the experience from a patient point of view even with maybe one or two examples so that they can triangulate what they're hearing at the top level with what's actually happening on the ground.

Councillor Harrison stated that for October, the pharmaceutical needs assessment and the pharmacy first system should be rolled in together, because the pharmacy first system relates to a limited number of complaints and it's supposed to be part of the system to reduce GP's workload.