Geographic information
TECHNOLOGY IN ACTION
Luton tPCT: Geographic information systems improve immunisation
uptake
Until 2005, Luton was among primary care trusts (PCTs) with the
lowest uptake of MMR and primary immunisation at 24 months.
Following a detailed project supported by geographic information
systems (GIS), however (see Mapping Healthcare), Luton now sits among elite PCTs, with immunisation uptake rates at 98% for primary
immunisations and 92% for MMR at 24 months.
February 2007
 In 2001/2, county-level immunisation uptake statistics for
Bedfordshire (which included Luton) were reported at 92% for primary
immunisations and 83% for MMR. When reported by individual PCTs,
however, the actual figures were found to be much lower — 81% for
primary immunisations and 72% for MMR — which was far below national
performance levels.
Luton has a diverse, transient population and includes a
relatively large number of people who have entered the country
without immunisations. Areas are densely populated and several Luton
wards are among the 25% most deprived in England. The large numbers
of people travelling through Luton airport coupled with the areas
young population increase risk of disease transmission, making high
immunisation uptake essential to avoid outbreaks. The projects key
objective was to establish Luton's childhood immunisation uptake
accurately.
Working practices, data reporting and historical processes in
partnership with key stakeholders were reviewed. This revealed that
stakeholders carried out their roles in the immunisation process in
an isolated, silo-style manner, so the complete picture of the
process was hidden. Within the 35 general practices in Luton, for
example, the variation in reporting was considerable.
Implementation of the NHS General Medical Services contract in
2005/06 provided an opportunity to review the system of recording
childhood immunisations, standardise the reporting process through a
streamlined immunisation protocol and encourage reporting to the
child health (CH) database. The immunisation protocol was intended
to achieve a consistent reporting and recording process through:
- identifying children not accessing immunisation and
surveillance monitoring;
- involving health visitors in giving families access to health
information and treatment; and
- remunerating general practices for child immunisations based on
uptake accurately recorded on the CH database.
Figures 1 and 2 illustrate the success of the new reporting
procedures (Luton's rates have improved significantly). The green
line represents the national uptake for 2005/6, 94% for primary
immunisations, 84% for MMR. The national performance target for
both of these performance indicators is 95%.
Figure 1 Luton’s primary immunisations uptake at
24 months
Source: COVER Data, HPA, Colindale
Figure 2 MMR uptake at 24 months
Source: COVER Data, HPA, Colindale
As part of this project, a health equity audit was conducted to
identify where future work to improve MMR uptake should be focused.
Working with the local authority, GIS and data from Ordnance Survey
was used to produce maps of the crude rates of MMR defaulters and
the Indices of Multiple Deprivation (IMD). GIS helped the team
investigate links with deprivation and with planning future health
initiatives to target areas of need.
A map of Luton GPs relative to the Index of Multiple Deprivation
2004 (IMD 2004) across Super Output Areas (SOAs) (see jargon buster
below) in Luton (Map 1), was compared with a map of the crude rates
of MMR defaulters (Map 2). The latter map highlighted possible
hotspots or areas of low MMR uptake in both affluent and deprived
SOAs. Due to the small numbers involved in this preliminary
analysis, however, further geographical analysis is needed once
subsequent cohort data has been validated.
Above: Map 1. Luton GPs relative to the Index of
Multiple Deprivation 2004
across Super Output Areas.
View larger
image of map ...
Source: IMD 2004, Office of the Deputy Prime Minister
Map 2 Map of the crude rates of MMR defaulters
View larger image of map ...
Source: Child Health data
In summary, developing an effective system has ensured sufficient
herd immunity to reduce the risk of an outbreak of a preventable
communicable disease in Luton. General practices are now advised of
those children registered with their practices who are lacking a
full immunisation history. Families of non-immunised children are
contacted and given information by health visitors, which often
leads to their children subsequently being immunised. This approach
provides greater assurance of child protection.
This work to improve immunisation uptake data quality continues,
to ensure that uptake rates are sustained. GIS continues to help in
the targeting of specific areas in Luton with low uptake of MMR and
also to plan initiatives to improve service delivery.
Jargon Buster
Index of Multiple Deprivation 2004 (IMD 2004)
A measure of multiple deprivation at the small area level. The IMD
2004 is based on the idea of distinct dimensions of deprivation,
which can be recognised and measured separately. These are then
combined into a single overall measure. Super Output Area (SOA)
Super Output Areas were developed by the Office for National
Statistics from the Census 2001 Output Areas. There are three
levels, or layers, the lowest (which the index is based upon) being
smaller than wards and containing a minimum of 1,000 people and 400
households. The middle layer contains a minimum of 5,000 people and
2,000 households. The upper layer Super Output Areas have not yet
been set. The Index of Multiple Deprivation is measured at the
‘lower layer’ Super Output Area level.
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