In many areas school-based immunisation programmes are run separately from 5-19 Healthy Child Programme services, but that is not the case in Stockport where the HPV, the teenage three-in-one booster and MenACWY vaccines programmes are delivered by the service. The approach has helped ensure high uptake of immunisations and meant the service was well placed to respond to the demands placed on it by the pandemic. This case study showcases the important role of school nurses in the education system.
Immunisation is an opportunity to engage pupils
Stockport’s school nursing service is delivered by Stockport NHS Foundation Trust and is part of Stockport Family, an integrated Stockport Council service. The team consists of specialist public health school nurses, a children’s continence team, a complex safeguarding nurse and the immunisation team, which focuses on school-based immunisations.
Stockport is a relatively small borough – there are around 14,000 young people within the 12–15-year-old cohort – within this there are significant differences in health inequalities.
School Nurse Team Lead Anne-Marie Gallogly said: “We have some very affluent areas and some very deprived areas. That creates a lot of challenges with immunisations, but having the immunisation offer within the school nursing service helps us to address some of those inequalities.
“There are several benefits to the model we have. The school nurses know the schools, the layout of the buildings and the children and their families, there are already good relationships with our colleagues in education. They are trusted – and that is of major significance when it comes to immunisations. They are aware of the young people from whom you may not get parental consent and the most vulnerable young people and can engage with families when appropriate.
“Each school has a named school nurse so when the immunisation team go in the school it is the named nurse that leads the immunisation session. It is a valuable opportunity to engage pupils. We find they will often disclose other issues – eg anxiety, mental health concerns, sexual health or safeguarding issues.
“We are proactive too - we also talk to them about our service and how they can get in touch with us. During the COVID immunisation programme we were able to use the time the young people spent with us talking about a new online offer - Chat Health. This is a confidential new text messaging service that enables children and young people aged 11-19 to contact the Stockport school nursing team about any health queries or concerns they may have. A school nurse will then get back in touch with the person who has contacted them to offer health advice and support.
“It is about making every contact count. You don’t get that if the services are separate.”
Meeting the challenges of the pandemic
The set up proved hugely beneficial in terms of meeting the challenges that emerged as a result of the pandemic. The first lockdown in spring 2020 meant that immunisation services across the country fell behind in their HPV and three-in-one teenage booster vaccine programmes.
Stockport school nurses responded by setting up a vaccination clinic in a local church hall over the summer holidays in 2020. More than 1,000 children were vaccinated. Parents really appreciated the offer. One said: “I was so impressed with how organised it was – it worked like clockwork.”
Then, when the child COVID vaccination programme got under way in September 2021, the team combined those with routine immunisations.
Ms Gallogly said: “It was a huge undertaking and resulted in a very intense few weeks. We were determined that we did not want the other routine vaccinations to stop so we did both.”
This was achieved with help from the public health team at the council as the local COVID advice and testing team worked with the service to help with the admin side of the children’s COVID vaccination programme for the first dose.
The COVID-19 testing team went in with the school nurses and immunisation team to support with some of the data entry requirements. The arrangement worked well - Stockport had the highest uptake for the first dose in Greater Manchester with an uptake of 64 per cent.
“The pandemic has actually helped to build new relationships like that,” said Ms Gallogly. “And then when the second doses needed to be done, we were actually able to train the testing team as vaccinators under the national protocol that was allowed. They had seen what it entailed and had the support of our nurses.”
Other steps were also taken, including establishing a half-term catch up clinic at a local church to offer COVID vaccines to those who had not yet been vaccinated or were being home educated and had not had the chance to get vaccinated in school. A clinic for children and young people with needle phobias was also offered to allow those who were too anxious to access vaccines in school to have their vaccinations.
But now that is complete, the school nursing service is back prioritising routine vaccinations. Ms Gallogly said: “Immunisation is so important that we cannot let uptake drop. The focus and controversy over the COVID vaccine has affected other vaccines with negative press and misinformation being shared, so we are still working hard to make sure the right information is available and rebuild the confidence of parents in the programmes.
“We are going through the data and identifying areas where there has been a lower uptake so we need to think about what the barriers are and how we can overcome these. We are engaging families one-by-one and even offering home vaccinations where appropriate. It is time-consuming, but it is worth it.”