Mandatory vaccination enforced in care homes amid mounting staff gaps and job loss warnings

Provider body says care home members fear loss of 8% of staff from compulsory vaccination as Homecare Association warns of substantial job losses when policy comes into force in domiciliary care next spring

Old metal sign with the inscription Vacancies
Photo: Zerbor/Adobe Stock

Care home staff in England who are not fully Covid-19 vaccinated will not be able to work in homes from today amid mounting staff shortages and warnings of many more job losses to come from the policy and its extension next year to home care.

The policy, which will also apply to many professional visitors to care homes, came into force as a National Care Forum survey revealed that its care home members feared losing 8% of staff as a result, of whom around half have already left. The government has estimated that 7% of staff may leave the care home sector due to the policy, a loss of 38,000 workers at an approximate recruitment cost to providers of £94m.

At the same time, the Homecare Association warned that domiciliary care faced losing substantial numbers of staff when the same policy comes into force, for Care Quality Commission-regulated providers, next April – as announced this week by the government. A survey of 150 members last month found that 23% anticipated losing a quarter or more of their workforce and 40% between a tenth and a quarter of their staff.

The warnings come amid mounting staff shortages across the sector in England.

Mounting staff shortages

Skills for Care figures show that, among organisations who have submitted data to its adult social care workforce data set this year, there has been a 3.1% drop in the number of filled posts, from April to October, with steeper declines among care workers (3.6%), for services for older people (3.5%) and in care homes (3.7%).

At the same time, vacancies have risen, from 6.2% in March this year to 9.1% in October, with rates increasing particularly among care workers (up by four percentage points) and registered nurses (up by 6.3 percentage points). In domiciliary care, vacancies reached 12.2% in October, up from 9% in April.

In its State of Care report last month, the CQC said the phenomenon of rising vacancies and falling numbers of filled jobs showed employers were finding it increasingly difficult to find the right people to fill roles.

Causal factors

And earlier last month, Skills for Care, in its annual report on the state of the workforce, pointed to factors behind the current staffing situation, including:

  • The lack of pay progression, with care workers with more than five years’ experience being paid just 6p more an hour than those with less than a year in the role in 2020-21.
  • A doubling in sickness absence rates during 2020-21, reflecting the impact of Covid-19.
  • A fall in the number of overseas staff starting to work in the sector from 2019-21, on the back of the end of free movement of people from Europe.
  • The impact of mandatory vaccination on the care home sector.

The NCF’s survey, responded to by care home providers employing 14,000 staff, found that 3.5% of workers had left already as a result of the mandatory vaccination policy and a further 4.4% might yet leave.

Chief executive Vic Rayner said the research had found that the policy had also “absorbed a huge amount of time and energy of staff, which could have been better devoted to recruitment and the well-being of existing staff”.

Ninety one per cent of providers said they had required additional HR and management time, 93% had run one-to-one sessions for staff, 58% had run disciplinary hearings and 53% had paid for specialist legal advice.

Respondents also said the policy had been rushed and disorganised, with the approach to exemptions from full vaccination particularly criticised.

Rayner said there had been an “unnecessary high cost” from the policy, including in terms of the “loss in trust and goodwill amongst care staff and their employers”.

‘Unwitting guinea pigs’

“Care homes have been the unwitting guinea pigs through the implementation of this policy, and the impact on people must not be swept under the carpet,” she added. “It is vital that the government learns from this experience and makes changes for the wider roll out of this policy.”

Giving its response, UNISON general secretary Christina McAnea said: “The staffing crisis will become a catastrophe for a sector already on its knees. Some homes may have to close if care staff are barred from their jobs. The upheaval and distress caused to many elderly residents and their families would be disastrous.

“Forcing the vaccine on care staff is an own goal by the government. Take-up rates will only increase with persuasion, not punishment.”

The proportion of care home staff reported to have had their second vaccine in older adult care homes was 89.1% as of 26 October, up from 72.8% as of 22 June, just after the policy was confirmed. For staff in younger adult care homes, reported double vaccination rates rose from 70.1% to 85.9% over the same period.

A Department of Health and Social Care spokesperson said: “Our message is clear: vaccines save lives and while staff and residents in care homes have been prioritised and the majority are now vaccinated, it is our responsibility to do everything we can to protect vulnerable people.

“We are working closely with local authorities and care home providers to ensure there will always be enough staff with the right skills to deliver high quality care.”

Mandatory vaccination: how will it work?

Under the Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) Regulations 2021,the registered person for the care home must ensure that no one who has not been fully vaccinated against coronavirus with an approved vaccine enters the home, unless:

  • They should not be vaccinated for medical reasons.
  • They are a resident or one of their relatives or friends.
  • It is reasonably necessary for them to provide emergency assistance or carry out urgent maintenance on the premises.
  • They are a member of the emergency services and attending in the execution of their duties.
  • They are a child.
  • They are visiting a resident who is dying or it is reasonably necessary for them to attend to support a resident in relation to bereavement.

The DHSC has published guidance on the implementation of the policy. This states that it is up to the registered person to determine how to check vaccination status.

The CQC will enforce the policy from today. In a statement in August, it said it would seek assurance at registration that providers were monitoring the vaccination status of staff and relevant visitors, and monitor compliance through information returns, inspections and other intelligence.

Majority opposition

The government this week confirmed that staff with direct, face-to-face contact with people receiving services in other CQC-regulated social care services will have to be fully vaccinated against Covid-19 by 1 April next year.

This was despite 65% of almost 35,000 respondents to the consultation, and 58% of just over 15,000 health and social care workers, opposing compulsory Covid-19 vaccination for social care staff outside of care homes.

However, in its response to the consultation, the DHSC said it saw “a clear public health rationale to protect those receiving health and social care, who may be most at risk from Covid-19 and its complications, by driving vaccination uptake in those deployed to deliver CQC-regulated activity”.

Along with similar exemptions to care homes, the DHSC said that Shared Lives carers would not face mandatory vaccination, while personal assistants would also not be covered as they are not CQC regulated.

In domiciliary care, the reported double vaccination rate as of 26 October was 74.3%. The Homecare Association, drawing on its survey, said it was disappointed by the decision to proceed with compulsion because of the potential loss of staff.

Persuasion ‘more effective than compulsion’

“From the outset…we have argued that persuasion is likely to be more effective than compulsion in encouraging uptake among the remaining workers with genuine fears about vaccination, without losing vital workforce capacity,” it said.

“Unmet need is already high, and rising, at the same time that recruitment and retention of the homecare workforce has never been more difficult.”

It also criticised the exclusion of care staff in unregulated services, such as personal assistants, from the policy.

“If the government’s motivation is to ensure safety of older and disabled people, it is hard to understand why ministers would choose to exempt unregulated care, which is not subject to oversight, requirements for careworker training or other checks and balances,” the association said.

However, it welcomed the delay in enforcement until 1 April, 2020, saying it would buy time for the sector to persuade the remaining quarter of the workforce to be fully vaccinated.

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