David Ibbotson, Operations Director for the NHS Immunisation Management Service, reflects on the success of the national vaccination programme as we commence the start of the winter vaccination campaign (COVID-19 boosters and flu). He sums up the programme milestones and describes how the learnings will benefit the ongoing rollout of invitations.

Friday 18 June 2021 was a defining moment for the SCW national Immunisation Management Service. We had successfully completed sending letters and SMS to the entire adult population through our Call and Recall service inviting them to have a COVID-19 vaccination. 

Only now am I able to truly reflect on what I’ve learnt over the past nine months and share with you some of the behind-the-scenes activity required to deliver a ‘simple’ letter inviting someone for a jab and hit this key milestone.

What keeps me going 

It seems a long time since the programme dispatched our first national invite letters for COVID-19 on 7 January 2021, and since then we’ve gone on to send out over 116 million invitations and reminders. Quite staggering volumes when you look back. 

It’s been a tough journey on a rocky road, but a very rewarding one; it really does feel that we are doing our bit to help the health of our nation. It also continues to be a humbling experience, working in an environment where everyone has this great can-do and ‘in-it-together’ attitude to their work, spanning all partners and stakeholders who we interact with. 

This outlook has been important for our service, as we have needed to significantly evolve to support the shape, pace, and changes of the national delivery programme. 

Where did we start?

To send out a letter or a text message, you’ve got to know who that person is and have their basic contact details. So first up was to identify the population. We needed to work with various NHS organisations and our partners, to build the supporting infrastructure, then establish the required data flow to access the much-needed demographic and geographical information. 

And underpinning all of this was ensuring all the significant information governance and clinical safety elements were in place to flow the right data for the right purpose, including all full security measures. 

Once we got the data, we then needed to overlay the Joint Committee for Vaccination and Immunisation (JCVI) Greenbook guidance to identify the cohorts, establishing who was in which age group, at-risk group etc., so we knew who to contact first. 

In parallel to all of this, we needed to stand up new teams, services and processes to deliver an end-to-end service. Our team had a lot of help here – working with our trusted partners – System C & Graphnet who provide and support the backbone platform to the service, and Synertec who provide the hybrid mailer service.  

Building a team of specialists

What I learned early on, was that this was not a linear process, and very much an integrated service with the national vaccination Tech & Data products and services, plus other third parties. 

One example of the complex integration was the introduction of an application programme interface (API), to enable point of care systems and the national booking service (NBS) to perform checks against eligible individuals. Is this person in an eligible cohort and/or have they already had their vaccination event captured? This gets used up to an astonishing 3 million times per day and is a vital part of the infrastructure to book and capture vaccination events safely.

Another area requiring our specialist help was to identify and invite individuals at the right pace and timing to match the mobilisation of all the waves of vaccination centres and community pharmacies being stood up at the start of the year. 

This was quite significant as we couldn’t just select the ‘all over 80s’ and issue an invitation letter, in case there was insufficient vaccine supply. We also didn’t want people to have 3-hour car journeys. That would have been a bad user experience. 

To meet this need, we introduced another piece of new tech and service, with the help of our expert GIS team, who provided accurate drive time mapping capability using specialist software. 

This enabled us to issue invite letters to people within a 45-minute drive time radius of a particular site and expand the footprint as more and more vaccination centres were being opened across the country. This level of precision enabled the national data modelling team to manage effective supply and demand across the vaccination centres. 

Building it better

As the national vaccination programme gained momentum throughout January and February, our invitation mapping processes became even more complex. We needed to fine-tune invite volumes per region given that not all vaccination centres had the same capacity, coupled with the variances of population density across the country. 

New processes were put in place to select individuals by STP, by CCG, by PCN and even by postcode. And the key to this was introducing the right assurance checks to make sure invites weren’t incorrectly sent out or that people were being left behind. 

The colour of envelopes

Sometimes, in these heavily process-driven programmes, it is dangerously easy to lose sight of the people that we are ultimately serving. I make sure to remind myself of putting patients first and being focused on the end outcomes that we are trying to achieve.

One of the things that we did introduce in conjunction with the national team and Royal Mail, was to introduce blue envelopes instead of the standard white ones with an NHS logo. The rationale being that the envelopes would clearly stand out in Royal Mail sorting and delivery offices. I have to admit I wasn’t sure of the impact this would have on both the programme and the recipient, but I was definitely willing to give it a go.

This posed a significant challenge to our team, from agreeing the re-design, sourcing materials, testing them through machines… and then you learn things such as ink reduces the integrity of an envelope, so when loaded up with a leaflet and other inserts, we started to see failures with the envelope edges and ink transfer... But, it was all sorted, and from start to finish, we were sending out blue envelopes in just over a month, which was an impressive turnaround with everything else going on. 

More than words

And finally, just to touch on the content of the letter and text message. If you received an initial invite letter from us, you may have noted that it’s two A4 sheets, plus language translation, plus a PHE public health guidance leaflet. Wording on the letter goes through constant change control as it has been tweaked for the various cohort groups. PHE leaflets are also continually updated. Also, working with DHSC we have conducted text message variance testing, to ensure that the words we use lead to the greatest response and encourage someone to go and book their vaccination.

All in all, it's been a huge team effort led by our team working hand in hand with our partners System C & Graphnet and Synertec. Establishing new services required super-fast learning, developing and refining processes and resolving competing priorities.

Next chapter, a smoother journey

And now we look forward, where we will be continuing to invite and to encourage uptake across all cohorts and ensuring we vaccinate all types of people including covid boosters and flu vaccinations. 

Change will also be at the forefront of our strategy as we look ahead, the key to this is having the right channel strategy, which will be focussed on digital-first (we are now sending out email invitations) and complemented via non-digital journey (letters), and also aim to integrate our services with the NHS app to leverage the use of push notifications. 

So what’s behind a simple letter? Quite a lot!

Operations Director, Immunisation Management Service

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