Vaccinations and Health Screening Services

Baroness Barran Excerpts

Tuesday 14th May 2019 Grand Committee

[Baroness Barran (Con)]

My Ladies—I like saying that rather than “My Lords”, so I will go for it—I echo noble Baronesses in thanking the noble Baroness, Lady Walmsley, for securing the debate and I thank noble Baronesses for their fascinating and well-informed contributions.

I want to take this opportunity to emphasise the Government’s efforts to promote the uptake of vaccines and health screenings. Keeping uptake rates as high as possible is one of our top priorities; we are constantly reviewing ways to do so. We are committed to ensuring that everyone who is eligible takes up that offer. The noble Baroness, Lady Finlay, reminded us of her friends and family members who have been personally affected by the absence of vaccination. Last night, I was talking to my noble friend Lady O’Cathain, who cannot be with us today; she remembered the introduction of the first polio vaccine when she was 10 in Dublin, but then arriving at university and seeing one of her childhood friends who had not had the vaccine suffer in the way the noble Baroness, Lady Finlay, described.

Overall, our routine vaccination programmes in England have a high uptake, with over 90% coverage for almost all childhood vaccines. In addition, more than 11 million people benefit from NHS screening programmes every year and record numbers of people receive life-saving NHS interventions. Local teams in the NHS work incredibly hard to make this happen and find out where improvements are needed. As well as to the work of the great NHS staff, I also pay tribute to the many charities that fight on behalf of those whose lives have been changed for ever by a range of diseases; for example, meningitis charities such as Meningitis Now and the Meningitis Research Foundation, and cancer charities such as Jo’s Cervical Cancer Trust, Breast Cancer Now, Breast Cancer Care and Cancer Research UK.

Although such programmes are promising and are core components of our health protection offer, there is still a lot to do, as noble Baronesses pointed out. There is still regional variation in our programmes—as seen between those in London and those in rural areas—room for improvement in providing services to underserved groups and, regrettably, a slow decline in both vaccination and screening coverage. We are continually taking action to improve uptake of these programmes. However, a number of complex factors need to be addressed. As the noble Baronesses, Lady Walmsley and Lady Hayman, pointed out, there are difficulties in accessing immunisation and screening services for some people. There can also be difficulties in accessing the right information on the benefits and safety of screening and immunisation. In certain areas, particularly London, we face population mobility and particular groups which are underserved. As has been quite fairly pointed out, the robustness of the IT that supports our screening and vaccination programmes is challenging.

Before I turn to those points, I will try to answer some of the questions that have been raised. The noble Baronesses, Lady Thornton and Lady Finlay, asked about herd immunity. There are different levels for different diseases. For measles it is 95%; the UK programme’s objective is obviously to reach 95% for most childhood vaccines. In 2018, when measured among children aged five—I appreciate that there are risks below the age of five—coverage for measles, mumps and rubella was close to this threshold at 94.9%, while coverage for the primary immunisations was above it at 95.6%. However, we are not complacent and Public Health England, together with NHS England, is working to reverse the decline that we have seen among some younger children. If I may, I will come on to talk about where we will capture the data under what we are doing to address IT.

The noble Baronesses, Lady Walmsley and Lady Hayman, talked about regional variations. We are absolutely aware that although our overall screening and immunisation rates are encouraging, there are differences in regional uptake, particularly in London. This is in part due to a transient population, which potentially results in GP databases becoming quickly out of date, and a younger population who may, understandably perhaps, feel that the risks they face are less great. We are doing a great deal to try to share information across different areas. If time permits, I will try to give a couple of examples of that.

A number of noble Baronesses talked about misinformation, including on social media—not only in this country but, as many of us heard on the news this morning, in DRC in relation to Ebola. There is a troubling rise in misinformation, as my noble friend Lady Bottomley pointed out. It is hard for us to be accurate about its impact but it is clearly negative, and clearly so across a number of countries; look at the trend in measles, not only in this country but in Europe and the United States. We are trying to counter this with our own social media campaigns and training for health professionals, which my noble friend Lady Wyld asked about. If I may, I will write to her with more details about the exact numbers for the training of health visitors and midwives.

A number of noble Baronesses asked about using our imagination, I think it was, in trying to find different ways of offering vaccination and screening. I will give one example of this in relation to cervical screening. There is now a partnership with the health and well-being app, Treatwell, which is to introduce conversations about the importance of cervical screening among 25 to 34 year-olds—one of the groups where take-up is very low.

I hear the concerns of the noble Baroness, Lady Thornton, about trust in doctors and nurses, but we have done a number of studies on this and believe that 93% of parents feel that the health professionals they work with give them accurate information. That confidence is crucial.

The noble Baroness, Lady Hayman, mentioned options around compulsory vaccination. She will be aware of the remark made recently by the Secretary of State that nothing is being ruled out. I felt she gave a helpful and interesting example.

The noble Baroness, Lady Finlay, talked about low levels of uptake of cervical screening. We share her concerns. My briefing advises that the HPV vaccination is now routinely recommended for all girls between 11 and 14 years old, so if I understood her rightly, that is a slightly lower age than she mentioned.

The noble Baroness, Lady Barker, raised a very valid point about getting information from people whom you can hear, so to speak, and it not being a matter of luck. There are charities, such as Jo’s Cervical Cancer Trust, which are training community champions so that someone who looks like you or me talks to you or me about cervical screening. She also talked about FIT testing. I think there may be a misunderstanding there. That is going to be introduced in this country in the summer of 2019. I hope that that is good news.

I am looking at the time. I have not even started my speech and I am running out of time.

The noble Baroness, Lady Walmsley, and other noble Baronesses asked what is happening to improve IT. It fits into two boxes. One is incremental improvements and the other is step-change improvement. The department is working incredibly hard to make sure that the end point we get to is the right end point. I shall give an example of incremental improvement. Work is going on with GPs to look at how they are incentivised to carry out immunisations and screening, including recall processes, reminders using text messages and being a bit more agile. In terms of a step-change, the beloved red book for children that many mothers in the Room will remember is going to be replaced by a digital red book. My noble friend Lady Wyld looks unhappy about that. I have still got my red books. That will be an important improvement in infrastructure. We are also developing a new IT system for cervical screening and breast screening.

I will have to write on the other points. I apologise that I was unable to cover them. They include the important issue of underserved groups.

I thank all noble Baronesses for their contributions; it has been a pleasure to respond to their questions. Although we believe that we should be proud of our successes in this country and of the public health benefits that our screening and immunisation programmes provide, we are absolutely not complacent and are working hard to improve these services for the future.