Highland: Fall in childhood immunisations amid vaccine row

The percentage of five-year-olds who had received a first MMR dose also fell year-on-year, from 97.1% to 94.5%.

INSIDE THE NHS: Leaked internal report reveals string of problems blighting Highland vaccination programme 

Table on childhood immunisation clinics from leaked report, 'Vaccination delivery challenges post-VTP in NHS Highland'. Appointments affected = booked appointments; capacity lost = total potential appointments lost due to cancellation of clinic (Image: NHS Highland)

In recent months, uptake of the four-in-one vaccine has fallen to its lowest level in around a decade with just 86.5% of five-year-olds having received the pre-school booster as of June this year to protect against diphtheria, whooping cough, tetanus, and polio. This is down from 91.6% in June 2022.

INSIDE STORY: Is Highland's vaccine programme running into problems already? 

The percentage of five-year-olds who had received their pre-school Hib/MenC booster against meningitis C and Haemophilus influenzae Type B (Hib) also fell from 97.2% to 93.7%.

There were also small declines in coverage for some infant vaccinations including rotavirus, the pneumococcal vaccine (PCV), and combined inoculations against tetanus, whooping cough, polio, Hep B and Hib - a type of bacteria that can cause life-threatening infections.

Some other infant vaccinations saw small increases in coverage, such as the first dose of MMR which 91.5% of toddlers had received by age two - up from 89.8%.

High levels of vaccination are necessary to reduce the risk of disease outbreaks in schools (Image: PA)

A spokeswoman for NHS Highland said its childhood vaccination figures "show similar rates and trends compared with previous quarterly results", adding: "Uptake for some vaccinations is lower and for some it is higher.

"Overall uptake does need to be improved and we are working to achieve this."

It comes amid controversy in the region over the transfer of responsibility for vaccine delivery from GP surgeries to the health board.

The move is in line with agreements struck by the Scottish Government and BMA Scotland trade union as part of the 2018 Scottish GP contract.

READ MORE: Highland woman told to travel 200 miles for Covid booster 

The goal was to reduce GP workload, but doctors in the Highlands voted against the contract and have long argued that the remote and rural geography of the Highlands meant it was more practical for GP practices to continue delivering vaccinations in-house.

Responsibility for fully delivering all vaccinations - from the Covid vaccine rollout to travel vaccinations, tetanus jags, and routine infant and pre-school vaccinations - finally transferred from Highland GPs to the health board in March this year in a process known as the Vaccine Transformation Programme (VTP).

However, a leaked internal report - which has been seen by the Herald - reveals concerns emerging as early as July this year.

Twelve childhood vaccination clinics were cancelled in Skye between March and May 10th (Image: PA)

The report, by NHS Highland public health consultant Dr Jenny Wares, states that NHS Highland is "experiencing significant challenges with respect to trying to deliver the VTP model", adding that it "does not adequately incorporate the existing challenges posed by the local geography and demography and is likely to be less effective, efficient and sustainable than other models".

Difficulties outlined in the report relate to long journeys to clinics and staffing shortages at health board-run vaccination hubs - leading to cancellations - and cases such as a family of Afghan refugees requiring childhood immunisations and travel vaccines who were expected to wait nearly four weeks for an appointment or travel 109 miles to a vaccine hub in Inverness despite having no car.

In another case, a 47-year-old man requiring a tetanus jag after a dog bite gave up after being told he would have to wait 13 days for a clinic appointment out of his local area.

READ MORE: Scientists says BA.2.86 'Pirola' Covid variant is 'one of the most immune evasive so far' - should we be worried? 

From March to May 10 this year, the report said that 64 childhood vaccination clinics had been cancelled across Lochaber, Skye, and Highland, affecting 114 pre-booked patient appointments.

The report also notes that an "options appraisal" could have enabled willing GP practices to opt into delivering vaccines in their area. This has been done in the Argyll and Bute Health and Social Care Partnership area, which falls within the NHS Highland region. As a result, a "small number" of Argyll and Bute GP practices are continuing to deliver vaccines "in keeping with local need".

However, no such options appraisal was carried out by Highland HSCP.

The report states: "As such, the current Highland HSCP model does not currently include any scope for delivery by GP practices in our most remote and rural areas. Clarification around the decision-making processes leading to the decision to not undertake any options appraisals was sought."

A spokeswoman for NHS Highland said: "We recognise that there are still improvements that can be made in the design of our vaccination service to maximise the opportunities for people across Highland to receive their vaccination, and we are working hard to make those improvements. We are committed to delivering vaccinations as close to the local communities as possible."