Implementing NICE

Implementing NICE Public Health Guidance for Childhood Immunisation

Public Health Guidance for Childhood Immunisation A low-cost community approach

Shane Mullen, Public Health Intelligence Analyst, North East Lincolnshire Care Trust Plus Emily Griffiths, PhD student, University of Sheffield Isobel Duckworth, Locum Consultant in Public Health, North East Lincolnshire Care Trust Plus

A low-cost community approach

Joanne Avison, Asgard Service Manager

Introduction Levels of childhood immunisation in some areas of the UK fall below levels required for herd immunity. Efforts to increase vaccine uptake protect not only the child, but also the health of their families, friends and the wider public. However, questions remain about the efficacy and costs associated with such efforts. We document an innovative low cost approach by proactively engaging with families using just five working hours per week. This supports NICE public health guidance on reducing the differences in childhood immunisation. The aim of this pilot project was to increase childhood vaccination in 1 electoral ward, East Marsh in North East Lincolnshire, England. 85 children up to 12 months old were identified as missing at least 1 vaccination.

Approach An outreach community engagement social enterprise Asgard, was commissioned and funded by North East Lincolnshire Public Health Directorate. An Asgard community worker was employed for 5 hours a week to contact parents of children who were known to her to have missed their scheduled immunisations. The Asgard worker made contact with their families and helped facilitate the children’s catch-up immunisations; this also aided better communications between the families and primary care services hopefully improving each family’s wellbeing.

Supporting the North East Lincolnshire region

Results During the first 3 months of the project 64 children had either begun or caught up their immunisation schedule directly because of the Asgard worker. This was achieved through informing families about the importance of vaccination or via one-to-one support in families that were leading chaotic lives. The initial project time frame was to run from December 2010 to March 2011, funding was secured allowing midpoint NHS band 4 workers to be in the community for 5 hours per week. Projected forward the worker costing for 5 hours per week for the ward per annum would be £3229.87. Comparing the two data extracts when broken down there were 21 children identified that re-appeared in the follow-up data extract, suggesting that the worker had an effectiveness of around 75% on childhood immunisation uptake in the area. The follow-up extract also showed that the net amount of children requiring immunisation within East Marsh fell from 89 to 59 which is a decrease of 30 children. This may suggest that the disseminated messages from the Asgard worker may have had an impact on overall vaccination rates.

Conclusions The project achieved its goal of improving childhood immunisation levels in the East Marsh electoral ward, this has long term benefits for the individual children and the wider community. A secondary benefit of the project was the improved engagement from the families involved in the study this also has the positive benefits for the children and family. The cost of the project combined with the cost of vaccines over the 3 months amounted to £2194, comparing this to an admissions cost estimate of £2713 which was based on the HRG code PA18B local tariff values, you can see that it is around 1/5 more cost effective to run the Asgard project than it is to treat the consequence in childhood admissions.

Case Study A family was identified by a GP practice where the child had failed to attend several appointments for immunisations. After much persistence the Asgard worker made contact with the family. It emerged that the family had only recently moved into the area and because there was a significant age gap between the parents they felt they were constantly judged by health professionals. Through the skilled and caring approach of the Asgard worker the parents made appointments for their child’s immunisations accompanied by the Asgard worker for support. The mother now attends all appointments regarding healthcare and attends parent and toddler groups at the local community centre.

Who we are & What we do Asgard is a model that reflects its name, it is a bridge Asgard is a place in Norse mythology where Gods and warriors went to be safe. It was surrounded by barriers but could be reached by a rainbow bridge. The Asgard model is about putting a ‘human bridge’ in place that enables and supports vulnerable individuals to access the right service for their need. This involves intense support in the initial phase which may involve ‘handholding’ an individual or family to the right provider. It may require the Asgard Worker to introduce the service user to the provider and advocate for them if required. The aim of the model is to ensure the service user has the knowledge, responsibility and confidence to use the relevant services in an informed way and be able to then source any future support, advice or guidance themselves. The model ensures that support is pro-active, and creates independence not dependence. The length of contact an Asgard Worker has with an individual/ family is short, the maximum length is six weeks. The model was initially developed to work with vulnerable young people who presented to Emergency Care Services inappropriately, because they were unaware or unable to access the right service. The model has now been adopted by other service providers, who need more affiliation with service users who could be deemed ‘hard to reach’. This includes an Asgard Immunisation service and an Asgard worker in General Practice.