Influenza (flu) is a common infection and mild for most people. However, it can be very dangerous for vulnerable people, including older adults, pregnant women and people with underlying health conditions, and seasonal influenza is a leading cause of excess deaths every winter.

Flu is also a key driver for winter pressure on the NHS, causing increased demand for primary (GP consultations) and secondary health care services (hospitalisations and intensive care bed admissions). When flu cases are high, as they were in the winter of 2017-18, elective treatment may have to be deferred in order to treat patients hospitalised with flu.

Achieving a high uptake of the annual flu vaccination programme is, therefore, crucial to saving the lives of the most vulnerable and reducing winter pressure on the NHS.

However, influenza vaccine coverage varies widely between eligible groups. Coverage rates for the over-65s are far higher than those for the at-risk under-65s and pregnant women. Flu vaccination coverage in these two groups is consistently below 50%.

To explore how flu vaccination rates can be improved, RSPH hosted two roundtables with national policymakers and local public health leaders. This paper captures the main themes of those discussions and recommendations for national, regional and local leaders in the public health system to act upon.

Main Recommendations

• Capacity which was lost to many Screening and Immunisation Teams after the 2012 Health and Social Care Act must be restored
• As England’s public health system goes through a period of transition, the Government must ensure the Screening and Immunisation workforce receives the support, training and professional public health leadership it needs
• The Government should review the possibility of centralising procurement of flu vaccines to support diverse delivery models and ensure reliable supply across providers.
• NHS England and Improvement should introduce incentives for GP practices to increase vaccination uptake in historically underserved groups, and increase the Global Sum Payment to provide funding for flexible delivery models
• NHS England and Improvement should work with General Practice IT system providers to improve their ability to flow data effectively to the central database and their direct interoperability
• Primary Care Networks and Integrated Care Systems should develop data dashboards, showing in real-time the coverage rate of each provider, and encourage the sharing of best practice across the area