Nurses working in public health win RCNi Leadership award for immunisation programme
A nationwide, school-age immunisation programme set up from scratch and launched within six months is delivering impressive take-up results thanks to the leadership and commitment of the two nurses who run it.
Healthy Child Programme service lead Susie Scales and immunisation co-ordinator Amy Sims, from Derbyshire Community Health Services (DCHS), sought to take over responsibility for vaccinations throughout the county. Vaccinations had previously been delivered through GP surgeries, but take-up rates were historically poor.
The nurses were already involved in the delivery of children’s public health services and could see an opportunity to improve vaccination take-up rates through the collaboration of health visitors, schools nurses, and school and local authority staff.
Having won the contract, Ms Scales and Ms Sims designed, led and implemented their immunisation service from nothing. They recruited, trained and developed a team that was not only competent and safe, but also able to cover an extensive geographical area.
The programme has been a great success, far exceeding all its targets. For what one judge called ‘an amazing feat of leadership’, Ms Scales and Ms Sims were crowned winners of the Leadership category of the RCNi Nurse Awards, the profession’s top accolade.
Ms Scales says: ‘We had to get policies written and ensure our practice was based on evidence. While going through the tender process, there was a lot of staff movement, with people changing roles and banding. We had to make sure that everyone was trained because, for many of them, it was a new role.’
‘The team had to negotiate with schools, not just in the state sector, but also the private and independent sectors. We had to ensure we had appropriate premises for the clinic and that the children had the information they needed for informed consent.’
Ms Sims adds that building a good relationship with general practice was essential. ‘We worked with 233 GPs to ensure that we had the data we needed and that our communication streams were open. Logistics – securing stock, the correct carrier and fridges – was a massive job.’
The team managed to deliver four different vaccinations to 45 senior schools and 235 primary schools over 1,000 square miles in one academic year. ‘We were also managing records with GPs,’ says Ms Scales. ‘We delivered 67,000 vaccinations in the first year with a team of six nurses.’
It also offered catch-up campaigns to all children who had missed their vaccinations when they were offered through general practice.
The team’s biggest challenge came within the first six weeks of the programme starting. Ms Sims says: ‘I had over 450 schools to book in for flu season and plan geographically. I had to ensure there were enough staff to visit the school and that sufficient vaccines were delivered weekly.
‘On top of this, I had to ensure 26,000 consent forms were delivered and checked before attending the schools, ensure staff were competent in delivering the programme and work closely with NHS England, all while learning a new role myself. We overcame so many challenges by sheer perseverance and commitment to the service.’
Ms Scales says it was also a challenge to ensure the service was offered to all schools, and the targets were tough.
‘As immunisations had not been offered in schools for many years, we had to communicate with schools to ensure they knew what to expect and were happy with the service we planned to give,’ she says.
To maximise take-up, Ms Scales and Ms Sims offered extra local clinics out of hours and at weekends. Special schools were afforded the same flexibility and support to ensure that vulnerable children and young people could access the service easily. The nurses targeted hard-to-reach children, such as those being educated at home and those in the Traveller community.
‘It is about what works with young person,’ says Ms Sims. ‘They may be unable to have their immunisations at school. We quickly saw that some of the young people weren’t coping, so we set it up differently. In one case, a young person had autism, so we spoke to the family and ended up giving her a vaccination at home.’
The nurses’ approach to young people was rewarded by an ‘amazing’ first year. ‘We met every target,’ says Ms Sims. ‘In our second year of flu, we were 8% up from the first year, which was 4% over the highest expected national target. We achieved 50% more than another trust in our area.
‘During this time we mobilised a team of nurses to deal with an outbreak of meningitis in a primary school. This meant we had to get a team together to immunise all the children in the school without disrupting the normal schedule and routine.’
When it started, flu vaccine take-up rate was 40 %, but in its first year the team achieved 61%. That year the team gave 29% of year 11 pupils a teenage booster as part of a catch-up programme for diphtheria, tetanus and polio.
Other results have been excellent. Previously, GPs gave only 46% of year 9 pupils their school leaver boosters, but the nurse team achieved a 74% uptake in its first year and has already achieved more that 84% in the current academic year.
During 2015-16, 86% of year 9 pupils and more than 73% of year 11 pupils received the meningitis ACWY vaccine.
The responses of GPs and pupils has been positive. The team has sought feedback from younger children and children with learning disabilities so all service users can help them to improve their service.
‘Asking for feedback from pupils is daunting, but so far we have only had positive responses,’ says Ms Sims. ‘It is rewarding for the nurses that, despite being apprehensive, the pupils come in smiling’
The nurses’ manager at the time, Helen Cooper, nominated them for an RCNi Nurse Award. She says: ‘Starting a brand new, school-aged immunisation service with no trained staff, resources, equipment, office space, history or training requires extreme leadership. This is what these two amazing nurses brought to the table to provide an outstanding service to the children of Derbyshire.
‘It takes a proactive leader to recognise opportunities and to, not only take action, but to bring an entire team and wider partners on their journey.
‘Using authentic and compassionate leadership styles, they overcame challenges with grace and professional style, never losing sight that this initiative would protect the health of their 5-to-19 population. No obstacle was going to come in the way of achieving this goal.’
Ms Scales and Ms Sims have different leadership styles and different roles. Ms Sims is the immunisation team co-ordinator responsible for the day to day running and leadership of the team. Ms Scales is the clinical lead and budget holder. How do they ensure the partnership works?
Ms Scales says: ‘We both have a good understanding of each other’s roles and responsibilities, and we trust each other to carry out what is needed for the team to run smoothly.’
Ms Sims agrees, adding: ‘We have different leadership styles, but together we work well. We are proud of our team and what we achieved, and we share a commitment to continue to work hard and make a difference.’
Nursing Management consultant editor Barry Quinn was on the Nurse Awards judging panel and was struck by the nurses’ working relationship. He says: ‘This complementary relationship has enabled two innovative leaders to reach out to children and young people across Derbyshire’.
He adds: ‘I was particularly impressed by their approach towards including and working with harder-to-reach young people and children. The targets Susie and Amy reached were impressive, and they clearly demonstrated that, behind every figure and target, there is an individual child or young person who needed their team’s help.’
Ms Scales and Ms Sims stress their results and the positive feedback are the result of their team ‘working above and beyond to ensure the children in Derbyshire were protected’.
‘It was a year of hard, hard work,’ says Ms Scales. ‘We looked at our staff and used their strengths. We motivated them and they all care about what they do.
‘Through meticulous planning we stay within the budget. The team is aware of the bottom line and helps us keep within it. They have all helped shape the great service we provide and continue to be motivated to achieve better with each campaign.
‘We are incredibly proud of them every day, and of their continued enthusiasm and the effort they put in. They have worked above and beyond, from travelling the many miles they need to reach the school on time to the great number they have immunised in schools.’
The team has already been approached to share its ideas with other care providers. Ms Sims says: ‘I would love to share my ideas with other trusts and show them how we achieve such great results. Within DCHS, I would like to work with other new leaders and share my journey on how to really get the best from a team.’
Deputy director of nursing at Public Health England Joanne Bosanquet calls the team ‘a trailblazer, delivering their service to children at home, in tents on the streets’.
‘They are so passionate about what they do that I cannot imagine they will stop until they reach 100%,’ she says.
The nurses certainly have no intention of stopping their drive for even higher vaccination rates.
‘We would like to continue to improve the already great achievement of the team and work,’ says Ms Sims. ‘We want to ensure that every children and young person gets the immunisations that they need.’
The RCNi Nurse Award finalists
Katie De Freitas, Great Ormond Street Hospital NHS Foundation Trust
Ms De Freitas developed a cultural competence e-learning training tool for healthcare professionals to raise awareness, and to improve care and patient safety. She developed the tool, which helps staff understand issues of culture and health, after her research highlighted that staff need more support to develop skill and confidence when responding to the varied needs of patients, especially those from black, Asian and ethnic minority backgrounds.
Care Home Project Team, St Christopher's Hospice
The team has developed a research-based model of practice, the Steps to Success programme. The model enables and supports staff to deliver high-quality, end of life care to residents and family members, and is tailored to specific settings, such as nursing, residential and learning disability facilities. The number of residents dying in care homes has significantly increased over recent years, as has the number of residents with documentation on advance care planning and cardiopulmonary resuscitation decisions.
Joanne Strain, Four Seasons Health Care
Head of nursing Ms Strain led the implementation of a quality-of-life improvement programme in 350 care homes by developing educational packages, sharing success stories and leading culture change. The system provides live feedback from residents, care partners, visiting professionals and staff. It prompts nurses to conduct mandatory audits digitally, for example, ofmedication and weight loss. As a result of its implementation, the number of choking incidents and near-miss events has fallen 21.1%. The number of falls has decreased by 6.5% and that of infections by 13.9%.
Kerry Mutch and Rosie Everett, The Walton Centre NHS Foundation Trust and Oxford University Hospitals NHS Trust
These nurse specialists developed the world’s first nursing service for patients with neuromyelitis optica spectrum disorders, which are auto-immune conditions that cause inflammation of the spinal cord and optic nerves. About 700 people in the UK have such disorders. Ms Mutch and Ms Everett ensure their patients experience high-quality, evidence-based treatment and education, delivered with care, dignity and compassion. They co-ordinate primary and secondary providers, and share clinical experience with community colleagues to ensure patients receive care close to home.