Mandatory COVID-19 vaccination for adult social care workers in the UK has been approved and comes into effect in November. The duty to be vaccinated will apply not only to employees, but will extend to all agency workers, volunteers, healthcare workers and tradespeople who might be engaged by a home. Those medically exempt will not be vaccinated and, similarly, any visitors of residents who are exempt will also be excluded from new Department of Health and Social Care (DHSC) rules.
The DHSC (2021) launched a consultation this month aimed at ‘protecting patients by mandating vaccination for frontline health and social care staff in England’, which covers both the COVID-19 and flu vaccines and is open to the public. The consultation proposes that, if introduced, requirements would apply to frontline health and care workers, and would mean that only workers who have been vaccinated, or those with a legitimate medical exemption, could be deployed to deliver those services.
There is an accepted and long-standing precedent for vaccination requirements for NHS staff. Occupational health policies are already in place requiring those undertaking exposure-prone procedures, such as surgeons, to be vaccinated against hepatitis B—and flu vaccination has been recommended for staff and vulnerable groups in the UK since the late 1960s.
I have just completed the survey for the consultation and was keen to find out what happens in other countries. Castelló (2021) reviewed the approaches taken across Europe and noted that France has agreed on similar legislation to the UK with regard to health professionals, with vaccination against COVID-19 likely to be compulsory for people working in the health and social care sectors unless they are medically exempt. It is looking increasingly likely that in France, staff who have not been vaccinated had until 15 September 2021 to do so. From this date, health care and emergency workers who have not been vaccinated will now face suspension without pay (York, 2021).
In the Netherlands, although the subject of mandatory vaccination has been discussed at government level, the conclusion is that nobody can be forced to have it. Likewise, there are no proposals at present to enforce it in Spain since COVID-19 vaccination acceptance is exceptionally high among the population. The German government's position also continues to be that there will be no implementation of such an obligation (Castelló, 2021).
Redeployment concerns
This month, Ford (2021) reported that the Royal College of Nursing had written to a hospital trust expressing concerns about its decision to redeploy nurses who declined the COVID-19 vaccine to non-patient-facing roles. The trust confirmed that a ‘small number’ of staff who refused to have the jab would be moved away from working directly with patients. The RCN's concerns include possible breach of contract, breach of individuals’ right to confidentiality and possible disability discrimination for those who cannot have the vaccine for medical reasons.
One school of thought supported by many colleagues, as well as union representatives such the RCN, is that, even when staff have been double vaccinated, it doesn't stop them catching or transmitting COVID-19, and the view is that appropriate personal protective equipment is the vital action for all members of staff, regardless of vaccination status, and ongoing efforts should focus on the benefits of vaccines and good clinical practice. Other issues that have been raised are that, given the significant workforce constraints the NHS and care sector, there is a feeling of discontent about the proposed requirements and concern that people might be put off working in health or social care, thus increasing the strain on already limited resource.
The outcome of the DHSC consultation needs to be taken as an opportunity to guide us in the NHS, to provide us with a standard approach and stop potential variations and consequently confusion across different organisations. Many colleagues and I are now seeing of resentment among staff who are making different choices.
For example, staff who have chosen to attend large gatherings such as festivals and contracted COVID, subsequently requiring them to self-isolate, have faced negativity from others who have chosen to stay away from large public gatherings. The latter are unhappy with what they see as avoidable staff absences that are putting pressure on already exhausted colleagues.
If the choice is left to individual health professionals, this is a state of affairs that will only continue. It is vital that we have clear guidance to implement a standard approach across the health and social care sectors, supported by the scientific evidence that accepting COVID and flu vaccinations will protect both our staff and our patients.