Cem Kemahli: Vaccination would be even more of a success were it not for problems with data

5 Apr

Cllr Cem Kemahli is the Lead Member for Adult Social Care and Public Health on Kensington and Chelsea Borough Council.

The UK vaccination drive has been a success. Over 30 million doses of vaccines which didn’t exist a year ago have now been administered. It is only through, sadly, seeing other nations struggling that we can understand the sheer logistical human endeavour which has gone into getting this right in the UK.

The vaccines provide a way to protect our most vulnerable and therefore help protect our economy and the livelihoods of our residents.  But they have also highlighted an issue in the way that the Office for National Statistics, the NHS and local GPs manage data and patient records.

As a local authority we have been caught between a data rock and a media hard place.

London, in general, sits below much of the rest of the country. This is a fact frequently reported by the national and local press, often highlighting particular boroughs without a firm understanding of the cause of the statistics.

We receive criticism in the papers for a rollout that we are merely supporting. “Low vaccine uptake in Kensington” reads better than “Low vaccine uptake in the West London Clinical Commissioning Group, encompassing Kensington and Chelsea as well as GPs in Westminster”.

The common media reasoning for lower take-up has been the ethnicity differences apparent on any London street – each bringing their own cultural quirks and often intrinsic hesitations of state-provided healthcare.  This issue is even more acute, given the propensity for Covid to impact these communities most virulently.

A fairer though somewhat less quantifiable or journalistically appealing reason is one of data management.

Our vaccination uptake is measured against out-of-date but best guess ONS population figures, as it is for every borough in London. The census will hopefully address these figures, although we in Central London have hesitations –  because our Capital is a transient city, our borough especially so, and this fact feeds through into the ONS data.

So, whilst our overall population might remain the same, the actual people accounting for these figures, and thus their NHS numbers, change frequently.

Lockdowns have provided some solace for GPs, in that everyone, bar a few exceptions, are where they say they are, and available at short notice to receive their jab.  That is, if they are in the country.

We know anecdotally that our borough has somewhat emptied out over the last year. We usually have 1.2 parking permits issued for every available space, and parking is always hard to come by.  But during the pandemic we have been able to accommodate over 4,000 key workers who wished to drive into the borough. These cars have had to go somewhere – and they have simply taken the spaces of those who have left.

The negative side of a transient population for GPs is that they have lists of patients that are constantly falling out of date. Usually, this is no problem: the data is cleansed often, and records updated as people move around or fall off their lists. GP practices work hard to manage their patient numbers and offer excellent services to our residents. But they can only work with those who engage with them, and update their information.

We are, along with our neighbouring borough of Westminster City Council, also home to an exceptionally high number of international residents, dual and indeed triple nationals who may not necessarily be eligible for NHS treatment.

In ordinary times, this is not a cause for concern: they are able to return home, go privately for treatment or use international insurance. But now we have a single point of access for vaccines this is bringing to light the inherent consequences of travel bans and access to healthcare.  Many of our residents simply aren’t eligible for the vaccine through the NHS.

This trifecta of residents out of town, residents not entitled to vaccination and residents who no longer reside here, but who remain on GPs’ lists, has caused the overall figures we see today. Whilst I have not seen the minutiae for other boroughs, I suspect this is true for most inner London authorities.

As a local authority, our role is not to carry out the vaccination drive, but it is to assist the NHS and local GPs in engaging with our harder to reach communities; the digitally excluded, non-English speaking and those not familiar with accessing healthcare have been our main target.

We have put on successful community pop-ups in faith settings, and reached out through digital and physical signage, as well as offering advice in a variety of languages to offer support to those willing, eligible, but not knowing how a vaccine can be obtained.

Thankfully, we see little anti-vax sentiment: far more pervasive is vaccine hesitancy. A wait and see approach which we can help to overcome with evidence-based sessions and information from trusted sources.

We have also been working with GPs by helping them to call their patients and take admin out of their hands, so that they can focus on vaccine delivery. Through this work, we have found profound issues with the NHS database. Deceased residents, residents already vaccinated, and residents who have left the borough years ago are all still showing as eligible for a vaccine. Each one pulls down the overall uptake – through either being a numerator which should be counted or as a denominator which should be excluded.

When you appreciate the inability to vaccinate the deceased, you start to understand the underlying problems with a vaccination drive that aims to reach 100 per cent of the adult population, but uses somewhat faulty databases on which to base success.

And a success it remains: we have reached well over 75 per cent of our residents over 70 years old, but when you factor in the dead, ineligible, abroad or already vaccinated we are more likely reaching 85 per cent. Much more in line with national figures. We have thankfully not had a single confirmed case in anyone over the age of 75 since the 11th March – a testament to a successful vaccination drive.

We have worked constructively with the NHS and local GPs so far, but the underlying issue remains one of data sharing. We have council tax lists of residents in the borough; we know where people live. GPs know who is registered with them, and the NHS knows who holds an NHS number. These three systems rarely need to work alongside one another but with contact tracing, self-isolation and now vaccination, knowing where a resident with an NHS number is residing is all the more important.

Our local council has stood up a team in our “hub” to ring residents, and we have had great success in reaching those that have been missed.  We are imploring the NHS to give us more people to ring, we have the resource funded by government to make these calls, but we need to feed the system with the information, and make sure we find everyone willing and able to be vaccinated.

The borough knows the figures are wrong. The GPs know they are wrong. And the NHS knows they are wrong. But without someone to clean the information or update the systems, we will struggle to lift ourselves off the comparative bottom.

I fear the overall national success will mean not enough focus is brought back on ours and other residents who are being missed due to data issues putting themselves and their families at risk.