NHS England

Our experts were embedded in NHSE and Government teams throughout this historic national endeavour. They brought to the challenge expertise in disciplines as diverse as strategic planning and finance; technology and data; modelling; workforce planning; operational performance; and behavioural change and communications. The initial mission was to ensure that as soon as regulators cleared a vaccine, NHSE would be ready to roll it out swiftly and safely. As time progressed, the mission became to rapidly top up the population with booster vaccines to counter the spread of the Omicron variant.

When the programme launched, it demonstrated a phenomenal capacity to deliver life-saving vaccines. Within one month, 1.7 million doses had been delivered, a figure that rose to almost 20 million within two months. One year later, a booster programme delivered doses at a rate of almost one million a day, helping break a new wave of infection driven by the Omicron variant.

Key successes

• Enabling the delivery of 133 million vaccine doses by December 2021
• Delivering a critical national programme estimated to have saved some 120,000 lives
• Applying technology and data specialisms to launch the UK’s National Immunisation Management System
• Introducing ground-breaking changes to workforce design that will continue to enable NHSE to assemble a larger, more flexible workforce on demand

Maximising the impact of COVID-19 vaccines

Three months after England first locked down to limit the impact of a new coronavirus, COVID-19 had killed almost 50,000 people in England, and NHSE healthcare teams were fighting every day to save lives. Novel vaccines looked like the best hope of bringing the pandemic under control. As a result, NHSE were developing plans to rapidly vaccinate tens of millions of people – even though no vaccine had yet completed clinical trials or received regulatory approval.

A mass vaccination programme on this scale posed an extraordinary challenge. It spanned everything from determining where vaccinations would take place to getting precious supplies to delivery hubs on time. It also involved ensuring enough trained people would be available to administer jabs and that patients were in the right place at the right time to receive them. The faster the roll-out, the more lives would be saved.

A shared endeavour

From the start, we worked with teams across NHSE to bring industry expertise, strategic insights and practical support to turn this ambition into a reality.

The initial ambition was to vaccinate those over the age of 65 in one single, uninterrupted programme. The eventual scale of the task was to vaccinate the entire adult population – an unprecedented feat. Our teams worked alongside NHSE, tapping into our breadth of expertise across sectors to bring shape and structure to the challenge.

Simon Collier, Healthcare expert at PA, recalls the sense of responsibility and anticipation he felt. He said: “It’s rare to have an opportunity to save tens of thousands of lives, but this is exactly what the programme presented. From day one, we felt a powerful sense of purpose. Healthcare teams and communities across the country were depending on us to deliver. This drove and motivated every one of us as we brought the best of PA to the programme over the months ahead.”

Funding a critical national mission

Our finance and commercial experts worked hand-in-hand with NHSE, the Department of Health and the Treasury to rapidly establish financial structures that would underpin the vaccine roll-out.

With a fine balance to be struck between securing funds as quickly as possible and ensuring value for public money, it was vital that a streamlined reporting function was established early on, as our team was reporting to the Treasury and NHSE.

To release this level of funding, Government departments would normally spend months, if not years, developing a robust business case.

By building a bespoke end-to-end management reporting framework, our experts could develop a business case to present to the Treasury that would eventually secure £3 billion in funding in just six weeks.

Modelling the population’s vaccination needs

From the start, the number of moving parts and changing variables in rolling out such a vaccine programme demanded expert modelling capability. It required a blended team bringing both technical skills and an ability to think pragmatically.

The models became the compass for the programme, orientating teams around the key ambition: to get the vaccine out to people as quickly as possible, with minimal wastage.

The first model tested anticipated demand for vaccines, depending on how many doses were required, what interval they had to be given at, and who would receive them. This model used a mix of datasets, from sources such as GP records, care homes and the Office of National Statistics. Our software programmers applied their skills to move data between the model and the various platforms.

The second model examined factors such as the prioritisation of at-risk groups, the preferred delivery model for different cohorts, and the availability of vaccines and how these would shape the roll-out. These factors continued to change, sometimes daily, through the programme’s planning and delivery phases.

Combined, the two models made sense of the constantly changing data and identified the real-world requirements in terms of workforce, estates, equipment, and consumables to deliver vaccines under different scenarios. Output from these models also enabled senior stakeholders to talk confidently about preparations for the roll-out and its progress once it was underway.

Designing the delivery strategy

Simultaneously with the development of finance structures and models, work began on the delivery strategy. At this point, there was no certainty around whether the COVID-19 vaccine would be part of a joint COVID/flu jab programme, whether NHSE doctors and nurses would be available to deliver jabs, and when and how batches of the vaccines would be supplied.

What was certain was the requirement to deliver a strategy that would hold up under even the most challenging scenario – for example, a requirement to run an ultra-cold supply chain, administer huge batches within days, and operate vaccination centres with strict social distancing in place.

This is when the idea of a multi-pronged model, featuring a mix of delivery routes, began to take shape. These included mass vaccination centres capable of handling large deliveries and best suited to younger, more mobile people. Conversely, local vaccination services such as GP surgeries and pharmacies were more suited to older and more vulnerable people. Hospital hubs were the best solution to vaccinate the two-million strong health workforce. Roving services, with doctors visiting the most vulnerable in their homes, drive-thru hubs for those in the most rural communities, and pop-up hubs to serve homeless people were ideas also in the mix at this early stage.

Providing flexibility with a ‘pod’ model

For all of these delivery routes, a flexible approach was needed that could be scaled up or down according to the volume and mix of vaccines available at any one time. The team came up with the concept of a ‘pod’ – a unit capable of delivering 520 vaccines in a 12-hour day.

The team began by working out the requirements to operate one pod – staff, space, consumables (such as PPE, needles and syringes) and equipment (such as temperature-controlled storage for the vaccines, chairs, screens etc.). They then multiplied these according to the size of the planned delivery hub to could scope out and flex the required resources. A mass vaccination centre, for example, might require six pods’ worth of resources to operate for one day, while a hub at a GP surgery might require just one.

Next came the task of designing the delivery hubs in detail to maximise through-put while maintaining a COVID-safe environment and ensuring a positive experience for people arriving for their jab. Here the team drew on expertise in operational improvement to design for optimum efficiency.

As part of this, the team designed the user journeys, defining how the experience of getting the vaccine would work for patients at each type of hub – from the initial invitation to attend, through check-in at the hub, pre-vaccination screening and vaccination itself, to post-vaccination observation. Throughout, the team engaged with senior stakeholders and experts across the health sector to secure feedback and refine our designs.

A ‘live play’ exercise in early October 2020 enabled us to put our calculations to test. One hundred volunteers acted as patients, while staff from local healthcare providers acted as vaccinators. This allowed us to confirm precisely how long it took to vaccinate one patient.

By the time the Pfizer-BioNTech vaccine received the green light in early December 2020, plans for immediate deployment were in place. The first vaccine was delivered at University Hospital Coventry on 2 December 2020.

As 2021 began and vaccine supplies increased, more hubs opened up, with regional health authorities taking responsibility for rolling out hubs in their areas. By February, one of the biggest, at the Excel Conference Centre in London, was administering 20+ pods’worth of vaccines to more than 10,000 people a day. As new vaccines came on stream, the flexibility built into the delivery model enabled the hubs to absorb the additional complexity.

Building a plane in flight: Creating the supply chain

Akin to building a plane in flight, the complexity of creating a functioning supply chain of this magnitude during a national emergency was an extraordinary task.

The aim of having the supply chain up and running within seven days of a vaccine being approved was an incomparable challenge for our supply chain and logistics experts.

The solution our team settled on was to design multiple supply chains to test how they would perform in various scenarios, giving an indication of which option would fit best for each potential vaccine.

An NHSE first: Designing the data system

Two of the issues our data and analytics experts were tasked to solve were the lack of centralised immunisation records and a delay in reporting when vaccinations took place.

As with any national-scale project such as this, having real-time, harmonised data was critical to supporting the vaccine roll-out. The insights gained from having the right data systems would directly impact the prioritisation of patients and help save the maximum number of lives.

The team we assembled featured experts in digital architecture, system design and delivery, business analytics and service design.

Within two months, the team delivered a brand-new National Immunisation Management System (NIMS). This data system ensured stakeholders countrywide had clear, timely and accurate information to make decisions fast and in a co-ordinated manner.

Facing down a new threat from Omicron

The roll-out came to be seen as an extraordinary national success story as the number of people being vaccinated accelerated steadily through the first half of 2021. Patients who had received their jabs – sometimes after many months of shielding – came forward to speak of their relief and delight. Meanwhile, healthcare teams battling on the front-line commended the rapid vaccine roll-out as a vital contribution to the shared fight against the virus.

With our support, NHSE had a world-class infrastructure, including a new National Immunisation Management System, to enable the delivery of COVID-19 vaccines in the months and years ahead. Towards the end of the year, this infrastructure was put to the test as a new variant of the virus, Omicron, arrived in the UK.

Accelerating insights to outpace a new variant

Our team was already working with the NHSE to prepare a booster programme for the winter. But the timing of Omicron’s arrival, the speed at which the variant was spreading, and uncertainty around the severity of the ongoing side effects made the degree of threat hard to assess.

With cases rising fast and businesses and families gearing up for the Christmas holiday period, the Government required urgent insights to decide on the right response. Our data experts didn’t miss a beat. As the Government sought to understand the evolving threat and weigh up different courses of action, the team delivered key insights to the Prime Minister and his team on an almost-daily basis.

Drawing on our analysis, the Government made the decision not to call a third lockdown, with all its negative implications for lives and livelihoods. Instead, on 12 December 2021, anticipating a tidal wave of Omicron infections, the Prime Minister announced a target of providing a booster dose to one million adults a day. This was double the rate at which vaccines had been delivered at any point in the initial programme.

Delivering booster jabs faster than ever

Our experts moved fast to prepare the infrastructure to support this extraordinary delivery challenge. This included getting the national booking system ready to handle the surge in demand for jabs expected ahead of the Christmas holiday period.

The team also made sure the applications to record and report every single booster dose delivered at GP surgeries, vaccination centres and hospital hubs were ready for this new phase. Real-time data from these systems provided NHSE, regional health teams and local site teams with insights to manage the booster programme for maximum impact. It was quickly apparent, for example, where special efforts were needed to encourage different cohorts and communities to come forward.

As the booster programme got underway, the team ran ‘hyper care’ for the whole system – monitoring and managing it hour by hour to optimise performance. At points of peak demand, some 200,000 people were queuing to book their booster. The system proved impressively robust, never buckling in the face of a huge national effort to build a defensive wall of immunity. By the end of 2021, over 28 million adults had received a booster.

Assembling an army of workers

Modelling showed that at peak capacity, the vaccine roll-out would need 125,000 workers to ensure nobody waited longer than necessary for a jab.

To put together a workforce of that size that could safely and swiftly administer this volume of vaccines, we called on our expertise in human capital, healthcare workforce planning, change management and operational performance.

The workforce model we implemented was flexible so workforces at individual vaccination centres could be scaled up or down according to the supply of vaccines available. Data tools created by our team were able to predict workforce needs ahead of time, ensuring the vaccine rollout never missed a beat.

Driving uptake with effective communication

From the outset, the roll-out’s success depended on how willing the public would be to accept a novel vaccine. Consistent messaging based on correct, factual information would be vital to winning trust.

Besides targeting the public directly, the team needed to consider other groups that would have an impact on public attitudes: politicians and political stakeholders from across six separate Government departments; NHSE and public health organisations at local, regional and national level; and the press and other media, who were subjecting every element of the pandemic response to intense scrutiny.

To meet the challenge, our team blended expertise in behavioural change, leadership and communication with NHSE communications expertise in a fully integrated team. Our proven ability to work collaboratively with large, complex organisations, across long supply chains, in times of crisis was central to the effort.

As scientists raced to develop vaccines, our focus was to establish the strategy and plans that would enable effective communication as soon as the roll-out began. Our plans were agile to accommodate the significant uncertainty that still existed.

Regulatory approval for the Pfizer vaccine marked a dramatic shift in pace. At this point, our ability to work with organisations to help them drive towards an ambition came to the fore. Our partnership with the NHSE was at the heart of an immense, practical effort to reach out to members of the public, volunteers and health and care workers in every community.

The pace was intense. Daily briefings were prepared to ensure consistent messaging from Government departments. Additionally, targeted initiatives were developed to engage communities where vaccine take-up was initially low. In tandem with the NHSE, our team managed communications with 80,000 volunteers who joined to support the national vaccination effort. We also undertook crucial work to help counter misinformation around vaccine efficacy and safety.

Our work continued as new cohorts were invited for vaccination. Three months after regulators had cleared the first jab, attitudes to the vaccine were positive. In the UK, almost 90 per cent of people said they would be willing to receive a vaccine. Media commentary on the vaccine roll-out was overwhelmingly positive. Our team had played a vital role in winning hearts and minds for vaccination.

Building an enduring legacy

Almost two years on from the start of the pandemic, the Government finally lifted all COVID-19 restrictions in February 2022. The speed of the booster roll-out helped make England the first country in Europe to do this.

The experience of the pandemic has been transformational for NHSE and the wider health system. With our support, NHSE now has a world-class technology infrastructure to manage and deliver a wide range of public health vaccination and screening programmes.