commissioning support for london
TRANSCRIPT
February 2010
Commissioning Support for London – Products and ServicesMichael Wilson, Assistant Director – Prevention and Wellbeing
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Confidential-3rd February 2010
What we are now
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Strategic themesThe London Integrated Strategic Plan identified four priority actions
for the next financial year:Quality
Putting prevention into practice
Improving London’s response to urgent care in the community
Prevention, early identification and better management of those with long-term conditions
Moving planned care closer to home.
Productivity
Acute providers
Non-acute providers
Pathways
Staying healthy
Acute
Long-term conditions
Planned care
New care settings
Polysystems
Hospital care, especially implementation of major acute hospitals.
Confidential-3rd February 2010
Key products for Public Health
The web based information portal to support London's NHS Quality Agenda.
An interactive resource to support London’s health needs assessment
and health intelligence analysis.
An online suite of tools helping PCTs make informed commissioning decisions by showing commissioners
how their providers are performing.
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MMR uptake by London PCTs with national comparator
Immunisation rates at age 2 by PCT
50%
55%
60%
65%
70%
75%
80%
85%
90%
PCT 2008/09 Q4 Performance data
% a
ge
< 2
yea
rs
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Insight with MMR ‘doubters’ audience
The UCL study found that socio-economic status influences uptake of MMR, with low uptake in both low and higher SEG groups.
It recommended further examination of why particular audiences do or do not vaccinate.
NICE guidance found some evidence that uptake of MMR has declined at a greater rate among children of more highly educated parents and among those living in more affluent areas. This audience accepted other vaccinations (they were not immunisation ‘rejecters’ as such) but had specific concerns about MMR. The primary concern driving their reluctance to accept MMR was the perceived link with autism.
Confidential-3rd February 2010
The imbalance of risk
The perceived
risk of autism
(Long term)
The perceived
Risk of measles
(short term)
• This fear was not limited to the ‘Higher SEG Doubters’• It seems to have permeated all sections of society
Confidential-3rd February 2010
Key differences higher / lower SEG
Higher SEG parents…..
Keeping the MMR under constant review
Interested in up dating their knowledge
Torn between the horns of their dilemma
Feel guilty, because they should vaccinate their children
And they understood that there were arguments for and against
Lower SEG parents….
Heard bad things
Not agonising about it
There must be something to it if all these people think there is.
More comfortable with their decision
Don’t feel guilty
More likely to ignore further communications about it
Did not want to be persuaded
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Workshop
What approaches would you implement to increase uptake of MMR vaccination?
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Effective Immunisation and Vaccination Programmes require:
• Active information management
• Active patient management
• Active performance management
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Behaviour Change I
• One size fits all communications / messages are not effective
• Trust in NHS staff (on this particular issue) is generally poor amongst higher SEG doubter parents, however they are not at ease with their decision and are open to re evaluating it
• ‘Doctor knows best’ approach not successful in changing their behaviour. Training for Health Care Professionals (HCP) needed to enter into debate with higher SEG parents?
• Lower SEG parents have decided not to have vaccination, influenced by personal networks, not actively concerned about this decision, but do respect HCPs on this issue
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Behaviour Change II
• Are existing interactions with services fully exploiting trust in NHS staff? Do all staff actively support MMR?
• ‘One in ten’ campaign not a great success, how best to communicate risk which is motivational whilst remaining honest and not sensational? Don’t avoid discussing the autism link as will not be effective.
• LSMU have commissioned discourse analysis; - reviewing wide range of recent communications inc. invite letters, web coverage and media to understand the language that is used to inform future intervention pilots.
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The ‘1 in 10’ campaign