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NAO report praises NHS for data and digital leadership in Covid-19 vaccine roll-out

The £5.6bn programme has delivered value for money to date – and ‘creative’ use of data despite complexities was among the factors that led to successful delivery, says report

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According to a report by the National Audit Office (NAO), work carried out by the NHS around the development of digital platforms and use of data and digital innovation was among the key success factors behind the achievements of the Covid-19 vaccination programme.

The report evaluated the government’s Covid-19 vaccine programme, focusing on events up to the end of October 2021, and assessed whether the programme was well-placed to meet its objectives in full.

The programme spent £5.6bn out of total available funding of £8.3bn for the two years to the end of March 2022 to achieve its objectives. Considering the unprecedented circumstances and the programme’s achievements, the NAO concluded the initiative had provided value for money to date.

In terms of the roles and responsibilities of the various stakeholders, NHS England and NHS Improvement (NHSE&I) drove the operational delivery of Covid-19 vaccines to the public in England, and is accountable for delivery models, performance monitoring and ensuring delivery meets government targets, as well as ensuring equality in access to and uptake of vaccines.

On the other hand, NHS Digital (NHSD) provides digital services to the programme as commissioned by NHSE&I, such as booking services and data systems that identify those who have received the vaccines, including their vaccination status.

“In our review, we saw many examples of good practice, including clarity of purpose and priorities, timely and data-driven decision-making, and a willingness to innovate and adapt where necessary, balanced with the repurposing of existing infrastructure and expertise,” the NAO report said, adding that evidence indicates that the programme “has saved lives and reduced the incidence of serious illness and hospitalisation”.

Findings of the report include the observation that the programme met “stretching and unprecedented targets” to offer two doses of the Covid-19 vaccine to most adults in a short space of time.

It also noted that uptake had exceeded expectations and had been higher than previous flu vaccination programmes, and that the programme had taken steps to make the vaccine convenient to access, with GPs and community pharmacies administering many more doses than originally planned.

One of the key findings of the report was the role of NHS England, NHS Improvement and NHS Digital (NHSD) in creating new digital tools to support the vaccine deployment.

While stating that the Covid-19 vaccine roll-out was the largest vaccination programme in UK history and employed a number of successful approaches, the report set out factors that facilitated delivery at speed, including the “effective use of data to manage the programme closely and intervene quickly when problems emerged”.

The NAO noted that the national data system set up by the programme allowed the NHS to identify, record and transmit patient vaccination data across the health and care system for the first time. This included the “point of care” system, where details about the individual and type of vaccination administered were recorded when people were vaccinated.

“These tools supported programme leaders to manage key programme risks and monitor divergence from central directions in local areas,” the report said, adding that this helped with some priority groups such as the social care workforce and unpaid carers, which were hard to identify from five main disparate national data sources.

The NAO acknowledged that NHSE&I made “creative use of multiple other data sources to improve identification” and “effective use of imperfect existing data”.

Moreover, the report noted that NHSE&I’s use of data “added value to the leadership of the programme, assisted with the management of key programme risks, and allowed both central and local bodies to understand quickly and in detail differences in [vaccine] uptake”.

Addressing complexities

The NAO report also mentioned the national online booking system set up by NHSE&I in partnership with NHSD, which was primarily available for dedicated vaccination centres and community pharmacies. However, there were mixed views on how well the system facilitated access and supported the operations of the places where vaccination was taking place.

The report said the booking system was generally seen by those consulted by the NAO as an effective innovation which helped to expand convenient access, although some found it lacked flexibility in relation to functions such as cancelling a booking. Some also mentioned that the lack of a single booking system for all types of location made it difficult for some sites to manage their workload.

The NAO received feedback from NHS Digital on the matter, noting that it had “continued to make changes to the booking system over time in response to feedback from users”.

In addition, NHSD described its approach as “modular”, building on existing systems to set up the system for the vaccination programme quickly. The NAO was told that NHSD had further developed this into a streamlined template, which could be used for vaccination programmes in the future.

The NAO noted NHSE&I also built teams with the right leadership, skills and experience to make the decisions needed to deliver, both within NHS Digital and the wider industry, to get a number of platforms up and running – such as Foundry for internal management, and the National Booking Service for the public, which built on existing systems and data sources.

The report described how NHSE&I used the Foundry software to underpin the daily operations of the vaccination programme, which enabled pre-existing data from sources such as GPs and hospitals to be combined with new Covid-19 vaccination data in real time. The system enabled other types of analyses, such as vaccination delivery and uptake by site, region and local area, as well as uptake by ethnicity.

However, the report noted that the process of identifying priority groups was not always easy from established data, requiring “creative” use of multiple data sources, including data from councils in some cases.

“NHSE&I’s programme leadership team dedicated time every morning to reviewing Foundry data,” the NAO said, adding that the system was used to manage key programme risks and to monitor divergence from central directions, such as identifying local areas that were providing second doses too early.

From the start of 2021, local health systems and authorities were also able to use a version of Foundry to model demand and capacity for sites. The system was also used for benchmarks against similar areas to gain greater understanding of vaccine inequalities. Later, in April, primary care networks and pharmacies had access to information on vaccination numbers.

According to local case study interviews carried out by the NAO as part of the report, four out of 10 respondents found the software useful in terms of reducing inequalities in vaccine administration, while five out of 10 used their own information sources and others mentioned limitations such as issues around access to data or coverage gaps.

Lessons to be learned

The speed and uptake of the vaccine programme should be considered a real success, said Public Accounts Committee chair Meg Hillier.

“Great credit is due to all those involved, including the scientists creating the vaccines, the national bodies involved in securing the doses we needed, and all those administering the jabs,” she said.

However, Hillier pointed out the success of the roll-out didn’t extend to all parts of society. “Government needs to do more to understand how it can better reach those groups and communities where uptake was low. Now the worst of the pandemic has hopefully passed, the government can’t afford to put its feet up. It must learn lessons from its response to Covid to ensure the country is better prepared for future emergencies,” she added.

In recommendations set out in the report, the NAO advised the Department of Health and Social Care (DHSC) and the Department for Business, Energy & Industrial Strategy (BEIS) to work with the Vaccine Taskforce, NHSE&I and the UK Health Security Agency (UKHSA) to capture wider lessons from the programme, including the adaptations and innovations that should be retained for other health and public health programmes, as well as potential future emergencies.

In addition, the NAO report noted that these bodies should “identify and address acknowledged weaknesses, such as the accuracy and availability of care sector data and the identification of unpaid carers”.

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