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12.42 pm
The Parliamentary Under-Secretary of State for Health (Yvette Cooper): I thank my hon. Friend the Member for Erewash (Liz Blackman) for her excellent timing in raising the topic of flu immunisation during flu awareness week and for her interesting speech and informed points. She is certainly right to say that there is scope for improvement.
This is the time of year, ahead of the winter, when those patients for whom flu can be a serious illness should be getting their jabs from GPs. For most people--those who are otherwise fit and healthy--flu is unpleasant but not serious. The doctor's advice is usually to stay home, stay warm, drink plenty of fluids and look after oneself. For others, however, it can be very serious. As many as 3,000 to 4,000 people, mainly elderly, are estimated to die from flu each year, even in years when flu has been relatively mild.
In the last severe epidemic, in 1989-90, as many as 26,000 deaths over and above those expected were recorded during the epidemic period. Flu is not a subject that we take lightly and it is important that we do everything that we can to prevent flu among those likely to suffer most.
The Joint Committee on Vaccinations and Immunisation identifies the risk groups as people with underlying diseases such as chronic respiratory disease, chronic heart or kidney disease or diabetes; and people whose immune systems are impaired by disease or through treatments such as cancer therapy or steroids. They have a higher risk that a bout of flu will lead to serious illness such as bronchitis or pneumonia.
Although the elderly are more at risk, people of any age with those conditions are at increased risk and that risk increases further when an individual has more than one of the underlying problems. The Department of Health recommends, on the basis of the committee's recommendations, that people in those circumstances should get a flu jab before the winter begins. The Department also recommends that people in long-stay residential accommodation should also be vaccinated, because flu, once introduced there, can spread very rapidly. From last year, everyone aged 75 or more has also been recommended to be immunised.
My hon. Friend asks whether we will consider extending that to everyone over 65. Further investigation and analysis are taking place. The Joint Committee on Vaccinations and Immunisation is examining the question and will make recommendations according to the evidence of what impact there will be on different groups.
As my hon. Friend says, we have increased the number of vaccinations in the past few years. Last year, more than 7 million doses were given, compared with only 6 million
doses three years ago. This year, we have more vaccine than ever available--more than 8.5 million doses; but she is absolutely right, we could do better. The most recent national data point to low uptake rates, especially among younger people in the risk groups. Ultimately, it is up to patients to decide for themselves whether they want to be vaccinated but we must ensure that they are fully aware of the options and the risks when they make that decision.
My hon. Friend is also right to say that the data that we have are not adequate to tell us exactly what is going on and what we should be doing about it. I want to explain in some detail the data that we have at the moment and the direction in which I believe we should be moving. For a start, we know from the manufacturers how much vaccine will be available in advance of the flu immunisation programme. Manufacturers also give the Department of Health a weekly update at this time of year on the number of doses distributed and what is still available should there be additional need.
We have some idea of the use of vaccines by GPs. Like the analysis given by my hon. Friend today, we can use prescription data to show the number of vaccine doses that GPs are delivering, but she is absolutely right to say that they do not tell us whether an individual GP is targeting the vaccine to those most in need--those identified as belonging to high-risk groups.
Before last year, reliable national estimates of flu vaccine uptake in our targeted groups were not available. Last year, that gap was partly plugged. The Public Health Laboratory Service calculated the national uptake rates using the general practice research database: records from a representative sample of general practitioners throughout the country. That analysis has allowed us, for the first time, to make an assessment of the recent performance of the NHS in delivering flu vaccine policy, as it enables us to track the health condition of those who are vaccinated.
Only by using such analysis can accurate figures be produced for uptake of flu vaccine in the recommended groups. The latest figures from the database show that in the winter of 1996-97, 23 per cent. of the high-risk population were vaccinated and 44 per cent. of those over 75 with high-risk conditions. That was before the aim to include all people over 75 was introduced.
The figures also show that half the total vaccinations given went to people not considered to be at high risk. We plan to use that system from now on to monitor uptake regularly and as a basis for reviewing the implementation of the programme in future and determining what further improvements can be made. That is a major step forward, but we still lack any information on how individual GPs, rather than a sample of GPs throughout the country, are managing to reach their target groups.
The flu immunisation programme is delivered largely by general practitioners and practice nurses. GPs should identify their targeted population through whatever methods are available to them: most can do it through their computer systems; others have chronic disease registers or can identify patients through repeat prescriptions for particular medicines. GPs then need to order their vaccine early in the year so that supply can be assured.
Vaccine is delivered to practices in September to October, when patients need to be contacted to attend an immunisation session or other arrangements are made.
My hon. Friend is right to say that we have very limited information on how far individual GPs are achieving that and how wide the variations are across practices in different parts of the country.
Given the Department's commitment to reducing health inequalities and to making sure that people's treatment from the NHS is not dependent on where they live, we consider this matter to be important. However, we are putting in place changes which should make the process easier in future. We are developing standards for electronic patient records and we plan to have comprehensive coverage by the year 2002. This, together with new systems, should enable us to tie together the information available and to examine individual practice level data. It should give us considerable scope to identify best practice across the country, and give us the opportunity to spread that further in future.
The second important strand in my hon. Friend's argument concerns how we spread best practice. First, the Government are promoting immunisation policy at a national level. Tips on how to run a successful programme are published in the Department of Health's memorandum "Immunisation against infectious disease"--the GPs immunisation bible. In that advice--entitled "Increasing the uptake of influenza vaccine"--the memorandum points out clearly that
The Department of Health works closely with the Association for Influenza Monitoring and Surveillance in the build-up to flu awareness week. The purpose of the week is to get the message to the public that if they think that they may be in a risk group, they should see their doctor and arrange to be immunised. Flu awareness week is a highly successful campaign. It is launched through a press conference--chaired by the chief medical officer--to which my hon. Friend referred. Hon. Members may have heard the chief medical officer on "Today", ITN and other media on Friday promoting the message that flu vaccine can save the lives of those at risk.
Flu awareness week is supported by Help the Aged, the British Diabetic Association, the British Lung Foundation, the National Asthma Campaign, the Royal College of General Practitioners and the Royal College of Nursing. Both Help the Aged and the British Lung Foundation have produced flu leaflets to help promote the uptake of immunisation in the risk groups.
Separately, the Department of Health and the NHS have this year run extra activities to raise public awareness of flu vaccine. In September this year--for the first time--as part of the winter planning round, health authorities were provided with a briefing pack, including a press release suitable for local use to support local activity around flu awareness week. The Department of Health has produced leaflets and posters which are available free.
Health authorities should be able to see whether an individual GP is prescribing broadly too little or too much vaccine, given the number of patients he has on his list.
GPs should be able to identify best practice locally. Using these data, health authorities should support those GPs who are not giving sufficient priority to the immunisation needs of their patients. They should encourage them up to the levels of the better GPs.
All practices should be able to identify risk groups and should be able to identify their own level of performance. Health authorities should be promoting good practice across their GPs. Prescribing advisers are employed by health authorities to help promote good prescribing practice, including flu immunisation.
The introduction of primary care groups should increase the peer pressure to follow better prescribing practices, and make the best use of resources to support the health needs of their populations. Clinical governance offers a framework within which primary care groups can work to improve and assure the quality of clinical services for all patients. In addition, we are currently looking at broader accountability and service issues within the GP contract, as is the General Medical Council. The GMC is looking to revalidate GPs and all doctors on the basis of the quality of service that they provide. Together, these new structures should provide a series of routes by which we should be able to increase the uptake of flu vaccine in recommended groups. However, we will continually monitor and examine this matter as progress is made.
Finally, my hon. Friend asked if we would consider introducing targets. I can tell her that I will certainly look closely at the points she makes. It is true that the Department does not at present set national targets for the uptake of flu vaccine. We have aimed at year-on-year increases. This has reflected the historical lack of good estimates of vaccine uptake. As I have mentioned, it is difficult to introduce targets when we do not have adequate information about who exactly is receiving the vaccine in the first place. However, we do now have estimates of flu vaccine uptake on a national level, and the equivalent data at a local level should be a matter for local planning.
Due to the difficulty in accurately estimating flu vaccine uptake, those health authorities which have looked at setting local targets on flu vaccination have focused on the percentage of over-75s being immunised. That is easier to quantify. Nevertheless, age on its own is not the most important risk factor. We must ensure that we do not divert attention from the need to maximise the uptake among everyone with these underlying risk conditions, whatever age they happen to be.
I can assure my hon. Friend that we will now be looking carefully at how targets could be used in the future to ensure that we achieve higher uptake without distorting the priority groups. We will review the latest data in the light of additional information from the general practice research database, and we will look at the direction in which the figures are moving in the future.
"the single most important factor in patients accepting influenza vaccine is that their doctor recommended it".
Doctors and nurses are encouraged to maintain registers of their patients who should be immunised. On top of this, the chief medical officer writes to GPs each year, reminding them further of the need to target the risk groups.
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