Dear colleagues,

We start the New Year having delivered an astonishing 13.8 million vaccinations to protect our population against COVID-19, including almost 3.5 million boosters and third doses as we race to increase people’s immunity against the highly transmissible Omicron variant.

Over the last 23 days, since the Prime Minister and the NHS launched an urgent national appeal calling for the public to Get Boosted Now, we have achieved extraordinary things to respond to the national Omicron emergency.

Within a week, we significantly “surged” capacity, with every site working flat out to make as many slots as possible available for booking, supported by our expanded workforce offer and meticulous placing of the vaccine to best meet local demand.

We have “boosted the booster” with targeted communications, proactive signposting, hyperlocal pop ups and walk-ins, and performance support, working more closely than ever with local government and other partners to turbo charge uptake. This film by Dr Richard Preece, North West Medical Director for COVID-19 Vaccination, addresses people’s questions about the booster, including the need for it, and its short-lived side effects.

We have harnessed the range of innovations already in use across the North West, including our Menu of Reasonable Adjustments and creative ways of flexing NHS capacity, to make sure all our communities have access to the vaccine, with no one left behind.

All this has seen us give bumper numbers of doses of the COVID-19 vaccine. On our busiest day so far, we hit 102,133 vaccinations on Saturday 18 December, topping 100,000 for the first time, with vaccinations given at more than 300 sites, including Anfield Football Stadium, Totally Wicked Rugby Stadium in St Helens, shopping centres and festive locations across the North West. At the busiest time in the middle of the day, about 200 people a minute were being vaccinated.

Some vaccination sites, such as at the Etihad Tennis Centre in Manchester, have run overnight sessions for the first time. Most were up and running over the festive season, with many open on Christmas Day and/or New Year’s Day. Conveniently sited walk-ins and pop ups, as well as GP practices, community centres, pharmacies, hospital hubs and vaccination centres continue to make it easy for people to find a site that fits with their busy lives.

We are getting boosters out to housebound people too. Our data suggests 84.7% of this highly vulnerable population have now had their booster. This newsletter has a few words from one such patient about what it meant to her.

Thanks to this extraordinary regional effort, everyone eligible aged 18 or over in the North West was offered the chance to book a booster by the end of December, in line with the national commitment by the NHS.

The way our amazing NHS staff, partners and volunteers have worked and continue to work together to “boost the booster”, responding to the needs of the people we serve, is truly heart-warming and makes me incredibly proud. I would like to give my profound thanks to everybody involved, along with all those who have come forward to have the vaccine. Together we are making a difference. I say more in this film of thanks.

But we must and will do even more. The number of cases of COVID-19 has climbed steeply in the North West and the numbers of people admitted to hospital with COVID-19, and in hospital with COVID-19 are both increasing rapidly. Almost certainly this is due to the Omicron variant, although we don’t yet know for sure whether the pattern of serious illness and deaths with this variant will follow that of previous waves or, as we all hope, be markedly less.

I was very moved by the impassioned plea by Grazy Philip, senior ICU sister at Royal Liverpool University Hospital, who drew on her own anguish over nearly losing her husband to COVID-19, and her very recent experience of seeing unvaccinated people in their 30s, 40s and 50s seriously ill in intensive care with COVID, to urge others to have the vaccine. You can see in this film clip how powerfully she puts the message across.

Our best defence in the North West is get as many people as possible in our region to have the booster as soon as possible over the next couple of weeks. This will maximise our chances of having a better January. Increasing uptake among children aged 12 to 15 is also a key priority.

Please encourage anyone you know who is not yet vaccinated to come forward and have the vaccine, to protect themselves, those closest to them, and our communities. It will help us all to have a happier new year.

Thank you so much for everything you have done and continue to do to protect our population against COVID-19. I wish you all the very best for 2022.

Yours,
Linda

Dr Linda Charles – Ozuzu
Regional Director of Commissioning and Regional SRO – COVID Vaccination Programme
NHS England and NHS Improvement – North West

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Latest news

Tackling health inequalities

Evergreen offer

Between 1 November and 31 December, more than 66,000 first doses were given to adults in the North West, as part of our evergreen offer, which is the continuing open offer for all adults to receive a first dose of the COVID-19 vaccine. High achievers over this period included Manchester CCG with  8,500 first doses and Central Liverpool primary care network with 1,429.

Over 6,500 of first doses in the North West in this period were given to people of Pakistani ethnicity, who comprise around 2.5% of the adult population.It is particularly pleasing to see people continuing to come forward for their first dose because it shows confidence improving in communities which have typically been slower to have the vaccine.

Over 80% of all those aged 12 and over in the North West have had at least one dose of the vaccine (GP registrations population estimates).

To encourage more people to have their first dose we are:

• making the offer of vaccination a routine part of care, for example in maternity services (more about this below), and working with NHS providers to explore how they can do the same in other areas, including screening and planned care, building on the successful approach taken in maternity
• encouraging pharmacy, optometry and dentistry staff in high priority geographical areas (identified through use of vaccination data) to promote the local vaccination offer to their customers and patients, and use vaccinations as an opportunity to highlight other services they could benefit from, using the principles of making every contact count
• targeting communications to unvaccinated people, led by local systems with additional financial support, using new, culturally appropriate material supported by technology such as QR codes. CCGs and local systems are working with local authorities and community and voluntary sector partners to deliver this. Paid-for social media and digital advertising is targeting key places and demographic groups.

 

Having a first dose

Temitope (pictured) had her first dose of the COVID-19 vaccine at Chester Cathedral in December after being reassured about how few major side effects there are from the vaccine. She said: “I was quite sceptical at first but at this point I’m like, people haven’t really had so much side effects and I might as well just have it because I feel more comfortable and confident.”
Altruism was also a big part of her decision. She said: “I’m trying to keep other people safe as well because without getting vaccinated I might actually be putting people at risk of contracting the virus through me.”

 

Second doses
The vast majority of people in the North West who have had a first dose of the COVID-19 vaccine go on to have the second one, but a minority do not. Overall, 3.4% of people in the region are clinically overdue their second dose – meaning it is 14 weeks or more since their first dose.

In total, 68% of adults aged 18 to 49 have had their second dose of the vaccine: 69% of people from White ethnic backgrounds and 59.8% from all other ethnic backgrounds (GP registrations population estimates). There is significant variation between people from minority ethnic backgrounds: uptake by Black Caribbean people is lowest, with 40.9% of the population receiving a second dose, while uptake by Asian Indian people is highest at 74.4%.

Meanwhile, 91% of adults aged 50 to 80+ have had their second dose of the vaccine: 91.7% of people from White ethnic backgrounds and 80.1% from all other ethnic backgrounds (GP registrations population estimates).  Again, uptake by Black Caribbean people is lowest, with 68.5% of the population receiving a second dose, and uptake by Asian Indian people is highest at 89.3%.

 

Booster doses

As of 5 January, 3,486,856 people in the North West have had their booster vaccination – the numbers have almost doubled in less than six weeks.

Every older adult care home in the North West has been visited at least once by a roving team offering booster doses of the COVID-19 vaccine to residents of older adult care homes. As of 29 December, 83.9% of residents have received their booster.

Booster uptake among younger adults

The halving of the time between second doses and booster vaccinations – as recommended by the Joint Committee on Vaccination and Immunisation on 29 November 2021 to enable acceleration of the booster programme to counter the Omicron variant – had an interesting potential bonus.

It meant that younger adults who were slower to come forward for their first or second dose were no longer disadvantaged compared to the rest of our population. This can be seen by looking at the statistics on 13 December, when the waiting period was reduced from 182 to 91 days. Of people aged 18 to 49 who had had two doses of the vaccine, 90% from white ethnic backgrounds and 86% from all other ethnic backgrounds were immediately eligible for the booster.

In practice, booster dose uptake is slower in some ethnic minorities, in line with previous patterns. In younger adults, uptake of boosters is lowest in people of Black ethnic backgrounds, with around 33% of those eligible having received a booster compared to around 55% of people of White British ethnic backgrounds who are eligible.

The challenges that remain in maximising vaccine uptake by people from minority ethnic backgrounds are described with the familiar “three Cs”, plus an additional “C”:

• Convenience: learning from the programme to date has made it clear that for disadvantaged communities and those less well served by services in general, convenience of access to the vaccine is critical.  Many people who had experienced some degree of hesitancy were enabled to get the first and second doses through hyperlocal offers, walk-in opportunities and other practical support to take up the vaccine.  These tailored offers can be more labour intensive and have lower throughput.
• Confidence: although those who have had two doses of vaccine may have overcome initial reservations regarding safety or efficacy about the vaccine, the change in messaging (why a further dose is needed) and, potentially, the change in vaccine offered compared to their primary course may impact their willingness to accept a booster.  Additionally, the experience of knowing vaccinated people who contract COVID-19 and require hospital treatment (which is more likely in communities where deprivation is highest) may impact confidence in the effectiveness of the vaccine.
• Complacency: the risk that people will consider the primary course sufficient.
• Communication: a coherent response to all the above issues from a trusted source in an accessible format will be required to support uptake of booster doses in the most deprived communities – consistent and targeted communications are a key feature of our Boost the Booster Plan.

 

Housebound people
Each of the three systems in our region (Cheshire and Merseyside, Greater Manchester, and Lancashire and South Cumbria) has got a nominated lead and an action plan for ensuring housebound people are offered the booster vaccine.

• As part of their action plans, systems have identified housebound people, offered them the booster dose, and arranged visits.
• They have worked with pharmacies and NHS partners, such as Mersey Care NHS Foundation Trust in Liverpool, to increase roving capacity and reach as many people as possible.
• St John Ambulance has provided transport for some vaccination staff to visit housebound patients, and some local places have provided transport for people with mobility issues to attend a vaccination site for their jab.

The BBC recently ran a piece about Christina Gerrard from Cheshire who has Parkinson’s Disease.

After being vaccinated by nurse Cathy MacDowall, Christina (pictured) said: “I feel wonderful. It’s a real bonus because I was worried about the virus obviously. I’ve been lucky to get through it up to now and no side symptoms.”

 

Vaccinating vulnerable people (cohort 6)

We continue to focus strongly on vaccinating people in cohort 6 – those aged 16 to 64 at risk, including people with a learning disability or severe mental illness, pregnant women, the adult household contacts of people with immunosuppression, and adult carers who are eligible for a carer’s allowance or who are the primary carer of a clinically vulnerable person.

Uptake in cohort six in the North West as a whole is 85.7%, though this masks differences between age groups. Uptake is above 92% in people aged 50 and over, dropping to over 85% in people aged 40 to 49, 78% to people aged 30 to 39, and over 74% in people aged 18 to 29.

About 140,000 people in cohort 6 are still to be vaccinated (based on GP registrations population estimates). The largest single group is people in their 30s. Uptake in each of the main cohort 6 sub-groups – those who are themselves at risk and those in close contact with others at risk – is similar, although there is evidence of lower uptake by people living with a severe mental illness.

Pregnancy
Tragic cases of unvaccinated mothers-to-be becoming seriously ill with COVID-19 are sadly occurring both nationally, and more locally in the North West. Part of the reason for this is misinformation circulating on social media, and people’s genuine concern that national guidance initially advised against vaccination in pregnancy. That advice changed when data confirming the safety of the vaccine for mother and baby became available, and it is now very clear that vaccination in pregnancy is safe, effective and extremely important to protect against the high risk of becoming severely unwell from COVID-19 if it is caught during pregnancy.

National data indicates that, as of 31 December 2021, 55% of pregnant women estimated to be at term in Cheshire and Merseyside had had a first dose of the COVID-19 vaccine, and 45% had had a second dose. For Greater Manchester, the rates were 54% and 44% respectively, and for Lancashire and South Cumbria, 52% and 41%.

To increase uptake of the COVID-19 vaccine by pregnant women and their partners, the following actions are in place:

• each of our three systems has a named lead and working group overseeing vaccination uptake in pregnant women. Each working group has input from all the local trusts which provide maternity services, GPs, pharmacists and other key stakeholders
• data on vaccination uptake by pregnant women is reviewed every month by each system. Detailed information showing uptake by geography, ethnicity and socio-economic status is available at both system level and for each maternity provider
• all pregnant women are asked about their vaccination status at their appointments. If they are not fully vaccinated, they are offered vaccination on site or at specific pop-ups for pregnant women where possible, or else are fast tracked through other sites which are convenient for them
• each system has tailored communications to encourage pregnant women to have the vaccine. These include banners in maternity units reminding them about the safety of the vaccine and inviting them to speak to staff; easy access to decision making guides and to printed flyers for people who are not online; and videos for Black African and Black Caribbean women in liaison with the Caribbean and African Health Network to raise awareness and provide reassurance
• staff in maternity services and at all vaccination sites are aware of and confident about offering up to date guidance about vaccination for pregnant people, and procedures are in place to provide this guidance across all antenatal settings
• there is targeted outreach to communities with lower rates of uptake.

Vaccination clinics for pregnant women are now in place across the region as part of the routine antenatal pathway. A pilot, led by midwife Lara Nilsson at the Countess of Chester Hospital, resulted in 28 pregnant or postnatal women being vaccinated with first, second or booster doses. The pilot is being continued as twice weekly clinics. There has been similar success at Liverpool Women’s Hospital. In both cases, the teams have also been vaccinating partners to maximise protection for the family.

Mental health
The team at St Helens Vaccination Centre has been making bespoke arrangements for some of the most vulnerable patients.

For instance, a young woman with anxiety and a learning disability attended with her mother. They were taken aside to a quiet area away from the crowds and a considerable amount of time was spent explaining the vaccination process and calming the young woman’s fears. Eventually she was vaccinated without any issue and her mother said how grateful she was, not just that her daughter was gaining protection against COVID-19 but also that the sympathetic treatment of her daughter would make it easier for her to have future medical interventions or vaccinations she may need.

St Helens also arranged for a child with complex physical and mental health needs and severe needle phobia to be admitted to the paediatric ward and vaccinated under sedation.

Gypsy Roma and Irish Traveller (GRT) communities
GPs supported by Lancashire Council took four months to build relationships with Gypsy Roma and Irish Traveller communities on three sites in Lancashire and South Cumbria, before running a session offering them the COVID-19 vaccine. A large proportion of residents were vaccinated and it has also strengthened relationships between them and the local NHS, which is promising for the future.

Homeless people
In Warrington, Dr Laura Mount, a GP from Folly Mount Medical Centre, and her team have organised pop-up clinics for homeless people, as well as supporting wider vaccinations.

Her work was mentioned by the Prime Minister in his 15 December address to the nation, and he and his wife phoned Dr Mount and her vaccination team, including Cheshire and Fire Rescue Service, just before Christmas to thank them for the “exhausting work” they are doing to protect the people of Warrington.

In Birkenhead, Dr Abhi Mantgani, the lead for the Birkenhead Vaccination Centre, and his team have delivered just under 10,000 vaccines to thousands of housebound patients and residents of care homes from more than 50 mobile vaccine clinics.

 

Vaccinating children aged 12 to 15

By the end of term, every school in the North West had been visited by School Age Immunisation Service teams administering the COVID-19 vaccine. 45.4% (GP registrations population estimates) of children aged 12 to 15 have now been vaccinated (including those who had the vaccine out of school).

Children and young people came forward over the Christmas holidays for their vaccination at walk-in sites as well as sites offering booked appointments. Second vaccinations are available for those eligible (having had their first dose at least 12 weeks earlier).

 

Making reasonable adjustments

Much of our success in increasing uptake in communities which were initially hesitant about taking the vaccine is due to making reasonable adjustments to services to meet people’s needs.

There are suggestions in our Menu of Reasonable Adjustments (MoRA) to help maximise vaccination uptake among under-served communities, including people from an ethnic minority background, people with a learning disability, people with severe mental illness, and inclusion health populations.

The Menu of Reasonable Adjustments draws together examples and resources for good practice in reaching a wide spectrum of diverse communities and groups that may typically experience poorer access to health services.

Our Menu of Reasonable Adjustments has been refreshed and updated to support you to engage with people who have been slower to have the vaccine, and give them confidence to take it up. There is a webinar on 12 January to talk through the updated MoRA. Details are below.

 

Webinars

Wednesday, 12 January 2022, 2-3pm:  A second webinar introducing the updated version of the North West’s Menu of Reasonable Adjustments, which has guidance, research and evidence, toolkits, case studies and lessons learned to support colleagues in serving minority and vulnerable communities. This session will include examples of how to use this resource in your clinical areas. The content covered will be the same as at the December webinar on this topic.

 

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Further information

Useful resources

A wide range of resources and case studies are available on the North West Community of Practice website.

 

Questions and feedback

If you have any questions or comments on this newsletter, please post them on the North West Community of Practice forum.

The North West Community of Practice is for everyone working in health and care in North West region. If you are working in this field and would like to become a member, please email england.pcn-development@nhs.net to request an invitation.