Let's assume that the denominator is the Registrar General's Mid-year estimate, which for the City of Westminster for under 5s is 11,700 for 2004. (source: NOMIS). Intriguingly the number of Child Benefit claims for the same area is 9,950 (source:HMRC). Therefore we either have an extremely large underclaim of 15% for Child Benefit or either estimate is a bit out. 

The NHS migrations estimates on NOMIS, which clearly only relate to children registered with a GP, show a substantial net outflow from the Westminster, kensington & chelsea area, predominantly within the first three years of life. - for the PCT area, a net outflow of 943 in 2004 as a whole for under 5s. Unregistered (with GP) children are unavailable under these measures.

The lack of second vaccinations in Westminster may partly be due to these population shifts (and unrecorded ones) and amongst other things to the difficulty of GPs contacting mothers within the area - apart from Census, it is notoriously one of the most difficult areas to conduct surveys in.


---------------------------------------------------------
Paul Bivand
Head of Analysis and Statistics
Direct Line: 020 7840 8335

Inclusion
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> -----Original Message-----
> From: John Whittington [mailto:[log in to unmask]]
> Sent: 07 February 2006 10:43
> To: [log in to unmask]
> Subject: Re: Chartered Society of Physiotherapy: MMR uptake 
> far lower in
> Westminster and Kensington and Chelsea than anywhere else in
> England[Scanned]
> 
> 
> At 00:04 07/02/06 +0000, Paul Bivand wrote:
> 
> >Westminster is in some parts a borough with high deprivation - just 
> >because it has some rich bits does not exclude deprivation in others.
> 
> True, but that can't really explain the more detailed 
> information of which 
> we are now aware - namely that the uptake of first MMR injections in 
> Westminster appears to be around the average for London, 
> whereas (if one 
> takes the figures at face value) the uptake of second MMR injections 
> appears to be only about one-sixth of that figure.  This 
> makes so little 
> sense (to me) that I'm more inclined to think that the the 
> figures are 
> misleading, rather than that over 80% of children in 
> Westminster who had a 
> first dose of MMR did not get the second dose.
> 
> >What it does have is a high proportion of recent migrants 
> and (related) high
> >amounts of population churn. Therefore I would expect 
> relatively low levels
> >of GP registration and hence low vaccination rates. 
> Kensington and Chelsea
> >has many of the same factors. The relevant statistical 
> question is what is
> >the denominator for these rates.
> 
> The notes in the annula request for COVER data (provided by 
> PCTs) indicate 
> that the data should relate to all children registered with an NHS GP 
> within that PCT AND all those children NOT registered with an 
> NHS GP, but 
> resident within the geographical area for which the PCT is 
> responsible.  The denominator therefore 'should' be all the 
> children within 
> an area - but how on earth a PCT is meant to gather statistics on 
> immunisation uptake on those children without an NHS GP is 
> not at all clear.
> 
> >The degree of population churn raises questions about follow-up 
> >vaccinations -
> >how is this recorded when people change GP? The note about 
> Source:COVER does
> >not say where the denominator comes from.
> 
> As above, it seems that the intended denominator is defined, 
> even though 
> it's difficult to see how a PCT can have all the necessary 
> information.  It 
> certainly is not clear to me what happens when people change GP/area.
> 
> However, whilst population migration is obviously a potential 
> factor, I 
> would think that it would have to be an extremely strange 
> (age-related) 
> pattern of migration to produce the results that are being 
> reported.  One 
> would be more inclined to suspect that inward and outward 
> migration of 
> children aged 3-5 years would roughly balance, so that the 
> 'uptake' of 
> second doses of MMR should not be appreciably affected.
> 
> As I said at the start, I'm far more inclined to believe that 
> there is a 
> problem of data collection/presentation than that 80%+ of Westminster 
> children who have a first doses of MMR don't get a second dose!
> 
> Kind Regards,
> 
> 
> John
> 
> ----------------------------------------------------------------
> Dr John Whittington,       Voice:    +44 (0) 1296 730225
> Mediscience Services       Fax:      +44 (0) 1296 738893
> Twyford Manor, Twyford,    E-mail:   [log in to unmask]
> Buckingham  MK18 4EL, UK             [log in to unmask]
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