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Vaccinations and Health Screening Services

Volume 797: debated on Tuesday 14 May 2019

Question for Short Debate

Asked by

To ask Her Majesty’s Government what plans they have to promote the uptake of vaccinations and health screening services.

My Lords—or perhaps I should say “My Ladies”, because all contributors to this debate are women—earlier this month the Public Accounts Committee in another place published a report about adult health screening. It commenced as follows:

“Health screening is an important way of identifying potentially life-threatening illnesses at an early stage. Yet the Department of Health & Social Care … NHS England and Public Health England … are not doing enough to make sure that everyone who is eligible to take part in screening is doing so, and do not know if everyone who should be invited for screening has been”.

I could not put it better myself, and this is a very sorry state of affairs when we know that timely health screening can save lives by early identification of disease, and save money by avoiding conditions becoming severe.

On vaccination, the other highly successful way of avoiding disease, it is clear that the NHS has been aware of its failure to meet targets for some time because paragraph 1.11 of The NHS Long Term Plan promises a review of GP vaccination records. My first question to the Minister therefore is: when will this commence and can she commit the DHSC to funding whatever is necessary to help GPs reach their target?

I turn first to screening programmes, of which there are 11. Four of them were considered in detail by the committee, none of which reached their targets, and there is unacceptable variation in different parts of the country. The committee concluded that the IT system used to identify the eligible population for screening has been unfit for purpose since 2011 but has still not been replaced. That probably means that the reach is even worse, because some people who should be called for screening are not being called. So my second question to the Minister is: what is being done to replace the IT system? The committee’s recommendation was that the department should find out why performance is poor in some areas and less so in others and then do something about these inequalities. Has the department set about doing that and is it going to make use of the large amount of data in the hands of local authorities, which could help?

When I first laid this Question for debate, I was concerned about the fact that only 71.7% of women eligible for a cervical smear were attending. Many years ago I worked in this service, so I have an interest in its success. Today things should be better because the treatment for symptoms has much improved. However, recent figures show that only one of the 207 CCGs meets the target of 80% attendance and that about half of women do not receive their results within the target time, despite the fact that the job I used to do is now done by artificial intelligence. This programme saves lives. It saves children losing their mothers. It saves suffering, and its cost-effectiveness is not in doubt. Why is NHS England not holding local providers to account for this poor record, as it has the responsibility to do? Of course we all hope that the administration of the HPV vaccines to girls—and very soon to boys too—will bring about a massive fall in this disease but, in the meantime, we need to do a lot better.

Breast screening—mammograms—also saves lives. The IT system that supports the breast-screening programme gives great cause for concern, yet the NHS plans to replace it only by 2020, three years later than planned, at a cost of £14 million. The state of the system undoubtedly contributed to the shambles in May last year when the then Secretary of State announced that 450,000 eligible women had not been invited for screening. The shambles was further demonstrated by the fact that the number turned out to be closer to 122,000. This caused a great deal of anxiety to women and who knows whether it contributed to any deaths. Will the Minister encourage her department to get a move on and replace this system with all haste?

Both of these screening programmes have suffered from a fall in attendances—a 21-year low in the case of cervical screening—yet it appears that none of the national health bodies has asked women themselves why they are not attending, offering instead platitudes about women having busier lives. This just will not do. In addition, there is a serious shortage of technicians to do the breast screening. What steps are the Government taking to address that?

I turn to health screening programmes for children. The Royal College of Paediatrics and Child Health sent a very helpful briefing, which emphasised the importance of the routine screening of children for height, weight, vision and hearing, and encouraged expansion of the national child measurement programme. In the light of the health inequalities in this country and the high proportion of overweight and obese children, these programmes are vital to ensure that each child gets a healthy start in life. Can the Minister answer two questions: what is the coverage of the national child measurement programme compared to its target, and why are children not also screened for dental decay, given the large number of children who have to be admitted to hospital to have teeth removed?

Vaccinations are the best way of protecting children and adults from serious and potentially fatal diseases. The routine schedule for babies—MMR, the six-in-one vaccination and the one for meningitis—is absolutely vital to protect each individual child, as well as providing herd immunity for the whole population. Failure to reach the desired immunisation rate resulted a few years ago in some serious measles outbreaks, for example in Swansea. The uptake of both doses of MMR has now decreased for four years in a row. Also, participation in the six-in-one vaccine was nearly 2% below the WHO target of 95% and has fallen for five consecutive years. These rates are not high enough to maintain herd immunity, according to the royal college.

A recent study of vaccination uptake among children linked lower immunity coverage with higher socioeconomic deprivation. Could the Minister say what is being done to address this? The royal college recommends that every contact between a child and a health worker should be utilised opportunistically to ensure he has had the full range of vaccinations. However, this requires a robust data collection system and interoperability between different parts of the digital health records. Could the Minister say how far we are from that being available?

The royal college believes that confidence in vaccinations is not falling but that the fall in numbers is instead attributable to a complex web of access to services, cost of travel, competing pressures on families, an ineffective system of reminders for parents, and workforce and resourcing pressures. What is being done to untangle this and get the numbers going up again? Are system-led changes being considered, or are we just using targets and pressure on hard-pressed GPs?

One important adult vaccination is the flu vaccination, which is available to all adults at a modest cost but is free to children aged over two, elderly people and other vulnerable people. In 2016-17, 16,000 people died of flu, yet many people with chronic lung disease are still not getting the vaccine. Compared to an uptake of 72.6% among other people aged over 65, just 50.8% of those with chronic respiratory conditions were vaccinated in 2017-18. This is another area where there is regional variation—the figure in Wales falls to 48.6%. Uptake among children from reception to year 4 varies significantly between NHS regions: from 47.8% in London to 70.7% in Wessex. My GP recently told me that last winter, she had to provide flu medication to a larger number of people than usual. Whether this was because fewer people were vaccinated or because it was a more virulent strain than usual, she did not know, but she was worried. What is being done to improve the coverage of flu vaccinations?

I would have liked to ask about bowel cancer and prostate cancer screening, but I fear there is no time. Instead, I end by asking the Minister when we will be getting the Green Paper on prevention. Will it contain proposals for flexible initiatives to improve the uptake of health screening and vaccinations, especially among harder-to-reach communities?

My Lords, let me be the first to pay tribute to the noble Baroness, Lady Walmsley, for introducing this important debate. I also pay tribute to her expert knowledge in this field, given all that she has said.

For some of us, what has happened with immunisation and vaccination is a mystery. I am looking at the noble Baroness, Lady Hayman, who was a Minister shortly after I was. One of the great battles that my then boss, Kenneth Clarke, had was with the GPs on introducing the new contract after 1987. It was about incentivising GPs to increase child immunisation and cervical cancer screening. There was a great hullabaloo that they were motivated only by feeling for their wallets, or whatever the expression was at the time. The fact is that there was a rapid increase in child immunisation and cervical cancer screening. I remember being summoned by the then Prime Minister, Margaret Thatcher, to a meeting of Finchley GPs in the Prime Minister’s room behind the Speaker’s Chair in another place. They all gave their views on the programme and whether they had been coerced into following the cervical cancer rulings, and so forth. Whatever was said, it did the job.

Nearly all of us in this Room, who are working women, know that our lives and our families’ lives have been freed from all those infant diseases that held back women at home for so many years. Vaccinations are an extraordinary success story. They have an amazing ability to leave people free from disease if a sufficient number create herd immunity. Smallpox is the only infectious disease to be eradicated completely among humans through deliberate intervention; it was wiped out through a global programme. In 1988, there were 35,000 cases of polio globally but in 2018, there were only 33. I remember the wonderful work of the rotarians and their PolioPlus campaign, spreading the polio vaccine all around the world. It seemed as though this was an unstoppable course to having healthier citizens through a civilised approach.

Some 150 potentially life-saving vaccines are currently being tested, which is absolutely phenomenal. So now we have to study the extraordinary phenomenon of vaccine hesitancy, which for many of us really is a paradox. Why should people be against vaccinating their children? Some believe that vaccines are no longer necessary or that they cause autism, but Andrew Wakefield has been comprehensively discredited for his work that tried to connect autism and bowel disease to MMR. It was a really disgraceful piece of work. Some believe that doctors and scientists cannot be trusted; that vaccines contain harmful levels of toxins; or that they can overload a child’s immune system. It seems as though, once again, this is an adverse effect of our wonderful, modern and interconnected world of social media. Scare stories are thrown up and it is almost impossible to rebut them.

There may also be a lack of trust in doctors and nurses. But goodness knows, their figures for inspiring confidence and being trusted, at 96% and 92%, are a lot better than those for government Ministers or politicians, which are at 22% and 19%. I still think we should hold on to the doctors and nurses to promote the programme.

The noble Baroness, Lady Walmsley, talked about the worrying fall in levels in the UK despite our comprehensive National Health Service, our focus on prevention and so forth. The World Health Organization has devised a 3Cs model in its vaccine communications working group, referring to complacency, convenience and confidence. We do have a degree of complacency. In the UK, before vaccines were introduced, each year 3,500 people died of diphtheria, 200 of tetanus, 1,000 of pertussis, 200 of polio and 60 of haemophilus influenzae. Perhaps people have lost the fear factor that has been there for so long.

On convenience, we have a comprehensive health service. There is of course always room for improvement, but it is there for all. On confidence, the evidence is absolutely there.

I congratulate the Government on some of the recent vaccinations that have become available. The service is phenomenal. Now, we have vaccinations for children’s flu, rotavirus, shingles, MenB and MenACWY. Similarly, I congratulate them on some of their screening programmes. I campaigned long and hard for screening programmes for abdominal aortic aneurysm, bowel cancer, breast cancer and so on.

What must we do to promote this issue and encourage people to live up to their responsibilities? We have the convenience and I have the conviction. I want the Minister to let us know what not only the Government but all of us can do to help to bring back urgency in taking up these wonderful opportunities.

My Lords, I too congratulate the noble Baroness, Lady Walmsley, on securing this important debate.

I want us to look back in history. In 1796, Jenner took fluid from cowpox pustules and gave it to a child. He then tested whether that child had immunity by giving him fluid from smallpox pustules—an experiment I do not think would get through any ethics committee anywhere in the world today but which marked the beginning of immunology as we know it. There were anti-vaxxers then, who made his life hell and gave him a really hard time. There are still anti-vaxxers today. I am afraid that people are living with the human tragedy of their activity. Smallpox seems to have been eradicated; it was declared as such in 1980.

I want to focus on five diseases in my five minutes. What have we got now? There is polio. The vaccination against polio was introduced in the 1950s, too late for a friend of mine whose paralysis has completely crippled his life. He is still alive but with long-term complications through paralysis from polio. It is a terrible disease. Before the introduction of the vaccination, there were more than 7,500 cases of paralytic polio a year, with up to 750 deaths. Each one of the people who got polio carried with it the damage. This is not about statistics; this is about human lives.

People think of diphtheria as something of the past. It was absolutely terrible. Before the vaccine was introduced in 1942, there were more than 55,000 cases a year and 3,500 deaths. One of those cases was an aunt in our family, who described to us what having diphtheria was like. The terrible legacy of her disease was that she came home with it and gave it to her younger sister, who died. She recalls having diphtheria and watching her younger sister dying. It is incredibly contagious. Sadly, it is now breaking out in parts of the world among refugee communities, particularly Rohingya Muslims.

Why do we need herd immunity? We need it because it acts like a firebreak, and we need it above 95%.

We have sort of pretended that measles is a disease that is not still there—but it is. The latest figures show that between January and October 2018, there were 913 laboratory-confirmed cases of measles in England; that represents a steep rise compared with the 259 cases the previous year. Measles is not a trivial illness. The pneumonia leaves people with permanent lung damage that will blight the rest of their lives; they will be prone to infection if they survive it. It is a terrible thing to see children ill and dying of measles. I worked in paediatrics; I have seen it. In Ukraine, following the death of a teenager not related to vaccination but attributed to it, in combination with political unrest and health service corruption, the actual rates fell to one in six of all children.

I will go back for a moment to Jenner and TB. Jenner lost his eldest son, two sisters, Mary and Anne, and his wife to tuberculosis. Today there is the BCG—bacille Calmette-Guérin—vaccine against TB, but that is not actually as good as we need it to be. It perhaps helps against TB meningitis in children, but I have seen a child dying of TB meningitis—it is absolutely terrible. BCG is not as effective as one would hope. The problem is that rifampicin came along; everyone thought it was wonderful, and now we have drug-resistant TB.

In my last seconds I will touch on HPV. I was privileged to be working with Les Borysiewicz and Malcolm Adams in Cardiff when they were doing the early work on cervical cancer. They showed that invasive cancer instance was dropping dramatically—by 80%. We now need to lower the age of vaccinations for this age group, because we know that children are sexually active below the age of 14. We need to introduce it at 10 to 12 years. We have the tools to keep herd immunity, and we are just ignoring them.

I learned so much from the speech of the noble Baroness, Lady Finlay. I thank the noble Baroness, Lady Walmsley, for tabling this debate.

When I put my name down for this I realised that I had a vaccination schedule pinned to my fridge. It has every vaccination that your child has to have between birth and five years of age. I cannot tell you where I got it from; I imagine I must have got it when my last daughter was born. I realised with a certain degree of guilt that is uniquely gifted to mothers—perhaps that is why this debate is all-women—that I had forgotten to book my third daughter in for her three years and four months old vaccination. While listening to the noble Baroness, Lady Finlay, I also realised how lucky I was not to know what some of these diseases are. My generation has taken that for granted. I will of course rectify the fact that we need to have this vaccination—we are still in time.

It struck me that we spend so much time and energy in public life and politics talking about anti-vaccination fake news campaigns in social media and about how to tackle them. It is right that we fight them, but do we spend enough time, as the noble Baroness said, really focusing on the nitty-gritty of ensuring that the system for take-up works as efficiently and seamlessly as possible?

I cannot base my entire speech on mother’s instinct, so I was very pleased to have the briefing from the Royal College of Paediatrics and Child Health. It was most helpful, particularly in stressing the point about making every contact count. We need to think more deeply about the way we talk to pregnant women and parents at the start of their journey. By the time you go into the room to give your baby his or her first vaccinations, you are actually already quite a long way into the parenting journey and will usually have had quite a lot of interactions with midwives and health visitors. While I am not letting fathers off the hook in the slightest, we know that maternal health is vital to determinants of child health. What are the Government doing to ensure that health visitors and midwives have the training, confidence and space within those consultations to press the need for maternal immunisations, which do not get a lot of coverage, and then to start those early conversations about child vaccinations?

More broadly, so many of the messages that we aim at first-time mothers in particular—I do not aim this just at the Government but across charities and public life—focus on childbirth and breastfeeding. These are obviously very important, but it would much better to prepare parents for at least the next five years, not simply saying, “You just get to the other side of the delivery suite”. This is where the system-wide approach is crucial. What systems are in place to collect the data and remind parents along the way that vaccinations are due, and what methods are being used to support those who may just be struggling to navigate or access services? There is debate over whether we should exclude non-vaccinated children from schools, but are we missing the practicalities, including perhaps a more effective method of using the school or nursery entry check to ascertain children’s vaccination status and using that as a reminder or trigger for boosters?

I would have loved to have had more time to talk about screening. We need to look at public health as a whole. I happened to be shopping earlier this week and was in the beauty department of House of Fraser. When I made my purchase, I got an NHS card reminding me to go for cervical screening, which I am up to date with. However, can we not think more creatively about ways to get to people that do not just involve opening a letter from the NHS? We need to be much better at thinking laterally about what is going on in people’s lives. I thank the noble Baroness for initiating this conversation and hope that we get more opportunities to talk about this subject.

My Lords, I add my congratulations to the noble Baroness, Lady Walmsley. It is a great pleasure to follow the noble Baroness, Lady Wyld, because I agree very much with what she said. I want to speak mainly about vaccine hesitancy and the important role of vaccines in the developing world. I do not want to bowl the Minister a googly but the Question relates to the Government and vaccines. Through DfID we have an enormously important role in the use of vaccines in the developing world, where for millions of children they are a matter of life and death.

I agree very much with the noble Baroness, Lady Wyld, that the reducing rates of vaccination in this country are not solely the result of the dangerous and destructive cod science peddled on the internet and elsewhere; they are also the result of the difficulty that some families have in accessing services and our inability to bring together in that smooth and creative way that the noble Baroness talked about the services that families need. When families and the NHS are under pressure, people will fall through the net, and we cannot simply blame them for taking bad advice. Like others, I would like to hear from the Minister exactly what the department will do to differentiate between and gain an understanding of these low rates in particular areas or localities or among certain types of families and how we will target measures to improve them.

I also agree that mandatory vaccination is not the way forward. However, it is important to look at specific instances. I have a grandchild who goes to a nursery-type play group where one child, recently admitted, has multiple food allergies. The nursery has decided to ban the other children from bringing any food into the nursery, and all children who have lunch there eat a diet that suits that individual child. This is done to protect one member of that community whose life could be in danger. Where a nursery, for example, has an immuno-compromised child as one of its members, I think it is perfectly reasonable to look very carefully at whether it is responsible to admit to that nursery children who are not vaccinated and to put that child’s life at risk. I am not talking at all about universal compulsion but I think that there might be instances where it is important to take responsibility as a community for particular children who need us to do that.

Huge efforts are being made—I have already mentioned DfID’s work—through the global alliance on vaccinations, the Vaccine Alliance, UNICEF and the WHO to save the lives of millions of children across the world. We have programmes that have halved deaths from measles and tetanus since 2010, in less than 10 years. We are investing in new vaccine development that is absolutely essential if we are going to deal with malaria, TB, dengue and Zika. There are parallels here, but the obstacles are different. Because of false information, polio vaccinators have been killed in Pakistan and there has been difficulty in administering the Ebola virus during the current outbreak in DRC. When there is conflict it is difficult to get to families.

Finally, I hope that the Minister and her department will take notice of the work of Professor Peter Hotez. He is not only a vaccinologist and a paediatrician; he also has an adult daughter with autism. Personal testimonies are tremendously important. He has written a book called Vaccines Did Not Cause Rachel’s Autism. He will be in London at the Wellcome Trust and the Royal Society for Tropical Medicine next month. I hope that the department will listen and learn from what he has to say.

My Lords, I thank my noble friend Lady Walmsley for the opportunity to take part in this extremely well-informed debate.

As chair of the All-Party Parliamentary Group on Sexual and Reproductive Health, I start on a sad note. Some Peers are aware, but others are not, that the FPA—formerly the Family Planning Association—has gone into insolvency this week. This means that a charity which for many years has been the source of important information and advice for women, and men, about sexual and reproductive health, screening and all that has ceased to function. I say to the Minister that I am sure there are other professional bodies, such as the royal colleges and the Faculty of Sexual and Reproductive Healthcare, which will have to look in coming months at how the work which was done by the FPA can be covered.

As the figures we have on cervical screening—particularly from Jo’s Cervical Cancer Trust—show, it remains extremely important to have informed, accurate messaging systems to the public. Sometimes the NHS does a good job, but sometimes it is not the body to talk to people, particularly young people, in ways they understand in order to make them understand the importance of screening and prevention services in particular.

The figures for women attending cervical screening are going down. This is worrying. It is even worse in some minority communities. I want to take the opportunity to focus on my minority community. I am worried because I hear of instances of lesbians and bi-women being wrongly told that they do not need to go for screening and that they cannot get cervical cancer. This is not true. When someone is told that, it is not unreasonable that they might not go along and take part in a procedure which is not particularly pleasant. However, that has potentially fatal consequences. Having said that, there are other women who register really good treatment. When they have come out and been open about their sexuality, their doctors have been fine and open with them. This is a hopeful sign that we have moved on, but it should not be a matter of luck for a patient to be treated well. It should be system-wide. I commend some NHS staff who, in the absence of leadership from the top of the NHS or their professions, have tried to take matters into their own hands. They have their NHS rainbow badge initiative —100,000 of them are now wearing the badge—to give a direct indication to patients that if you happen to be LGBT it is safe to talk to them—not to everybody, but to them. I hope we shall see some more of that.

We are very lucky to have our National Health Service and national screening but, looking at the papers that my noble friend Lady Walmsley referred to, we do not seem to allow very much for variation. In particular, we have either a national screening programme or nothing. We do not seem to be able to concentrate some of our efforts among people who are perhaps more likely to be at risk than others. For example, I think of the work Macmillan Cancer Support has done on lung cancer screening. We do not have a national lung cancer screening programme, but Macmillan Cancer Support has been trying to identify ex-smokers to try to give them check-ups and to catch cancers early. I hope that through the reorganisation and sustainable transformation projects, the NHS might get to be much cannier about the way it uses the resources it has to begin to focus them.

I will make one final point about variation. I understand that there is a new test for bowel cancer screening called FIT—faecal immunochemical test—and that it will come in in Northern Ireland in 2020 but will not come to England. Will the Minister say why, if in Northern Ireland it has been identified as a more accurate test, it is not being rolled out here? We have a national service; we could use the resources in it in a far more targeted way to greater effect.

I declare an interest as a member of a CCG. I congratulate the noble Baroness, Lady Walmsley, on this important debate, which, as one would have expected, has been very well informed and wide-ranging. I, too, will focus on vaccination.

The noble Baroness, Lady Bottomley, reminded me that when I started school in 1956 as a rising five—noble Lords can work that one out—I was the eldest of four children. My mother says that she had a sick child for the whole of the following winter because I brought home measles, chickenpox and mumps. It was an absolute nightmare for her. Of course, I gave my siblings all my germs.

This week, the headline in my local freesheet is: “Lives at risk as vaccine rate drops”. It is not often you see that in your local freesheet, but that is what it says. One of our local doctors is quoted as saying that he and his colleagues are faced with the troubling task of telling parents that their children could die from preventable diseases, but still people refuse to have their children vaccinated. In our patch of London, I fear we might be heading for the statistic that means herd immunity will be compromised, which has implications for children throughout the borough, including my granddaughter.

The vaccination rate has fallen for four years in the UK and is declining across Europe. Will the Minister tell us the minimum percentage of cover for vaccinations that provides herd immunity? I think we know that. How close are we to it in the UK? How many areas are there where coverage is less than or close to the minimum for herd immunity?

I reminded myself in preparing for this debate of the response of the Minister, the noble Baroness, Lady Blackwood, to a recent Question posed by my noble friend Lord Faulkner:

“The UK has one of the most sophisticated vaccination programmes in the world and we constantly guard against threats that may reduce vaccination rates. I am pleased to say that 93% of parents trust NHS staff and advice. The Government recognise the threat posed by disinformation and the upcoming online harms White Paper will set out a new framework for tackling this”.—[Official Report, 1/4/19; col. 2.]

I beg to differ because the evidence points us in a different direction. If 93% of parents trusted NHS staff and advice, we would not be in a situation that could easily become a great health emergency. How can it be that 93% of parents trust the NHS when the Royal Society for Public Health says that one in five parents, including those who have had their child vaccinated, still believe that the jab is,

“likely to cause unwanted side effects”?

The Royal Society for Public Health’s chief executive, Shirley Cramer, said:

“We need to counteract health misinformation online and via social media”.

She also said,

“social media companies should take responsibility for misinformation about vaccines in the same way that they are doing for mental health”,

and that,

“four out of five adults agreed … that social media platforms should take steps to limit fake news regarding vaccinations”,

so the public are calling for this too. What are the Government going to do? Frankly, waiting for a White Paper and the legislation that might follow does not quite answer the point.

Furthermore, the RSPH recommended more education in schools on the value and importance of vaccinations to help bust the myths surrounding vaccines. Is that happening? Is the Department of Health talking to the Department for Education about this? We have a healthy schools programme in my borough; as a member of a CCG, I will talk to schools about the fact that they need to work with us to ensure that we get vaccination rates up. We want to see whether vaccinations can be offered in different locations, such as high street pop-ups, gyms and community centres. Finally, the public health budget has been slashed in recent years. Is it sufficient to respond adequately to what might become a serious health emergency?

My Ladies—I like saying that rather than “My Lords”, so I will go for it—I echo noble Baronesses in thanking the noble Baroness, Lady Walmsley, for securing the debate and I thank noble Baronesses for their fascinating and well-informed contributions.

I want to take this opportunity to emphasise the Government’s efforts to promote the uptake of vaccines and health screenings. Keeping uptake rates as high as possible is one of our top priorities; we are constantly reviewing ways to do so. We are committed to ensuring that everyone who is eligible takes up that offer. The noble Baroness, Lady Finlay, reminded us of her friends and family members who have been personally affected by the absence of vaccination. Last night, I was talking to my noble friend Lady O’Cathain, who cannot be with us today; she remembered the introduction of the first polio vaccine when she was 10 in Dublin, but then arriving at university and seeing one of her childhood friends who had not had the vaccine suffer in the way the noble Baroness, Lady Finlay, described.

Overall, our routine vaccination programmes in England have a high uptake, with over 90% coverage for almost all childhood vaccines. In addition, more than 11 million people benefit from NHS screening programmes every year and record numbers of people receive life-saving NHS interventions. Local teams in the NHS work incredibly hard to make this happen and find out where improvements are needed. As well as to the work of the great NHS staff, I also pay tribute to the many charities that fight on behalf of those whose lives have been changed for ever by a range of diseases; for example, meningitis charities such as Meningitis Now and the Meningitis Research Foundation, and cancer charities such as Jo’s Cervical Cancer Trust, Breast Cancer Now, Breast Cancer Care and Cancer Research UK.

Although such programmes are promising and are core components of our health protection offer, there is still a lot to do, as noble Baronesses pointed out. There is still regional variation in our programmes—as seen between those in London and those in rural areas—room for improvement in providing services to underserved groups and, regrettably, a slow decline in both vaccination and screening coverage. We are continually taking action to improve uptake of these programmes. However, a number of complex factors need to be addressed. As the noble Baronesses, Lady Walmsley and Lady Hayman, pointed out, there are difficulties in accessing immunisation and screening services for some people. There can also be difficulties in accessing the right information on the benefits and safety of screening and immunisation. In certain areas, particularly London, we face population mobility and particular groups which are underserved. As has been quite fairly pointed out, the robustness of the IT that supports our screening and vaccination programmes is challenging.

Before I turn to those points, I will try to answer some of the questions that have been raised. The noble Baronesses, Lady Thornton and Lady Finlay, asked about herd immunity. There are different levels for different diseases. For measles it is 95%; the UK programme’s objective is obviously to reach 95% for most childhood vaccines. In 2018, when measured among children aged five—I appreciate that there are risks below the age of five—coverage for measles, mumps and rubella was close to this threshold at 94.9%, while coverage for the primary immunisations was above it at 95.6%. However, we are not complacent and Public Health England, together with NHS England, is working to reverse the decline that we have seen among some younger children. If I may, I will come on to talk about where we will capture the data under what we are doing to address IT.

The noble Baronesses, Lady Walmsley and Lady Hayman, talked about regional variations. We are absolutely aware that although our overall screening and immunisation rates are encouraging, there are differences in regional uptake, particularly in London. This is in part due to a transient population, which potentially results in GP databases becoming quickly out of date, and a younger population who may, understandably perhaps, feel that the risks they face are less great. We are doing a great deal to try to share information across different areas. If time permits, I will try to give a couple of examples of that.

A number of noble Baronesses talked about misinformation, including on social media—not only in this country but, as many of us heard on the news this morning, in DRC in relation to Ebola. There is a troubling rise in misinformation, as my noble friend Lady Bottomley pointed out. It is hard for us to be accurate about its impact but it is clearly negative, and clearly so across a number of countries; look at the trend in measles, not only in this country but in Europe and the United States. We are trying to counter this with our own social media campaigns and training for health professionals, which my noble friend Lady Wyld asked about. If I may, I will write to her with more details about the exact numbers for the training of health visitors and midwives.

A number of noble Baronesses asked about using our imagination, I think it was, in trying to find different ways of offering vaccination and screening. I will give one example of this in relation to cervical screening. There is now a partnership with the health and well-being app, Treatwell, which is to introduce conversations about the importance of cervical screening among 25 to 34 year-olds—one of the groups where take-up is very low.

I hear the concerns of the noble Baroness, Lady Thornton, about trust in doctors and nurses, but we have done a number of studies on this and believe that 93% of parents feel that the health professionals they work with give them accurate information. That confidence is crucial.

The noble Baroness, Lady Hayman, mentioned options around compulsory vaccination. She will be aware of the remark made recently by the Secretary of State that nothing is being ruled out. I felt she gave a helpful and interesting example.

The noble Baroness, Lady Finlay, talked about low levels of uptake of cervical screening. We share her concerns. My briefing advises that the HPV vaccination is now routinely recommended for all girls between 11 and 14 years old, so if I understood her rightly, that is a slightly lower age than she mentioned.

The noble Baroness, Lady Barker, raised a very valid point about getting information from people whom you can hear, so to speak, and it not being a matter of luck. There are charities, such as Jo’s Cervical Cancer Trust, which are training community champions so that someone who looks like you or me talks to you or me about cervical screening. She also talked about FIT testing. I think there may be a misunderstanding there. That is going to be introduced in this country in the summer of 2019. I hope that that is good news.

I am looking at the time. I have not even started my speech and I am running out of time.

The noble Baroness, Lady Walmsley, and other noble Baronesses asked what is happening to improve IT. It fits into two boxes. One is incremental improvements and the other is step-change improvement. The department is working incredibly hard to make sure that the end point we get to is the right end point. I shall give an example of incremental improvement. Work is going on with GPs to look at how they are incentivised to carry out immunisations and screening, including recall processes, reminders using text messages and being a bit more agile. In terms of a step-change, the beloved red book for children that many mothers in the Room will remember is going to be replaced by a digital red book. My noble friend Lady Wyld looks unhappy about that. I have still got my red books. That will be an important improvement in infrastructure. We are also developing a new IT system for cervical screening and breast screening.

I will have to write on the other points. I apologise that I was unable to cover them. They include the important issue of underserved groups.

I thank all noble Baronesses for their contributions; it has been a pleasure to respond to their questions. Although we believe that we should be proud of our successes in this country and of the public health benefits that our screening and immunisation programmes provide, we are absolutely not complacent and are working hard to improve these services for the future.

Sitting suspended.