Dear Colleague,
Update on making COVID-19 vaccination a condition of deployment for health and wider social care workers in England
Our health and care workforces have acted heroically to deliver services throughout the pandemic - for people with COVID-19, for people with other urgent and emergency care needs and for those with ongoing care needs.
Throughout the course of this pandemic the first concern of government, the NHS and the care sector has been to protect the vulnerable. Whether in care homes, at home, in hospitals or in general practice, everyone working in health and social care knows that they have a unique responsibility to avoid preventable harm to the people whom they are there to care for, as well as the colleagues they work alongside. As Chief Medical Officer Chris Whitty has rightly said, 'people who are looking after other people who are very vulnerable do have a professional responsibility to get vaccinated’.
Incredible work has already been done to vaccinate 90.9% of our NHS and 77.8% domiciliary care staff, in addition to 94.3% of staff working in older adult care homes.1 However, while it is encouraging that a high proportion of those delivering health and care are now vaccinated, it remains the case that many health and care workers remain unprotected with variation around the country.
People receiving care include the most vulnerable in our society, whether due to their age, underlying health conditions, disability or other needs. At present they cannot be certain that they’re afforded the protection of being cared for by COVID-19 vaccinated health or care workers. A survey from Ipsos MORI earlier this year showed public support (79%) for introducing vaccination requirements to work on the frontline in the NHS or care sector.2
Public health rationale
I have been clear that there’s a strong public health rationale for ensuring that people who provide health and care services only deploy those people that have been vaccinated against COVID-19 in order to protect those who are most at risk.
UKHSA estimates suggest that at least 127,500 deaths and 24,144,000 infections have been prevented as a result of the COVID-19 vaccination programme. Furthermore, around 261,500 hospitalisations have been prevented in those aged 45 years and over (data for England only).
In light of the Omicron variant and the persistent level of COVID-19 in the population, we must act decisively to bolster our defences and protect the vulnerable. The COVID-19 vaccines being deployed in the UK have been assessed by the MHRA as both safe and effective. As such we have a duty - more so now than ever - to ensure they are taken up by our valuable health and social workers to protect all patients and service users.
Evidence shows that the Omicron variant has a growth advantage over Delta and the doubling time for new Omicron infections is currently estimated at around two to three days in England. SAGE has said that infections acquired in hospitals (nosocomial infections) are likely to be an even greater risk as a result of Omicron, particularly as hospitalisations increase, and that measures would be needed to reduce the risk of healthcare workers becoming infected and infecting others, in addition to infection control measures to reduce the risks of transmission between patients. SAGE noted that reducing nosocomial spread will be even more difficult with a more highly transmissible variant. SAGE also set out that a surge in cases could lead to greater staff absences.3
Increasing staff vaccination rates increases protection against infection and severe disease from COVID-19 - helping to reduce sickness absences and nosocomial infections. Vaccination ensures protection (antibody) levels are higher. This means that even if the effectiveness of vaccines against Omicron is reduced, people who are vaccinated will still benefit from a higher level of protection, which will help to reduce the risk of infection and severe illness, compared to those who are not vaccinated.
Current rates of COVID-19 vaccination
he NHS has always been clear that individuals should get the life-saving COVID-19 vaccination to protect themselves, their loved ones and their patients; the overwhelming majority have already done so. As of 5 December, 90.9% of NHS staff in England have had two doses of a COVID-19 vaccine (93.6% one dose), however this varies from 86.1% to 97.5% (one dose) between Trusts (as of 30 November). In domiciliary care, 85% of workers in England have had one dose of a COVID-19 vaccine, and 77% two doses (23 November).
We have also already seen the impact of introducing vaccination requirements in care homes. Throughout the development and implementation of the policy vaccination rates have continued to rise steadily. Contrary to what some feared we are not aware of any care home closures where vaccination as a condition of deployment has been the primary cause.
Regulations
On 9 November, with support from the Chief Executive of the NHS and following an extensive 6-week consultation in which we received over 34,900 responses, I brought forward regulations to make COVID-19 vaccination a condition of deployment for health and wider social care workers.
These important regulations would mean that, for CQC regulated activities (Annex A), providers must only deploy those workers who have been vaccinated against COVID-19 (subject to certain exemptions). This policy applies to all providers, both public and private, and covers a broad range of services including those provided by hospitals, GP and dental practices and regulated domiciliary care services. This would require health and care workers to have two doses of a COVID-19 vaccine.
We have included appropriate exemptions from the requirements. These limited exemptions help to ensure that the requirements do not exclude, or impose a disproportionate burden on certain individuals but also do not undermine the public health benefits of the policy or create a system that can be used by individuals to circumvent the requirement. Individuals that would be exempt are:
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those under the age of 18
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those who are clinically exempt from COVID-19 vaccination
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those who have taken part or are currently taking part in a clinical trial for a COVID-19 vaccine
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those who do not have direct, face to face contact with a service user, for example, those providing care remotely, such as through triage or telephone consultations
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those providing care as part of a shared lives agreement.
Clinicians have been clear that vaccines are safe for the majority of pregnant women, however we recognise that in some circumstances, vaccination may not be appropriate during pregnancy. There are already arrangements in place for demonstrating COVID-19 vaccination status with short-term exemptions available for
those with short-term medical conditions and as an option that some pregnant women may choose to take. For pregnant women the exemption expires 16 weeks post-partum. This will allow them to become fully vaccinated after birth.
Although NHS workforce figures are dynamic (as people join and leave the workforce), since Government consulted on the policy in September, the latest published figures show an overall net increase of staff vaccinated with a first dose of over 55,000.
Impacts of the policy
When the government introduced vaccination requirements in care homes earlier this year there were some concerns about the availability of an Impact Assessment (IA). I am pleased that the Department has published a full Impact Assessment for the regulations I am writing to you about today, which is available on GOV.UK.
While we have worked hard and at pace to finalise an Impact Assessment this has been challenging, taking account of new and emerging evidence and assessing areas where data is not readily available.
I do, however, feel that despite this the IA best sets out the likely impact of this novel policy in the uncertain circumstances we are all living through. That uncertainty - and urgency - has only increased. The Omicron variant has emerged since the IA was written, and with it new advice from SAGE and others, further strengthening the case for this measure. The Regulatory Policy Committee has asked for further information, particularly on the impacts for small businesses. Today, we published further analysis and information on the concerns raised, together with an updated Explanatory Memorandum. My Department will continue to engage with the sector and provide further information to the RPC and Parliament as soon as possible.
Workforce
I recognise the concerns raised about the potential impacts of these measures on workforce pressures and the pressures on services, particularly over winter. I want to reassure you on the action we are taking, in collaboration with the NHS and adult social care sector, to mitigate these risks and continue to encourage workers to take up the COVID-19 vaccine. This includes:
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The 12-week grace period, allowing time for both workforce planning, and for those colleagues who are not yet vaccinated against COVID-19, to make the positive choice to protect the people they care for, as well as themselves.
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Setting an enforcement date of the 1 April 2022 to assist providers over the winter period and help minimise workforce pressures.
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Increasing the number and diversity of opportunities to receive the COVID-19 vaccine. Using the booster campaign to make the most of walk-ins, pop-ups, and other ways to make getting the vaccine as easy as possible.
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The NHS have already written to all providers providing early guidance setting out what Vaccination as a Condition of Deployment means for the system, as
well as advising on next steps to boost uptake and help ensure smooth implementation. Guidance has also been published by NHSEI to assist providers in preparation and planning. Specific guidance for wider social care sectors will be published shortly.
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Increasing engagement with targeted communities where uptake is the lowest, including extensive work with ethnic minority and faith networks to encourage healthcare workers to receive the COVID-19 vaccine.
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The use of 1-2-1 conversations for all unvaccinated NHS staff with their line manager, with clear guidance on how to do this.
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In adult social care, £25 million has been made available to the sector and may be used to cover the wages and travel costs of social care staff who need to attend work or another location to receive a vaccination, as well as associated administrative costs.
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These steps sit alongside the key interventions that we have made to support services such as:
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Bolstering capacity across urgent and emergency care and the wider NHS, including with a £250 million investment in general practice, £55 million for the ambulance service, and £75 million for NHS111;
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publishing an adult social care winter plan, including £388 million to support infection prevention control and £162.5 million for workforce recruitment and retention; and
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investing £478 million for support services, rehabilitation and reablement care following discharge from hospital, and ensuring health and social care services are joined up.
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There are now record numbers of doctors and nurses working in the NHS, as well as record numbers of professionally qualified clinical staff overall. We are committed to recruiting and retaining more talented staff, including an additional 50,000 nurses by the end of this parliament.
Through each part of the policy development, we have taken onboard lessons learnt from the care homes roll-out, this includes:
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Reducing the time employers have to wait in order to deploy a newly vaccinated worker – now a worker can be deployed 21 days after their first dose, rather than having to wait 8 weeks.
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Reducing the complexity of the exemptions process and recognising mixed doses and vaccines received abroad.
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New Zealand as well as parts of Canada, Australia and the US. Many countries around the world are considering similar requirements.
Broader approach to vaccination
We continue to make every effort to encourage people to take up the offer of the vaccine, by emphasising the protections it affords, working with community leaders to assuage concerns, and removing barriers to access. We have developed the NHS COVID Pass to enable people to demonstrate their vaccination status and make international travel easier and safer. The Government does not intend to introduce vaccination as a condition of deployment for any other workforces, nor introduce mandatory vaccination for the general population.
I am clear that we must act now to maximise the protections of vaccines amongst our health and social care workers by passing these regulations next week. Throughout the pandemic we have had to take difficult decisions in order to minimise risk for the most vulnerable people in our society. The vaccines are our best defence against COVID-19 through reducing the likelihood of infection and thus helping to break chains of transmission.
Thank you for your continued support in protecting our health and care services, and saving lives.
International comparators
We are not alone in bringing in requirements for vaccinations in health and care settings. Similar requirements have been introduced in France, Italy, Greece and
