Social value case study: Immunisations for people facing barriers
The Off the Grid Project is a community‑led immunisation programme delivered by Hertfordshire Community NHS Trust, designed to reach people who face barriers to accessing traditional healthcare services. Using flexible, outreach-based models, the team brings vaccinations directly into trusted community settings. The project focuses on reducing health inequalities while supporting prevention, early intervention, and system efficiency across Hertfordshire.
The challenge
In Hertfordshire and surrounding areas, vulnerable populations, including those experiencing homelessness, isolation, trauma, or displacement are face long-standing barriers to immunisation. This includes people who:
- are not registered with a GP
- experiencing unstable or temporary housing
- limited mobility or transport access
- language barriers and low health literacy
- distrust traditional healthcare systems
The Off the Grid team was established to proactively bring vaccinations to these individuals, using a community-based outreach model that removes logistical and psychological barriers to care.
Project description
Now entering its third year, the Off the Grid project is led by a Senior Immunisation Nurse and a team of qualified nursing and administrative staff. The programme is delivered in partnership with:
- Primary Care Networks (PCNs) and local GP surgeries
- Public Health Hertfordshire
- Looked After Children Nursing Teams
- Care home managers, university teams, and humanitarian public health services
- Mental health services, asylum support providers, and voluntary sector partners
- Vaccination sessions are provided within the community, including:
- Care homes
- Homeless shelters
- Mental health secure units
- Pop-up clinics
- Asylum seeker accommodation
- Services for separated migrant children
- Housebound patient visits
The team supports seasonal campaigns such as Autumn COVID and Flu vaccinations, offering person-centred, compassionate, evidence-based care in familiar settings.
Impact and outcomes
The Off the Grid project makes a significant contribution to reducing health inequalities by delivering immunisation services directly to individuals and communities who face persistent barriers to accessing traditional healthcare. It has delivered 4,631 vaccinations to underserved individuals in non-clinical, familiar settings, the programme has successfully reached people who are least likely to engage with mainstream services, strengthening equity of access for groups that are often excluded from seasonal immunisation programmes.
The project also plays a key role in prevention and early intervention. By improving protection against COVID-19 and influenza among high‑risk populations, Off the Grid supports better health outcomes while creating opportunities for brief, meaningful health conversations. These interactions frequently enable the identification of unmet health or social care needs, with appropriate onward signposting to other services, supporting more holistic care.
From a system perspective, the programme contributes to sustainability and efficiency across local health services. Proactive, community‑based delivery helps reduce pressure on urgent and primary care, while minimising non‑attendance by bringing care to settings where individuals are already accessing support. The project has also established strong, collaborative relationships with community service managers, supporting integrated working and longer‑term service resilience.
| Group | Number of vaccinations adminstered |
| Adults - asylum hotels | 778 |
|
Separated migrant children |
384 |
| Looked after children | 27 |
| Schools — measles outbreak | 14 |
| Mental health secure units | 327 |
| Care homes (elderly) | 765 |
| Housebound patients (65+) | 884 |
| Househound patients (under 65) | 232 |
| Homeless adults | 156 |
| Pop-up clinics — adults (including universities) | 76 |
| Total vaccinations administered | 4,631 |
Lessons learned
The Off the Grid project has demonstrated the value of sustained relationship‑building and visibility within local communities. Over time, increased awareness of the service has led to stronger engagement from partner organisations and frontline services. Trust developed with service managers and staff has been central to effective delivery, enabling coordinated planning and smooth integration of vaccination activity within existing community settings.
A flexible and responsive delivery model has been a key strength of the programme. The use of pop‑up clinics, mobile provision via the vaccination bus, and in‑reach clinics has allowed the team to adapt to differing local needs and remove practical barriers to access. This adaptability has significantly improved reach among individuals who would otherwise be unlikely to attend conventional healthcare appointments.
Alongside these successes, the project has identified important areas for development. While awareness has grown, experience has shown that early, consistent, and well‑targeted promotion is essential to maximise attendance. Clearer advance communication and greater alignment with partner organisations’ messaging have been highlighted as opportunities to further improve engagement.
Overall, the learning from Off the Grid reinforces that consistency, visibility, and collaboration are critical to building long‑term trust and sustaining participation among underserved populations. These insights continue to shape the programme’s approach and inform future delivery.
Next steps
- Strengthen advance planning with partners
- Develop improved promotional materials and digital outreach
- Continue targeting underrepresented groups, including women’s refuges and young adults in supported housing
- Evaluate vaccination outcomes and health literacy impact using follow-up surveys and community feedback
