The next item is a statement by the Minister for Health and Social Services on the national immunisation framework for Wales, and I call on the Minister to make the statement—Eluned Morgan.

Diolch yn fawr. Today, I am publishing our new national immunisation framework. Vaccination has long been a critical part of NHS Wales's delivery to protect our citizens and our communities. The pandemic required us to think differently about the deployment of vaccination, in particular the need to maximise uptake and to ensure equity. We must learn these lessons and apply them to our future arrangements, and it is through this national immunisation framework that we will do that. I want this framework to enable positive changes to deliver and improve vaccination arrangements and to increase uptake across all our vaccination programmes.

The vaccination transformation programme was established earlier this year to look at the provision of vaccination services to ensure arrangements are fit for the future. In July, I published the winter respiratory vaccination strategy, which paved the way for an integrated COVID-19 and influenza vaccination programme that launched on 1 September. The programme is progressing well, with both the COVID-19 and flu campaigns now in full swing. All those eligible for a COVID-19 booster will have their invites by the end of November, and those eligible for flu vaccination will have theirs by the end of December. It’s so important that we maximise the uptake of both vaccines, and I encourage everyone to take up their appointments this autumn to protect themselves and their families.

As important as they are, especially at this time of year, this framework is about much more than vaccination against respiratory viruses; it covers all our vaccination programmes, including childhood immunisations. And it is the success and good practice of these programmes that has been the foundation for the transformation process. Indeed, they provided the basis for our world-leading COVID-19 vaccination programme.

Our vision for the future of immunisation in Wales is high uptake of a sustainably delivered, effective vaccine at the right time to reduce severe illness and death. We want to see vaccination services that are clear, where people know what vaccinations they are eligible for and how to receive them, with high levels of uptake and equity of access at the heart of service design and provision. This is the first national immunisation framework to be issued for Wales and its development has been on a co-production basis, with the Welsh Government and the NHS working as one team to identify and use lessons from the pandemic to transition to a position of improved business as usual for all vaccination programmes.

Health board accountability will remain unchanged, with boards assessing local need, commissioning, performance managing and evaluating provision in line with the national strategic direction. Our intention is to support that, to enable improvements and to maximise uptake to protect everyone in Wales. The NHS executive will have a key role in planning and performance managing vaccination programmes in the future.

So, the framework identifies six key areas of focus, within which our strategic priorities and expectations are set, and these are vaccination equity, digitally enabled vaccination, eligibility, public vaccination literacy, deployment and governance. The majority of commitments outlined in the framework build on practices that have worked well from our experience and flexibility of the COVID-19 programme or best practice from existing, long-standing programmes. All have been identified by key partners, including those delivering services on the ground. We know that health harms from COVID-19 have not affected people in Wales equally. Tailored support has been needed to enable and encourage underserved groups to take up the offer of vaccination. People from harder-to-reach communities will come forward for vaccination, which points to accessibility rather than acceptability being a key barrier. That is something that we must tackle, and it is why we have put vaccination equity at the core of Wales’s vaccination approach and this framework.

Public understanding and engagement are critical in supporting people to come forward for vaccination, so the framework focuses in on this. It includes priorities on the co-production of patient materials, robust communications and engagement strategies, and training to increase awareness of vaccination among the health and care workforce, and community and trusted figures, so that they can advocate for vaccination and make every contact count.

Joyce Watson took the Chair.

The framework commits to building a core immunisation resource in health boards. It changes governance structures to ensure that there is appropriate, integrated oversight and management of all vaccination programmes and work streams to transform the digital infrastructure for vaccination, which presents huge opportunities for services and citizens.

Another significant commitment within the framework is a move to a central procurement process for the flu vaccine. We have seen unprecedented levels of uptake in our COVID-19 programme. I accept that some of this is about the context, but some of it is also due to the way that the system has engaged with and included groups that it has struggled to capture in the past. I want to apply this focus on health protection to the flu programme in the future. We cannot expect primary care providers to carry the risk of ordering more vaccines. We recognise that the risk must be borne at a national level, so we are exploring how we can move to a model of national procurement from 2024 onwards.

Primary care providers, including community pharmacies, will continue to play a really important role in the delivery of the flu vaccine and other vaccination programmes beyond 2024. They are a key element of the options that should be provided to citizens in order to maximise vaccination uptake. We are working closely with all those involved in the implementation of these changes.

Publication of the national immunisation framework is a key milestone that marks a move into the implementation phase of the transformation of vaccination, with a process of transition to the new arrangements expected during 2023 and 2024. Throughout the implementation period, existing programmes will continue to be delivered effectively and our governance arrangements will reflect that. The NHS Wales delivery unit will oversee the implementation, and that unit will become part of the NHS executive in 2023, with the Welsh Government moving into an oversight role. We remain committed to co-production during the implementation phase, and our intention is to publish an update in 2023 to share progress towards the transformational change and commitments set out in the national immunisation framework. Thank you.

Can I thank the Minister for her statement today? I know that the First Minister and you have stated on numerous occasions throughout the pandemic that your Government would be guided by the science. I agree, of course, with that approach as well, and the Government set up the technical advisory cell and has also taken on board the joint committee on vaccination and immunisation’s recommendations as well, on which groups should take COVID vaccinations. Now, in your framework, you note that you’re guided by the advice of the JCVI, but the framework also goes on to say,

‘However, even with normally stable programmes, there will be times where an emergency response is required at pace.’

So I just wanted to ask what does this mean in the context of when you are waiting for advice from JCVI. Of course, the JCVI is an incredibly important organisation, made up of clinicians and experts across the UK, and the UK health security agency. It also provides recommendations to all the UK health authorities on other vaccinations, not just COVID-19. So I’m just trying to ask you where you see the future for JCVI, for example, will its role be strengthened, or do you take a different view?

I also read with interest, Minister, the section on digitally enabled vaccination, and it notes that you have commissioned Digital Health and Care Wales—previously NHS Wales Informatics Service—to review all vaccination systems, but that you’re looking for shorter term solutions. So, I’m aware that the current Welsh immunisation system was set up during the pandemic to log and manage COVID vaccine delivery, but I’m also told that NWIS is, or can be, burdensome and inflexible, so perhaps you could give a view on that. But, while the system has been, perhaps, adequate for logging COVID vaccines that were scheduled in advance, I’m just speculating that the system may not be likely to be appropriate in its current form for recording flu vaccines and other vaccinations that patients may need. So I wonder, Minister, whether, therefore, you expect NWIS to become the primary IT system for managing and recording vaccines in the future, and if so, how do you plan to improve the system so it’s more flexible, less bureaucratic and simpler to use?

A quick update on the flu and COVID vaccinations among health and social care workers would be appreciated. I know that you, or I think your officials, wrote to health boards in that regard, so an update on that would be appreciated. And finally, Minister, I did read with delight that you’ve mentioned using the long-awaited NHS Wales app in the framework, but there’s no information on when this will happen. Will this be before the winter, within the next six months, next year? We’re waiting for something that will revolutionise patient access to appointments, prescriptions and more, so can you confirm when this will be introduced? Thanks, Minister.

Thank you very much, Russell. We have, throughout the pandemic, been following the advice of the JCVI, which, as you know, is embedded in science and a clinically led approach, and we will continue to do that. Obviously, if there are times when we need to work at pace, they have also demonstrated, during the pandemic, that they can also work at pace. I think we'd have to have quite a good reason to go away from JCVI advice, so that's certainly the model that we've followed so far. 

When it comes to digitally enabled vaccination, we will develop a person-centred digital vaccination journey, and that will include an integrated vaccination record, digital consent and improved booking and communication and recording functionality. So, as you've noted, Digital Health and Care Wales are going to review all vaccination systems. At the moment, they don't speak to each other, so interoperability is absolutely key, and that's what they're working to do. So, while thinking about long-term digital solutions, we are going to need to have some shorter term fixes to make improvements with an immediate effect. There are existing digital improvement schemes that will link to things like our digital medicines transformation portfolio, the national data resource and the digital services for patients and public programme.

The NHS Wales app—. Okay, I'm going to tell you quietly, Russell. It is actually being tested at the moment; it has been tested. What we want to do is to make sure that it works and that the functionality works. It's got to have three very key issues that make it work well. One is that the technical bits need to work well. The second is that you need the patient to be able to use it, and so make sure that it's a very simple process that everybody can access. And the third is that you need, for example, GPs to be able to link in with it. So, that is being tested at the moment in a real live operation; 1,000 people are using that as we speak. So, things are progressing, but what I don't want to do is to launch something, as they did in England, that then all the GPs switch off because it's just too overwhelming. We're just trying to make sure that we're taking things and not launching it formally until we are absolutely sure that the thing is going to work. 

Thank you for the statement. I'm eager to confirm the strong support of these benches to vaccination programmes in general and their contribution to the nation's health. In a way, it's strange, whilst welcoming the new framework, that we didn't have a framework previously, because vaccination is such an important a part of the health landscape in Wales. But, we have been through a period where more focus has been placed on vaccinations than at any other time in our history, given the pandemic. One question on the pandemic vaccination programme. The Government said that the autumn booster programme is progressing well, but the figures do suggest that the uptake is lower than it has been, particularly among the immunosuppressed. So, I wonder whether the Minister could look into or give a commitment to look into why the uptake seems to be so much lower this autumn. 

But to return to the statement in more general terms, I think the six focus areas are sensible. I particularly welcome the focus on aiming for a system where everyone has equal access to vaccination, because at the moment, as the Minister has said, that isn't the case.

I want to focus on one thing particularly here. The statement refers to the intention to create a central procurement system for flu vaccination from 2024 onwards. At the moment, surgeries procure their own vaccinations directly from suppliers. Scotland has already said that they will turn to a central procurement system, where health boards buy all of the vaccinations and distribute them locally. Now, whilst there are benefits to moving to a centralised system such as this one for the longer term, I think it is important, at this early stage in the discussions, to bear in mind the challenges that are very likely to arise, and we know that from the Scottish experience. When Scotland introduced the system, they realised that (1) it would take a period of around three years to introduce such a system, but, secondly, that it would have a negative impact on pharmacies—or, rather, surgeries. In responding to that uncertainty, what the Scottish Government did was to provide an additional £5 million to ensure that the process not only accelerated and happened effectively, but also compensated surgeries during that initial period. So, can I ask whether the Minister will give a commitment to work closely with GPs and surgeries to find ways of mitigating those possible negative impacts, if this is introduced? And also will she agree to consider following the Scottish example and providing particular financial support where required?

Thank you very much. In terms of the booster, I'm pleased to say that, on the seventeenth of this month, 471,488 people had received the booster. We have a target of 75 per cent. I'm pleased to say that, if you're in a care home, we're up to 74 per cent already. So, that is well on the way to our target. We are somewhat concerned about staff working in care homes and staff working in the health boards, so I know that the chief executive of the NHS has written to the health boards to ask them to make a little bit more effort with the staff. I know that they're tired and that they're making a big effort, and maybe it's work pressure that's stopped them from doing that, but it is important for them to protect themselves as we go into what we know will be a very hard winter. You're right about the risk group: so, we are looking at about 7 per cent of people between five and 49, but the focus hasn't been placed on that yet; we're doing it in order of priority, and that's why we've ensured that we are focusing first on care homes.

In terms of the national procurement system, evidently this is not going to happen tomorrow, but even what's happened this year, where we've seen GPs, for example, procuring the flu vaccine—they haven't ordered enough and we've had to step in as the Government. So, we're already intervening, and that means that additional funding is being provided. But, if you're going to a procurement system on a national level, you're more likely to get a better deal, so I do hope that that will make a difference.

Thank you.