Seasonal influenza vaccine uptake in frontline healthcare workers in England: winter season 2023 to 2024
Published 23 May 2024
Applies to England
© Crown copyright 2024
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This publication is available at https://www.gov.uk/government/statistics/seasonal-influenza-vaccine-uptake-in-healthcare-workers-winter-season-2023-to-2024/seasonal-influenza-vaccine-uptake-in-frontline-healthcare-workers-in-england-winter-season-2023-to-2024
This report describes the final influenza vaccine uptake for frontline healthcare workers in trusts and GP practices in England from 2023 to 2024.
Main points
In the 2023 to 2024 season:
- 42.8% (503,499 out of 1,176,102) of all frontline health care workers (HCWs) in NHS trusts with direct patient care received the influenza vaccine in England: a decrease of 7.1 percentage points compared with that seen in the 2022 to 2023 season (49.9%)
- the response rate for the final survey was 93.6% (218 out of 233) for NHS trusts and 9.9% (642 out of 6,459) for GP practices, a higher response rate than the 2022 to 2023 season
- this is the third consecutive season to show a decrease in the vaccination of frontline HCWs, and is the lowest uptake since the 2010 to 2011 season
- seasonal influenza vaccine uptake in NHS trusts ranged from 7.1% to 82.2%
- the proportion of NHS trusts that achieved vaccine uptake of 75% or more was 1.3% (8 out of 228 organisations submitting data)
- the highest vaccine uptake in NHS trusts by staff group was 48.7% in all doctors and the lowest vaccine uptake was 38.2% in total support staff
- the highest vaccine uptake in GP practices by staff group was 68.8% in all nurses and the lowest vaccine uptake was 59.0% in total support staff
Response rate
The data was collected alongside COVID-19 returns for the third consecutive year to reduce the data burden on data providers. The response rate to the frontline HCW influenza vaccination survey was higher than last season. For the 2023 to 2024 season, a total of 218 out of 233 NHS trusts (response rate of 93.6%) and 642 out of 6,459 GP practices (response rate of 9.9%) submitted data on seasonal influenza vaccinations administered up to 29 February 2024. In comparison, in the previous season (2022 to 2023), a total of 167 out of 233 NHS trusts (response rates of 71.7%) and 941 out of 12,940 GP practices (response rate of 7.3%) submitted data.
Throughout the 2023 to 2024 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 (93.6% for trusts and 9.9% for GP practices) was higher than that observed in the previous provisional monthly surveys Table 1. 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. Responses in response rates account for the slight decrease in vaccine uptake seen between the January and February 2024 provisional monthly surveys (Table 1) (43.1% and 42.8%, respectively: see Table 4).
Table 1. NHS trust and GP collection response rate (%) in each provisional monthly survey for the 2023 to 2024 season
| Month | NHS trust response rate (%) | GP response rate (%) |
|---|---|---|
| October | 75.8 | 3.9 |
| November | 79.8 | 6.0 |
| December | 82.8 | 8.1 |
| January | 83.3 | 8.6 |
| February | 93.6 | 9.9 |
National vaccine uptake rates
Overall, based on submitted data, 42.8% (503,499 out of 1,176,102) of frontline HCWs in NHS trusts received the seasonal influenza vaccine during the 2023 to 2024 season compared with 49.9% in the previous season (2022 to 2023). This was a decrease of 7.1 percentage points (Table 3 , Figure 1). Approximately 56.9% (680,677) of frontline HCWs in direct contact with patients in organisations responding to the survey did not receive the influenza vaccine this season. This is the third consecutive season to show a decrease in the vaccination of frontline HCWs, and uptake is lower than that observed in the previous 12 seasons (the 2010 to 2011 season saw an uptake of 34.7% and the 2011 to 2012 season saw an uptake of 44.6%).
Table 2. Seasonal influenza vaccine uptake in frontline healthcare workers in England for the 2023 to 2024 season, uptake by month and staff group
| Month | All doctors (including GPs) | All qualified nurses (including GP practice nurses) | All other professionally qualified clinical staff | All support staff (clinical and GP support) | Total (all healthcare workers) |
|---|---|---|---|---|---|
| October | 31.1 | 28.8 | 32.5 | 26.5 | 28.9 |
| November | 43.3 | 38.6 | 42.7 | 34.1 | 38.5 |
| December | 47.6 | 42.6 | 45.3 | 37.6 | 42.0 |
| January | 48.5 | 43.2 | 46.8 | 38.7 | 43.1 |
| February | 48.7 | 43.0 | 46.6 | 38.2 | 42.8 |
The responding organisations are considered to be broadly representative of all NHS organisations of the same type. Non-responding organisations may have lower uptake than organisations that have provided data.
Table 3. Seasonal influenza vaccine uptake in frontline healthcare workers in England, for the 2023 to 2024 season, 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 |
| 2023 to 2024 | 42.8 |
Figure 1. Seasonal influenza vaccine uptake in frontline healthcare workers in England for the 2023 to 2024 season, compared with previous seasons
Notes for Figure 1 and Table 4 symbols:
*: an asterisk demonstrates that 2009 to 2010 was the 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.
~: the tilde symbol demonstrates when the Commissioning for Quality and Innovation (CQUIN) payment incentive scheme for trusts to reach specified vaccine uptake targets was introduced or continued. It was introduced in the 2016 to 2017 season, continued in the 2017 to 2018 season, and again in the 2019 to 2020 season, and then again in the 2022 to 2023 season.
▪: the bullet point demonstrates when the CQUIN scheme was suspended because of the COVID-19 pandemic (between 2020 and 2022).
\^: the caret symbol demonstrates when the CQUIN scheme was continued, but was no longer linked to the ImmForm surveys which are used to generate the data for the government official statistics used in this report.
During the 2023 to 2024 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 4, 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.
Table 4. Seasonal influenza vaccine uptake in frontline healthcare workers in England by month during the 2023 to 2024 season, compared with 10 previous seasons
| Month | 2023 to 2024^ | 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 | 28.9 | 30.9 | 38.8 | 51.6 | 43.6 | 46.3 | 45.9 | 40.4 | 32.4 | 36.8 | 35.0 |
| November | 38.5 | 41.8 | 52.5 | 70.6 | 61.5 | 61.0 | 59.3 | 55.6 | 44.1 | 48.2 | 48.6 |
| December | 42.0 | 46.7 | 58.8 | 75.3 | 68.5 | 65.7 | 63.9 | 61.8 | 47.6 | 52.6 | 53.1 |
| January | 43.1 | 48.9 | 59.6 | 76.3 | 72.4 | 68.6 | 67.6 | 63.0 | 49.5 | 54.6 | 54.8 |
| February | 42.8 | 49.4 | 60.5 | 76.8 | 74.3 | 70.3 | 68.7 | 63.4 | 50.8 | 54.9 | - |
Notes on the symbol markings are available here.
Figure 2. Seasonal influenza vaccine uptake in frontline healthcare workers in England by month during the 2023 to 2024 season, compared with the previous 4 seasons
Vaccine uptake rates by organisation type
Seasonal influenza vaccine uptake by trust type ranged from 23.2% for staff in independent sector health care providers (ISHCP) compared with 61.8% in those working in GP practices (Figure 3).
Figure 3. Seasonal influenza vaccine uptake in frontline healthcare workers in England by organisation type for the 2023 to 2024 season compared with the 2022 to 2023 season
Vaccine uptake for all trusts
For the 2023 to 2024 season, vaccine uptake in frontline HCWs in trusts was 42.8% compared with 49.9% in the previous season. This was a decrease of 7.1 percentage points. Vaccine uptake by commissioning region ranged from 37.1% in the North West to 49.7% in the Midlands, with none of the commissioning regions achieving vaccine uptake of 70% or more (Figure 4).
The median seasonal influenza vaccine uptake for trusts was 43.0% among those submitting data. The highest seasonal influenza vaccine uptake reported by a trust was 82.2%, with the lowest reported as 7.1%. This season, 3.5% of all trusts (8 out of 233) achieved the goal of 70% or more. For comparison, last season 8.8% (20 out of 228) achieved 70% or more. Vaccination data by trust is available in the data tables that accompany this report.
Figure 4. Seasonal influenza vaccine uptake in frontline healthcare workers in England in trusts by commissioning region in the 2023 to 2024 season compared with the 2022 to 2023 season
Figure 5. Seasonal influenza vaccine uptake in frontline healthcare workers in England for the 2023 to 2024 season, histogram of uptake in trusts by vaccine uptake (%) categories
Vaccine uptake for GP practices
Seasonal influenza vaccine uptake in GP practice settings was 61.8% compared with 66.3% in the 2022 to 2023 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 (61.8%) is higher than those in trusts (41.9%), and this trend is consistent across all staff groups (Figures 6 and 7). 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 48.7% in all doctors. The lowest vaccine uptake was 38.2% in total support staff (Table 4). In GP practices, the highest vaccine uptake was 68.8% in all nurses, and the lowest uptake was 59.0% in total support staff (Table 4).
Figure 6. Seasonal influenza vaccine uptake in NHS trusts based frontline healthcare workers in England based in NHS trusts by staff group for the 2023 to 2024 season compared with 2022 to 2023 season
Figure 7. Seasonal influenza vaccine uptake in frontline healthcare workers in England based in GP practice and independent sector health care providers (ISHCP) by staff group for the 2023 to 2024 season compared with the 2022 to 2023 season
Glossary
Green Book
The Green Book, or Immunisation against infectious disease has the latest information on vaccines and vaccination procedures, for vaccine preventable infectious diseases in the UK. Chapter 19 refers to influenza.
ImmForm
A website that provides a secure online platform for vaccine uptake data collection for several immunisation surveys, including the seasonal influenza vaccine uptake collection.
Data sources and methodology
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 2023 to 29 February 2024 (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). 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 season 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 season. 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.
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 7 as ISHCPs have historically had to self-declare and register with ImmForm to be included. This number is fewer 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 information
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 2023 to 2024 winter season among frontline HCWs, a seasonal influenza vaccine uptake survey of all 233 NHS trusts and 6,459 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 2023 to 2024 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 aims and objectives of the 2023 to 2024 seasonal influenza vaccine uptake campaign among HCWs in England were to:
- monitor vaccine uptake among 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 among frontline HCWs
- For the 2023 to 2024 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
Feedback and acknowledgements
To provide feedback about this report and data, please email HCWvac@ukhsa.gov.uk.
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, the ImmForm team and the ImmForm support team.