Childhood Vaccinations in New Spaces service: London Borough of Lambeth

Lambeth is a diverse inner-London borough with a young, mobile population and longstanding challenges with childhood vaccination uptake and inequalities. Coverage for key childhood immunisations has remained below the World Health Organisation (WHO) target of 95 per cent, with inequalities evident across deprivation, ethnicity and geography.

In response, Lambeth Council’s Public Health team worked with NHS and community partners to develop a borough-wide Childhood Immunisation Strategy grounded in community engagement, data-driven insights and evidence review.

One of the early interventions arising from this work was the Vaccinations in New Spaces service. It aimed to strengthen routine childhood immunisation delivery by taking vaccination support into trusted community settings such as children’s centres and family hubs, while also providing bespoke outreach support for families facing barriers to access.

The service consisted of two key components delivered through trusted community settings and targeted outreach support. The first component combined informal vaccine education sessions with walk-in community vaccination clinics delivered through children’s centres and family hubs. The second component was a targeted home vaccination service for children who remained unvaccinated despite routine GP call and recall processes. The overall aim was to increase uptake amongst children who may otherwise not receive vaccinations and reduce inequalities in access.

The model was initially piloted for six months before being extended following positive early findings and continued system support.

Like many urban areas, Lambeth has experienced longstanding challenges with childhood vaccination uptake and inequalities. Local analysis showed that uptake for all childhood vaccinations remained below WHO herd immunity targets.

The borough also faced several structural and demographic factors that may influence uptake, including:

• significant levels of deprivation
• a highly mobile population
• ethnic and linguistic diversity
• variation in uptake between GP practices, PCNs and neighbourhoods
• vaccine misinformation, hesitancy and mistrust
• practical access barriers such as appointment availability, childcare and working patterns.

The local childhood immunisation needs assessment highlighted that inequalities in vaccination are driven by a complex interaction of personal, community, institutional and policy-related factors.  

Community engagement undertaken as part of the strategy development identified several recurring themes from residents, including:

• difficulty accessing appointments
• low trust in services
• concerns about vaccine safety and side effects
• misinformation
• language and communication barriers
• low health literacy
• challenges navigating the healthcare system.

Stakeholder engagement also identified a group of children who were repeatedly missed through traditional delivery models despite routine call and recall processes. These included children from families who were challenging to contact, repeatedly missed appointments, or faced wider social and practical barriers to accessing vaccination services.

Lambeth adopted a community and people-centred approach to improving childhood vaccination uptake.

The borough’s Childhood Immunisation Strategy was developed through:

• extensive community engagement
• literature reviews and evidence synthesis
• learning from local and regional best practice
• stakeholder interviews
• vaccination uptake and inequality analysis
• system-wide workshops involving NHS, local authority and voluntary sector partners.

This work informed the development of the Vaccinations in New Spaces model.

The service was commissioned by Lambeth Council Public Health and delivered in partnership with Guy’s and St Thomas’ NHS Foundation Trust/Evelina London.

The model used a multi-component intervention model designed to improve:

• capability (knowledge and understanding)
• opportunity (ease of access)
• motivation (confidence and trust).

This approach was informed by the COM-B behaviour change framework and wider evidence on improving childhood immunisation uptake.  

The model consisted of two main components:

1. Community-based education and vaccination clinics

Informal educational sessions and walk-in vaccination clinics were delivered through trusted community settings including children’s centres and family hubs, particularly in areas of lower uptake and higher deprivation.

The model aimed to:

• improve vaccine-related health literacy
• create opportunities for open discussion
• address misinformation and concerns
• reduce practical access barriers
• provide a more flexible and family-friendly vaccination offer.

Importantly, the sessions were delivered in familiar community settings rather than traditional clinical environments. Clinics also allowed additional time for discussion with healthcare professionals where needed.

Families could attend without referral and access support locally within their communities.

2. Targeted home vaccination service

The second component of the service provided targeted outreach and home vaccination support for children who remained unvaccinated despite routine primary care efforts.

GP practices could refer eligible children where:

• routine call and recall had been unsuccessful
• booked appointments had repeatedly been missed
• families were challenging to contact
• family’s choice or additional outreach support was considered beneficial.

The service included:

• proactive follow-up
• flexible appointments
• home vaccination visits where appropriate
• language interpretation support
• personalised engagement.

Importantly, the service was not designed for families who had actively declined vaccination. Instead, it focused on reducing barriers for families who may have wished to vaccinate but experienced difficulties accessing services.

Evaluation findings from both the initial pilot and the subsequent first year of delivery demonstrated encouraging outcomes across community engagement, caregiver experience and intermediate behavioural outcomes.

Between April and December 2024, the service delivered 56 workshops across nine children’s centre sites, with over 1,000 caregiver attendances. Earlier pilot delivery included 40 workshops across six sites with 211 caregiver attendances.

The service successfully engaged families who may not otherwise have accessed vaccination services and provided a more flexible and community-centred offer.

Feedback from workshops was consistently positive. In the post-pilot evaluation:

• 100 per cent of attendees agreed or strongly agreed they felt comfortable asking questions and felt more informed after sessions
• 96 per cent agreed or strongly agreed they could trust the staff.

The pilot evaluation also demonstrated improvements in vaccine-related knowledge and confidence:

• average knowledge ratings increased by 26 per cent
• 16 per cent of respondents reported a positive change in vaccination intention following workshops.

Subsequent evaluation findings demonstrated continued positive movement in vaccination intention following workshops, with all recorded changes occurring in a positive direction.

The service also demonstrated the ability to reach underserved groups through targeted and opportunistic delivery models, including vaccination delivery within sanctuary services, children’s centres and trusted community settings.

Key strengths identified through the evaluation included:

• trusted relationships built through children’s centres and family hubs
• increased opportunities for informal vaccine conversations
• improved accessibility through walk-in and outreach approaches
• positive parent feedback regarding the supportive and non-judgemental environment
• ability to provide tailored support for underserved families.

Qualitative feedback suggested parents particularly valued:

• the opportunity for open discussion
• additional time to ask questions
• flexibility of access
• trusted community locations
• feeling listened to by staff.

The model also strengthened partnership working between:

• local authority public health
• NHS vaccination services
• children’s centres and family hubs
• primary care
• community organisations.

Importantly, the service reinforced the principle that improving vaccination uptake is a shared system responsibility rather than solely the responsibility of primary care.

The work has informed wider local vaccination and inequalities approaches, including strategy refresh work and future targeted interventions.

Lambeth continues to build on this work through its wider childhood immunisation strategy and partnership governance arrangements across the borough and Southeast London system.

Future priorities include:

• further targeting of underserved communities
• strengthening data and health equity analysis
• continued community engagement and co-production
• embedding flexible vaccination delivery models
• strengthening partnership approaches across health, local government and community sectors.

The Public Health team also continues to share learning regionally and nationally to support wider efforts to reduce childhood vaccination inequalities.