Vaccinations and Health Screening Services

Baroness Walmsley Excerpts

Tuesday 14th May 2019 Grand Committee

Asked by

[Baroness Walmsley]

To ask Her Majesty’s Government what plans they have to promote the uptake of vaccinations and health screening services.

[Baroness Walmsley (LD)]

My Lords—or perhaps I should say “My Ladies”, because all contributors to this debate are women—earlier this month the Public Accounts Committee in another place published a report about adult health screening. It commenced as follows:

“Health screening is an important way of identifying potentially life-threatening illnesses at an early stage. Yet the Department of Health & Social Care … NHS England and Public Health England … are not doing enough to make sure that everyone who is eligible to take part in screening is doing so, and do not know if everyone who should be invited for screening has been”.


I could not put it better myself, and this is a very sorry state of affairs when we know that timely health screening can save lives by early identification of disease, and save money by avoiding conditions becoming severe.

On vaccination, the other highly successful way of avoiding disease, it is clear that the NHS has been aware of its failure to meet targets for some time because paragraph 1.11 of The NHS Long Term Plan promises a review of GP vaccination records. My first question to the Minister therefore is: when will this commence and can she commit the DHSC to funding whatever is necessary to help GPs reach their target?

I turn first to screening programmes, of which there are 11. Four of them were considered in detail by the committee, none of which reached their targets, and there is unacceptable variation in different parts of the country. The committee concluded that the IT system used to identify the eligible population for screening has been unfit for purpose since 2011 but has still not been replaced. That probably means that the reach is even worse, because some people who should be called for screening are not being called. So my second question to the Minister is: what is being done to replace the IT system? The committee’s recommendation was that the department should find out why performance is poor in some areas and less so in others and then do something about these inequalities. Has the department set about doing that and is it going to make use of the large amount of data in the hands of local authorities, which could help?

When I first laid this Question for debate, I was concerned about the fact that only 71.7% of women eligible for a cervical smear were attending. Many years ago I worked in this service, so I have an interest in its success. Today things should be better because the treatment for symptoms has much improved. However, recent figures show that only one of the 207 CCGs meets the target of 80% attendance and that about half of women do not receive their results within the target time, despite the fact that the job I used to do is now done by artificial intelligence. This programme saves lives. It saves children losing their mothers. It saves suffering, and its cost-effectiveness is not in doubt. Why is NHS England not holding local providers to account for this poor record, as it has the responsibility to do? Of course we all hope that the administration of the HPV vaccines to girls—and very soon to boys too—will bring about a massive fall in this disease but, in the meantime, we need to do a lot better.

Breast screening—mammograms—also saves lives. The IT system that supports the breast-screening programme gives great cause for concern, yet the NHS plans to replace it only by 2020, three years later than planned, at a cost of £14 million. The state of the system undoubtedly contributed to the shambles in May last year when the then Secretary of State announced that 450,000 eligible women had not been invited for screening. The shambles was further demonstrated by the fact that the number turned out to be closer to 122,000. This caused a great deal of anxiety to women and who knows whether it contributed to any deaths. Will the Minister encourage her department to get a move on and replace this system with all haste?

Both of these screening programmes have suffered from a fall in attendances—a 21-year low in the case of cervical screening—yet it appears that none of the national health bodies has asked women themselves why they are not attending, offering instead platitudes about women having busier lives. This just will not do. In addition, there is a serious shortage of technicians to do the breast screening. What steps are the Government taking to address that?

I turn to health screening programmes for children. The Royal College of Paediatrics and Child Health sent a very helpful briefing, which emphasised the importance of the routine screening of children for height, weight, vision and hearing, and encouraged expansion of the national child measurement programme. In the light of the health inequalities in this country and the high proportion of overweight and obese children, these programmes are vital to ensure that each child gets a healthy start in life. Can the Minister answer two questions: what is the coverage of the national child measurement programme compared to its target, and why are children not also screened for dental decay, given the large number of children who have to be admitted to hospital to have teeth removed?

Vaccinations are the best way of protecting children and adults from serious and potentially fatal diseases. The routine schedule for babies—MMR, the six-in-one vaccination and the one for meningitis—is absolutely vital to protect each individual child, as well as providing herd immunity for the whole population. Failure to reach the desired immunisation rate resulted a few years ago in some serious measles outbreaks, for example in Swansea. The uptake of both doses of MMR has now decreased for four years in a row. Also, participation in the six-in-one vaccine was nearly 2% below the WHO target of 95% and has fallen for five consecutive years. These rates are not high enough to maintain herd immunity, according to the royal college.

A recent study of vaccination uptake among children linked lower immunity coverage with higher socioeconomic deprivation. Could the Minister say what is being done to address this? The royal college recommends that every contact between a child and a health worker should be utilised opportunistically to ensure he has had the full range of vaccinations. However, this requires a robust data collection system and interoperability between different parts of the digital health records. Could the Minister say how far we are from that being available?

The royal college believes that confidence in vaccinations is not falling but that the fall in numbers is instead attributable to a complex web of access to services, cost of travel, competing pressures on families, an ineffective system of reminders for parents, and workforce and resourcing pressures. What is being done to untangle this and get the numbers going up again? Are system-led changes being considered, or are we just using targets and pressure on hard-pressed GPs?

One important adult vaccination is the flu vaccination, which is available to all adults at a modest cost but is free to children aged over two, elderly people and other vulnerable people. In 2016-17, 16,000 people died of flu, yet many people with chronic lung disease are still not getting the vaccine. Compared to an uptake of 72.6% among other people aged over 65, just 50.8% of those with chronic respiratory conditions were vaccinated in 2017-18. This is another area where there is regional variation—the figure in Wales falls to 48.6%. Uptake among children from reception to year 4 varies significantly between NHS regions: from 47.8% in London to 70.7% in Wessex. My GP recently told me that last winter, she had to provide flu medication to a larger number of people than usual. Whether this was because fewer people were vaccinated or because it was a more virulent strain than usual, she did not know, but she was worried. What is being done to improve the coverage of flu vaccinations?

I would have liked to ask about bowel cancer and prostate cancer screening, but I fear there is no time. Instead, I end by asking the Minister when we will be getting the Green Paper on prevention. Will it contain proposals for flexible initiatives to improve the uptake of health screening and vaccinations, especially among harder-to-reach communities?