The number of vaccinations given to pre-school children is declining, with the government’s 2013 reorganisation of the NHS identified as a major factor, Whitehall’s spending watchdog has found.
The National Audit Office found limited evidence of any major impact from so called “anti-vaxxers” who have been blamed for spreading rumours about side effects. Instead, the NAO found several possible reasons for dropping vaccination rates, including the timing and availability of GP appointments and parents needing childcare.
Auditors confirmed fears that one in every seven children by the age of five have not been given the measles, mumps and rubella (MMR) jab. NHS England missed the 95% uptake target for six out of seven pre-school jabs in 2018-19, following a general downward trend since 2012-13.
Take up of the booster for haemophilus influenzae type B and meningitis C vaccines, known as Hib/MenC, had never exceeded the 95% target and continued to fall, the NAO said in a report released on Friday.
One significant factor identified by auditors was the Conservative former health secretary Andrew Lansley’s 2013 reorganisation of the NHS, auditors said.
“There is evidence that the 2013 health system reorganisation in England resulted in fragmentation in the way the vaccination programme has been delivered,” the report concludes.
Auditors said that responsibility for vaccinations before 2013 was mixed between primary care trusts and service providers, who manage children’s clinical care records. This was then passed on to NHS England after the reorganisation, the report said.
“NHS England has not set out requirements of GPs for call/recall under the changed arrangements. As a result, call/recall is done inconsistently and there is no coherent system,” the report said.
Helen Donovan, a public health professional lead for the Royal College of Nursing, said the findings were alarming. “There isn’t only one barrier to increasing vaccine uptake as the report says but not having enough nurses makes it more difficult to make strides in other areas,” she said.
“Rather than laying the blame for the resurgence of measles solely at the door of those spreading myths on social media, policymakers should read this report which provides more evidence that we need to improve the services we provide for children and families.”
Doubts about the MMR jab, fuelled by anti-vaxxers, have spread across social media. Measles cases have been rising across Europe and the World Health Organization withdrew the UK’s measles-free status earlier this year, granted three years ago, because of the outbreaks.
The report said children were called for vaccines to “varying extent by GP practices” and also by regional Child Health Information Services. But while NHS England checks how call and recall is handled by CHIS, it does not review the work done by GPs.
Auditors also found that NHS England and PHE “do not use a consistent national approach to engage with under-served groups” such as Travellers, who have a low uptake of vaccines.
The study found “limited evidence of any major impact on vaccination uptake rates” from anti-vaccination messages on social media, but said a “small minority of parents” had concerns that made them reluctant to vaccinate.
While a combination of all these factors appear to be behind falling vaccination rates, NHS England and PHE “do not know the relative impact of each potential cause”, the study said.
The findings come after the health secretary, Matt Hancock, said last month that he was seriously considering mandatory vaccination for children.
NHS England does not believe that the decline in vaccinations is a result of how it commissions services from GPs. In response to the report, it said it would introduce new measures, including boosting the cash given to GPs for ensuring children have MMR, and working to create networks of GP surgeries which could mean more appointments in the evenings and on weekends.
It would also introduce a consistent way of reminding people to attend vaccinations, although the details have not yet been agreed with GPs.
Prof Helen Stokes-Lampard, who chairs the Royal College of GPs, said doctors had systems in place to notify patients when childhood vaccinations were due and to follow up children who missed their jabs.
“However, these systems will be on a practice-by-practice basis, and we would agree with the NAO that a more standardised approach would be a sensible measure to consider,” she said.
She said GPs “try to be as flexible as possible” in offering appointments at certain times, but doctors were “working under intense resource and workforce pressures”.
A Department of Health and Social Care spokesman said: “We are incredibly concerned by the decline of vaccination rates and are taking urgent action to reverse this.”