Screening and Immunisation Teams (SITs) are responsible for identifying areas of inequalities and working closely with providers and primary care to address them through increasing access, information and choice for disadvantaged communities. As well as gaining assurance of their plans to reduce inequalities, Local Authorities can play an active part in these plans given their deep knowledge of the local community, their relationships with community organisations, champions and leaders, and their direct relationship with at-risk groups through their adult and children’s social care teams. 

For example, local public health teams could support SITs’ work on reducing inequalities in coverage through: 

• Supporting community champions to disseminate communications about vaccinations among their networks and peer groups beyond the Covid-19 vaccine roll-out.  
• Conduct a community listening and engagement exercise to identify concerns about vaccinations, or barriers to accessing these services. The Local Authority should work with commissioners, providers and primary care to ensure that this intelligence is acted upon and to avoid duplication which could lead to fatigue and frustration. Community members must also be informed about what has changed as a result of their feedback so that they see the impact and value of their involvement.  
• Partnering with NHS colleagues and members of the community to co-design communications which are culturally literate, relevant and appropriate for particular underserved groups in the area. 
• Involving Community Development Workers in direct outreach to groups where uptake rates are low. 
• Identifying settings for pop-up clinics which would be accessible and familiar to underserved or at-risk groups, e.g community centres, substance misuse services, nurseries. 
• Working with adult and children’s social care teams to ensure all care workers have a good understanding of vaccinations, eligibility criteria and how they work. Social care workers should be fully vaccinated themselves (including having an annual flu vaccination) and be able to signpost the people they support to vaccination services, and constructively address any causes of vaccine hesitancy. The council might consider, for example, rolling out RSPH's Level 2 Award in Encouraging Vaccination Uptake among its public health and social care workers 
• Creating a channel for intelligence from health visitors regarding underserved groups. Health visitors have a wealth of knowledge about the health and wellbeing of families in the area: they identify safeguarding concerns, need for support and barriers to accessing immunisations (e.g. access to transport, attitude towards vaccinations, other caring responsibilities). To benefit from this intelligence, local public health teams can work with health visiting managers to run regular reports on inequalities in uptake, common concerns and barriers to access which could be fed back into the wider system. 
• As part of their assurance activities, local public health teams should evaluate whether providers are fulfilling their legal responsibility to not exclude anyone protected under the 2010 Equality Act from their services. They should also assess whether local strategies to reduce inequalities in immunisation uptake are robust and effectively translated into action. 

Providing vaccinations to people experiencing homelessness in Birmingham

Resources 

• Public Health England, Immunisation Inequalities Strategy and Local Action Plan is designed to help assess and take action to reduce health inequalities related to immunisation programmes. 

• World Health Organisation, Guide to Tailoring Immunisation Programmes 

• Case studies of Covid-19 vaccination outreach services for people experiencing homelessness (Queen’s Nursing Institute) 

• Case study of flu vaccination outreach service to rough sleepers in London (Queen’s Nursing Institute)