Official Statistics

Seasonal influenza vaccine uptake in frontline healthcare workers in England: winter season 2022 to 2023

Published 22 June 2023

Applies to England

Main points

In the 2022 to 2023 season:

• 49.4% (574,933 out of 1,163,586) of all frontline health care workers (HCWs) in NHS trusts with direct patient care (from 215 out of 228 organisations submitting data) received the influenza vaccine in England, a decrease of 11.1 percentage points compared with that seen in the 2021 to 2022 season (60.5%)
• this is the second consecutive season to show a decrease in vaccination of frontline HCWs, this is the lowest uptake since the 2012 to 2013 season
• seasonal influenza vaccine uptake in NHS Trusts ranged from 11.5% to 82.3%
• the vaccine uptake ambition for frontline healthcare workers was 100% offer with Trusts having a goal set by the Commissioning for Quality and Innovation (CQUIN) of between 70% and 90% vaccinated, no goal was set for GP practices, as outlined in the annual flu letter
• the proportion of NHS Trusts that achieved vaccine uptake of 70% or more was 8.8% (20 out of 228 organisations submitting data)
• the highest vaccine uptake in NHS Trusts by staff group was 53.1% in all other professionally qualified clinical staff and the lowest vaccine uptake was 45.3% in total support staff
• in GP practices, the staff group with the highest uptake was all nurses (73.6%) and the lowest was all other professionally qualified clinical staff (58.0%)

For the final survey on cumulative influenza vaccines administered from 1 September 2022 to 28 February 2023, 94.3% (215 out of 228) NHS Trusts and 14.6% (947 out of 6,470) GP practices returned data. Data was collected by staff group (doctors, qualified nurses, other professionally qualified clinical staff and clinical support staff) at each organisation and aggregated by Trust, region and nationally.

Response rate

The data was collected alongside COVID-19 returns for the second consecutive year to reduce data burden on data providers and the response rate to the frontline HCW influenza vaccination survey was higher than last season. A total of 215 out of 228 NHS trusts (including independent sector health care providers (ISHCPs)) responded (response rate of 94.3%) and 947 out of 6,470 GP practices (response rate of 14.6%) submitted data on seasonal influenza vaccinations administered up to 28 February 2023. In comparison, last year, a total of 168 out of 214 NHS trusts (response rates of 78.2%) submitted data. The number of organisations should not be compared to previous years as in the 2022 to 2023 season ISHCPs moved from the GP survey to the Trust survey.

Both the higher response rate and the change to ISHCP reporting is likely to have contributed to the larger denominator seen this season than last season.

Throughout the 2022 to 2023 season, provisional uptake data was published on GOV.UK on a cumulative monthly basis. The final end of season response rate for this annual report (94.3% for Trusts and 14.6% for GP practices) was higher than that observed in the provisional monthly surveys. This includes the February 2023 survey (published March 2023) which had a response rate of 86.5% for Trusts and 7.3% for GP practices with a total of 49.9% of all frontline health care workers with direct patient care receiving the influenza vaccine in England. Caution should be used when interpreting provisional monthly data as the vaccine uptake percentages are based on denominators of those trusts returning data each month.

The responding organisations are considered to be broadly representative of all NHS organisations of the same type; it is readily conceivable that non-responding organisations may have lower uptake than organisations that have provided data.

National vaccine uptake rates

Overall, based on submitted data, 49.4% (574,933 out of 1,163,586) of frontline HCWs in NHS trusts received the seasonal influenza vaccine during the 2022 to 2023 season compared with 60.5% in the previous season (2021 to 2022), a decrease of 11.1 percentage points (Table 1, Figure 1). Approximately 50.1% (599,473) of HCWs in direct contact with patients in organisations responding to the survey did not receive the influenza vaccine this season. This is the second consecutive season to show a decrease in vaccination of frontline health care workers and uptake is lower than that observed in the previous 9 seasons (the 2013 to 2014 season saw an uptake of 54.8%).

Table 1. Seasonal influenza vaccine uptake in frontline healthcare workers (HCWs) in England for season 2022 to 2023 compared with previous seasons

Season	Vaccine Uptake (%)
2002 to 2003	14.0
2003 to 2004	14.8
2004 to 2005	15.4
2005 to 2006	19.4
2006 to 2007	14.0
2007 to 2008	13.4
2008 to 2009	16.5
2009 to 2010	26.4
2010 to 2011	34.7
2011 to 2012	44.6
2012 to 2013	45.6
2013 to 2014	54.8
2014 to 2015	54.9
2015 to 2016	50.6
2016 to 2017	63.2
2017 to 2018	68.7
2018 to 2019	70.3
2019 to 2020	74.3
2020 to 2021	76.8
2021 to 2022	60.5
2022 to 2023	49.4

Figure 1. Seasonal influenza vaccine uptake in frontline healthcare workers (HCWs) in England for season 2022 to 2023 compared with previous seasons

* 2009 to 2010 influenza pandemic year in which the HCWs vaccine uptake survey expanded from acute trust only to include other Trusts, such as ambulance, mental health, and primary care trusts.
~ CQUIN scheme was introduced or continued.
▪ COVID-19 pandemic when CQUIN scheme was suspended.

During the 2022 to 2023 season, vaccine uptake increased during the first 3 months of vaccination and then began to plateau from December onwards. At all points in the season, vaccine uptake was lower than corresponding times in previous seasons (Table 2, Figure 2). Historic data for September is not available prior to the 2021 to 2022 season as this was the first season that data was collected at this time point.

Table 2. Seasonal influenza vaccine uptake in frontline healthcare workers (HCWs) in England by month during the 2022 to 2023 season compared with 9 previous seasons

Month	2022 to 2023	2021 to 2022	2020 to 2021	2019 to 2020	2018 to 2019	2017 to 2018	2016 to 2017	2015 to 2016	2014 to 2015	2013 to 2014
September	7.3	17.0	-	-	-	-	-	-	-	-
October	30.9	38.8	51.6	43.6	46.3	45.9	40.4	32.4	36.8	35.0
November	41.8	52.5	70.6	61.5	61	59.3	55.6	44.1	48.2	48.6
December	46.7	58.8	75.3	68.5	65.7	63.9	61.8	47.6	52.6	53.1
January	48.9	59.6	76.3	72.4	68.6	67.6	63	49.5	54.6	54.8
February	49.4	60.5	76.8	74.3	70.3	68.7	63.4	50.8	54.9	-

Figure 2. Seasonal influenza vaccine uptake in frontline healthcare workers (HCWs) in England by month during the 2022 to 2023 season compared with the previous 4 seasons

Vaccine uptake rates by organisation type

Seasonal influenza vaccine uptake by Trust type ranged from 43.5% for staff in Mental Health NHS Trust compared with 66.5% in those working in GP (Figure 3). Although vaccine uptake by all organisation types decreased compared with the previous year, caution should be used as including ISHCPs where part of GP collection in previous seasons.

Figure 3. Seasonal influenza vaccine uptake in frontline healthcare workers (HCWs) by organisation type 2022 to 2023 compared with 2021 to 2022

Please note, in the 2022 to 2023 season, ISHCP’s were part of the GP collection and so no direct comparisons between the 2 years for ISHCP and GP can be made.

Vaccine uptake for all trusts

For the 2022 to 2023, season vaccine uptake in frontline HCWs in Trusts was 49.4% compared with 60.5% in the previous season. Vaccine uptake by commissioning region ranged from 42.3% in London to 55.7% in the South East, with none of the commissioning regions achieving vaccine uptake of 70% or more (Figure 4).

The median seasonal influenza vaccine uptake for Trusts was 51.9% amongst those submitting data. The highest seasonal influenza vaccine uptake reported by a Trust was 82.3%. This season 8.8% of all Trusts (20 out of 228) achieved the CQUIN goal of 70% or more. For comparison, last season (when there was no CQUIN in place) 18.2% (39 out of 214) achieved 70% or more. The lowest seasonal influenza vaccine uptake reported by a Trust was 11.5%. Vaccination data by Trust are available in the data tables that accompany this report.

Figure 4. Seasonal influenza vaccine uptake in frontline healthcare workers (HCWs) in Trusts by commissioning region in 2022 to 2023 compared with 2021 to 2022

Vaccine uptake for GP practices

Seasonal influenza vaccine uptake in GP practice settings was 66.5% compared with 73.8% in the 2021 to 2022 season. Note that the complementary NHS influenza vaccination offer (that was introduced in 2021 to 2022 season) for primary care staff was not extended for the 2022 to 2023 influenza season.

National vaccine uptake rates by staff group

Vaccine uptake in frontline HCWs varies by staff group and across trust and GP practices. Of all frontline healthcare workers, vaccination in GP practices (66.0%) is higher than those in Trusts (49.4%), and this trend is consistent across all staff groups (Figures 5 and 6). Vaccine uptake by staff groups varies more in GP practices compared with trust settings. The highest vaccine uptake in NHS Trusts by staff group was 53.1% in all other professionally qualified clinical staff; and the lowest vaccine uptake was 45.3% in total support staff (Table 3). In GP Practices, the highest vaccine uptake was 73.6% in all nurses, and the lowest uptake was 58.0% in all other professionally qualified clinical staff (Table 4).

Figure 5. Seasonal influenza vaccine uptake in NHS Trusts based frontline healthcare workers (HCWs) by staff group in England for 2022 to 2023 compared with 2021 to 2022

Figure 6. Seasonal influenza vaccine uptake in GP practice and ISHCP-based frontline healthcare workers (HCWs) by staff group in England for 2022 to 2023 compared with 2021 to 2022

Glossary

Green Book

The Green Book is ‘Immunisation against infectious disease’, a UK Health Security Agency (UKHSA) publication on vaccines, vaccine-preventable infectious diseases and vaccination procedures. Chapter 19 refers to influenza.

ImmForm

ImmForm is a website that provides a secure online platform for vaccine uptake data collection for several immunisation surveys, including the seasonal influenza vaccine uptake collection.

Methods

Cumulative data on seasonal influenza vaccine uptake was collected from all NHS Trusts (including ISHCPs acute, ambulance, care, community, mental health and other NHS Trusts, and primary care) and GP practices in England, using the ImmForm website. Monthly data was collected on frontline HCWs involved with direct patient care for vaccinations administered between 1 September 2022 and 28 February 2023 (inclusive). This included doctors, qualified nurses, other professionally qualified clinical staff, and clinical support staff; and are the same groups that were monitored in previous seasons. Trusts identify frontline HCWs eligible to receive seasonal influenza vaccine (the denominator) and record all those that are vaccinated (the numerator) to calculate their overall vaccine uptake.

Each monthly survey on the ImmForm website was opened for data submission over the first 9 working days of each survey month, (with adjustments and extensions made to allow for public holidays in some weeks). The 2022 to 2023 monthly data collection schedule with original survey deadlines is provided in Appendix B. Trusts had 7 working days to submit data manually onto the ImmForm website. Additional follow-up was undertaken by UKHSA of non-responding Trusts or for data validation as required. Last year was the first time UKHSA collected and published data a month earlier for vaccinations given to the end of September, therefore comparable data is available for only one previous year. The data collection this year combined influenza and COVID-19 vaccinations with the aim of reducing data burden where it was possible for organisations to submit data for either vaccination programme with the same denominator of frontline HCWs with direct care.

The data in this report is as submitted by the above organisations and has not been altered except by specific request from data providers.

ImmForm website

One of the functions of the ImmForm website is to provide a secure platform for vaccine uptake data collection for several immunisation surveys, including this collection. It allows data providers to:

• provide information on the trust type, trust status and survey coverage
• view vaccine uptake rates by staff group allowing data providers to review and assess progress for their own organisation
• allow local NHS England and Screening and Immunisation teams to view a ‘non-responder’ report that highlights trusts and primary care providers in their region that have not yet submitted data, thus allowing follow-up

Data limitations

Reported uptake is based on responses from organisations. Non-responding organisations are not included in uptake figures.

All the data needed to calculate vaccine uptake was entered manually, directly onto the ImmForm website by Trusts (including ISHCPs) and GP practices. The number of ISHCPs included is 17 as ISHCPs have historically had to self-declare and register with ImmForm to be included. This number is less than the number of ISHCPs licensed. All Trusts were asked to submit cumulative influenza vaccine uptake data monthly over 6 months. This manual element means there is the possibility of human error or misinterpretation. The ImmForm survey form has basic automated validation checks to ensure logical consistency. For example, ensuring that the sum of the figures for individual staff group match the total for all frontline HCWs, and that the number vaccinated must be less than or equal to the number of reported frontline HCWs. As part of an exercise to improve data quality and remove input errors, the submitted data was then manually checked and validated before publication.

Staff group definitions

All staff group definitions used in this report are the official NHS definitions. A full index of these is available on the NHS website.

Background

HCWs involved in direct patient care are encouraged to receive a seasonal influenza vaccine annually, to protect themselves and their patients from influenza. HCWs themselves may be at increased risk of exposure to influenza compared with the general population and their patients may have a suboptimal response to their own vaccinations. HCW vaccination also protects healthcare services by reducing sickness absences.

To assess vaccine uptake for the 2022 to 2023 winter season among frontline HCWs, a seasonal influenza vaccine uptake survey of all 228 NHS trusts and 6,470 GP practices in England was undertaken. NHS trusts comprise acute, ambulance, care, mental health and other NHS Trusts including ISHCP, and General Practice.

UKHSA co-ordinated and managed the data collection and produced monthly provisional data on vaccinations allowing the NHS and Department of Health and Social Care (DHSC) to track the progress of the programme during the 2022 to 2023 influenza season. This collection received approval as a mandatory collection from the Data Alliance Partnership Board (DAPB) under the reference ‘DAPB2204 Amd 37/2021 Influenza and COVID-19 vaccine uptake in Frontline Healthcare Workers (HCWs) survey’.

The CQUIN scheme was introduced in the 2016 to 2017 season with the intention to providing clinical quality improvements and drive transformational change. One of the indicators under the NHS Staff health and wellbeing framework is improving the uptake of influenza vaccination for frontline staff within providers by introducing payment incentives to trusts who reach high uptake rates.

Since the introduction of the CQUIN scheme, vaccine uptake in all trusts (excluding in primary care organisations) rose from 50.5% in the 2015 to 2016 season, to 75.2% in the 2019 to 2020 season. However, due to the COVID-19 pandemic, the CQUIN scheme was suspended for the 2020 to 2021 and 2021 to 2022 season. CQUIN was reintroduced for the 2022 to 2023 season with an uptake of 49.4%.

The aims and objectives of the 2022 to 2023 seasonal influenza vaccine uptake campaign amongst HCWs in England were to:

• monitor vaccine uptake amongst frontline HCWs to inform and progress of the national vaccination programme
• allow DHSC, NHS England, Screening and Immunisation Teams, NHS Trusts and integrated care boards (ICBs) to review national, regional, and local vaccine programme performance and identify staff groups and local or regional areas where coverage is high (to identify best practice to inform activities to increase uptake) and low (to increase uptake further)
• gather epidemiological data to support the evaluation and future planning of seasonal influenza vaccinations amongst frontline HCWs

For the 2022 to 2023 season, details on the inclusion and exclusion criteria of frontline healthcare workers continued to be included in the user guide. Alongside efforts by participating NHS Trusts to ensure accuracy of provided data, UKHSA continued to carry out additional data validation to ensure the minimisation of double counting by contributing organisations (see Staff group definitions).

The Health and Social Care Act 2008 code of practice on the prevention and control of infections and related guidance, emphasises the need to ensure, so far as is reasonably practicable, that HCWs are free of and are protected from exposure to infections that can be caught at work, and that all staff are suitably educated in the prevention and control of infection associated with the provision of health and social care. Registered providers should therefore ensure that policies and procedures are in place in relation to the prevention and control of infection such that:

• all staff can access occupational health services or appropriate occupational health advice
• occupational health policies on the prevention and management of communicable infections in care workers are in place
• decisions on offering immunisation should be made on the basis of a local risk assessment as described in Immunisation against infectious disease (The Green Book)
• employers should make vaccines available free of charge to employees if a risk assessment indicates that it is needed (COSHH Regulations 2002)
• there is a record of relevant immunisations

Further information on the Code of Practice can be found on the DHSC website.

Acknowledgements

The authors would like to thank everyone that contributed to the data collection, specifically:

• all the staff and data providers who participated in and supported the frontline HCWs seasonal influenza vaccine uptake data collection
• ImmForm team and the ImmForm support team