7 Summary and Conclusions
Introduction
Remit
To consider the implementation of the recommendations contained in the Aldridge Review of the seasonal influenza vaccination programme. In addition, as a consequence of this work, to make any associated recommendations for the management of the programme
7.1 In addressing its remit and drawing the many separate strands of this review together, all of the members of the Steering Group are conscious of its limitations and the expectations of the service in NHS Scotland. Along the way, the members of the Working Groups involved many service colleagues, and the Reference Group, which included patient representatives and frontline staff, have contributed willingly to the review process. Input from the UK Vaccine Industry Group ( UVIG) and experience from other UK countries have been take into account, including: the report of the Department of Health (England), Seasonal Influenza Programme published in 2007 and the use of letters of invitation to at-risk groups aged under 65 years in Northern Ireland.
7.2 While the main purpose of a review is to identify any omissions or weaknesses and to suggest possible remedies, it must also acknowledge achievements and build on existing strengths in order to strike a fair balance.
Acknowledging Achievement
7.3 The annual Seasonal Influenza Vaccination Programme is a massive public health endeavour of significant complexity, reaching out to more than one million Scots annually. It provides the offer of protection for what at best, is a nasty infection and at worst, a very serious and sometimes life-threatening or fatal illness. As well as the huge tide of human misery, morbidity and significant mortality, influenza places a heavy burden on in-hours and out-of-hours primary care services and serious pressures on hospital inpatient admissions.
7.4 For most of the time, particularly when sufficient supplies of the vaccine are ordered in good time, when there are no manufacturing delays and adequate quantities of the vaccine are distributed on a timely basis, the annual influenza vaccination programme could be regarded as one of the unsung 'success stories' of NHS Scotland. Increasingly, Government policy is reflecting the importance of health protection, anticipatory care and primary prevention of illness, particularly in vulnerable members of our society. As such, the seasonal influenza vaccination programme maps well to these aspirations.
7.5 Moreover, the programme engages almost every part of the NHS in Scotland and although activity is primarily focussed on the influenza season in the winter of each year, the successful implementation of the programme depends upon key milestones and outputs being met, as acknowledged in the Aldridge Review. It is to the great credit of the many concerned in this mighty endeavour that these milestones are usually met and that around 75% of Scots aged 65 years and over and a significant number of at-risk individuals under 65 years are being immunised each year.
Promoting Progress
7.6 Although in most years the programme proceeds smoothly, this is not always the case. The Scottish Government recognised this when they commissioned the Aldridge Review, primarily triggered by significant shortages and delays in vaccine supplies in the 2005/06. In addition to the failure of offering timeous and equitable protection to all target groups, vaccine supply difficulties cause significant disruption to the service, duplication of effort and necessitate countless re-arrangements of vaccination clinics in primary care. This can result in misunderstandings; unmet expectations; failed communications; and unhelpful friction within the service itself, and between the service and the general public.
7.7 The influenza vaccine manufacturing process operates to a tight time window and insuperable technical difficulties can and do sometimes arise which jeopardise the timely and sufficient delivery of supplies for the annual vaccination programme. However, these need to be mitigated as far as possible by enhanced and timely communications between the manufacturers, Government and the NHS in order to bring to bear effective pre-emptive actions.
7.8 In order to address these and other issues this report provides 24 main recommendations to support the implementation of the Aldridge Review and a number of other recommendations and considerations to be taken into account at all levels of the service.
Conclusions
7.9 This report is not the final word on the Seasonal Influenza Vaccination Programme. In making the recommendations contained in this report, we have done so, in the expectation that there will be continual and ongoing review of progress. In some cases this is explicit: in respect of the vaccine arrangements where we have recommended more work is done; and in the case of the new marketing campaign where we have clearly indicated the need for annual evaluation. In other cases this need for ongoing review is implicit, but no less important.
7.10 Throughout the process, we have striven to take account of the views of the many professional groups and stakeholders involved in delivering the Seasonal Influenza Programme. In moving forward, we suggest that a similar open and inclusive approach should be the guiding principle of related discussions and endeavours at all levels in the programme.
7.11 The work of all of the Groups engaged in producing this report has been, at times, intensive and complex. The commitment and diligence shown by all involved reflect the importance of the Seasonal Influenza Programme to the people of Scotland. Our aspiration is that the recommendations in this report will receive wide support throughout the service: securing consistently higher uptake rates of influenza vaccine in all at-risk groups of patients, personal carers and in both NHS and social care staff.