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Greater Manchester Health and Care Board

Date: 26 July 2019

Subject: Screening and Immunisation in Greater Manchester

Report of: Sarah Price, Executive Director Population Health and Commissioning, GMHSC Partnership

SUMMARY OF REPORT:

This paper provides a strategic overview to the Greater Manchester Health and Care Board on the screening and immunisation programmes available to citizens of Greater Manchester. It describes how these programmes are commissioned, why they are so important to the population, and their importance as key population health activities. Also highlighted is the continuing need to address the inequalities across the city region and the need to target and support specific groups to access the screening and immunisation offer available to them. Key activities for the 2019/20 year are described as well as what the impact of these is expected to be.

KEY MESSAGES:

Screening and immunisation are essential population health activities that save hundreds of lives and improve outcomes for thousands of Greater Manchester residents each year.

There are over 30 immunisation programmes and 11 national screening programmes that we ensure run effectively and safely across the City region. These programmes cover the whole life course, from before birth right the way through to the very end of life. Screening and immunisation programmes are some of the best value for money interventions we can do for our health and wellbeing. For example, not only can immunisation reduce the number of people who catch diseases, it can also reduce anti-microbial resistance by lowering the level of diseases circulating in the community so that we need to prescribe fewer antibiotics and antivirals to treat these illnesses. Screening can pick up early signs and symptoms of diseases, meaning that people are more likely to have treatment that is effective, or be able to make choices about their pregnancy which can lead to better outcomes for individuals.

Whilst the vast majority of people in Greater Manchester do access all of the screening and immunisation offer available to them, we know that there are still significant numbers of people who do not access screening or immunisation programmes. These individuals tend to be from specific population groups and so

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this creates health inequalities across the city region. For example, some ethnic and religious groups are less likely to have some vaccinations, and people with learning difficulties are less likely to access screening appointments. We need to address these barriers to ensure that everyone can understand the benefits of taking up this offer, and that people can access screening and immunisation no matter where they live in Greater Manchester. We therefore have developed a programme of key activities to address this.

Senior leaders have a role to play in promoting and supporting screening and immunisation activities. Whilst GMHSC Partnership lead the commissioning of these programmes, the system delivers them, with GPs, pharmacies, opticians, dentists, midwives, schools and school nurses, health visitors, district nurses, hospitals, NHS and Social Care staff and care homes, and many others playing their part in supporting uptake and ensuring these programmes are safe and effective. Everyone therefore has a part to play in helping us to improve the uptake and access to these programmes, so that we can truly improve the outcomes for the Greater Manchester population.

PURPOSE OF REPORT:

Provide an overview of screening and immunisation programmes in Greater Manchester and includes a high level summary of performance and actions required to improve uptake and reduce health inequalities.

RECOMMENDATIONS:

The Greater Manchester Health & Care Board is asked to:

Note the report and the performance data contained within;

Support the activities outlined to improve screening and immunisation uptake in Greater Manchester; and

Consider acting as senior strategic ambassadors for Screening and Immunisation programmes in Greater Manchester to help increase uptake and outcomes for the population.

CONTACT OFFICERS:

Jane Pilkington, Deputy Director of Population Health, GMHSC Partnership

jane.pilkington1@nhs.net

Siobhan Farmer, Public Health Consultant, GMHSC Partnership

siobhan.farmer@nhs.net

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1.0 INTRODUCTION

1.1. Screening and immunisations are some of the most effective and cost-

effective activities we can do to improve the health of the population.

1.2. There are currently over 30 national immunisation programmes and 11

national screening programmes in England. These are under regular review

to make sure that they remain cost effective and safe.

1.3. This paper provides a summary of the importance of these programmes for

the Greater Manchester population. It describes how they are

commissioned and monitored and what the key areas for improvement are.

The report concludes with a summary of the important role of a wide variety

of partners in ensuring screening and immunisation programmes reach their

full potential in Greater Manchester in order to benefit the population and

improve health and wellbeing for our citizens.

2.0 THE IMPORTANCE OF SCREENING

2.1. UK screening programmes are internationally renowned for their quality,

rigour and effectiveness. Population health screening programmes use tests

to check for early signs, symptoms or risk of disease in people who appear

healthy. If the test is positive, further tests are then needed to confirm the

diagnosis and course of treatment needed. The reason screening

programmes are so beneficial are because detecting diseases at early

stages means that people are more likely to have treatment that is effective,

or can receive advice and support to enable them to make choices about

further tests or treatment. This can lead to better outcomes for individuals

and reduce the burden of disease.

2.2. There are eleven national screening programmes in England across the

lifecourse (Appendix 1). These are:

3 cancer screening programmes (breast, bowel, cervical);

3 antenatal screening programmes - fetal anomaly screening programme; - infectious diseases in pregnancy (HIV, hepatitis and syphilis); - sickle cell and thalassemia screening;

3 newborn screening programmes - newborn and infant physical examination (eyes, heart hips and testes); - newborn blood spot (to check if the baby has any of 9 rare conditions); - hearing test;

Diabetic eye screening (checks for signs of diabetic retinopathy)

Abdominal aortic aneurysm (looks for potential weaknesses in the aorta)

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2.3. Whilst screening programmes have huge potential to save lives and improve

outcomes of treatment, these benefits have to be weighed against potential

harms of screening programmes. For example, because screening tests are

non-diagnostic, sometimes people are given a result that may suggest they

are at high risk of having the disease being screened for, which can cause

anxiety and concern whilst waiting for further tests. Similarly, sometimes

people receive a “normal” result suggesting they are at low-risk of disease,

when they may already have the condition. This can provide false

reassurance and sometimes means that the chance to diagnose and treat an

illness early is missed. An independent group called the UK National

Screening Committee uses a range of criteria to decide whether the benefits

of a screening programme might outweigh the harms. These

recommendations are then made to the NHS, who then need to identify

funding to implement programmes.

2.4. Screening programmes are regularly audited and reviewed to ensure that

the risk of harms to patients remains low. Incidents in screening

programmes do occur from time to time, and these are reviewed by the

providers of the programmes, and by local screening and immunisation

teams (see below), and the Public Health England Screening Quality

Assurance Service (SQAS). These mechanisms ensure that there is a

continuous cycle of improvement across the programmes and lessons learnt

are shared nationally and used to improve the quality of care for all those

accessing screening programmes.

3.0 THE IMPORTANCE OF IMMUNISATION

3.1. There are now over 30 immunisations in the UK that cover the lifecourse

from before birth (e.g. when mothers are vaccinated against pertussis to

protect their unborn child from getting whooping cough in the first few

months of life) to protection against flu, shingles and pneumococcal disease

in later life (Appendix 2). Many vaccines are universally offered, but some

are offered to specific risk groups (e.g. babies at greater risk of tuberculosis

(TB) infection) or given to individuals with specific medical conditions (e.g. flu

for adults with diabetes).

3.2. After clean water, vaccination is the most effective service intervention in the

world. It is also cost effective, with estimated annual savings to the NHS per

year from reduced flu treatment alone totalling over £30 million. The first

vaccine was invented in 1796, and since the 1920s when commercial

production became more possible, vaccines have saved millions of lives. It

is estimated that the measles vaccine (introduced in 1968) has averted 20

million cases of measles and 4,500 deaths. More recently, the rotavirus

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vaccine, introduced in 2013, has reduced hospital admissions for this

infectious stomach illness down by 80%

3.3. The vast majority of individuals can be safely given vaccines. However,

some people with specific medical conditions, the very young, or the very

elderly may not be able to have some immunisations. It is therefore

important to ensure that a high proportion of individuals are vaccinated so

that it becomes much more difficult for infectious diseases to spread

because there are fewer people who can be infected. This is called ‘herd

immunity’ or ‘herd protection’ and is important to stop diseases passing

between people and protects the more vulnerable in our communities. In

addition, fewer people with the disease means that we can reduce the

amount of drugs we use to treat disease, and so can help to prevent

microbes from becoming resistant to treatments (anti-microbial resistance).

3.4. Vaccinations are incredibly safe medical interventions with very few side

effects. Unfortunately, negative news stories with inaccurate information

about the possible effects of vaccination can impact upon people’s

willingness to be immunised against disease. It remains an ongoing

challenge in Greater Manchester to challenge myths and misconceptions,

and we work in partnership with all stakeholders to do this. Early this year,

Public Health England developed the #ValueofVaccines campaign that

aimed to educate the public and professionals about vaccines. These

resources are available on request.

3.5. New vaccines are developed all the time. The Joint Committee on

Vaccination and Immunisation reviews the evidence for the effectiveness of

these vaccines and suggests to the Department of Health which ones would

provide value for money. Not all vaccines are automatically implemented, as

there needs to be funding and a way to ensure that people can access the

vaccine put in place too, as well as the benefits needing to outweigh the

costs.

4.0 HOW SCREENING AND IMMUNISATION IS COMMISSIONED &

DEVILVERED

4.1. The responsibility for ensuring that screening and immunisation programmes

are commissioned is set out in the public health functions agreement listed

under Section 7A of the 2012 Health & Social Care Act (sometimes referred

to as “S7a services”). There is an annual agreement between the Secretary

of State and NHS England to commission these services. All programmes

have a national service specification that should be implemented locally.

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4.2. Under the GM devolution agreement, the Secretary of State has delegated

the NHS England S7a responsibilities to the Chief Officer of the GMHSC

Partnership. This function is delivered on the Chief Officer’s behalf by the

Public Health Commissioning team within the directorate of the Executive

Director for Population Health and Commissioning.

4.3. Public Health England offer expert advice and support at national and local

levels for both screening and immunisations. For GMHSC Partnership, a

dedicated, embedded Screening & Immunisation Team works closely with

the Public Health Commissioning team and providers. This team provides

support and advice on routine immunisation queries, supports the PHE

Health Protection team when outbreaks of vaccine-preventable disease

occurs (e.g. the recent GM measles outbreak) and advises and supports

investigation into safety and quality incidents.

4.4. Delegation of Primary Care commissioning (General Practice) to localities

means that Clinical Commissioning Groups also have a role to play in

supporting screening and immunisation performance and GMHSC

Partnership staff work closely with them. A national NHS England team also

directly commission some aspects of screening and immunisation (e.g.

cervical screening invite letters, flu vaccine stock).

4.5. Local Authority Directors of Public Health (DsPH) also have a key role in

assuring locality leaders that screening and immunisation programmes are

effectively commissioned and delivered and providing good value for money.

DsPH also support communication of key messages and support the

response to incidents.

4.6. Providers of screening and immunisation programmes span a large

proportion of the Health & Social Care system. Whilst some staff are

specifically employed to deliver some programmes (e.g. breast screening

mammographers, sonographers for antenatal programmes, bowel screening

colonoscopists), many functions are carried out as part of wider roles.

Examples include opticians (diabetic eye screening), GPs (immunisations,

cervical screening tests), school nurses (immunisations), midwives and

health visitors (delivering/supporting antenatal and newborn programmes,

pharmacists (flu vaccine, promoting uptake), and care home staff (e.g. being

vaccinated themselves, or supporting residents to be vaccinated).

4.7. Footprints for screening services are not always the same as GM

boundaries, making reporting and commissioning oversight complex. For

example, Stockport breast screening services are part of the East Cheshire

Breast Screening programme and therefore are commissioned by

colleagues in Cheshire and Merseyside; similarly, GMHSC Partnership

commissions the South Lancashire Breast Screening Service which covers

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Wigan, Wrightington, Leigh and South Lancashire residents. Over time, this

will be reviewed as part of new commissioning arrangements for specialist

services develop.

5.0 MEASURING SCREENING & IMMUNISATION PERFORMANCE

5.1. Immunisation is measured by looking at the number of people who are

eligible for each vaccine and working out how many people are then

immunised. Screening programme performance is also measured in terms

of uptake1, but also coverage2. As screening programmes are delivered

based on the GP practices patients are registered to, these figures do not

always match with Local Authority boundaries.

5.2. Data on uptake and coverage of screening and immunisation for people

living in GM are published annually by Public Health England. We are

working with information governance colleagues to allow greater sharing of

data among partners to enable more timely and in depth understanding of

uptake, coverage and inequalities of screening and immunisations.

5.3. Performance is reported on each programme at individual screening

programme boards (antenatal and newborn covers 6 programmes,

immunisations is under 1 board). These operational boards have system-

wide representatives and look at performance data, new programme

developments, challenges and barriers and sharing good practice. They

report into the quarterly Greater Manchester Screening and Immunisation

Oversight Group chaired by the Executive Director for Population Health and

Commissioning. This group is currently reviewing its terms of reference to

continue to ensure it is fit for purpose in the GM system.

5.4. Performance and/or safety and quality issues are reported to the GM Cancer

Board, the GM Quality Board, Performance and Delivery Board, and to the

GMHSC Partnership senior leadership as appropriate. Often these data are

included as part of other reports (e.g. immunisation uptake in children might

form part of a wider report about Children’s Services outcomes). There is a

need to ensure that as the Joint Commissioning structures continue to

1 Uptake is defined as the proportion of eligible people who, having been sent an invitation for screening, attend a screening unit and undergo screening within a given period of time.

2 Coverage is defined as the proportion of eligible population (at a defined point) screened within a given period of time e.g. for cervical 3 years/ 5 years.

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develop, that the relevant groups receive the appropriate level and depth of

information to enable ongoing improvement across Greater Manchester.

5.5. Regular contract monitoring meetings are also held between commissioned

providers and the GMHSC Partnership Public Health Commissioning and

Screening & Immunisation teams to review key performance indicators and

promptly deal with any quality and safety issues. Escalation of any ongoing

or significant issues is via the Deputy Director for Population Health.

6.0 SCREENING AND IMMUNISATION UPTAKE IN GREATER

MANCHESTER

6.1. The scale of impact of screening and immunisation is significant (Appendix

3). For example, in Greater Manchester in 2017/18:

Over 700,000 seasonal flu immunisations were delivered

Over 33,000 2 year olds completed primary immunisations

Over 33,000 5 year olds completed immunisation boosters

Around 34,000 5 year olds had 2 doses of MMR

Over 13,700 12 year old girls received 2 doses of HPV vaccine

Over 35,000 births and over 175,000 associated ANNB screens per year

Over 128,000 bowel screens per year3

Over 155,000 cervical screens per year

Over 74,000 breast screens per year4

Over 100,000 DESP screens per year

Nearly 12,000 AAA screens per year

6.2. Performance compared to both England overall and other regions is good for

immunisation programmes. Childhood immunisations (except for rotavirus)

across the whole of Greater Manchester are above the national average

(Figure 1). For seasonal flu, in 2018/19, Greater Manchester was the

highest-ranking region for uptake in the over 65s. However, adolescent

immunisations (e.g. HPV and Meningitis ACWY) are below the national

average for uptake (Figure 2).

3 Kits returned over financial year 4 Includes parts of South Lancashire

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Figure 1: Childhood Immunisation Uptake in GM (2017/18)

Figure 2: Routine Adolescent and Adult Immunisation Uptake in GM (2017/18)

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6.3. Screening uptake (Figure 3) however is a mixed picture. Whilst cervical

screening uptake is similar to the national average, we know that nationally

and in GM fewer women are being screened than at any point over the last

twenty years. Breast, bowel, diabetic eye and abdominal aortic aneurysm

screening uptake are all below the England average (Figure 3).

6.4. Antenatal and newborn screening programmes, perform very well in Greater

Manchester with programmes at or close to the national average. There are

many key performance indicators over 6 programmes. Examples of these

are shown in Figure 4. Whilst uptake and coverage are generally good, we

know that there is a need to improve the timeliness of screening and to

address onward referral capacities so that mothers and babies can access

the support they need.

6.5. It is important to note when interpreting all screening and immunisation data

that Greater Manchester as a region is growing faster than many parts of

England, and so using percentages can mask the additional numbers of

people that need to be screened just to maintain current performance. It

also needs to be noted that uptake can vary year on year and analysis of

trends over time is also essential to understand screening and immunisation

performance. This detail is now more readily available through the locality

reports that have been developed by the GMHSC Partnership team and

there is an aspiration that this will be available on the visualisation software,

Tableau in the coming months.

Figure 3: Adolescent/Adult Screening Uptake in GM (2017/18)

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Figure 4: Antenatal and Newborn Screening Uptake in GM (2017/18)

6.6. As with most Health and Social Care data presented at the Greater

Manchester level, these high-level figures do hide health inequalities across

the localities within the city region. Uptake varies between locality footprints,

but also within localities themselves, often (but not always) with uptake being

lowest in areas of highest deprivation. We also know that certain groups are

less likely to access the offer of screening and/or immunisation. This

includes specific ethnic or religious groups, the LGBT community, and those

with learning disabilities for most of the screening programmes. There also

needs to be consideration of access for those with disabilities, mental health

issues, and other social barriers such as homelessness or the prison

population. In addition, there are groups with specific requirements that

need sensitive consideration, such as pre-operation transgender men who

will require cervical and breast screening. All programme groups consider

these issues and develop plans to address such health inequalities.

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7.0 FUTURE DEVELOPMENTS TO IMRPOVE SCREENING AND

IMMUNISATION

7.1. Recognising the need for the way we commission and performance manage

services in Greater Manchester for both screening and immunisation

programmes to keep pace with wider system architecture changes in

Greater Manchester, the GMHSC Partnership team has been reviewing its

ways of working. Key to achieving better uptake across all programmes will

be developing a shared responsibility across all stakeholders. Actions

include:

Participation and involvement in the Future of Commissioning review in Greater Manchester, and actively ensuring that screening and immunisation (Section 7A) services are considered in this context. This has included seeking legal advice on potential delegate some services and exploring possibilities for neighbourhood level commissioning of e.g. cervical screening and flu vaccination.

Reviewing of the health inequalities in screening, and intention to develop a strategy for Greater Manchester, accompanied by a locality plan for each area.

Reviewing data sharing agreements to allow better intelligence on cancer screening to be used by all stakeholders to improve uptake and coverage

Realignment of the Screening and Immunisation team work to ensure greater engagement with locality teams especially with colleagues working on quality in the CCG and in public health in localities.

Attendance by the Screening and Immunisation lead at GM Cancer SMT and at GM Directors of Public Health groups to ensure alignment and communication of progress and challenges in the system.

Review of the reporting arrangements for cancer screening performance

7.2. The GMHSC Partnership team reviews performance across the screening

and immunisation programmes and focusses on key activities to improve

uptake. Due to the range and number of programmes, it is sometimes

necessary to concentrate efforts on specific screening or immunisation

programmes to ensure that focussed action leads to real impact and change.

Appendix 4 presents some of the key activities being undertaken in 2018/19

to improve screening and immunisation uptake in Greater Manchester.

7.3. Two national screening incidents in the breast and cervical programmes last

year have created increasing scrutiny of the cancer screening programmes

and current commissioning arrangements. The following reports have

been/will be published:

Independent Breast Screening Review (Nov 18)

National Audit Office: Investigation into the Management of Health Screening (Feb 19)

Public Accounts Committee: Adult Health Screening Inquiry (May 19)

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Sir Mike Richards: Review of Cancer Screening Programmes (due Sept 19)

The recommendations of these reports will be considered and implemented as part of our ongoing work to transform screening and immunisation services to be fit for the new system architecture that is developing across Greater Manchester.

8.0 STRATEGIC SUPPORT

8.1. We ask the Health & Social Care Board to note the significant range of work

to commission, implement and improve screening and immunisation in

Greater Manchester. As discussed, work is ongoing to improve these

programmes, and reviewing governance and partnership arrangements for

oversight and improvement of screening and immunisation in GM will be

essential.

8.2. The wide range of partners and stakeholders involved in screening and

immunisation in Greater Manchester highlights the importance of these vital

population health programmes. Senior leaders can support screening and

immunisation by acting as advocates for the uptake of programmes,

encouraging staff and the public to access the offer, and supporting the

GMHSC Partnership to address barriers and inequalities in screening and

immunisation programmes. This would help support the step change

needed to ensure that all residents of the city region can access and benefit

from these valuable and effective programmes that will lead to better health

and wellbeing for all.

9.0 RECOMMENDATIONS

9.1. The Greater Manchester Health & Care Board is asked to:

Note the report and the high-level performance data contained within;

Support the activities outlined to improve screening and immunisation uptake in Greater Manchester; and

Consider acting as senior strategic ambassadors for Screening and Immunisation programmes in Greater Manchester to help increase uptake and outcomes for the population.

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Appendix 1: NHS Screening Programmes Across the Lifecourse (England)

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Appendix 2: Immunisation Programmes

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Appendix 3: Greater Manchester Screening & Immunisation Numbers

Screened/Immunised in GM

Category Programme Actual (to Nearest

00s)

Target Actual (to Nearest 00s) Distance to

Target

Immunisations

Flu vaccination Flu - Over 65s 333,700 Target Exceeded + 3900

Flu vaccination Flu - 6mo-under 65 years in a clinical at risk group

203,200 209,000 -5,800

Flu vaccination Flu – All 2 and 3 year olds 33,000 35,000 -2,000

0-5 years

Immunisation

DTaP/IPV/Hib, By 1Yr 34,500 34,700 -200

0-5 years Immunisation

DTaP/IPV/Hib, By 2Yr 35,500 Target Exceeded + 500

0-5 years Immunisation

DTaP/IPV/Hib, By 5Yr 36,600 Target Exceeded + 600

0-5 years Immunisation

MMR, 1 Dose by 2Yr 34,400 35,000 -600

0-5 years

Immunisation

MMR, 2 Doses by 5Yr 34,200 36,000 -1,800

Immunisation HPV, 2 Doses 13,800 15,600 -1,800

Immunisation MenACWY 27,000 30,500 -3,500

Cancer Screening

Cancer

Screening

Bowel Screening Uptake - Kits Returned 128,800 130,700 -2,000

Cancer

Screening

Breast Screening Uptake 95,700 96,900 -1,200

Cancer Screening

Cervical Screening, those aged 25-64 years of age screened in a Year

157,900 Targets Set over longer time Span, Not appropriate here

Non Cancer Screening

Screening AAA Screening - Coverage of Initial

Screen

11,400 11,400 0

Screening Diabetic Eye Screening - Uptake of RDS 122,200 Target Exceeded + 6400

ANNB HIV Screening 40,800 Target Exceeded + 200

ANNB Fetal Anomaly Screening Coverage 2,800 Target Exceeded + 0

ANNB Sickle Cell and Thalassaemia Screening Coverage

40,800 Target Exceeded + 200

ANNB Newborn Blood Spot Screening 29,300 30,200 -800

ANNB Newborn Hearing Screening Coverage 28,700 29,300 -600

ANNB Newborn and Infant Physical Examination Coverage

25,900 27,300 -1,400

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Appendix 4: Greater Manchester Screening & Immunisation Improvement Activities

Screening Improvement Activities

Screening Programme Improvement Activity

Cancer Screening Bowel

The test for bowel screening will soon be changing from the FOBt test to the FIT test.

This is a more sensitive and easier to use test and so should increase uptake (modelling suggests by 7 percentage points) and numbers of cancers detected.

However, we need to ensure enough capacity for the associated increase in requirement for colonoscopies and pathology.

A task & finish group involving providers, CRUK, patient representatives and relevant clinicians and commissioners from across the colorectal pathway has been assessing readiness of GM providers to deliver FIT testing.

Consideration of FIT for symptomatic and how this might provide additional capacity.

There is a national aspiration to reduce this to 20 in time and reduce the age for bowel screening to 50, making it even more effective at detecting cancer early.

Breast

There has been ongoing work with the GM programmes to ensure programme quality this includes round length.

There is a national trial to examine the effectiveness of offering some women one extra screen between the ages of 47 and 49 and one between the ages of 71 and 73.

Insight work has been undertaken and we continue to work with stakeholders to identify opportunities for innovation.

Cervical

GM has completed its conversion of the testing of cervical screening samples to HPV primary screen (as opposed to cytology) ahead of many areas of England. This process means that fewer samples need to go to cytology for analysis, meaning that women helping to ensure that

women receive their results more quickly and reducing the need for further tests.

In March 2019, there was a large national campaign (Cervical Screening Saves Lives) that was run across multiple media channels for the whole month. Provisional figures show that the lab received an increase in samples of around 25% compared to March the previous year. The

campaign will be evaluated nationally.

Ongoing work to explore how cervical screening can be reintroduced into sexual health services in a safe and effective way. We are contributing to the national task and finish group on this.

We continue to identify opportunities for innovation and intend to further research potential interventions in the following areas e.g self-sampling for HPV; this involves women taking a

swab at home which is posted for analysis. Cross Cutting

Pharmacies in GM are signed up to deliver cancer prevention campaigns throughout the year. These include specific work on cancer screening.

The Cancer Vanguard enabled GM to test and implement innovative projects to gain insight into what might improve screening attendance. Lower uptake correlated to practices in the most

deprived areas. A Cancer Screening Engagement Service is now commissioned (a consortium of VCSE providers- Salford CVS, Voluntary Sector North West, 10GM and Unique Improvements). This will focus on improving access among specific populations e.g BME

communities, people with learning difficulties, and people of specific faiths. It will also continue to deliver the Cancer Champions programme moving forward. We are now using improved data to identify areas to support this team to direct where resources should be better targeted.

Working with providers to support them to employ patient navigators/cancer screening improvement leads to help follow up people who don’t attend for their screening appointments e.g. following a positive FOBt test in the bowel programme. We hope this will decrease numbers of people who then present as emergency admissions in the GM and improve

outcomes for these individuals.

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Screening Programme Improvement Activity

Antenatal and

Newborn Screening All trusts have had EQA visits in the last 2 years and have worked / are working hard to achieve

all of the recommendations made.

Raising profile / sharing best practice event has helped engage more senior / broader staff groups than just ‘screening lead midwife’

Improved attendances at local and GM board meetings

More open working relationships with all providers – better reporting of incidents, and early input and advice being sought

3 trusts now have failsafe officers in post to help run the day to day failsafes for all programmes. This has resulted in improved KPI’s, reduced stress and a more manageable workload for the screening lead midwives.

General improvements in many of the KPI’s over the last few years

Infectious diseases

Excellent coverage by all providers, very few declines and most will then accept screening later in pregnancy prior to delivery

Service improvements made by trusts where newly diagnosed Hep B / high infectivity were not being seen within allotted time frames – appears to now be resolved

Sickle cell & thalassaemia

Identified that some women do not present to maternity services in recommended timescales (some unplanned pregnancies, some cultural reasons etc). Work beginning with teams re

better births, to link in with GM website for maternity services to encourage women to refer earlier, and to access online screening information.

Fetal anomaly

Preparations with training have been completed for the national roll out of non-invasive pre natal testing (NIPT)

Newborn blood spot

Big improvements have been made by trusts in relation to avoidable repeats. Shared learning, training packages and tours of the laboratory have all helped towards this.

Newborn infant physical examination

Two trusts are still to implement mandated national failsafe (Smart4NIPE), however with ongoing support and actions taken by GMSCP team, have both agreed to implement and are currently working with the national team to identify timeframes – this should be completed by the end of the financial year.

Newborn hearing screening

Generally good performance by all providers. Ongoing work to improve staff resource available to programmes to cover when there is sickness and/or maternity

Diabetic eye This service has recently been recommissioned. Focus is on mobilisation of service and safe transfer of patients. Once this has been achieved, we will work with the provider on improving

uptake in this programme. The new provider has improved outcomes in all other areas in which they are commissioned

Abdominal aortic

aneurysm The programme has been commended recently on their patient engagement. The service has

improved based on feedback by service users and now offer a Saturday morning clinic, once a month.

Immunisation Improvement Activities

Immunisation Programme Improvement Activity

Seasonal influenza Plans for seasonal flu 19/20 season are well underway and include a clear strategic

focus on improving uptake of the vaccine in all 2 and 3 year olds and those aged 6

MMR Work is underway with GM PHE Health Protection team to implement the Measles and

Rubella Elimination Strategy (published earlier this year). This year, GPs will also

receive a £5 additional payment for vaccinating children aged 10 and 11 who haven’t

had their MMR jab.

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HPV HPV vaccination will now also be offered to boys in Year 8 as well as girls from

September 2019. Providers have agreed to implement this programme, and a

communications and engagement strategy is being developed, alongside an education

event for stakeholders in the Autumn. The GM Head and Neck Cancer pathway board

are also supporting the programme and a patient has offered to be a North West case

study for comms campaigns.

Men ACWY A recent research study (Fletcher et al.) using GM data has shown that schools where

there are a high proportion of children with English as a Second Language and/or BME

pupils have lower uptake of this vaccine. The Believe Achieve Trust have asked to

support some work to improve this vaccine uptake and will also support work in

Universities for young people who missed their vaccine at school.

Value of Vaccines PHE has developed a suite of materials called #ValueofVaccines to combat myths and

misconceptions about vaccines among the public. Insight has shown that health

professionals remain the most trusted source of information on vaccines, and work is

underway to support health professionals to give accurate and timely information to

people to help them decide about being immunised.