Public Health England’s Joint Committee on Vaccination and Immunisation updated their guidance on eligibility for the seasonal immunisation in the summer of 2014 to include specific reference to people with learning disabilities The 2014/15 Public Health England Winter Flu Plan published that year asked GP practices and other immunisation providers to ‘prioritise the improvement of vaccine uptake’ among people with learning disabilities (among other groups). From this point, people with learning disabilities were eligible for the immunisation free of charge.

Reasonable Adjustments
There is a legal obligation to put reasonable adjustments in place to ensure equal access to healthcare services for people with disabilities. This means that services should be making changes that help people with learning disabilities have a flu vaccination. These might be changes at a service level, for example sending out an easy-read leaflet about why it is important to have a flu vaccination. It might be changes at an individual level, for example
offering a home visit to someone who finds attending the GP surgery difficult. All organisations that provide NHS or adult social care must now follow the accessible information standard by law. The standard aims to make sure that people who have a disability, impairment or sensory loss are provided with information that they can easily read
or understand with support so they can communicate effectively with health and social care services.

Examples of reasonable adjustments
Many people with learning disabilities are anxious about needles but there are a lot of resources and approaches that can help them to tolerate injections or blood tests. There is more detailed advice, as well as good practice case studies, in our report Blood tests for people with learning disabilities: making reasonable adjustments.  This includes guidance on:

  • how to help someone to be prepared, for example desensitisation work
  • how to support the person to make an informed decision if they have capacity to do so, for example using accessible leaflets and videos
  • how to improve their experience, for example the use of topical applications to numb the skin prior to needle insertion
  • how safe-holding and sedation can be used if other approaches such as desensitisation have failed and a best interests decision has been taken that this is warranted

Nasal spray vaccine
When someone with learning disabilities who is anxious about needles requires a blood test or an injection there should always be consideration of less invasive alternatives. This would include the use of the nasal spray flu vaccine.
The live intranasal influenza vaccine is given as a single spray squirted up each nostril. This has the advantage of being needle-free and for children it is more effective than the injected flu vaccine. This is not licensed for adults, as there is evidence it may be less effective than the injected inactivated vaccine. However, guidance for healthcare workers says that medical practitioners can choose to use the nasal spray “off-label” and that this can be for
“patients with learning difficulties who become seriously distressed with needles”.

PHE has agreed that the national stock of the nasal spray flu can be used for this purpose but it needs
to be individually prescribed using a Patient Specific Direction (PSD).