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This publication is available at https://www.gov.uk/government/consultations/revoking-vaccination-as-a-condition-of-deployment-across-all-health-and-social-care/revoking-vaccination-as-a-condition-of-deployment-across-all-health-and-social-care
Aim of consultation
The aim of this consultation is to seek views on government’s intention to revoke provisions within the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (as inserted by the Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) Regulations 2021 and the Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) (No.2) Regulations 2022) (collectively referred to as ‘the regulations’). These regulations place requirements on health and social care providers relating to the vaccination of workers against coronavirus (COVID-19) and, in the case of care homes, individuals entering the care home premises.
During the course of the pandemic the overriding concern for government, the National Health Service (NHS) and the social care sector has been to protect the workforce, patients, and the people who receive care and support.
Following a public consultation which closed on 26 May 2021, the government laid regulations on 22 June 2021 requiring registered persons of all Care Quality Commission (CQC)-registered care homes to ensure that a person does not enter the premises unless they have been vaccinated, subject to specific exceptions, to protect at-risk residents. These regulations came into force on 11 November 2021.
The government launched a further consultation on making COVID-19 vaccination a condition of deployment in healthcare and the wider CQC-regulated social care sector in September 2021. The government’s response to the consultation was published in November 2021, and regulations were laid to extend the vaccination as a condition of deployment policy to health and wider social care. The regulations required the CQC registered person to only deploy workers to undertake a regulated activity if they were fully vaccinated, subject to specific exemptions. The regulations were subsequently approved by Parliament in December 2021. Some provisions, amending the policy in care homes, came into force on 6 January 2022 and the remaining provisions, which extend the policy to health and wider social care, are set to come into force on 1 April 2022.
The government was not alone in looking carefully at this issue, with other European countries as well as the United States considering or implementing vaccine requirements for specific workers in certain sectors.
In taking these steps the government has always followed the best, and latest, clinical and scientific evidence and the principle of maximising the protection of public health while minimising the intrusion of people’s everyday lives. That is why we are now consulting on revoking the vaccination as a condition of deployment policy.
Latest COVID-19 vaccine uptake
This section sets out information on COVID-19 vaccine uptake by health and social care workers. The variation in the levels of vaccination is important to understand in considering whether intervention by the government is required.
Data collected for the NHS shows that over 1.45 million (95%) NHS trust staff have received at least one dose, with 1.4 million (92%) staff having received 2 doses. The percentage of staff receiving a first dose is above 96% in all regions (2 doses above 90%), bar London, which is at 92% for first dose (87%, 2 doses). Over 1.17 million (77%) have received a booster. All data as of 3 February 2022, covering vaccinations up to 30 January 2022.
More than 1.3 million social care workers in England have now taken up at least one dose of the vaccination.
As of 30 January 2022, 96% of staff in care homes have received a first dose of the vaccine and 95% a second dose.
In wider social care settings, while the regulations have not come into force, providers were reporting that 88% of home (domiciliary) care staff and 76% of staff in other settings had received one dose of the vaccine, as of 30 January 2022. There is little regional variation in care home uptake, however there is some variation in domiciliary care staff uptake, which ranges from 83% in London, to over 90% in the South West.
Uptake since September 2021
Since the government launched the consultation on vaccination as a condition of deployment in health and wider social care settings in September 2021, there has been a net increase of 134,000 people working in NHS trusts who have received a first dose of a COVID-19 vaccine, becoming part of the 19 out of 20 NHS workers who have done so.
During the same time, we have also seen a net increase of 36,000 people working in social care getting vaccinated, including 22,000 people working in care homes and 14,000 people working in domiciliary care.
The government is grateful to the millions of health and care colleagues who have come forward and made the positive choice to become vaccinated – and the health and care leaders who have supported them to do so.
The fantastic efforts of the NHS and all the volunteers that stepped forward to help have played a vital part in raising our wall of protection even higher, keeping all of us safer. As of 1 February 2022, over 84% of England’s population aged 12 and over have received 2 doses of the vaccine, while 64.6% have received their third dose or booster.
As of 30 January 2022, 96% of all care home residents have received 2 doses of the vaccine and 87% have received a booster.
In the general population, 92% of adults aged 80 and over have received 2 doses of the vaccine and 88% have received their third dose or booster.
Of those identified as clinically extremely vulnerable, 94% have received 2 doses of the vaccine and 85% have received their third dose or booster.
Clinical evidence at the time regulations were laid
In the face of the Delta variant, with a population that had immune systems that had never been exposed to this specific virus, the data provided strong evidence to ensure as many of the population were vaccinated as possible, both to reduce the risk to the individual, as well as the risk of transmission to a vulnerable person.
At the time government laid the regulations for both care homes and health and wider social care, Delta was the predominant variant.
For the COVID-19 Delta variant vaccine effectiveness against infection after 2 doses was estimated at around 65% with Oxford-AstraZeneca vaccine and 80% with Pfizer-BioNTech vaccine. Studies reported 65% to 70% effectiveness against symptomatic disease with Oxford-AstraZeneca vaccine, and 80 to 95% with Pfizer-BioNTech (after 2 doses). Effectiveness against hospitalisation of over 90% was observed against the Delta variant with both vaccines (after 2 doses).
Several studies provided evidence that vaccines were effective at preventing infection. Uninfected individuals cannot transmit; therefore, the vaccines were also effective at preventing transmission.
Analysis from Public Health England indicates that the COVID-19 vaccination programme had directly prevented between 23.8 and 24.4 million infections, over 82,100 hospitalisations, and between 102,500 and 109,500 deaths.
The updated clinical evidence
The first cases of Omicron were reported on 27 November, just over 2 weeks after the regulations for wider health and social care were laid. Very shortly after its discovery, Omicron became the dominant variant in the UK and now represents nearly all infections. Omicron is so transmissible that over a third of the UK’s total number of confirmed COVID-19 cases happened in just the last 9 weeks.
Severity of Omicron
While Omicron still presents a threat to public health, especially for those that are unvaccinated, relative to Delta, it is intrinsically less severe. There is emerging evidence that Omicron may have lower virulence due to:
- a preference to replicate in a different part of the respiratory system
- a different cell entry mechanism compared to previous variants
This has resulted in the risk of presentation to emergency care or hospital admission with Omicron being approximately half of that for Delta. When coupled with the high vaccination rate in the population, this has meant the impact of the circulation of Omicron has been less than initially feared.
Effectiveness of primary course of COVID-19 vaccine
Further data collected by the UK Health Security Agency (UKHSA) now shows that a full primary course of an approved vaccine does not provide the intended longer-term public health protection against the spread of COVID-19 on which the vaccination as a condition of deployment policy was originally decided.
Nonetheless, it remains a fact that a primary course is an important foundation to building up the resilience of the immune response. Each exposure to a vaccine teaches the immune system to respond to the virus reducing the risk of severe disease or death.
Coronavirus (COVID-19) booster vaccine effectiveness
Initial data from UKHSA shows that a booster increases protection against symptomatic and asymptomatic Omicron infections to 62% in those without a prior infection rising to 71% in those with prior infection. Protection against Omicron symptomatic infection after the booster, however, does decline, suggesting that protection against infection may also decline quite quickly; 2 to 4 weeks after a booster dose vaccine effectiveness against symptomatic infection ranged from around 65 to 75%, dropping to 55 to 65% at 5 to 9 weeks, 45 to 50% at 10 to 14 weeks, 30 to 40% at 15 and over weeks after the booster.
For those in the general population who have had a booster dose, protection against hospitalisation with Omicron is higher and more durable than protection against infection. Protection against hospitalisation after the booster is above 90% initially dropping to around 75% after 10 to 14 weeks.
UKHSA has marked a subvariant of Omicron called BA.2 as a variant under investigation (VUI), one level below a variant of concern (VOC). While a VUI has mutations which are potentially concerning and UK or international community transmission, a VOC has demonstrated significant characteristics such as increased transmissibility, severity or ability to infect a person. However, an initial analysis of vaccine effectiveness against the BA.2 subvariant reveals a similar level of protection to symptomatic infection compared to BA.1, the original variant of Omicron. At least 25 weeks after 2 doses, vaccine effectiveness against symptomatic infection was reported as 9% and 13% respectively for BA.1 and BA.2, which increased to 63% for BA.1 and 70% for BA.2 at 2 weeks following a third booster dose. Receiving a full course of vaccination, and in particular a booster dose, therefore remains crucial in ensuring the level of protection that individuals can receive against COVID-19. JCVI will continue to review the booster programme and how frequently vaccination may be needed as part of our enduring response. It is possible that in the future this may include annual vaccination programmes for those who need additional protection.
Population exposure to Omicron variant
Omicron’s increased infectiousness meant that at the peak of the recent winter spike, 1 in 15 people had a COVID-19 infection, according to the Office for National Statistics (ONS). Around 24% of England’s population has had at least one positive COVID-19 test. The latest analysis shows that there is an additional incremental benefit from each vaccine exposure, even in those who have had prior infection, showing that if you have had prior infection, you should still get all 3 vaccinations if you want the highest level of protection available.
Current testing regimes and infection prevention and control measures
While the purpose of this consultation is to seek views on revoking the vaccination as a condition of deployment regulations, the regulations are not the only means of preventing infection in health and social care settings. In addition to increasing the uptake of COVID-19 vaccinations across the general population, and in particular in the health and social care workforce, the government has put in place robust measures to support infection prevention and control (IPC) and made available regular testing of staff for COVID-19.
Infection prevention and control
The government has set out that it will consult on updating the Code of Practice for regulated providers to strengthen requirements in relation to COVID-19. This will be a separate consultation and will reflect the latest advice on infection prevention and control.
Strong IPC measures including testing and personal protective equipment (PPE), remain in place for health and care settings. The NHS has a well-established plan for reducing healthcare associated COVID-19 infections. Following the publication of the UKHSA revised UK IPC guidance, the Chief Nursing Officer for England and the National Medical Director circulated revised guidance to the system in November 2021 that affirmed the measures needed to protect staff and patients.
This included several important updates on procedures that all organisations that provide NHS care should implement in order to reduce the spread of coronavirus in healthcare settings. This included the universal use of face masks for staff and face coverings for all patients and visitors in health and care settings and additional transmission-based precautions for COVID-19 and other respiratory infection patients.
The social care sector continues to implement robust IPC measures, across care homes and domiciliary care settings and this will continue as we return to business as usual.
Our guidance for care settings is continuously monitored and updated in response to emerging evidence. We have provided funding to support the implementation of IPC measures, most recently including funding for carbon dioxide monitors and air cleaners to support improved ventilation within care homes through the Omicron Support Fund for Adult Social Care. We have also made available additional support by launching the IPC Champions Network, led by the Chief Nurse for Adult Social Care. This provides a sector led forum to promote IPC best practice.
Moving into the next phase of the pandemic, as we seek to transition to more normal working arrangements for care providers, we will update our guidance with a view to harnessing the learning from the work that providers have done to keep those they care for safe from COVID-19.
Testing across health and social care remains important to help protect the people who are the most vulnerable to COVID-19. The government will continue to ensure testing arrangements across health and social care are in line with the latest evidence to reduce the spread of COVID-19, prevent outbreaks and save lives.
NHS staff have access to regular testing. NHS England issued further staff testing guidance at the start of January 2022 that applies to all non-clinical and clinical staff, contractors or students working in settings with patients.
Extensive testing is available to the entire sector, covering care homes, extra care and supported living settings, day care centres, homecare and all other workers and unpaid carers across adult social care.
By 16 February, all adult social care workers taking part in routine asymptomatic testing will be asked to take a rapid lateral flow test each day before starting work. This will replace asymptomatic polymerase chain reaction (PCR) testing for all staff across adult social care. The introduction of a daily pre-shift rapid lateral flow test for staff will help to rapidly identify and isolate people who are at a high likelihood of spreading the virus, helping to break the chain of transmission, prevent hospitalisations and save lives.
This sits alongside ongoing testing in place for residents, service users and visitors across different services, and alongside outbreak testing in care homes. Full guidance on testing for adult social care is available.
The proposed way forward
Given the changes in clinical evidence it is not only right but responsible to revisit the balance of risks and benefits that guided government’s original decision last year. At that time the government considered the weight of clinical evidence in favour of vaccination as a condition of deployment outweighed the potential risks to workforce capacity.
When vaccination as a condition of deployment was first introduced, Delta was the dominant variant. Omicron has now replaced Delta as the dominant variant, representing up to 99% of cases across some regions. Our population as a whole is now better protected against hospitalisation from COVID-19 thanks to our world leading vaccine programme. This, combined with the reduced vaccine efficacy against infection and the fact that Omicron is intrinsically less severe, meant that it is right and responsible to revisit the vaccination as a condition of deployment policy.
Government has listened to the best clinical and scientific advice and considered how we can achieve public health and safety with the minimum number of restrictions or requirements on people’s lives.
While vaccination remains our very best line of defence against COVID-19, and all people working in health and social care settings have a professional duty to be vaccinated, the view of this government is that it is no longer proportionate to require vaccination as a condition of deployment through statute in health, care homes or other social care settings.
While the government’s intention is to revoke the vaccination as condition of deployment requirements in the regulations, the importance of vaccination remains clear: vaccines save lives, and everyone working in health and social care has a professional duty to be vaccinated against COVID-19. The government is therefore taking the following steps:
The Secretary of State for Health and Social Care has written to the professional regulators operating across health to review current guidance to registrants on vaccinations, including COVID-19, and to emphasise their professional responsibilities in this area.
Engaging with the NHS to review its policies on the hiring of new staff and the deployment of existing staff, taking into account their vaccination status.
Reviewing the Code of Practice on the prevention and control of infections with a view to strengthening the obligations providers must satisfy in meeting the required standard set out in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The Department of Health and Social Care will seek views on this in a separate consultation.
The health and social care workforce has worked heroically to deliver services throughout the pandemic, for people with COVID-19, for people with urgent and emergency care needs, for people with ongoing care needs, and for people waiting for planned care or treatment.
It is also right to acknowledge the incredible efforts of the health and social care sector over the past year to encourage staff to receive their COVID-19 vaccinations. We will continue to work with the NHS and other health and social care partners to support those who remain hesitant to make the positive choice to get vaccinated.
As we have said throughout the pandemic the government will always follow the latest clinical and scientific evidence. Should we see another dramatic change in the virus, we will not hesitate in reviewing the policy again as necessary to safeguard the most vulnerable in society.
It is a statutory requirement that CQC-registered persons only permit those individuals who are vaccinated against COVID-19, unless otherwise exempt:
to be deployed for the provision of a CQC-regulated activity in health and/or social care and;
to enter CQC-registered care home premises
Which of the following best describes your preference for this requirement?
I feel strongly that the requirement should be revoked
I would prefer that the requirement is revoked
I don’t mind either way
I would prefer that the requirement is not revoked
I feel strongly that the requirement should not be revoked
I don’t know
Thinking about yourself, your colleagues, your staff or care providers who are hesitant to get vaccinated, do you believe there are other steps (other than those set out in the original consultation) the government and the health and care sector could take to increase vaccine uptake?
I don’t know
If yes, what specific actions do you believe government and the health and social care sector should be taking to further increase vaccine uptake?
Consideration of potential impacts
The equality impact assessment undertaken as part of previous consultations set out that the effects of the vaccination as a condition of deployment policy could be significant as a result of a greater prevalence of vaccine hesitancy in some groups making up the workforce. This could lead to the redeployment or dismissal of staff who work in health and social care settings who refuse to be vaccinated. It could also result in these workers feeling pressured to have vaccinations when they would not have otherwise.
Vaccination as a condition of deployment may have a beneficial effect on the outcomes of COVID-19 infection in some staff groups where vaccine uptake is lower, as a result of protection against infection that they might not otherwise have had.
In revoking vaccination as a condition of deployment, these impacts and benefits would be greatly reduced. For settings where the regulations have not yet come into force, the government has made a statement advising employers that there should be no further dismissals in relation to the policy.
There may be a positive impact on service users in healthcare settings and the social care sector if vaccination as a condition of deployment were to remain in place. These are predominantly vulnerable individuals who may face a higher risk from COVID-19 infection than the wider population. The policy would mean that more staff would be vaccinated, providing some time limited protection against COVID-19 infection.
Patients in health settings and care recipients in adult social care settings are particularly vulnerable to severe illness and death from COVID-19. Some of those receiving care and support or healthcare services remain at the highest risk of getting seriously ill, in spite of being vaccinated. People who are immunosuppressed, or have specific other conditions, for instance Down syndrome, have a reduced ability to fight infections and other diseases, including COVID-19, and are deemed to be at higher risk. Some of these at higher risk may have protected characteristics.
However, strong infection prevention and control measures, including testing and PPE, remain in place for health and care settings. It also remains a professional responsibility for health and care staff to be vaccinated and we will be strengthening this expectation through the professional regulators and in government guidance. Therefore, on balance and taking account of the latest clinical evidence, we believe we can continue to appropriately support the management of COVID-19 and protect vulnerable people through means other than vaccination as a condition of deployment.
As part of the vaccination as a condition of deployment regulations, impact assessments (IAs) were produced, setting out any expected impacts of the policy.
While it is uncertain how many and when workers may have chosen to leave their jobs rather than have a vaccination, our central estimates in the impact assessment suggested around 88,000 (73,000 workers in NHS, 15,000 in independent health sector) and 35,000 workers in domiciliary care and other care services may remain unvaccinated and not be exempt, with a range of between 62,000 to 115,000 in health in the low and high scenario ranges.
The IA for vaccination as a condition of deployment in healthcare and social care settings other than care homes estimated that the cost of replacing staff as a result of the vaccination requirements would total £270 million; this comprised £153 million in the NHS, £32 million for independent healthcare providers, and £86 million for adult social care providers.
Revoking the regulations would greatly reduce the potential impacts and costs. For settings where the regulations have not yet come into force, the government has made a statement advising employers that there should be no further dismissals in relation to the policy.
Are there particular groups of people, such as those with protected characteristics, who would be particularly negatively affected by a COVID-19 vaccination not being a condition of deployment in healthcare and social care?
If, yes, which particular groups might be negatively impacted and why?
Are there particular groups of people, such as those with protected characteristics, who would particularly benefit from a COVID-19 vaccination not being a condition of deployment in healthcare and social care?
If yes, which particular groups might be positively impacted and why?
What actions can the government and the health and social care sectors take to protect those with protected characteristics, or the groups you’ve identified, if COVID-19 vaccination is not a condition of deployment?