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•Wide variation in uptake of flu vaccine persists in English NHS hospitals.•Many factors of high uptake are linked to leadership and organisational culture.•Embedding the flu programme in well-being policy helps acceptability and adherence.•A supportive culture is likely to achieve higher uptake than a coercive one.•Middle managers’ facilitating role in delivering the programme is key to uptake. Health care workers are a priority group for seasonal influenza vaccination, which is recommended by the World Health Organisation. There is a wide variation in uptake between and within countries. England has achieved 69.5% of health care workers vaccinated overall in 2017/18 across NHS acute and community health care settings, but it varies between Trusts from 50% to over 92.3%. While attitudinal factors have been well researched, there is limited evidence on organisational factors associated with high uptake. In England, most NHS Trusts are now implementing a similar range of interventions as part of their flu programme, and it remains unclear why performance remains so variable. This qualitative study is the first to explore reasons for this variation and provide recommendations for lower performing Trusts on how to improve. Fifty-seven interviews of managers and vaccinators were conducted in nine hospitals with flu vaccination uptake ranging from just over 55% to above 90%. Our study found that while Trusts deployed a wide range of both demand generating and supply interventions to increase uptake, there were marked differences in the organisational and delivery models utilised. Our study suggests that organisational culture was possibly the most important ingredient when trying to differentiate between high and low performing Trusts. We found that a positive culture aimed at fostering continuous improvement and favouring non-coercion on balance yielded more adherence from staff. Where influenza vaccination was embedded in the organisation wellbeing strategy, rather than executed as a siloed seasonal programme, this tended to foster good performance. Improving performance of influenza vaccination in health care workers will involve not only deploying the right interventions, and following “best practices”. It will require the adaptation of flu progamme delivery strategies to the organisation context, and embedding vaccination into the organisational culture, thus supporting the normalisation of yearly vaccination.

Nurses' responsibility to advise parents in favour of MMR vaccine. [(BNI unique abstract)] 8 references

Introduction The problematic use of substances is linked to many forms of chronic and life threatening conditions, the majority of which affect people in later life. In part as a consequence of population ageing and with evidence suggesting that older people's substance use is increasing, this complex and heterogeneous group is growing. Thus greater numbers will require palliative care and present new challenges to end of life services. This study explores the nature and extent of these changes and the needs of service users and providers. Aim(s) and method(s) There are five strands to the study; evidence for practice: an international review via a Rapid Evidence Assessment (REA), establishing what is known about prevalence and incidence via a secondary analysis of qualitative and quantitative datasets, exploration of the experiences of people with chronic or terminal illness and a similarly for the experiences of family members and carers, and professionals' perspectives collected via key informant interviews. Results The study began in May 2016 and we will have preliminary findings for presentation from the REA, the quantitative dataset analysis, and the secondary analysis of carer/family study data by October 2016. Conclusion(s) This is a key and under-researched area of palliative and end of life care, and an area which we already know results in considerable challenges for both end of life service providers and also for substance use services. Little is known about what may already be in place and still less about the composition and scale of the relevant populations. References Galvani S, Hutchinson A, Dance C. Identifying and assessing substance use: findings from a national survey of social work and social care professionals. Br J Social Work 2014;44 (7):1895-1913 Harling M, Overy C, Beckham G, et al . Addressing negative attitudes toward substance use in nursing: A peer-led approach in nurse education. Drugs Alcohol Today 2006;62 ):38-41 Reisfield GM, Paulian GD, Wilson GR. Substance use disorders in the palliative care patient. J Palliat Med 2009;12 (5):475 Wadd S, Papadopoulos C. Drinking behaviour and alcohol-related harm amongst older adults: analysis of existing UK datasets. BMC Res Notes 2014;7 (1):741