By Anthony Berendt
A: I can't believe it! I'm furious!
Q: Oh? Why? What's happened?
A: They've imposed a 75% flu vaccination target for healthcare workers! It's crazy!
Q: Aren't you a supporter of healthcare worker flu vaccination?
A: Yes, passionately!
Q: Even though it's not that effective?
A: Well hang on...it's 60% or so effective. That's not bad
Q: Enough to want to promote it?
A: For sure! That's a good reduction in the risk of catching flu at an individual level and if we were all immunised it could impact on spread
Q: How so?
A: Flu is highly infectious and we know cases are infectious a little before symptoms start, are infectious even with mild illness and remain so for some days.
Q: But aren't lots of people immune or innately resistant? Isn't that why many healthcare staff still don't want the jab?
A: That's their argument but there is no evidence to support that view. And there are plenty of examples of serious or fatal flu in people "who've never had flu".
Q: So you don't you want everyone in the NHS to be immunised?
A: Yes. I would argue that all health and social care workers should be.
Q: What's wrong with having a target then?
A: Well it's not mandatory, so we have to persuade our staff to have the vaccine. We know some hate targets and don't want to be part of one. Introducing a target will just infuriate them!
Q: Let me get this straight. A target will "infuriate" people, including the ones who think flu vaccination is the right thing to do?
A: Yes! Well, perhaps...I suppose it might actually encourage those who believe in the jab to see it being taken even more seriously.
Q: And the effect on the waverers who are not sure?
A: Perhaps some of them might take it more seriously. I recall meeting one doctor who said they would only have it if it was made compulsory. But others will see it as punitive I am sure.
Q: But this target is linked to a reward, not a punishment, isn't it? Who exactly will it infuriate?
A: It will certainly infuriate the ones who don't agree with having the flu jab!
Q: Who at the moment don't have the vaccine anyway?
A: Exactly!
Q: So how were you hoping to persuade that group to change their minds?
A: Well... Every year we have increased uptake, so it looks as if people are slowly being won over.
Q: How slowly? And are you winning over the "resisters" or just drawing in the "late majority"?
A: Hmmm....not entirely sure.
Q: Did you say the target was 75%? So how long to reach 75% using your existing methods?
A : Hard to know at present. Nationally the figures are increasing but we still had under 50% of front line staff immunised in the 2012 season. Several more years I guess.
Q: Can I just play this back to you for a moment?
A: Go ahead...
Q: You support flu immunisation for healthcare workers and you want the uptake to be much higher?
A: Yes
Q: Uptake rates are rising only slowly despite lots of effort and measures to draw staff in?
A: Yes...
Q: The "target" links eligibility for winter pressure funding in 2014 with 75% vaccine uptake in 2013? With something which, it sounds like, you would quite like to happen anyway?
A: That's right!
Q: So tell me again...what is wrong with the target? Isn't it a piece of "disruptive innovation" that might help you breakthrough to much higher uptake? Isn't it really what you want?
A: We really want 100% uptake! The thing is, we think staff will never agree and after Mid Staffs, targets have such a bad name...
Q: But can you blame all targets for how some leaders and cultures have responded to some targets?
A: It would just be so much easier if we kept this on a level where we could not be accused of coercing people in order to hit the target!
Q: That's a leadership choice isn't it? I remember you blogging about this before...is that where you are going with this?
A: Exactly! We should be doing this by leading, not by following some Government target!
Q: And tell me...do the Government have the right to set a target?
A: Yes, but...
Q: A target you want to exceed anyway?
A: Again, yes, but...
Q: A target that might encourage supporters, persuade waverers, and will only really annoy a group of people you are currently not winning over anyway?
A: You think I should stop moaning and get behind the target don't you?
Q: I'm just asking questions... But I'm wondering what the impact would be, on your leadership of your flu programme, if you felt comfortable that the target was no different from a CQUIN, and was a legitimate expression of your own ambition for your colleagues and their patients? Would that make it OK to follow the line?
A: Maybe. And maybe as a leader I have to recognise there are times I have to follow just as I ask others to follow me.
Q: Well...I didn't like to ask about following, but it is important...and I don't know what you will make of this next question?
A: Fire away!
Q: Do you think you can make the target, if you try?
A: If we all get behind it, as leaders and followers committed to our patients, we will smash it to pieces!
Q: What are you waiting for?
