On 9th November the Department of Health and Social Care made a statement mandating health and social care workers, including volunteers who have face-to-face contact with service users, will need to provide evidence they have been fully vaccinated against COVID-19. These measures were aimed to ensure patients and staff are protected against infection.
The deadline for care home workers to be double jabbed was Thursday 11 November. Health and social care providers in England were required to ensure workers are fully vaccinated against COVID-19, unless they are exempt, under the plans announced by the Health and Social Care Secretary.
Why the decision to legislate?
The rationale behind ensuring the maximum number of NHS staff are vaccinated will help ensure the most vulnerable patients gain the greatest possible levels of protection against infection. The measures will also protect workers, which is important for hospital trusts where extensive unexpected absences can put added pressure on already hardworking clinicians providing patient care. Findings from the REACT study have shown fully vaccinated people were estimated to have around 50% to 60% reduced risk of infection, including asymptomatic infection, compared to unvaccinated people.
Who else does it apply to?
The regulations will apply to health and social care workers who have direct, face-to-face contact with people while providing care – such as doctors, nurses, dentists, and domiciliary care workers, unless they are exempt. They will also apply to ancillary staff such as porters or receptionists who may have social contact with patients but are not directly involved in their care. This will apply across the Care Quality Commission (CQC) regulated health and social care sector.
The majority of NHS workers are already vaccinated, as over 92.8% have had their first dose and 89.9% have had both doses of a COVID-19 vaccine. In social care, 83.7% of domiciliary care workers have had their first dose and 74.6% have had both doses.
Latest published data shows, however, that over 103,000 NHS trust workers and 105,000 domiciliary care workers have not been reported as fully vaccinated and the government is urging them to take up the offer now, to keep themselves and those they care for safe.
The requirements will come into force in the spring, subject to the passage of the regulations through Parliament. There will be a 12-week grace period between the regulations being made and coming into force to allow those who have not yet been vaccinated to have both doses. Enforcement would begin from 1 April, subject to Parliamentary approval.
This will allow time for health and social care providers to prepare and encourage workers uptake before the measures are introduced.
Govt and NHS Response
Health and Social Care Secretary Sajid Javid said:
“Vaccines save lives and patient safety is paramount. Many of the people being treated in hospitals or cared for at home are the most vulnerable to COVID-19. We have a responsibility to give patients and staff the best possible protection. We have consulted closely with the sector and will introduce new regulations to ensure people working in healthcare are vaccinated from next spring.”
Amanda Pritchard, NHS Chief Executive, said:
“The NHS has always been clear that staff should get the life-saving COVID vaccination to protect themselves, their loved ones and their patients and the overwhelming majority have already done so. Working with NHS organisations, we will continue to support staff who have not yet received the vaccination to take up the evergreen offer.”
Chief Nurse for Adult Social Care, Deborah Sturdy, said:
“We know that vaccines save lives which is why earlier this year we set out our plans to make vaccines a condition of deployment in care homes to protect those who are more vulnerable to this virus. I encourage anyone working in social care who has not yet had their vaccine to come forward as soon as possible to protect yourselves, your colleagues and those you care for.”
Sajid Javid announced to the commons on Monday 31st January that a U-Turn would be taking place on the NHS vaccine mandate. He told MPs: “While vaccination remains our very best line of defence, I believe it is no longer proportionate to require vaccination as a condition of deployment by statute. I will launch a consultation on ending vaccination as a condition of deployment in health and all social care settings. Subject to the response and the will of this house, the government will revoke these regulations.”
In the aftermath NHS England informed health service leaders that this change in government policy means employers do not serve notice of termination to employees affected by the vaccination as a condition of deployment. NHS organisations were reporting that approximately 60,000 staff would have been dismissed, after the 3 February deadline, if the govt hadn’t performed a U-Turn.
Sir David Nicholson, the chief executive of the NHS in England until 2014, summed up the frustration of many health service bosses about the 11th-hour reversal when he said: “It’s hard to imagine a greater shambles.”
Royal College of Nursing called the policy “self-sabotage”.
With almost 90% of NHS staff already double jabbed, the fact that the Omicron variant of coronavirus is much milder than its predecessor, Delta, and that a large majority of the population have been fully vaccinated translated into a lack of political capital to force the legislation though. Though the philosophical implications of using the coercive force of the state to mandate a citizen to be vaccinated (at risk of losing their livelihood) have not featured much in the political discourse it goes without saying that there was an ethical malaise around the mandate. Practical and logistical arguments formed most of the opposition against these steps such as endangering patient safety by triggering the loss of key personnel from the already understaffed health service. There have been weeks of warnings from staff groups that made clear pressing ahead with the policy would lead to even worse staff shortages. It was particularly critical to maternity services, and especially in hospitals in London and Birmingham, which have significant numbers of unvaccinated staff. However, the NHS Confederation warned that the decision to allow health and social care workers to continue working even if they remain unvaccinated could affect the drive to promote wider vaccine take-up.
It is disappointing that the government’s indecisiveness and eventual U-turn has meant that many doctors, social care workers, nurses, midwives, and allied health professionals have already left the NHS and sought new employment elsewhere in the private sector etc. This at a time when even more NHS staff are required as demonstrable in the govt’s delivery plan for tackling the COVID-19 backlog of elective care. Furthermore, it is concerning that those who contributed to the fight against COVID-19 have, because of their vaccination status, had to face such job insecurity. So though V4CE is pleased to see the government reverse their decision, it is discouraged by the unnecessary limbo that NHS staff were made to endure.