Doctors condemn Hunt’s plan to link emergency department funding to staff flu vaccination rates

BMJ 2013; 347 doi: (Published 17 September 2013) Cite this as: BMJ 2013;347:f5639
  1. Zosia Kmietowicz
  1. 1BMJ

Public health and emergency doctors’ leaders have denounced England’s health secretary for linking extra payments to hospital accident and emergency departments to flu vaccination rates among staff, criticising him for taking the wrong tack to protect vulnerable patients.

Hunt announced the plan last week when he described how the extra £250m (€300m; $400m) for emergency services in England for 2013-14 would be allocated. A further £250m is being made available to help emergency services next year, but these payments will be made in full only to trusts where 75% of their staff members are vaccinated against flu this year, said the department, although it could not say how much of the payment trusts would lose if they missed the target.

John Ashton, president of the Faculty of Public Health, acknowledged that greater effort was needed to improve vaccination rates among frontline NHS staff. But he added, “There’s no silver bullet fix for reaching the 75% take-up rate the secretary of state wants to see. The trusts that have taken hand hygiene and sending sick staff home most seriously have also vaccinated more of their staff. Punitive measures like holding back extra funding are not the answer: we need effective advertising campaigns that mean patients don’t get flu in the first place and pass it onto staff.”

The health department said that increases in numbers of flu cases put extra pressure on emergency services and that the new target was not meant to penalise trusts. Less than half of frontline NHS staff get vaccinated against flu, and in some hospitals the proportion is less than one in five.

England’s chief medical officer, Sally Davies, said, “Frontline staff, by the very nature of their jobs, deal with people who are unwell every day. Simply by having the flu vaccine, as recommended by the GMC [General Medical Council], NHS staff can play an important role in not picking up the flu virus and passing it on to other patients—often people who are already poorly and vulnerable to infection.”

Commenting on the new proposal, Cliff Mann, president of the College of Emergency Medicine, said, “Trusts should ensure all workers are availed of the opportunities required to do so; this should include access to influenza immunisations. Encouragement rather than coercion has always been the manner in which immunisation has been promoted in the UK, and the college sees no reason to change this advice or approach.”

Dean Royles, chief executive of NHS Employers, which organises the national NHS staff flu vaccination campaign, said that achieving the 75% target would be a huge challenge for many trusts, “especially when their immunisation plans are already in place.”

He added, “It’s important to emphasise that getting vaccinated is a personal choice.”

Barts Health in London, which had to stop admitting patients to one of its hospitals on 10 and 11 September because it could not cope, is receiving the biggest boost to its finances this winter, with a payment of £12.8m. It said that it was “working closely with our colleagues in occupational health to ensure as many of them as possible are immunised.”

Leicester Hospitals is getting £10m this year. Its chief operating officer, Richard Mitchell, admitted that this “winter will be tough.”

He added, “Last year 51% of our staff had the flu vaccination. We have set an ambitious target again for this year and have a strong communications campaign to encourage even more staff to have the vaccine this winter.”


Cite this as: BMJ 2013;347:f5639