North West vaccine
NHS has concerns over rural sites and staff recruitment
NHS has concerns over rural sites and staff recruitment
NHS bosses are identifying sites in rural communities that could be hosting Covid-19 vaccination sessions within weeks.
The urgency of the programme – which aims to vaccinate 75 per cent of adults in England over the course of three months – means large-scale delivery models are needed, according to an NHS regional planning document seen by Big Issue North.
Mass vaccination sites are being set up in urban venues such as football grounds and conference centres – but areas with more scattered populations require a different approach.
In places such as Cumbria – where there are no large sites and transport links are poorer – it is understood civic buildings such as community centres will host pop-up sessions to try to cover as much of the local population as possible.
Plans are evolving by the day but the document says the programme’s first phase will focus on vaccinating the North West’s 85,500 care home residents plus their staff – along with people deemed clinically vulnerable and prison inmates.
This GP-led part of the programme could start in December and will rely on “roving” delivery – where vaccinators go to the patients. Modelling suggests more than 250 vehicles could be needed for this across the North West.
It is understood that home visits in dispersed rural areas must be carefully planned to avoid wastage, since the contents spoil within hours of a vial being punctured. Depending on the vaccine, each vial holds between five and eight doses.
The document says: “The intention is to follow the national lead and focus on mobilising the delivery models most focused on the first cohort of people to be vaccinated initially.
“Therefore, establishing a roving team will be key to success. This will be more difficult in rural areas.”
Next will be the over-80s and health and social care staff, along with key workers, and many of these will be asked to attend mass vaccination sites. Health trust employees will largely be vaccinated by their employer or by sister organisations, the document says.
Phase two then kicks off with the over-75s, followed by the rest of the adult population, in age cohorts. Groups deemed at high risk from Covid-19, such as black and minority ethnic communities and homeless people, will be prioritised.
The ambition of vaccinating 100 per cent of the adult population has been revised downwards to 75 per cent
The plans say vaccination sites will open from 8am to 8pm, seven days a week – with around 350,000 jabs per day expected to be given across England.
The document also says the ambition of vaccinating 100 per cent of the adult population has been revised downwards to 75 per cent. The reason for this is unclear but there is scepticism about vaccine safety and the speed of development among some sections of the public.
Professor John Ashton, a former director of public health for the North West and the author of the book Blinded by Corona, said work needs to go into reassuring people the jab is safe.
“There are some who believe conspiracy theories about the pandemic and the vaccine and will never be convinced but there is also a cohort of people who are simply cautious about vaccines,” he said. “They need to be convinced if we are to get the high take-up that we need to keep us all safe.”
The UK has ordered two promising Covid vaccines that have yet to be approved by regulators – the Pfizer-BioNTech version is codenamed “Courageous” in the plans while the Oxford University-AstraZeneca version is codenamed “Talent”. Test results suggest both could be up to 90 per cent effective.
Everyone who receives a vaccine will need a second shot of the same brand three to four weeks later, and immunity takes several more weeks to develop.
NHS England is now recruiting thousands of staff for the programme. Its website says the law has been changed to allow a wider cohort to be trained to deliver vaccines – including dental staff, healthcare scientists and others “with appropriate first aid training”.
NHS England’s online call says: “While we don’t yet know which vaccines will be approved for use and when, the NHS is preparing extensively to begin delivering them as soon as we are able to. This will be a huge task. The NHS has agreed a contract with GPs to ensure we benefit from their vast experience in delivering immunisations, but vaccinating millions of people as quickly as possible – at the same time as keeping other vital services going – will require lots more staff.”
According to the planning document, almost 600,000 NHS volunteers will be needed across England, alongside paid staff.
Modelling suggests almost 6,500 full-time equivalent staff will be needed in the North West. This includes 575 vaccinators, 2,450 additional registered healthcare professionals, 300 healthcare assistants, 1,525 stewards and 513 volunteers from St John Ambulance, plus drivers, admin staff and managers. It is understood the army may help set up the centres.
Places like Cumbria have long struggled to recruit healthcare staff but the document notes “concerns around timeframes for recruitment and training due to current Covid-19 pressures in the NW region”.
Regional NHS managers are now holding daily meetings to pull the plans together, with a planned start date of 1 December – although the programme is not likely to begin in earnest until the new year.
Across England, more than 40 large-scale mass sites could each vaccinate more than 2,500 a day, with around nine planned for the North West.
More than 60 pop-up vaccination clinics will also take place in smaller communities and potential sites are currently being reviewed for suitability.
It is understood that non-NHS buildings being leased for this purpose will need to be registered with the Care Quality Commission and careful thought is required about their facilities, cleaning regimes and waste management.
Big Issue North understands that rural communities and isolated areas such as Millom – a coastal town in South Cumbria with poor transport links – could prove a particular challenge in terms of logistics, and tailored solutions may be needed to cover as many people as possible.
As the document puts it: “There are challenges around the geography and population willingness to travel to particular points of delivery of vaccines. Therefore hub sites may deviate from national proposals to accommodate local nuances and to promote uptake.”
Vaccines will be shipped at -75 to -80 degrees Celsius to designated hubs linked to hospital pharmacies, before being thawed and transported to the delivery sites where they are needed. The North West expects to receive 11.6 million doses over the coming months, the document says. The Pfizer jab must be used within five days once it is thawed and refrigerated but the Oxford vaccine is easier to manage since it lasts around six months in a fridge.
Within the Lancashire and South Cumbria integrated care system, the vaccines will be stored in Burnley, Blackpool, Preston and Barrow-in-Furness. But the document raises the possibility that further sites could be required.
It says: “There are significant concerns in the ability of the vaccine hubs above to deliver the required logistics and cold chain requirements for all vaccine administration sites in [Lancashire and South Cumbria].”
“The GPs and others who I talk to in that area are confident they can deliver this programme.”
If the programme runs to time – which depends on regulatory approval and manufacture – the whole thing could be finished by April, although insiders say the summer is more likely.
Ashton, for one, is confident the NHS in areas such as Cumbria – where he lives – will do a good job of delivering the vaccine programme.
“The GPs and others who I talk to in that area are confident they can deliver this programme despite any logistical challenges,” he said. “Areas such as the west coast of Cumbria can be problematic as some of those communities are far from everything.
“The whole story of the delivery of the vaccine is emerging day by day but I worked closely with GPs in that area for many years and know from experience that they are very well organised – they are pioneers.”
Ultimately, he added, whether the programme succeeds will depend a lot on trust. “The main story about this might not be the manpower but making sure people are confident about the vaccine.”
A spokesperson for the NHS in the North West said: “These draft documents, which are over a month old, are out of date and do not take account of the latest information from the vaccine manufacturers. As there is of course yet no authorised vaccine in the world, the NHS is having to plan for several different scenarios.”
Photo: the Oxford University-AstraZeneca, codenamed “Talent” by the NHS