Mandatory vaccination for NHS staff

From 1 April 2022, vaccinations against COVID-19 will be mandatory for patient-facing health and care staff in England. Dr Heidi Mounsey, Medicolegal Consultant at Medical Protection, takes a closer look at what these changes mean

The UK government hosted a public consultation between 9 September 2021 and 22 October 2021 on whether COVID-19 and flu vaccination should be made a condition of deployment within health and wider social settings.

Overall, the response to the proposal that those deployed to undertake direct treatment or personal care as part of a CQC regulated activity in a healthcare or social care setting (including in someone’s home) must have a COVID-19 vaccination was unsupportive, with 65% of respondents being not supportive or slightly unsupportive, and 29% stating they were supportive or slightly supportive. Managers of healthcare or social care services were the most likely to support the policy, and members of the public were the least likely to be supportive. Within the health and care workforce, 58% of respondents were unsupportive or slightly unsupportive of the proposal, and 35% were supportive or slightly supportive.

However, following the consultation, Sajid Javid, the Secretary of State for Health and Social Care, announced that from 1 April 2022 it will be mandatory for patient-facing health and care staff in England to have received a full course of COVID-19 vaccination. The proposal to make flu vaccination compulsory has been dropped but this will be kept under review. The measures are intended to protect patients and staff within the health service.

Compulsory vaccines: what are the new requirements?

The COVID-19 vaccination will be compulsory for any individual deployed to deliver Care Quality Commission (CQC) regulated activities who has direct, face-to-face contact with patients or service users. This also includes non-clinical staff such as receptionists and porters.

The requirement will apply to both privately and publicly funded CQC-regulated activities, and the CQC would be expected to monitor and take enforcement action in appropriate cases.

The CQC-registered person, either the registered manager or the service provider, will need to ensure that employees are only deployed once they have provided evidence that they have received their COVID-19 vaccination. Alternately, the CQC-registered person must be satisfied that staff have provided evidence of exemption from vaccination. Medical exemptions include severe allergies to all currently available vaccines, or an adverse reaction (such as myocarditis) to the first dose of a vaccine. Those individuals under 18 or who have taken part in a clinical trial for a COVID-19 vaccine will also be exempt.

It has been stated that it will not be possible to be exempt from the vaccine based on religious grounds.

Vaccination will not be required for individuals who do not have face-to-face contact with service users or who are providing care as part of a Shared Lives agreement.

Once legislation is in force, although employers should make every effort to persuade staff to be vaccinated and consider redeployment away from patient-facing roles, it may be necessary to dismiss staff who refuse to be vaccinated but do not have an exemption.

What can employers do to prepare?

In the impact statement published alongside the consultation, it is predicted that 73,000 NHS workers and 53,000 staff working in the independent and social care sectors will not be fully vaccinated (or hold evidence of exemption) by 1 April 2022. It is noted that the loss of NHS staff will add further pressure on NHS services.

Employers are recommended to prepare themselves for implementation of the new legislation by ensuring staff are aware of the need to be vaccinated and establishing who is medically exempt and who does not intend to be vaccinated. For those members of staff who are not exempt but who do not intend to be vaccinated, it is recommended that their reasons for declining vaccination are explored. It would be useful to consider whether deployment is feasible, but if not their notice periods should be taken into account as dismissal may need to be considered.

If a number of staff are likely to be unvaccinated by 1 April 2022 then staffing levels may be affected and a plan should be developed to mitigate the risks of understaffing.

It is worth noting that the GMC’s guidance Coronavirus: Your frequently asked questions states:

“In Good Medical Practice we say that doctors should be immunised against common serious communicable diseases, unless this is contraindicated.

“We recognise that you may need to take account of any underlying health conditions. In some cases, there may be other appropriate options for managing any risk to patients and colleagues. 

“If you have good reason not to be vaccinated, you need to be confident that there are measures in place where you work to manage any risk of transmission to patients. You will need to take appropriate steps to reduce risks and prioritise patient safety.”

For members of staff who have direct, face-to-face contact with patients and service users but who do not intend to get vaccinated, it may be prudent for those staff members to enter into discussion with employers about the reasons for declining vaccination and whether redeployment may be feasible from 1 April 2022. 

The government’s response to the consultation can be found here.