A pilot delivering flu vaccinations to two to three-year-olds in early years settings (EYS) across high deprivation, low-uptake areas in Cornwall to improve access and knowledge.
Synopsis
A pilot delivering flu vaccinations to two to three-year-olds in early years settings (EYS) across high deprivation, low-uptake areas in Cornwall to improve access and knowledge. Six settings participated, reaching 169 eligible children; 27 per cent consented and 21 per cent were vaccinated. Uptake varied across sites. Parents and staff viewed the model as convenient and acceptable, but parental attendance requirements, late delivery, and complex consent processes limited participation.
Key learning highlights that improving access alone is insufficient. Strong communication, timely delivery, simplified consent processes and clear governance arrangements are critical to maximising uptake. Early years settings remain a feasible delivery platform if engagement and operational barriers are addressed.
Background
Seasonal influenza can cause significant illness in young children, with higher risks of complications and hospitalisation in the under fives. Vaccinating two to three-year-olds helps protect the child and reduces transmission within families and the wider community.
In rural, coastal areas such as Cornwall and the Isles of Scilly (CIoS), access to vaccination services can be more challenging due to geography, service distribution, and wider inequalities. Although the NHS offers flu vaccination for this cohort through primary care, uptake in Cornwall and the Isles of Scilly (CIoS) remains below the regional average (45.51 per cent versus 49.96 per cent in the South West). Uptake is also unequal, with lower coverage in more deprived areas and substantial variation between GP practices; in some communities, 60 to 72 per cent of eligible children remain unvaccinated.
To help address these inequalities and take vaccination closer to families, this pilot tested an alternative delivery approach by offering flu vaccination in early years settings (EYS). Clinics were delivered by ICB-commissioned vaccination teams in settings located in IMD quintiles one to two and/or near GP practices with historically low uptake. The approach aimed to reduce access barriers and improve parental confidence and engagement by delivering vaccination in familiar, community-based environments.
The delivery model changed during the set-up phase. The pilot was originally designed to vaccinate children within their childcare setting without a parent or guardian present. However, due to late-stage governance constraints, delivery was delayed and parental attendance was required, introducing an additional access requirement for families.
Objectives
The pilot set out to explore both impact and implementation. Its objectives were to:
- test whether delivering flu vaccination in early years settings could improve uptake
- assess the feasibility and acceptability of this delivery model
- increase early years staff knowledge and confidence in supporting vaccination
- identify barriers and facilitators to uptake from the perspectives of parents, staff and vaccination teams.
The wider aim was to inform future commissioning decisions and understand how community-based delivery could reduce inequalities.
Quantitative findings
Six early years settings participated in the pilot, offering flu vaccination to 169 eligible children. Of these, 46 children (27 per cent) had parental consent, and 36 children (21 per cent) were vaccinated. Among those with consent, uptake was high (78 oer cent), indicated that delivery within EYSs was feasible and effective once consent was secured.
However, most eligible children did not reach the consent stage, suggesting that the primary limitation lies in engagement and consent processes rather than delivery capacity or acceptability.
There was substantial variation between settings (consent rates ~15 to 100 per cent), indicating that contextual factors such as, timing, communication, and relationships between early years staff and parents, strongly influenced uptake.
Survey findings support the model’s feasibility and acceptability, with early years staff and vaccination teams reporting high confidence and willingness to support delivery.
Overall, the quantitative findings suggest that EYSs are an acceptable delivery platform, but improving communication, parental engagement and consent processes is critical to increasing uptake. While the impact of the change in delivery model and delayed implementation cannot be directly quantified, they likely introduced additional barriers to access and reduced participation in the setting-based offer, as supported by the qualitative findings.
Qualitative findings
Free-text responses from parents/carers, EYS staff, and vaccination teams were thematically analysed and grouped into seven themes:
Communication and engagement
Early, clear, proactive communication and strong coordination increased awareness and consent; late/inconsistent communication reduced participation due to parents/carers accessing vaccinations elsewhere.
More notice of it happening would have been helpful.”
Accessibility, timing, and reach of delivery
The timing of clinics in relation to nursery attendance influenced uptake. Where clinics did not align with attendance patterns, opportunities were missed. Late delivery also reduced relevance, as some children had already been vaccinated elsewhere.
I would have liked to, but my child wasn't booked in to attend nursery on the day that the NHS team was in”
Convenience and acceptability
Vaccination in nursery settings was widely seen as convenient and acceptable for parents/carers, reducing disruption compared with attending GP appointments.
No time was needed off of work as I was due pick her up anyway.”
This model was described as straightforward and accessible by both staff and delivery teams.
It saved parents using up a weekend day, it is very convenient-”
Service organisation and delivery experience
Clinics were generally positive; collaboration between vaccination teams and EYS staff supported smooth delivery. There were some administrative inefficiencies identified; however, these were easily fixable.
Logistics and facilities
Most settings provided suitable environments for delivery. Issues such as space constraints, parking and traffic were reported but were considered minor and manageable with adequate planning.
We were given a room of adequate size… also toys if we needed them”
Administrative processes and system efficiency
Consent processes were a key challenge. Forms were described as lengthy and repetitive, and reliance on parents bringing completed paperwork resulted in delays and duplication.
Workforce capacity and pressures
The combination of clinical tasks and heavy administration created strain, particularly at peak times (drop-off/pick-up). A two-person model (clinical + admin), adopted in some sites, improved efficiency and burden on the vaccination team.
Two people worked well. One doing admin whilst the other goes through the routine”
Lessons learned
- Parental attendance requirement likely reduced uptake: Requiring parental presence introduced practical barriers, particularly for working families,
potentially limiting participation and reducing the accessibility benefits of the model. - Early years settings are trusted and practical delivery venues: EYS were consistently described as convenient, familiar and acceptable. Staff were engaged and willing partners, and delivery teams reported strong readiness and capability.
- Access improvements alone are not sufficient: Improving access did not automatically lead to higher uptake. Achieving impact requires a
multi-component approach, combining access with strong communication, invitation and engagement strategies. - Timing and system coordination are critical: Delayed delivery reduced relevance and overlap with existing vaccination routes limited demand. Early planning and coordination across the system are essential.
- Implementation quality drives variation: Large differences between sites indicate that local delivery factors (communication, consent support, scheduling, admin capacity) strongly influence outcomes. Standardising core components while allowing local adaptation may improve consistency.
Conclusion
This pilot demonstrates that EYSs can provide a feasible and acceptable platform for delivering flu vaccination in a rural-coastal context. Overall uptake was limited by challenges in parental engagement and consent processes, alongside delays in delivering the pilot earlier in the flu season. Addressing these barriers will be critical to maximising impact. With refinement, this approach has strong potential to reduce inequalities and improve vaccination uptake in underserved communities.