Our Improvement Unit’s independent service evaluation led to the recommendation of an integrated hub and spoke model, aiming to standardise practices across Greater Manchester and set a national benchmark for high-quality, equitable immunisation service delivery.

Background

NHSE Greater Manchester Public Health Commissioning Directorate commissioned NHS Midlands and Lancashire’s Improvement Unit to undertake an independent service evaluation of the School Age Immunisation Service (SAIS) and the School Flu Service throughout Greater Manchester. This initiative was prompted by several identified drivers for change, emphasising the need for a proactive review of these services to guide future commissioning decisions and enhance service delivery.

Action

Our Improvement Unit conducted the independent service evaluation through:

Quantitative analysis:

• Analysis against service specification requirements
• Review of local vaccination uptake data sets
• Examination of quarterly quality and performance reports.

Qualitative research with key stakeholders:

• We conducted 11 semi-structured interviews with service delivery leads to understand the variances and similarities in service planning, delivery, and management  across the 10 different localities
• Organised three face-to-face workshops with providers to engage with the wider teams
• Engaged with commissioners outside of Greater Manchester to identify best practices
• Held a virtual workshop with commissioners and public health officials across Greater Manchester.

Options Appraisal:

We collated and triangulated intelligence to support an options appraisal which included:

• Defining the service function and ambitions
• Analysing the market context and developing an exhaustive list of options
• Developing a framework for the assessment criteria
• Conducting a SWOT analysis on the shortlisted options and providing independent scoring for each model option.

Impact

The independent service evaluation revealed fragmented commissioning arrangements posing significant challenges for providers, commissioners, and other stakeholders, including public health, local authorities, schools, parents, children and young people. Key issues identified included:

• Lack of standardisation in working practices and processes
• Limited opportunity for sharing best practices and lessons learned
• Confusion among schools, parents, children and young people
• Excessive processing and duplication of activities

Following the evaluation, we conducted an options appraisal process on four shortlisted service delivery models. This appraisal included gathering feedback from key stakeholders for each model, and considering all collected intelligence to score the models based on their ability to meet essential service delivery objectives.

We recommended adopting an integrated hub and spoke model for future deployment of the SAIS across Greater Manchester. The integrated hub and spoke model recommended for the SAIS across Greater Manchester involved centralising essential administrative and strategic functions at a main hub, while distributing the actual delivery of immunisation services through various local ‘spokes.’ These spokes are typically located in easily accessible community locations like schools and health centres. This model streamlines operations, ensuring consistency and high standards of service across all locations, while also maintaining local adaptability to meet specific community needs effectively. This structure not only optimises resource utilisation but also enhances the overall effectiveness and reach of the immunisation program.

This model scored highest in achieving the standards required for excellent service delivery. The adoption of this model presents an opportunity for Greater Manchester to establish a national benchmark in standardised practices and processes, enhancing equity of access while retaining local expertise to address health inequalities. NHSE Greater Manchester has initiated the procurement process for this integrated service delivery model following our recommendations.

Feedback

Excellent piece of work and the team were very understanding and thorough in their approach. Kim was always very accommodating and was always proactive in her approach taking onboard our changing requests and implementing these into the work. The work completed has supported and informed our decisions around the future commissioning of the services reviewed. Robert Pope | Public Health Manager (Commissioning) | NHSE Greater Manchester

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