Guidance

Recommendations

Recommendations

People have the right to be involved in discussions and make informed decisions about their care, as described in NICE's information on making decisions about your care.

Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off-label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

1.1 Service organisation

These recommendations should be read together with the NICE guideline on flu vaccination: increasing uptake.

Named vaccination leads

1.1.1

Ensure that each organisation that commissions, provides or organises vaccination services has a named vaccination lead with responsibility (as relevant) for ensuring that:

  • vaccination records are validated and updated

  • people who are eligible for vaccination are identified

  • invitations and reminders are sent to people eligible for vaccination

  • vaccines are administered and recorded

  • there is coordination between providers and other services involved in organising and reporting vaccinations.

  • GP practices and child health information services (CHIS) understand each other's reporting systems and processes

  • best practice is followed for ordering, storing, distributing and disposing of vaccines (see the Green book for more information).

1.1.2

Commissioners and providers should ensure that the named vaccination leads have access to the relevant information and facilities they need to carry out their role.

1.1.3

Nominate a named person in each primary care provider to be responsible for identifying people who are housebound and need vaccination.

1.1.4

Social care providers and providers of other non-healthcare services (who are asked to identify people eligible for vaccination opportunistically [see recommendation 1.2.9]) should identify a named lead responsible for the organisation's approach to:

  • identifying people who are eligible for vaccination and

  • ensuring that it is clear where to signpost these people to get vaccinated or to obtain further information.

1.1.5

In supported living settings and care homes, the named vaccination lead should also ensure that there is a policy in place covering what actions to take in response to vaccination invitation letters for residents.

1.1.6

For secondary and tertiary care providers who do not provide vaccinations, ensure that there is a named vaccination lead who can identify people eligible for vaccination and signpost them to relevant services.

For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact section on named vaccination leads.

Full details of the evidence and the committee's discussion are in:

Designing and raising awareness of payment schemes

These recommendations are for regional and local commissioners of NHS vaccination services.

1.1.7

Raise awareness among healthcare professionals and providers:

  • about payments and funding streams to support the delivery of vaccination services, including those for populations with low vaccination rates

  • that submission of information about vaccination uptake directly affects any linked organisational incentive payments.

1.1.8

When designing incentive schemes for providers, take into account that using incentives to prioritise certain vaccinations could have unintended consequences on the uptake of other vaccinations.

For a short explanation of why the committee made these recommendations and how they might affect services, see the rationale and impact section on designing and raising awareness of payment schemes.

Full details of the evidence and the committee's discussion are in evidence review G: interventions to increase the uptake of routine vaccines by improving infrastructure.

Making vaccination services accessible and tailoring to local needs

1.1.9

NHS commissioners and NHS providers should ensure that they identify:

  • local population needs

  • barriers to vaccine uptake (see box 1)

  • areas or populations with low vaccine uptake (see box 2).

    They should do this using data from the Joint Strategic Needs Assessment and other data sources.

Box 1 Some key barriers to routine vaccine uptake

  • Inflexible and inconvenient clinic times and locations

  • Perceived lack of balanced information (including misinformation)

  • Language and literacy problems

  • Insufficient time in consultations to discuss concerns about vaccinations

  • Lack of staff training in how to discuss vaccinations effectively

  • Uncertainty about vaccine safety and effectiveness

  • Uncertainty about whether vaccines are needed (including how severe the diseases are or how likely it is that someone will be exposed to the disease)

  • Previous negative experiences of vaccination

  • Lack of trust in the government, drug companies and the healthcare system

  • Religious or cultural views that are against vaccination (this may relate to specific vaccinations, for example HPV [human papillomavirus])

  • Individual barriers such as needle phobia or sensory impairment.

Box 2 Some population groups that are known to have low vaccine uptake or be at risk of low uptake

  • People from some minority ethnic family backgrounds

  • People from Gypsy, Roma and Traveller communities

  • People with physical or learning disabilities

  • People from some religious communities (for example, Orthodox Jewish)

  • New migrants and asylum seekers

  • Looked-after children and young people

  • Children of young or lone parents

  • Children from large families

  • People who live in an area of high deprivation

  • Babies or children who are hospitalised or have a chronic illness, and their siblings

  • People not registered with a GP*

  • People from non-English-speaking families*

  • People who are homeless*

Communities with low uptake other than those listed above may also be identified specifically in your local area.

Sources: UK Health Security Agency (previously Public Health England) Health Equity Audit of the National Immunisation Programme, apart from those marked with an asterisk, which were raised by the committee.

1.1.11

Commissioners and providers should ensure that they:

  • Involve people in the local community when identifying barriers to vaccine uptake and when making decisions about accessibility of services (see the section on involving people in peer and lay roles to represent local needs and priorities in the NICE guideline on community engagement).

  • Tailor service opening hours and locations for vaccinations to meet local needs. This should include providing multiple opportunities for people eligible for vaccination to have their vaccinations at a time and location convenient to them. Locations such as community pharmacies, clinics people attend regularly, and GP practices could be used.

  • Provide a range of accessible options for booking appointments (such as telephone booking and online systems). Take into account that some people may need additional support to use these systems.

1.1.12

Consider using sites outside healthcare settings as settings for vaccination clinics, such as mobile vaccination units, children and family centres, or community or faith centres that provide a more family friendly environment, if this would address specific local barriers to vaccine uptake.

1.1.13

Consider providing vaccination services during extended hours and extended access appointments in evenings and weekends for people who may find it difficult to attend at other times. These services could be in primary care or community pharmacies, or be provided by a centralised service in each local area. If possible, provide these as part of existing out-of-hours services.

1.1.14

Commissioners and providers should coordinate vaccination services between providers to minimise wastage where vaccine supply is limited.

1.1.15

GP practices should ensure that contractual obligations and best practice on patient registration is followed (for example, not requiring immigration status or proof of address).

For a short explanation of why the committee made these recommendations and how they might affect services, see the rationale and impact section on making vaccination services accessible and tailoring to local needs.

Full details of the evidence and the committee's discussion are in evidence review D: interventions to increase the uptake of routine vaccines by improving access.

Audit and feedback

1.1.16

NHS commissioners should ensure that there is a coordinated system in place for a quarterly cycle of feedback and audits of vaccine uptake data that can be compared against similar providers at a local and national level.

1.1.17

Providers should use available data to review current and past activity to help with continuous improvement.

1.1.18

To help increase vaccine uptake in the future, vaccine services should:

  • evaluate initiatives for improving the uptake of routine or COVID‑19 vaccinations carried out during the SARS‑CoV‑2 pandemic, and

  • identify initiatives that could be used to increase the uptake of routine vaccination programmes.

For a short explanation of why the committee made these recommendations and how they might affect services, see the rationale and impact section on audit and feedback.

Full details of the evidence and the committee's discussion are in:

Training and education for health and social care practitioners

1.1.19

Vaccination leads (see recommendation 1.1.4) should ensure that health and social care practitioners and other related staff who are in contact with people eligible for vaccination, but do not administer vaccines, have ongoing education about vaccination. These could include:

  • Practitioners working in primary care settings, including GP practices, optometry, dental practices and community pharmacies.

  • Secondary care practitioners, for example in clinics for children with chronic conditions, emergency departments or wards such as oncology, antenatal or neonatal.

  • Social care practitioners who may have contact with carers and other eligible groups, such as people with learning disabilities. This may include contact during home visits, individual needs assessments and carers' assessments.

1.1.20

Ensure that education for health and social care practitioners and other related staff who are in contact with people eligible for vaccination, but do not administer vaccines, includes:

  • an understanding of who is eligible for vaccination on the NHS routine UK immunisation schedule

  • awareness of barriers to vaccination (see box 1)

  • benefits and risks of vaccination

  • where to signpost people for further information and vaccination.

    Tailor the level and content of the information to the person's role.

1.1.21

Healthcare practitioners who administer vaccines should be given the time, resources and support to:

  • Undertake mandatory training before administering vaccines (UKHSA [previously PHE] national minimum standards and core curriculum for immunisation training for registered healthcare practitioners).

  • Include training on vaccination as part of their continuing professional development plan, including how to have effective and sensitive conversations about vaccination.

  • Ask people for any questions and concerns they may have about vaccination and give them personalised responses (or signpost people to relevant sources).

  • Provide tailored information on the risks and benefits of vaccination.

  • Understand when a vaccine is contraindicated, for example for people with certain allergies or conditions, and when it can still be delivered, and be able to discuss this with the person concerned (see recommendation 1.2.18).

  • Overcome particular individual barriers to vaccination such as those experienced by people who have a learning disability, needle phobia or sensory impairment.

  • Offer and administer vaccines.

For a short explanation of why the committee made these recommendations and how they might affect services, see the rationale and impact section on training and education for health and social care practitioners.

Full details of the evidence and the committee's discussion are in:

Appointments and consultations

1.1.22

Providers should ensure that there is sufficient time in an appointment or consultation to:

  • allow the healthcare professional and individual, family member or carer (as appropriate) to have a discussion where any concerns can be identified and addressed. This could include using written information or websites to help the discussion

  • gain informed consent

  • administer vaccines

  • complete documentation.

    For information on how to support people to make informed decisions, see the NICE guideline on shared decision making.

For a short explanation of why the committee made this recommendation and how it might affect services, see the rationale and impact section on appointments and consultations.

Full details of the evidence and the committee's discussion are in evidence review E: education interventions to increase the uptake of routine vaccines.

1.2 Identifying eligibility, giving vaccinations and recording vaccination status

These recommendations should be read together with the NICE guideline on flu vaccination: increasing uptake.

NICE has produced a visual summary on identifying people eligible for vaccination and opportunistic vaccination.

Using compatible systems and processes

1.2.1

Ensure that compatible systems or processes are in place to enable vaccination records to be shared and transferred effectively and in a timely way between different parts of the healthcare system, including other vaccination providers such as community pharmacies.

For a short explanation of why the committee made this recommendation and how it might affect practice, see the rationale and impact section on using compatible systems and processes.

Full details of the evidence and the committee's discussion are in evidence review A: identification and recording of vaccination eligibility and status.

Keeping records up to date

1.2.2

Child health information services (CHIS) should ensure that their vaccination records are updated within 5 days or within service specifications if they exist, whichever is shorter, in response to new information about a person's vaccination status.

1.2.3

GP practices should ensure that their vaccination records are updated within 2 weeks (or as specified in the GP contract if shorter) in response to new information about a person's vaccination status.

1.2.4

GP practices should use an up-to-date clinical system template that includes relevant SNOMED CT codes to record vaccinations.

1.2.5

GP practices should validate their vaccination records at least monthly against data sources received. Check registered populations and vaccine eligibility and status, investigate any discrepancies and correct the record accordingly.

1.2.6

CHIS should give GP practices a monthly update (or as specified in the CHIS contract if shorter) on children who are not up to date with their vaccinations.

1.2.7

GP practices should inform CHIS if 3 invitations for vaccination are made but a child remains unvaccinated (see recommendation 1.3.16).

1.2.8

GP practices should ensure that they have up-to-date medical records, phone numbers, email addresses and addresses for people who are eligible for vaccination, or their family members or carers (as appropriate). Include the person's preferred methods of contact (such as letters, texts, emails or phone calls) and whether there are additional literacy issues or language needs.

For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact section on keeping records up to date.

Full details of the evidence and the committee's discussion are in evidence review A: identification and recording of vaccination eligibility and status.

Identifying people eligible for vaccination and opportunistic vaccination

1.2.9

Use every opportunity to identify people eligible for vaccination. This could include:

  • at registration in general practice

  • during health and developmental reviews as part of the healthy child programme and health visitor and school nursing targeted contacts

  • during the annual learning disability health check for people with learning disabilities

  • when making contact with people in healthcare settings, community health clinics, sexual health services or drug and alcohol services (including hospitals, emergency departments, inpatient services, rehabilitation services and general practice)

  • when making contact with women who are trying to conceive or have a newly confirmed pregnancy, and at antenatal and postnatal reviews

  • on admission to day care, nurseries, schools, special needs schools, pupil referral units, and further and higher education

  • on admission to care homes and supported living settings

  • when people visit community pharmacies for health advice, a medication review or an NHS New Medicine Service, or to collect prescriptions

  • during home visits for healthcare or social care

  • any health service contact with people who are homeless

  • when new migrants, including asylum seekers, arrive in the country

  • within 7 days of arrival in prisons and young offender institutions, during any contact with healthcare services in these places, and when people leave

  • as part of a looked-after child or young person's health plan, and during initial health assessments, and annual and statutory reviews (see also the NICE guideline on looked-after children and young people)

  • any contact with home-educated children

  • during occupational health checks for everyone who works in a clinical or social care setting, even if their role is not healthcare related.

1.2.10

Offer people (or their family members or carers, as appropriate) access to online systems or apps to allow them to view and check their NHS vaccination records (or those of their child or the person they care for).

1.2.11

Providers of online systems or apps should ensure that people automatically have access to their vaccination status as part of their electronic records as the default option.

1.2.12

Use the NHS summary care record, or any other available vaccination records (including records held by the person), to opportunistically identify people who are eligible for vaccination.

1.2.14

GP practices should ensure that there is a mechanism in place to check the vaccination status of people registered as temporary residents and offer any vaccinations needed.

1.2.15

Providers should routinely use prompts and reminders from electronic medical records to opportunistically identify people who are eligible and due or overdue for vaccination.

1.2.16

Add prompts to the records of parents or carers (as appropriate) if children are overdue vaccinations.

1.2.17

Midwives should offer vaccination to pregnant women during routine antenatal visits, as recommended by the Green book and the NHS routine UK immunisation schedule. If the midwife cannot administer the vaccine, they should signpost women to vaccination services, drop-in clinics or their GP practice.

1.2.18

When uncertainties exist around contraindications and allergies, consult the Green book and seek expert help if needed.

1.2.19

When people eligible for vaccination have been identified opportunistically:

  • Healthcare professionals should:

    • if possible, discuss any outstanding vaccinations with them (or their family members or carers, as appropriate) and offer vaccination immediately

    • otherwise, encourage them to book an appointment to discuss the vaccinations or an appointment for vaccination

    • think about referring a child's parents or carers to the health visitor or school nurse, as age appropriate.

  • Non-healthcare practitioners should signpost them to vaccination services.

    See also recommendation 1.2.15.

For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact section on identifying people eligible for vaccination and opportunistic vaccination.

Full details of the evidence and the committee's discussion are in:

Recording vaccination offers and administration

1.2.20

When offering a vaccination, record in the GP record or other medical record whether it was accepted or declined or there was no response (see recommendation 1.3.20).

1.2.21

The person administering the vaccine should ensure that information is recorded accurately and consistently, regardless of where the vaccine is administered, and includes:

  • details of consent to the vaccination (including if someone else has consented on the person's behalf, and that person's relationship to them)

  • the dose, batch number, expiry date, vaccine name and vaccine product name

  • the date, route and site of administration

  • any reported adverse reactions

  • whether the vaccine was administered under Patient Specific Directions or Patient Group Directions. (See the NICE guideline on patient group directions.)

1.2.22

Providers should ensure that clinical and patient-held records (including records held on behalf of children) are updated at the time of the vaccination. If the patient-held record is not available at the appointment, give the person a printed record of the vaccination and ensure that the patient-held record is updated at a subsequent healthcare appointment.

1.2.23

Providers should use electronic health record templates with compulsory data fields to support accurate recording of vaccination offers and administration (see recommendations 1.2.15 and 1.2.16).

1.2.24

Providers should ensure that vaccinations are reported promptly (within 5 working days, or in line with required standards if shorter) to GP practices and child health information services (CHIS) (if relevant).

1.2.25

Where commissioned locally, CHIS should send details of vaccinations administered outside of the GP practice to GP practices within 2 weeks or as specified in the CHIS contract if shorter.

1.2.26

Providers should ensure that the information they provide to GP practices and CHIS is clear and in a readily accessible format that minimises the need for manual re-entry of data.

For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact section on recording vaccination offers and administration.

Full details of the evidence and the committee's discussion are in evidence review A: identification and recording of vaccination eligibility and status.

1.3 Invitations, reminders and escalation of contact

These recommendations should be read together with the NICE guideline on flu vaccination: increasing uptake.

System organisation and accessibility issues

1.3.1

NHS England public health commissioning teams and screening and immunisation teams should ensure that there is a coordinated system in place at the local level for providers to send out invitations and reminders.

1.3.2

Consider sending invitations and reminders for different vaccinations together (for example, the pneumococcal vaccine with the flu vaccine).

1.3.3

If possible, ensure that the information, invitation and any subsequent reminders are given in a format and language appropriate for the person and their family members or carers (as appropriate).

1.3.5

Give people who have come from outside the UK:

  • details of the NHS vaccine schedule, how it is delivered, where and by whom if they:

    • have started vaccinations before arrival and not completed them or

    • are eligible for vaccination.

  • help to access healthcare, if needed.

    Be aware that expectations of who delivers vaccine services may differ by cultural background.

For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact section on system organisation and accessibility issues.

Full details of the evidence and the committee's discussion are in:

Vaccinations for babies, infants and preschool-aged children, and adults

NICE has produced the following visual summaries:

Initial invitations
1.3.7

Invite people who are eligible for vaccination or their family members or carers (as appropriate) to book an appointment or attend an open access clinic. Do this opportunistically during consultations if possible, or by letter, email, phone call or text. Use the person's preferred method of communication for invitations if possible.

1.3.8

Practitioners working in maternity services and other healthcare practitioners who have contact with pregnant women should ensure that pregnant women are invited for vaccination or signposted to vaccination services or drop-in clinics.

1.3.9

Ensure that the following people (or their family members or carers, as appropriate) know how to get home visits for vaccination if they cannot attend vaccination clinics or other settings where vaccinations are available:

1.3.10

Consider sending the vaccination invitation and any subsequent reminders from a healthcare professional or service that is known to the person or their family members or carers, such as a school, GP practice, doctor, nurse, midwife or health visitor.

1.3.11

Ensure that the vaccination invitation contains:

  • The vaccines being offered (named in full) and the targeted diseases.

  • A statement that the NHS and the relevant provider (with the type of provider specified) recommends the vaccination.

  • Details on contacting a healthcare professional (for example, practice nurse, GP, school nurse or pharmacist) to discuss any concerns the person (or their family members or carers) might have (including about possible contraindications or allergies that could affect whether the person can have a vaccination).

  • Instructions for how to book an appointment at a vaccination clinic, if relevant, or where and when drop-in clinics are held. If possible, include options for online booking.

  • A reminder to bring any relevant patient-held records for updating.

1.3.12

If space allows, include the following in the vaccination invitation or provide links:

  • Information on the vaccines, including:

    • the potential severity of the targeted diseases

    • the risks and benefits of vaccination, including individual benefits (including to the baby for maternal pertussis vaccination) and population benefits (protecting other people in their community)

    • if relevant, the importance of having all doses of a vaccination course

    • if relevant, why some vaccines are given at specific ages (for example, the HPV [human papillomavirus] vaccine).

  • Instructions for accessing additional videos and information (including interactive information and decision tools) from trusted sources such as the Oxford University's Vaccine Knowledge Project, NHS England and the World Health Organization. Include hyperlinks or QR codes if possible.

  • Information about what to expect at the appointment.

1.3.13

Ensure that the parents or carers (as appropriate) of babies who are in neonatal care units when they are eligible for their vaccinations receive relevant information (see recommendations 1.3.11 and 1.3.12) and are made aware of when and how their baby's vaccinations will take place.

For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact section on initial invitations.

Full details of the evidence and the committee's discussion are in:

Reminders and escalation of contact
1.3.14

Providers (such as GP practices) should identify people who do not respond to invitations or attend clinics, vaccination appointments or other settings where vaccinations are available and send a reminder. (See also recommendation 1.3.10.) Confirm that the person has received the reminder.

1.3.15

At a pregnant woman's first appointment after the 20‑week scan, antenatal care providers should check whether they have been offered and accepted vaccination against pertussis in this pregnancy. If not, ensure they receive offers of vaccination or reminders (as relevant) at subsequent antenatal appointments or during any contact with their GP, midwife, health visitor or any other healthcare provider.

1.3.16

Talk to parents or carers (as appropriate) of children aged 5 or under who have not responded to a reminder if a vaccination delay is approaching:

  • 2 weeks, for immunisations for babies up to age 1 year

  • 3 months, for immunisations for children aged 1 year and over.

    Explore with them the reasons for their lack of response and try to address any issues they raise.

1.3.17

For pregnant women and older people who do not respond to reminders, consider more direct contact such as a phone call. Explore with them the reasons for their lack of response and try to address any issues they raise.

1.3.18

Consider a multidisciplinary approach to address any issues raised in recommendations 1.3.16 and 1.3.17, involving other relevant health and social care practitioners such as health visitors, social workers or key workers, while respecting the person's decision if they refuse vaccination.

1.3.19

Consider home visits for people who have difficulty travelling to vaccination services. Discuss immunisation and offer them or their children (as relevant) vaccinations there and then (or arrange a convenient time in the future).

1.3.20

If someone declines an offer of vaccination, record this with the reason why, if given, and make sure they know how to get a vaccination at a later date if they change their mind.

For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact section on reminders and escalation of contact.

Full details of the evidence and the committee's discussion are in:

People who are not registered with a GP practice
1.3.22

Commissioners should ensure that people who are not registered with a GP practice are aware that they are eligible for NHS vaccinations, and where and how to access them.

1.3.23

CHIS should identify children who are eligible for vaccination but are not registered with a GP practice. Where commissioned, they should send invitations to parents and carers or ensure this cohort is highlighted to the service commissioner. This might include children from Traveller, Gypsy and Roma communities, newly arrived immigrants or asylum seekers.

For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact section on people who are not registered with a GP practice.

Full details of the evidence and the committee's discussion are in evidence review C: reminders interventions to increase the uptake of routine vaccines.

Vaccinations for school-aged children and young people

1.3.24

When administering vaccinations to secondary school-aged children and young people, do this in schools if possible.

Routine vaccinations at school

NICE has produced a visual summary on vaccinations for school-aged children and young people: invitations, reminders and escalation of contact.

1.3.25

School-aged immunisation providers and schools should work together to organise and carry out vaccinations for secondary school-aged children and young people.

1.3.26

Ensure that schools are involved in sending invitations (including consent forms) for vaccinations on behalf of the providers to pupils who attend school. Make the format of the invitation accessible to parents and secondary school-aged children and young people.

1.3.27

Ensure that the invitation, information and consent form are available in a digital format, with non-digital options available where needed.

1.3.29

Providers and schools should work together to ensure that school-based education about vaccines is available in an age-appropriate format to children and young people to increase their understanding about vaccinations.

1.3.30

Providers should offer incentives, such as a ticket for a prize draw, that encourage the return of consent forms.

1.3.31

If a completed consent form is not returned, send a reminder.

1.3.32

Phone the child or young person's parents or carers (as appropriate) to ask for verbal consent if they have not responded by the time preparations are being made for vaccination day. If contact cannot be made, involve other health and social care providers who may be involved with the family to help gain consent.

1.3.33

Be aware that young people under 16 can give their own consent to vaccination if they are assessed to be Gillick competent. Include an assessment for capacity to consent in the absence of parental consent or if there has been parental refusal, in line with guidance on consent in the Green book and from professional bodies such as the General Medical Council's advice on making decisions.

1.3.34

School-aged immunisation services should ensure that they have a policy in place to support school-aged immunisation teams in assessing Gillick competence. Include guidance on what action to take when a young person's vaccination preference is different from that of their parents or carers.

1.3.35

Commissioners should ensure that school-aged immunisation services offer catch-up vaccination sessions to children and young people who are not up to date with their school-aged vaccination schedule.

1.3.36

If children and young people who are not up to date with their school-aged vaccinations miss the catch-up sessions, alternative provision should be made for them to be offered the vaccinations.

1.3.37

Where children and young people are not up to date with any vaccinations that are not part of the school-aged programme, signpost parents and carers (as appropriate) to their GP to ensure that the children and young people can be offered these vaccinations.

1.3.38

CHIS should provide information to school nursing teams to help them identify children and young people who are not up to date with their preschool vaccinations.

Children and young people who do not attend schools where vaccinations are provided
1.3.39

Commissioners of vaccination services for school-aged children should ensure that children and young people who do not attend schools where vaccinations are provided are invited for vaccination at another setting.

For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact section on vaccinations for school-aged children and young people.

Full details of the evidence and the committee's discussion are in:

Terms used in this guideline

This section defines terms that have been used in a particular way for this guideline. For other definitions, see the NICE glossary and the Think Local, Act Personal Care and Support Jargon Buster.

Family members or carers

People with legal responsibility for decision-making for a person who is eligible for vaccination but cannot make this decision for themselves. These include parents of babies, children and young people and may also include other family members or guardians or carers if they have this responsibility (for example, if they hold a lasting power of attorney in health and welfare for another adult). See the Green book: chapter 2 on consent for more details.

Housebound

People who are unable to leave their home environment through physical or psychological illness. The decision about whether someone is classified as housebound should be made according to relevant local or national policies. This terminology is used to maintain consistency with NHS documents and websites.

Low vaccine uptake

An area or population in which uptake of a particular vaccine is lower than the national or regional average, as reported in the Public Health Outcomes Framework. This recommends a 95% vaccine coverage target for UK routine childhood vaccination programmes, with at least 90% coverage in each defined area. The performance indicators are set out in section 7A of the NHS public health functions agreement. See annex B of the NHS public health functions agreement 2019/2021.

Older people

Adults who are eligible for routine vaccination on the UK schedule, excluding pregnancy-related vaccinations. At the time of publication (May 2022), the UK schedule had routine vaccinations for adults who are aged 65 years and over, but this is expected to change in line with the reduction in age of eligibility for the shingles vaccination. Consult the Green book for information about current age limits and vaccinations for older people.

Pregnant women

Women who are pregnant as well as trans or non-binary people who are pregnant. This terminology is used to maintain consistency with NHS documents and websites.