The Covid-19 vaccine rollout shows the opportunities of place-based partnerships

The vaccination programme has been one of the few almost unqualified success of the UK’s response to the Covid-19 pandemic. It has prevented tens of millions of infections, at least a quarter of a million hospital admissions and well over 100,000 deaths.

It still has a way to go: completing the booster and third dose programme and continuing to persuade the hesitant to receive even a first dose, while a fourth and even a fifth dose may yet be needed – particularly if a new variant were to prove capable of significant evasion of the current vaccines.

The techniques used, and the joint working with local government, offer a real opportunity to engage with those who are least in touch with health and care...

Yet it has also provided key lessons on how the NHS can improve its services more widely, which we set out in our new report, The Covid-19 vaccination programme: trials, tribulations and successes. The techniques used, and the joint working with local government, offer a real opportunity to engage with those who are least in touch with health and care in order to improve screening for cancer, diabetes, high blood pressure and other programmes, including childhood vaccinations, thus saving more lives and preventing or delaying disease.

A wide range of interlocking factors played a part in the successes of the roll out. The NHS has never used so much data so quickly and so powerfully. That made it possible to map who had had the vaccine, identifying, at near street level, where there were gaps in uptake – whether by age, gender, ethnicity, deprivation, care home, NHS site and so on. That in turn allowed much better outreach. Gaps in provision could be plugged by additional sites – whether a pharmacy, temple, mobile van or other pop-up centre. At least as importantly, however, it also made clear where more work was needed to build trust and overcome, as far as possible, vaccine hesitancy.

And that was made possible by one of the best examples ever of joint working between the NHS, local government and the voluntary sector. The NHS provided, in the words of one interviewee, ‘the scale of the offer’ – the logistics behind the availability of the vaccine and the staffing of vaccine sites, aided by tens of thousands of volunteers. But, at the programme’s best, it was local government and its directors of public health who found the community champions, as many councils called them, to spread the word about the vaccine and provide reassurance about its safety and efficacy, while also helping find the most effective pop-up and other sites. This was integrated care in action.

It was not sufficient for the NHS only to offer a universal service. It had also to offer equal access. That meant taking the service to places that the NHS would not otherwise routinely go. Into temples, mosques, churches, and other venues, with those who volunteered their sites also arguing that continuing to take NHS programmes into such places would improve their population’s health.

In other words, the combination of these factors is perhaps the key lesson from the roll out. Far better use of data and mapping data, improved integration between local government and the NHS, including local government’s ability to take NHS services to places they do not normally go, with all of that helping build trust and thus uptake, and with important parts of the community wanting to facilitate that.

It should be noted that this was not entirely successful. Uptake remains lower among ethnic minorities and in areas of deprivation. But there can be little doubt that it is higher than it would otherwise have been without those factors.

The question is: ‘how much of that can be bottled and re-used?’

Place-based partnerships will be one of the absolutely key factors in deciding how far integrated care systems achieve their aims.

Place-based partnerships will be one of the absolutely key factors in deciding how far integrated care systems achieve their aims. Not just on the vaccine but in the broader response to the pandemic, elements of the NHS, local government and the voluntary sector have worked together more closely than ever before. Relationships have been built that should survive – if the old ways of working (excessive assurance, jealousy over budgets, suspicion of motives) can be overcome. Primary care networks, as a focus for delivery of care and partnerships at a neighbourhood level, proved their worth, not least in seeking out the clinically most vulnerable. There is something to build on there – as is the growing role that community pharmacies played as the vaccine rolled out.

In a recent piece of work by The King’s Fund around social care, both social care leaders and voices from the NHS noted how during the pandemic barriers had been broken by the need of the two sectors to work together in the crisis. But even then, those voices were worrying, a year ago, that there would be a return to business as usual. The same risk applies to the strengthened relationship between local authorities and the NHS. But it is clear that there are opportunities here for improved population engagement and for improved services that should not be wasted.