Government proposes mandating Covid-19 vaccination for care home workers

The government has proposed making Covid-19 vaccination mandatory for care home staff working with older people, after scientists warned immunisation levels were below recommended levels in nearly half of such homes.

Ministers today launched a rapid five-week consultation on the proposal, which would apply to 10,000 homes in England, over half the total, two months after Community Care reported that the policy was under ‘serious consideration’. 

The Department of Health and Social Care (DHSC) said the policy was designed to bring vaccination levels up to the thresholds recommended by the Scientific Advisory Group for Emergencies (SAGE) to control infection.

However, it was met with scepticism by care provider bodies and condemnation by UNISON, which warned it risked causing an exodus from the workforce.

Nearly half of homes falling short of SAGE vaccination threshold

The DHSC said SAGE’s social care working group had advised 80% of staff and 90% of residents needed to have had their first dose of the vaccine to provide a minimum level of protection against outbreaks of Covid-19.

This is based on emerging evidence that Covid vaccines prevent people from passing on the virus, as well as protecting them against the disease.

However, it said only 53% of homes with residents over 65 in England were currently meeting this threshold. As a result, homes caring for 150,000 people were not meeting the threshold. 

Currently, the staff vaccination rate is below 80% in 89 local authority areas – more than half – and all 32 London boroughs, and there are 27 local authority areas with a staff vaccination rate below 70%, the DHSC said.

Making jab accessible and advertising campaign not enough

The DHSC said it had sought to make the vaccine accessible to care home staff – with vaccination teams visiting each home four times.

The national booking service for vaccination was also opened up to care home staff for seven weeks, to enable them to book jabs themselves, though this closed on 1 April, since when staff have been able to get vaccinated through their GPs.

This approach has been coupled by an advertising campaign targeted at care home staff.

However, it said: “Despite these efforts, vaccine uptake amongst care home workers is not consistently at the level we know from SAGE advice is needed to minimise the risk of outbreak…It is right that the government acts now to ensure that those deployed in older adult care homes are vaccinated to protect everyone in these settings.”

The proposed policy would amend the key regulations governing care providers, requiring homes with at least one older resident to only deploy staff – including from agencies – who have been vaccinated, excluding those with a legitimate medical exemption.

It would apply to care workers, as well as those in other roles, such as cleaning or kitchen staff. The government is also mulling extending it to professionals visiting care homes but is not proposing that at this stage.

The requirement would be enforced by the Care Quality Commission through warning notices, imposing conditions on registrations and, ultimately, cancelling registration in cases of serious risk to life, health or wellbeing.

Mandatory vaccination ‘something many care homes have called for’

Health and social care secretary Matt Hancock said: “Making vaccines a condition of deployment is something many care homes have called for, to help them provide greater protection for staff and residents in older people’s care homes and so save lives.”

The DHSC said that some providers were already implementing similar policies.

In February, Barchester Healthcare said new staff could not start working with residents until they had been vaccinated (so long as they were medically fit to receive the jab).

In the DHSC press release announcing the consultation today, Barchester’s chief executive, Dr Pete Calveley, said: “We have not lightly introduced our vaccine policy, but we take the view that providing safe care for those we care for is our paramount obligation.

“As the Chief Medical Officer has said, it is a professional duty for care home staff to accept the vaccine unless there is a medical reason they should not.” 

Consultation has ‘significant implications’

However, umbrella provider bodies were more sceptical.

Both National Care Forum chief executive Vic Rayner and Care England equivalent Martin Green questioned why mandation was only  – at this stage – being applied to one group of staff working with older people.

“Should the vaccine be mandatory for adult social care staff working in care homes for older people it begs the question whether it should not be mandatory for the NHS, those working in other care home settings, supported living, hospices, etc as well,” said Green.

Green also said that, with the sector divided on the case for mandatory vaccination, there was a need for a longer consultation, “rather than a curtailed timescale”.

‘A heavy-handed approach that could backfire badly’ 

Meanwhile, the proposal was criticised by UNISON, whose general secretary, Christina McAnea, said it was a “too heavy handed an approach could backfire badly”. 

With 5.7% of roles estimated to be vacant in residential adult care settings in 2020, she added: “Some staff may simply up and go, leaving a poorly paid sector already struggling with thousands and thousands of vacancies in a terrible state, that could damage the quality of care for the elderly and vulnerable, and no-one wants that.”

McAnea instead urged the government to concentrate its efforts on persuading care staff to take the jab by targeting adverts at them, lining up already-jabbed colleagues to offer reassurance, tackling misinformation and giving staff time to make the right decision.

“It’s what’s worked in the NHS and in other countries,” she said. 

McAnea added: “Resources should be ploughed into areas of the UK with low take-up rates to persuade rather than coerce nervous care workers, care employers should give staff time off work to make it as easy as possible for all concerned.”

The Association of Directors of Adult Social Services also raised concerns about the impact of the policy on the workforce.

President James Bullion said: “We welcome the announcement of the consultation on what is a difficult question for the government and all involved, but it is important that whatever is decided does not adversely impact the staffing numbers needed for safe and high-quality care.

“We should also think about this question alongside the urgent need to improve the employment deal for care workers.”

The consultation closes on 21 May.