Taking flu vaccination closer to families in a rural-coastal setting: Cornwall’s early years pilot

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.

Seasonal influenza can cause significant illness in young children, with higher risks of
complications and hospitalisation in the under5s. Vaccinating two to three-year-olds helps protect the child and reduces transmission within families and the wider community.

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. Current uptake is 45.51 per cent, compared with the Southwest average of 49.96%. Uptake is also unequal, with lower coverage in more deprived areas and substantial variation between GP practices.

In  some communities, particularly those  with higher deprivation, 60–72 per cent of eligible children remain unvaccinated. To address these inequalities, 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.

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.

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 who consented, uptake was high, with 78 per cnet of children successfully vaccinated.

These results indicate that delivery within EYSs was operationally feasible and effective once consent had been obtained, with a high proportion of consented children progressing to vaccination. However, the majority of eligible children did not reach the consent stage, suggesting that the primary limitation of the model lies in engagement and consent processes rather than delivery capacity or acceptability.

There was also substantial variation between settings, with consent rates ranging from approximately 15 per cent to 100 per cent. This variability suggests that contextual and implementation factors, including timing of delivery, communication strategies, and the nature of relationships between early years staff and parents played a significant role in influencing engagement and uptake.

Survey findings further support the feasibility and acceptability of the model from a provider perspective. Early years staff reported high levels of preparedness and engagement, with all respondents indicating willingness to support future delivery, confidence in signposting vaccination information, and capacity to participate in the pilot. Similarly, vaccination delivery teams reported consistently high levels of agreement regarding the acceptability and feasibility of delivering vaccination in EYS, indicating strong confidence in the operational aspects of the model.

Taken together, these findings suggest that EYSs represent an acceptable delivery platform. However, improvements in parental engagement and consent processes are critical to achieving higher overall uptake. While the impact of the change in delivery model and delayed implementation cannot be directly quantified, they are likely to have introduced additional barriers to access and reduced participation in the setting-based offer. This interpretation is supported by the 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”

• 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.