In England, COVID-19 vaccinations are to become compulsory for staff in care homes the Secretary of State for Health has announced. This proposal could be extended to other sectors of health and social care. Opinion is split in the profession and among the public over mandatory vaccinations.
The Department of Health Social Care hosted a 5-week long consultation regarding proposals to make COVID-19 vaccination a condition of work. The proposal is to amend regulations so that older adult care home providers are required to deploy only those staff who have received their COVID-19 vaccination in accordance with government guidance. This requirement will not include those staff who are able to provide evidence of a medical exemption from COVID-19 vaccination. It is also the government's intention to amend the Code of Practice (Department of Health [DH], 2015) on the prevention and control of infections to provide an explanation of the requirement.
To make these changes – it is the government's intention to change the law quickly – and to make vaccination compulsory for those who work in older adult care homes, amendment to the Health and Social Care Act (2008) (Regulated Activities) Regulations 2014 would be required. The government is proposing to insert the requirement as a new provision in the fundamental standards in the part dealing with safe care and treatment. This will require that, as part of providing safe care and treatment, providers have to assess the risk of, and prevent, detect and control the spread of, infections: these include those that are healthcare-associated. Changes will also be required to amend the Code of Practice (DH, 2015) and the accompanying guidance and, in particular, Criterion 10 where providers must have a system in place to manage the occupational health needs and duties of staff with regards to infection. The proposed amendment to the Code of Practice reads, ‘All eligible staff in care homes with one or more residents aged 65 and over have had their COVID-19 vaccinations’.
It cannot be disputed that every effort needs to be made to ensure very high levels of vaccination of people living and working in health and care settings; vaccination is an essential public health intervention. To increase vaccine take up in health and care settings by considering amending the law, however, may not be the best way to do this.
There are a number of ethical and practical issues that arise when there is a compulsory requirement (or suggestion of a compulsory requirement) for all staff to be vaccinated against COVID-19. These controversial proposals will cause much discontent. Legal challenges will be made and this could backfire if those working in the sector decide to leave rather than be immunised. Under the proposed plans, those working with adults will have 16 weeks in which to be vaccinated, or they could face losing their jobs.
It has been mooted that the government is also eager to make it mandatory for the one million plus people directly employed by the NHS in England to be vaccinated against COVID-19, as well as winter flu. It would be inconsistent to demand vaccination for care home workers but not for NHS staff, given that district nurses, GPs, physiotherapists and others will often go into care homes to care for residents. The government believes the arguments in favour of protecting patients from potentially infectious staff outweigh those that permit health and care workers the right to choose to have either vaccination or not.
The Royal College of Nursing (RCN) position statement makes clear that it is essential that staff are given the chance to fully understand and have autonomy over what goes into their bodies (RCN, 2021): they have serious concerns about such a policy. They feel that it is counterintuitive to introduce a policy that has the potential to impact recruitment and retention in a sector where there is already a chronic shortage of staff. The RCN is objecting to staff being made or coerced into having the vaccine.
The consequences of these proposals need to be given much consideration prior to imposing them or making amendments to the law and terms and conditions. The scenario could be that Trusts may have to suspend or even fire members of staff who continue to refuse to be vaccinated against COVID-19, putting staff at odds with a policy that requires them to be vaccinated.