In its report published today, the National Audit Office (NAO) finds NHS England has missed the Department of Health and Social Care’s (DHSC) performance standard for the uptake of nearly all pre-school vaccinations in England in 2018-19. Uptake of nearly all pre-school vaccinations has declined since 2012-13 and in 2019 the World Health Organization withdrew the UK’s measles elimination status.1 NHS England data shows regional variations in uptake of vaccinations, with particularly low levels in London.

NHS England and Public Health England (PHE) have identified several potential causes for the decline in pre-school vaccination rates but cannot say which are having the greatest impact, according to the NAO.

In July 2019, PHE estimated that around 90,000 children in England (1 in 7) had not had both doses of MMR at the age of five. Current levels of uptake of the second dose of the Measles, Mumps and Rubella vaccination (MMR) are 86.4%, below the 95% recommended by the World Health Organization (WHO) to give herd immunity.

Most parents have confidence in vaccines. PHE conducts an annual survey into the wider public’s and parents’ attitudes to vaccinations. This survey in 2019 found that 95% of parents said they had confidence in vaccinations and only 3% had refused one or more vaccine. NHS England and PHE are alert to the need to emphasise the positive case for vaccination.

Of the potential causes identified by NHS England and PHE, no factor on its own explains the decline in pre-school vaccination rates since 2012-13. NHS England and PHE do not know the relative impact of each potential cause. There is evidence that the 2013 health system reorganisation in England resulted in fragmentation in the way the vaccination programme has been delivered.

The way healthcare professionals remind parents to vaccinate their children is inconsistent. Parents are contacted to book an appointment through being called and recalled by healthcare professionals. When primary care trusts were abolished in 2013, NHS England took responsibility for commissioning call/recall, but has not set out the requirements of GPs for call/recall under the new arrangements. This has led to inconsistencies in how the system works in different parts of the country.

Some parents have reported finding it difficult to access vaccination services due to the timing and availability of appointments. There are also communities which are “under-served” when it comes to healthcare, such as travellers, which may also affect their vaccination rates.

Since 2018, NHS England and Public Health England have been developing a plan to improve uptake of vaccinations. NHS England is creating an MMR catch-up programme for children aged 10-11 and published guidance in August 2019 for regional teams on how to improve uptake of MMR vaccination. In July 2019, DHSC announced that it would launch a new strategy on vaccination by spring 2020 and the Prime Minister has since requested it be brought forward to Autumn 2019.

Read the full report

Investigation into pre-school vaccinations

Notes for editors

  1. Measles elimination status is awarded when there have been no endemic cases for 12 months – that is the original source of infection for reported cases was outside the UK and then spread through the population in the UK.
  2. Press notices and reports are available from the date of publication on the NAO website. Hard copies can be obtained by using the relevant links on our website.
  3. The National Audit Office (NAO) helps Parliament hold government to account for the way it spends public money. It is independent of government and the civil service. The Comptroller and Auditor General (C&AG), Gareth Davies, is an Officer of the House of Commons and leads the NAO. The C&AG certifies the accounts of all government departments and many other public sector bodies. He has statutory authority to examine and report to Parliament on whether government is delivering value for money on behalf of the public, concluding on whether resources have been used efficiently, effectively and with economy. The NAO identifies ways that government can make better use of public money to improve people's lives. It measures this impact annually. In 2018 the NAO's work led to a positive financial impact through reduced costs, improved service delivery, or other benefits to citizens, of £539 million.

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