Guidance

Guidance on shielding and protecting people who are clinically extremely vulnerable from COVID-19

Updated 7 July 2020

People who are identified as clinically extremely vulnerable may be at high risk of serious illness if they catch coronavirus (COVID-19). They have been advised to take additional action to prevent themselves from coming into contact with COVID-19 when transmission of coronavirus in the community is high.

If you’re clinically extremely vulnerable, you’re strongly advised to stay at home as much as possible and keep interactions outside to a minimum. This is called ‘shielding’, and the government is currently advising people to shield until 31 July and is regularly monitoring this position.

This guidance is government advice. It’s not the law. This guidance will be kept under regular review.

This advice is of a general nature and should be treated as a guide. This does not replace any local public health measures put in place to protect the local population. If there is an outbreak of COVID-19 within your area, please follow any guidance set out locally or any specific law which applies to the area you live in.

What changed on 6 July

The government has made some changes to its guidance for people who are shielding because the transmission of COVID-19 in the community has gone down. The changes from 6 July are:

• you no longer need to socially distance from people you live with
• if you want to, you can meet in a group of up to 6 people outdoors, including people from other households
• you may also form a ‘support bubble’ with one other household if you want to, but one of the households in the ‘support bubble’ should be a single adult household (either an adult living alone or with children under 18 only). You can all spend time together outside and inside each other’s homes, including overnight, without needing to socially distance
• the government support offer has been extended: you can still get a food box, care and/or medicine delivery until 31 July if you want them, and have registered online by 17 July. If you have been recently advised to shield there is more information on the page below outlining on the support available to you below
• the latest evidence indicates that the risk of serious illness for most children and young people is low. All children and young people should continue to shield until 31 July. A clinical discussion with your paediatric specialist or GP will be needed before any child or young person is removed from the shielded patient list. Health services will be in touch with children and their families over the summer, ahead of the new school term, to discuss what the new evidence means for them personally in the longer term. Families, carers and young people do not need to make immediate contact

What will change from 1 August

From 1 August, the government will pause shielding unless the transmission of COVID-19 in the community starts to rise significantly.

This means:

• the government will no longer be advising you to shield
• the support from the National Shielding Service of free food parcels, medicine deliveries and care will stop
• NHS Volunteer Responders will carry on delivering the food you buy, prescriptions and essential items to you if you need it
• you will still be eligible for priority supermarket slots (if you have registered by 17 July)

You may still be at risk of severe illness if you catch coronavirus, so stay at home as much as you can and continue to take precautions when you do go out. You can do this by washing your hands regularly, avoiding touching your face and keeping 2 metres away from people outside of your household or bubble wherever possible and in any case at least 1 metre with protective measures in place.

From 1 August, you’ll be advised you could go out to more places and see more people, for example, the advice is:

• you can go to work, as long as the workplace is COVID-secure – but carry on working from home if you can
• children who are clinically extremely vulnerable can go back to school (when the rest of their class goes back)
• you can go outside to buy food, to places of worship and for exercise – keeping 2 metres away wherever possible and in any case at least one metre with protective measures in place

This guidance will be updated with these changes on 1 August.

Who this guidance is for

This guidance is for adults, and children and young people aged 0 to 18 who are clinically extremely vulnerable.

If you are clinically extremely vulnerable you should have received a letter advising you to shield, or have been told by your GP or hospital clinician directly to shield.

This includes clinically extremely vulnerable people living in long-term care facilities for the elderly or people with special needs.

Definition of ‘clinically extremely vulnerable’

Expert doctors in England have identified specific medical conditions that, based on what we know about the virus so far, place some people at greatest risk of severe illness from COVID-19. Disease severity, medical history or treatment levels will also affect who is in this group.

Clinically extremely vulnerable people may include:

• solid organ transplant recipients
• people with specific cancers:
  • people with cancer who are undergoing active chemotherapy
  • people with lung cancer who are undergoing radical radiotherapy
  • people with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage of treatment
  • people having immunotherapy or other continuing antibody treatments for cancer
  • people having other targeted cancer treatments which can affect the immune system, such as protein kinase inhibitors or PARP inhibitors
  • people who have had bone marrow or stem cell transplants in the last 6 months, or who are still taking immunosuppression drugs
• people with severe respiratory conditions including all cystic fibrosis, severe asthma and severe chronic obstructive pulmonary disease (COPD)
• people with rare diseases that significantly increase the risk of infections (such as severe combined immunodeficiency (SCID), homozygous sickle cell)
• people on immunosuppression therapies sufficient to significantly increase risk of infection
• women who are pregnant with significant heart disease, congenital or acquired
• other people who have also been classed as clinically extremely vulnerable, based on clinical judgement and an assessment of their needs. GPs and hospital clinicians have been provided with guidance to support these decisions

For more information about who has been classed as clinically extremely vulnerable, please visit the NHS Digital website.

If you’re still concerned, you should discuss your concerns with your GP or hospital clinician.

Clinically vulnerable groups

If you’re 70 or older, pregnant or usually need a flu jab for underlying medical conditions you might be in the ‘clinically vulnerable’ category. If so, follow the staying alert and safe (social distancing) guidance.

Clinically extremely vulnerable children and young people (0 to 18)

Specialists in paediatric medicine have reviewed the evidence on the level of risk posed to children and young people from COVID-19. The latest evidence indicates that the risk of serious illness for most children and young people is low.

Children and young people who are cared for just by their GP are very unlikely to need to continue to shield in the future. This includes children with conditions including asthma, diabetes, epilepsy and kidney disease. A small group of children who receive specialist care in hospitals may still be considered clinically extremely vulnerable following a consultation with their doctor. This includes those receiving cancer care or those at risk of severe infection due to an immunodeficiency.

All children and young people currently identified as Clinically Extremely Vulnerable, and advised to shield, should continue to do so until 31 July, when the government will pause shielding for everyone.

All decisions on whether children and young people should be removed from the shielded patient list (and therefore will not be advised to shield again in future if transmission starts to increase significantly) should be based on a consultation with your paediatric specialist or your GP who will be best placed to determine the most appropriate care. Your paediatric specialist or your GP will be in touch over the summer to have these discussions.

Returning to school

If your child is shielding, it is advised that they do not return to school or nursery before 31 July.

If you are a parent or carer who is shielding it is advised that your child only attends education or childcare settings if social distancing can be adhered to. If this is not possible, your child should be supported to learn or work at home until 31 July.

See guidance on supporting children and young people’s mental health and wellbeing.

Check this is the right guidance for you

You are not clinically extremely vulnerable if:

• you do not have any of the conditions listed above
• you have not been told by your GP or specialist that you are clinically extremely vulnerable or received a letter saying you are clinically extremely vulnerable

If you are not clinically extremely vulnerable you should follow the guidance on staying alert and safe (social distancing).

Spending time with family and friends

For adults or children who are shielding, what you need to do when spending time with other people depends on whether or not you live with them.

Spending time with people you live with

The rest of your household do not need to shield themselves, but they should do what they can to support you in shielding and to carefully follow guidance on staying alert and safe (social distancing).

You are no longer advised you need to observe social distancing with other members of your household as long as they are well. Everyone in your household should regularly follow the advice on hand washing and respiratory hygiene, including regularly washing hands with soap and water for at least 20 seconds, avoiding touching their face and cleaning thoroughly frequently-touched surfaces.

Spending time with people you don’t live with

You may form a ‘support bubble’ with one other household if you want to, as long as one of the households in the ‘support bubble’ is a single adult household (either an adult living alone or with children under 18 only). You can all spend time together outside and inside each other’s homes, including overnight.

Our advice is you can also spend time outside in a group of up to 6 people, including people from other households. If you do this the advice is to:

• stay 2 metres away from people from other households (except if they’re in your support bubble)
• wash your hands regularly with soap and water or hand sanitiser
• take particular care to minimise contact with others not in your household or support bubble
• do not share or exchange personal belongings (such as cups and water bottles) with others outside your household or support bubble
• avoid going into enclosed spaces and other shops, buildings and households (except the home of the other household in your support bubble)

Work and employment

The advice for what to do with work and employment is different for you if you’re shielding than for others you live with.

You are still advised not to work outside your home until 31 July.

If you usually work

If you have recently been told that you are clinically extremely vulnerable you should talk to your employer as soon as possible and discuss and agree your options around work.

If you’re able to work from home you should do so, and your employer is expected to help you to do this. At times, it may be appropriate for you to take up an alternative role or adjust your working patterns temporarily.

Statutory Sick Pay (SSP) is available where you are unable to work or to be furloughed under the Coronavirus Job Retention Scheme. Check if you’re eligible for SSP. You can use your letter from the NHS as evidence for your employer.

If you have not been working and your employer has been paying you Statutory Sick Pay (SSP) you will continue to be eligible for SSP until 31 July.

From 1 August, individuals will no longer be eligible for SSP on the basis of being clinically extremely vulnerable. Your employer should help you to transition back to work safely and support you to keep to social distancing in your workplace (if you can’t work from home).

If you are unable to work from home, some employers may be able to offer different types of leave. Beyond your statutory leave entitlements, this will be at your employer’s discretion:

• if you have previously been furloughed for a full 3-week period prior to 30 June, your employer may be able to apply for the Coronavirus Job Retention Scheme, under which you can be furloughed and receive 80% of your regular wages, up to a cap of £2,500. This scheme will run until the end of October

• Statutory Sick Pay is available as a safety net in cases where you are unable to work or to be furloughed under the Coronavirus Job Retention Scheme. If you are shielding you will be eligible for SSP until 31 July

Employers should be mindful of the particular needs of different groups of workers or individuals.

It is breaking the law to discriminate, directly or indirectly, against anyone because of a protected characteristic such as age, sex or disability, race or ethnicity.

Employers also have particular responsibilities towards disabled workers and those who are new or expectant mothers.

You can get advice on your specific situation and your employment rights by visiting the Acas website or calling the Acas helpline, 0300 123 1100. 

If you have concerns about your health and safety at work, you can raise them with any union safety representatives, or ultimately with the organisation responsibility for enforcement in your workplace, either the Health and Safety Executive or your local authority.

To support you if you’re self-employed through the coronavirus outbreak the government has announced the Self-employment Income Support Scheme.

If someone you live with needs to go back to work

The rest of your household do not need to shield themselves, but they should do what they can to support you in shielding and to carefully follow guidance on staying alert and safe (social distancing).

What support you can get

The section below is for people who may have recently been advised to shield.

If you’ve received a letter saying you’re clinically extremely vulnerable register online or call 0800 028 8327.

You can register for extra support at the same time. This can include:

• getting a weekly box of basic supplies
• getting priority for supermarket deliveries
• meeting your basic care needs

If you are registering for support, you will need to register before 17 July so that support can reach you in time.

Have your NHS number with you when you register. This will be at the top of the letter you have received letting you know you are clinically extremely vulnerable or on any prescriptions.

Help with getting food

Ask family, friends and neighbours to support you and use online services.

If you’d like help with your shopping, NHS Volunteer Responders are also here for you and will continue to support you after 31 July. You can choose what products you want and when you want them, and an NHS Volunteer Responder will then pick up and deliver your shopping to you. NHS Volunteer Responders can also pick up other essentials you need. Call 0808 196 3646 (8am to 8pm) to arrange volunteer support.

For further information about how to get food and other essential supplies, please see the guidance on accessing food and essential supplies. If you urgently need food or care, contact your local council.

Government food deliveries will stop on 31 July.

If you have registered for a priority supermarket delivery slot before 17 July, you will keep this priority slot from 1 August.

Help with getting medicines

If your medicines are currently being delivered through the government funded medicines delivery service then you will need to make other arrangements for after 31 July when this service will stop. The other ways you can get your medicines delivered are:

• ask someone to pick up your prescription from the local pharmacy (this is the best option, if possible)
• use an online NHS pharmacy who will offer free delivery of medicines
• contact your pharmacy to ask to help you find a volunteer (who will have been ID checked) to deliver it
• call 0808 196 3646 (8am to 8pm) to arrange for an NHS Volunteer Responder to pick up prescriptions for you
• contact your pharmacy to ask about other delivery options that they might provide

You may also need to arrange for collection or delivery of hospital specialist medication that is prescribed to you by your hospital care team.

Hospital and GP appointments if you’re shielding

Everyone should access medical assistance online or by phone in the first instance wherever possible.

However, you should continue to access the essential services that you need, and you should contact the NHS if you need urgent or emergency care.

If you have a scheduled hospital or other medical appointment before 31 July, talk to your GP or specialist to ensure you continue to receive the care you need in an appropriate setting and to determine which of these appointments are absolutely essential.

Your hospital may need to cancel or postpone some clinics and appointments. You should make contact to confirm appointments.

If you want someone to talk to

Use support you might have through your friends, family and other networks during this time. Try to stay in touch with those around you over the phone, by post or online.

NHS Volunteer Responders are available for you to have a friendly chat with someone new. You can call 0808 196 3646 (8am to 8pm) to set up a conversation – it can be as long as you like.

If you need support with your mental health

It is important that you take care of your mind as well as your body and that you get further support if you need it. Follow the advice that works for you in the guidance on how to look after your mental health and wellbeing during COVID-19.

Try to focus on the things you can control, such as where you get information from and actions you can take to help you feel prepared. The Every Mind Matters page on anxiety and NHS mental wellbeing audio guides provide further information on how to manage anxiety.

If you’re still struggling after several weeks and it’s affecting your daily life, contact NHS 111 online. If you have no internet access, you should call NHS 111.

If you are receiving services for your mental health, learning disability or autism and are worried about the impact of isolation, contact your key worker, care coordinator or provider to review your care plan. If you have additional needs, contact your key worker or care coordinator to develop a safety or crisis plan.

If you have help from a carer

Any carers or visitors who support you with your everyday needs can continue to visit unless they have any of the symptoms of COVID-19.

Essential care can be in any activity that contributes to living as full life as possible in our society. Those activities vary according to the needs and preferences of the individual.

Carers should follow advice on good hygiene:

• wash their hands with soap and water for at least 20 seconds on arrival to your house and often while they are there (or use hand sanitiser)
• avoid touching their face, particularly their eyes, nose and mouth
• catch any coughs or sneezes in a tissue or their sleeve and put used tissues immediately in the bin and wash their hands afterwards

They should follow social distancing guidance where close or personal contact is not required and where this is possible.

If your carer is a paid carer visiting you in your home, they will find information on the provision of home care and personal protective equipment (PPE) in the provision of home care guidance.

If you need support from a carer to leave the house, you can still meet in groups of up to 6 people outdoors.

If you have help from a friend, family member, or neighbour (unpaid carer) at home

More information on providing unpaid care is available.

Make sure you have back-up plans in place for your care in case your main carer is unwell or needs to self-isolate.

You should have an alternative list of people who can help you with your care if your main carer becomes unwell. You can also contact your local council for advice on how to access care.

It may also be helpful to contact your local carers support organisation who can help with contingency planning. You can find out about local carer organisations at Carers UK.

If your carer is a young person, their wellbeing and physical health is very important during this time. There is more information and advice especially for young people at Rise Above and Young Minds.

If you work in a care home

Shielding advice also applies to clinically extremely vulnerable people living in care homes. Care providers should carefully discuss this advice with the residents, families, carers and staff caring for such people to ensure this guidance is adhered to where appropriate. There may be additional specific measures in place in residential and nursing facilities to ensure all those being cared for are protected as much as possible. For more information on the use of personal protective equipment, please see the resource on working safely in care homes.

Residents’ individual circumstances must be considered in any decisions, ensuring that their human rights, personal choices, safety and dignity are upheld. For more information please see guidance on admission and care of residents in care homes.

Hand washing and respiratory hygiene

There are general principles you should follow to help prevent the spread of airway and chest infections caused by respiratory viruses, including:

• washing your hands frequently with soap and water for at least 20 seconds or using a hand sanitiser. Do this after you blow your nose, sneeze or cough before you eat or handle food and always immediately when you return home
• avoiding touching your eyes, nose, and mouth with unwashed hands
• covering your cough or sneeze with a tissue, then throwing the tissue safely in a bin and washing your hands
• cleaning and disinfecting frequently touched objects and surfaces in the home

If you develop symptoms

If you have any of the symptoms of coronavirus self-isolate at home and arrange to have a test as soon as possible.

Read the guidance about the NHS test and trace service, including what happens if you test positive for coronavirus.