National Immunisation Programme

Lord Allan of Hallam Excerpts

Thursday 18th January 2024 Grand Committee

[Lord Allan of Hallam (LD)]

My Lords, I am extremely grateful to the noble Baroness, Lady Ritchie, for both the opportunities she has provided us with to debate vaccination this week. The bulk of my remarks will follow closely the comments made by the noble Baroness, Lady Twycross, but first I want to follow up on the RSV Question yesterday. The Minister’s Answer made me rather more nervous than reassured. I asked who was going to be responsible for the RSV vaccination programme and he described a landscape in which there are different teams dealing with infants, children, old people and so on. I do not want to be mean to the Minister because I know he is struggling through a cold while turning up to debate these issues and I am hesitant to correct him, but I wonder whether the correct answer actually is that Steve Russell, the chief delivery officer of NHS England and the person responsible for vaccination screening, is the person whom we should praise if the RSV programme is rolled out well or hold accountable if it is not. It seemed to me as I looked at it that Steve Russell may be the name I was looking for as the single responsible owner for that programme.

In terms of my broader comments, there are three areas that I want to touch on. The first is access to vaccination and immunisation records where any individual wants to understand what they or their children have had and where the gaps are. This still leaves a huge amount to be desired. Again, we saw an example during Covid of how this can work well. Everybody had an immediate interest, not least related to travel and access to facilities, in getting hold of those records; we produced them in double-quick time, and they are still there today. However, if you go beyond that and try to find your broader vaccination and immunisation records, it is a mess. I went online to look for it and found Connected Nottinghamshire, which helpfully offered some advice. That advice is multiple screenshots saying go into the NHS app and click on “consultations and events” or “medicines” and various other routes through, and they all basically end up telling you to go back and ask your GP. That is a super inefficient use of a GP’s time.

We have done all this work with the NHS app—take-up was boosted dramatically though the Covid vaccination certificate programme, we have invested a huge amount in it, and we now have medical records accessible through it—but, unless the Minister can correct me, it seems that, in most of the country, if an individual says, “I want to see what vaccinations I have had and what is missing”, they will not be able to do that. There is no simple, straightforward way to do it. I hope that the Minister can talk about whether the Government have a programme to enable that to happen, as it seems a very basic and fundamental thing. Knowing that information can help to boost take-up rates, which is what we are looking for. If people can see the gaps, they are much more likely to try to fill them.

The other part of that is integration with other sources of vaccination and immunisation. Obviously, there are travel vaccines, most of which are, correctly, not offered by the NHS; they are seen as a voluntary thing that individuals should pay for. However, if they have paid for a travel vaccine, there is an interest for the individual and a broader public health interest to make sure that that is integrated into their medical records. That is not the case today. There may also be workplace vaccinations. A lot of workplaces offer flu programmes. Other noble Lords may have had this experience: I took up the flu vaccine here, at our workplace, and was then pinged every few weeks by a reminder from my GP practice to come in for a flu vaccine, and I would go back to it saying, “I’ve had it”, and it would say “We don’t know that you’ve had it”. There is clearly a lack of joined-up connection there. This year, I went to have it done by the GP just to make sure I did not get those reminders every week. If workplaces have gone to the trouble of putting in place vaccination programmes, the least that we could do is to integrate those into NHS records. There are models, such as Patients Know Best, that allow you to integrate your own personal health data, and I hope that the Minister can indicate that there is some work going on in government to make sure that we follow that kind of model and bring this all together.

The second area that I am interested in is around invitations to participate in programmes and how those information flows work. Again, Covid was a model of clarity: you knew what you were getting and why you were getting it. The invitations went out to people using lots of modern channels, which made it very easy. People learned the language of Covid vaccination—“Are you getting a Spikevax or a Pfizer?”—but it was a very rare and exceptional situation. If you look back at the norm, the norm is that it is very confusing. The NHS produces a nice chart of all the vaccinations that you will get, but it uses jargon and abbreviations. I understand why—those are the accurate terms—but, for an ordinary person coming across this, they really are not very clear about what they are getting, why they are getting it and why it is important for them.

Again, I do not think that this is just in the area of vaccinations. I cite my personal experience: I got a text message from my practice asking if I wanted to come in for AF screening. As I am a health spokesperson in this place, I thought “I should know what AF is”. I looked it up and it stands for atrial fibrillation. If it had sent me a message that said, “We want to check that your heart is ticking over as it should; please pop in”, it would have been a lot more attractive than one asking if I wanted to come in for AF screening. I think most people will not have bothered to look it up and decide whether they should have it. I hope that the Minister can say who is looking at both the language of and the distribution channels for all these invitations for vaccinations and immunisations to make sure that they are optimised. To people working in the tech sector, this is known as UX—user experience—and they understand that changing the language on something changes the click-through rate dramatically. Similar discipline is needed here to make sure that all the invitations to vaccinations and immunisations are optimised for the target audiences and make them as likely as possible to click and to go and get that vaccination.

There is a generalised problem with distribution channels in the NHS that each screening programme has its own systems for call and recall, and they are not co-ordinated or joined up. If we want take-up of screening, vaccination and immunisation, the least we can do is to join up those programmes, have consistency around language and channels and some kind of pattern and schedule so that people understand what they are being invited for and when. I hope the Minister comments on consistency and co-ordination.

The final area on which I will touch is that of risk. This again follows the comments of the noble Baroness, Lady Twycross, and this is critical to take-up. MMR showed us how this can go off course. People weighed a risk that turned out to be false against a genuine and much more significant risk of suffering from a real disease. The noble Baroness’s personal comments showed us just how important it is that people take up these kinds of vaccinations. The result was a situation in which children have been harmed and not benefitted, which is still ongoing today. There will be children catching measles now, some of whom will, sadly, have very serious complications, essentially because of a false assessment of risk: the risk of MMR against the so-called, supposed risk that people presented on the other side. In some ways, this is comparable to people switching to driving every time there is a train crash. The data is clear: the train is safer than the car at all times. People often react to a single incidence of a problem. With a vaccine, as we saw with Covid, there will be somebody who has a heart attack following a vaccination, but that does not mean that the risk of not having the vaccination is better than the risk of having it. It just means that one person, sadly, had a heart attack.

There is a lot to be done on communicating risk. We need continually to help people to understand the rationale for each vaccination programme, not just the new ones but existing ones, as MMR has shown. I would be interested in understanding what the Government are doing to address this challenge, particularly considering the different levels of trust that different messengers have. We all understand that doctors, for example, are far more trusted than politicians like us. Pharmacists have a very trusted role within the community. We need to think carefully about how we communicate risk and use the most trusted sources.

I again thank the noble Baroness, Lady Ritchie, for this opportunity, and I hope that the Minister will refer to the points I have raised, perhaps in writing, to spare his voice, if he cannot respond to everything verbally today.