Guidance

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

Updated 2 December 2020

Who this guidance is for

This guidance is for everyone who has been identified as clinically extremely vulnerable. If you are in this group, you will previously have received a letter from the NHS or from your GP telling you this. You may have been advised to shield in the past.

This guidance is effective from 2 December 2020.

Introduction

This guidance has been updated to support the clinically extremely vulnerable in protecting themselves from exposure to coronavirus (COVID-19). It replaces previous guidance on shielding that was in place during the 4-week period of national restrictions. The guidance is set out in 2 parts:

1. Updated advice on protecting the clinically extremely vulnerable, based on the tiers of local restrictions in your area. The 3 tiers are Tier 1: Medium, Tier 2: High and Tier 3: Very High. The advice sets out the additional things people at the highest risk from COVID-19 are advised to do to keep themselves safe for each tier.

2. Updated shielding advice that is more targeted and will only apply in some of the worst affected areas and only for a limited period of time. You are only advised to follow shielding advice if you receive a new written shielding notification.

What has changed

The country has moved back to a tiered system of local restrictions. We have reinstated this guidance for clinically extremely vulnerable people linked to these tiers.

This guidance offers additional advice to the clinically extremely vulnerable over and above the rules for the tiers, which apply to everyone. This guidance aims to strike a better balance between providing practical steps to help keep you safe while reducing some of the potentially harmful impacts on mental and social wellbeing that were associated with previous strict shielding. It sets out the steps clinically extremely vulnerable people can take to protect themselves for each local tier.

In the future, the government will only reintroduce formal shielding advice in the very worst affected local areas and for a limited period of time. This will only apply to some, but not all, Tier 3 areas and will be based on advice from the Chief Medical Officer. The government will write to you separately to inform you if you are advised to shield. You are not advised to follow formal shielding advice again unless you receive a new shielding notification advising you to do so.

What level of advice should you follow

You can check the tier for your local area or search by postcode.

If you are required to travel into an area in a different tier (for example to go to work or school), you should follow the guidance for whichever area is in the higher tier. For example, if you live in a Tier 1: Medium area but work in a Tier 2: High area, follow the work advice for Tier 2: High. If you live in a Tier 2: High area but work in a Tier 1: Medium area, continue to follow the advice for Tier 2: High areas.

General advice for clinically extremely vulnerable people at all tiers

These general principles apply at all local tiers. In addition to the rules you and your community must follow at each level, you can take additional precautions to protect yourself.

Socialising inside and outside the home

Continue to maintain strict social distancing, wash your hands regularly and avoid touching your face.

Try to keep the number of social interactions that you have low. The fewer social interactions you have, the lower your risk of catching COVID-19.

Avoid gatherings with large numbers of people, especially indoors, because it significantly increases the risk of viral transmission.

If the rules allow you to meet with others outside your household, your risk of catching COVID-19 is lower if you meet them outdoors. If you meet indoors, keep the area well ventilated with fresh air, for example by opening the window. You can also go out and exercise in an outdoor public place; further information on how you can keep fit and healthy is available. Continue to observe strict social distancing with anyone outside of your household or support bubble. The more you socially distance from others, including your own household, the less likely you are to catch COVID-19. You should always stay at least 2 metres away from other people visiting your home.

Try to reduce the amount of time you spend in settings where you are unable to maintain social distancing, or where other people’s activities may reduce the likelihood of individuals maintaining social distancing.

Work

Everyone is currently advised to work from home where possible. As a general principle, working from home reduces the chance of you being exposed to the virus.

If you need support to work at home or in the workplace you can apply for Access to Work. Access to Work will provide support for the disability-related extra costs of working that are beyond standard reasonable adjustments an employer must provide.

If you cannot work from home, you can still go to work in all tiers.

Your employer is required to take steps to reduce the risk of exposure to COVID-19 in the workplace and should be able to explain to you the measures they have put in place to keep you safe at work.

Where employers are not managing the risk of COVID-19, the Health and Safety Executive and local authorities will take action which can range from the provision of specific advice, issuing enforcement notices, stopping certain work practices until they are made safe and, where businesses fail to comply with enforcement notices, this could lead to prosecution.

If you have concerns about your health and safety at work you can raise them with your workplace union, the Health and Safety Executive or your local authority.

Consider how to get to and from work. If you need to use public transport, you must wear a face covering unless you are exempt. Consider travelling outside peak hours to reduce the number of people with whom you come into contact.

If you have concerns you can get advice on your specific situation and your employment rights by visiting the Acas website or calling the Acas helpline on 0300 123 1100.

If you cannot make alternative arrangements, your employer may be able to furlough you under the Coronavirus Job Retention Scheme, which has been extended until the end of March 2021. You should have a conversation with your employer about whether this is possible.

Education

The UK Chief Medical Officers have issued a statement on schools and childcare reopening which states that there is a very low rate of severe disease in children and young people from COVID-19. Schools have their own measures in place to limit the risk of transmission which can be found in guidance on reopening of schools.

All pupils and students should continue to attend education settings at all local tiers unless they are one of the very small number of pupils or students under paediatric or other NHS care and have been advised by their GP or clinician not to attend an education setting. Children and young people whose parents or carers are clinically extremely vulnerable can also continue to go to school.

Travel

If you need to travel, walk or cycle if you can. For longer journeys, or if you are unable to walk or cycle, try to minimise the number of people you come into close contact with. Travelling by car is likely to mean fewer social contacts than travelling by public transport. You should avoid sharing a car, especially with people outside of your immediate household or support bubble.

Going to shops and pharmacies

Consider shopping or going to the pharmacy at quieter times of the day. You must wear a face covering in all shops unless you are exempt.

You might also want to ask friends, family or volunteers to collect medicines for you.

The NHS Volunteer Responders programme is available to help support those who need it. Volunteers can collect and deliver shopping, medication and other essential supplies. Call 0808 196 3646 between 8am and 8pm, 7 days a week to self-refer or visit NHS Volunteer Responders for further information.

If you require additional care and support

Whatever tier your local area is in, it is important that you continue to receive the care and support you need to help you stay safe and well. Providers of social care and medical services are making every effort to ensure services remain open and as safe as possible.

You should continue to seek support from the NHS for your existing health conditions. You can access a range of NHS services from home, including ordering repeat prescriptions or contacting your health professional through an online consultation. To find out more visit Health at Home, or download the NHS App. If you have an urgent medical need, call NHS 111 or, for a medical emergency, dial 999.

Any carers or visitors who support you with your everyday needs can continue to visit. They should follow social distancing guidance where close or personal contact is not required.

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 and PPE for care workers delivering homecare guidance. If you receive unpaid care, your carer should refer to the Guidance for those who provide unpaid care to friends or family.

You should continue to access support from local charities and organisations, as well as NHS Volunteer Responders. As well as helping with shopping and medicines delivery, NHS Volunteer Responders can help with a regular, friendly phone call, either with someone else who has previously been advised to shield or with different volunteers and transport to medical appointments.

Call 0808 196 3646 between 8am and 8pm to arrange support or visit NHS Volunteer Responders website. Speak to your health care professional to arrange transport support.

Mental Health

It is also important to look after your mental health. Go to the Every Mind Matters website for advice and practical steps that you can take to support your wellbeing and manage your mental health during this pandemic.

If you or someone you care for are experiencing a mental health crisis, we urge you to make contact with a local health professional immediately.

Advice during the Christmas period

We recognise that many people may want to be with their friends and family over the festive period, particularly after a very difficult year. As a result, the government will be changing some restrictions on social contact, allowing you to form a ‘Christmas bubble’ in which you can spend time indoors and outdoors, including in your home, with people from up to 3 households including your own.

This will only apply for a very limited period of time, from 23 December to 27 December. More information about the rules on Christmas bubbles is available.

You can choose to be part of a Christmas bubble if you are clinically extremely vulnerable, but it does involve greater risks for you as you will be increasing the number of people you have contact with. You will continue to minimise your risk of infection if you limit social contact with people that you do not live with, even at Christmas. It is important that you and the other people in your Christmas bubble consider these risks carefully before agreeing to form a bubble. Forming a Christmas bubble is a personal choice and should be balanced against the increased risk of infection.

If you do decide to form a Christmas bubble it is advised that you maintain social distance from those you don’t normally live with at all times, avoiding physical contact. Everyone should wash their hands regularly and it is important to keep the space where you spend time with those you don’t normally live with well ventilated and to clean touch points regularly, such as door handles and surfaces. You may want to think about who you sit next to, including during meals, and also consider wearing a face covering indoors where social distancing may be difficult as well as encouraging others to do the same.

If you don’t feel comfortable spending time with other people indoors, think of other ways that you can safely spend time together, for example on walks outdoors or supported by technology, and how you can make that time feel different and special. Going outdoors carefully for exercise is also encouraged. It is important that you do not feel pressured to celebrate Christmas in an environment that makes you anxious.

There may be a lot of expectation and pressure around celebrating Christmas together, but you should feel comfortable to do what is right for you over this period. To do that, it is important that the other people in your Christmas bubble understand your needs and increased risk. They can help by being extra vigilant in the days before you get together, reducing any unnecessary contact with people, especially as some people with the virus have no symptoms.

Once the Christmas bubble period ends on 27 December, you should follow the guidance that was in place before Christmas, in line with the restrictions for your local area.

Further advice at Tier 1: Medium

Socialising inside and outside the home

At Tier 1: Medium, when seeing friends and family you do not live with (or have formed a support bubble with) you must not meet in a group of more than 6, indoors or outdoors.

In addition, we advise clinically extremely vulnerable people to take extra precautions by strictly maintaining social distancing, meeting outside if possible, and keeping the number of different people they meet low. You are encouraged to exercise in an outdoor public place.

The more you socially distance from others, including your own household, the less likely you are to catch COVID-19 but you should in any case always stay at least 2 metres away from other people visiting your home.

Work and education

You should continue to work from home where possible.

If you cannot work from home, you can still attend your workplace as your workplace should be COVID-secure. The general advice on work has further details about what to do if you have concerns.

If you cannot make alternative arrangements, your employer may be able to furlough you under the Coronavirus Job Retention Scheme, which has been extended until the end of March 2021. You should have a conversation with your employer about whether this is possible.

All pupils and students should continue to attend education settings at all local tiers unless they are one of the very small number of pupils or students under paediatric or other NHS care and have been advised by their GP or clinician not to attend an education setting. Children and young people whose parents or carers are clinically extremely vulnerable can also continue to go to school.

Travel

There are no restrictions on travel at Tier 1: Medium. We advise clinically extremely vulnerable people to limit journeys on public transport where possible.

Going to shops and pharmacies

We advise clinically extremely vulnerable people to consider shopping or visiting the pharmacy at quieter times of the day. You can further protect yourself by strictly observing good hand hygiene and maintaining social distancing as much as possible.

If you require additional care and support

At all times, you should continue to access the social care and medical services you need. Providers of these services are making every effort to ensure services remain open and as safe as possible.

You should continue to access the NHS services that you need, and you should contact the NHS if you have an urgent or emergency care need.

Further advice at Tier 2: High

Socialising inside and outside the home

At Tier 2: High, you must not meet with people indoors in any setting unless they are part of your household or support bubble. This includes private homes, and indoors in hospitality venues, such as pubs and restaurants.

You may continue to see friends and family you do not live with outside, including in a garden or other outdoor space. If you do so, you must not meet in a group of more than 6. In England, this limit of 6 includes children and young people of any age.

At this alert level, our additional advice for clinically extremely vulnerable people is that you keep the number of different people you meet with consistently low. The fewer people you meet, the less likely you are to catch COVID-19.

You are encouraged to continue to go outside because of the benefits of exercise. If you do choose to meet other households outside of your support bubble, this must be outside, must be in groups of less than 6 people and we advise you to keep the numbers low.

The more you socially distance from others, including your own household, the less likely you are to catch COVID-19. You should always stay at least 2 metres away from other people visiting your home.

Work and education

The advice is the same as for Tier 1: Medium.

You should continue to work from home where possible. If you cannot work from home, you can still attend your workplace as your workplace should be COVID-secure. The general advice on work has further details about what to do if you have concerns.

If you cannot make alternative arrangements, your employer may be able to furlough you under the Coronavirus Job Retention Scheme, which has been extended until the end of March 2021. You should have a conversation with your employer about whether this is possible.

All pupils and students should continue to attend education settings at local tiers unless they are one of the very small number of pupils or students under paediatric or other NHS care and have been advised by their GP or clinician not to attend an education setting. Children and young people whose parents or carers are clinically extremely vulnerable should also continue to go to school.

Travel

At Tier 2: High, all people are advised to minimise travel and to avoid busy times and busy routes where possible.

In addition, we advise clinically extremely vulnerable people to avoid travel where possible except for going to work, school, or for essential shopping.

If you need to travel, walk or cycle if you can. If this is not possible, travelling in a private car is generally lower risk than public transport because you are likely to come into contact with fewer people. You should avoid sharing a car, especially with people outside of your immediate household or support bubble.

Going to shops and pharmacies

You are advised to reduce the number of shopping trips you make. If you do go to the shops including pharmacies, consider doing so at quieter times of the day.

Consider using online delivery slots for food shopping or ask friends and family to help deliver shopping or collect medicines for you.

If you need further assistance with food shopping or medicine collection, NHS Volunteer Responders may be able to help.

If you require additional care and support

You should continue to receive care at home, either from professional social care and medical professionals, or from friends and family within your support bubble.

You should continue to access the NHS services that you need, and you should contact the NHS if you have an urgent or emergency care need.

Further advice at Tier 3: Very High

Socialising inside and outside the home

The rules at Tier 3: Very High apply to everyone and state that you can only meet friends and family who are not in your household or support bubble in certain outdoor public spaces. You can find a list of these places in the Tier 3: Very High guidance.

At Tier 3: Very High, we still advise clinically extremely vulnerable people to continue to go outside for exercise, but to avoid busy areas to minimise the chance of coming into close contact with others. Otherwise, we advise you to stay at home as much as possible.

You may want to maintain social distance within your household if practical.

Work and education

As a general principle, working from home reduces the chance of you being exposed to the virus.

Where possible you are advised to work from home, because the rate of transmission of the virus in your area may be very high.

If you cannot work from home, and are concerned about going into work, you may want to speak to your employer about taking on an alternative role or change your working patterns temporarily (for example, to avoid travelling in rush hour).

If there is no alternative, you can still go to work. Your employer is required to take steps to reduce the risk of exposure to COVID-19 in the workplace. Your employer should be able to explain to you the measures they have put in place to keep you safe at work.

Where some employers are not managing the risk of coronavirus, the Health and Safety Executive and local authorities will take action which can range from the provision of specific advice, issuing enforcement notices, stopping certain work practices until they are made safe and, where businesses fail to comply with enforcement notices, this could lead to prosecution.

If you have concerns about your health and safety at work you can raise them with your workplace union, the Health and Safety Executive or your local authority.

If you cannot make alternative arrangements, your employer may be able to furlough you under the Coronavirus Job Retention Scheme, which has been extended until the end of March 2021. You should have a conversation with your employer about whether this is possible.

All pupils and students should continue to attend education settings at all local tiers unless they are one of the very small number of pupils or students under paediatric or other NHS care and have been advised by their GP or clinician not to attend an education setting. Children and young people whose parents or carers are clinically extremely vulnerable should also continue to attend education settings.

Travel

At Tier 3: Very High, everyone may continue to travel to venues or amenities which are open, as well as for work or to access education. However, everyone should aim to reduce the number of journeys they make and should avoid travel into or out of a Tier 3 area.

In general, we advise clinically extremely vulnerable people to stay at home as much as possible.

Going to shops and pharmacies

You are advised to significantly reduce your shopping trips including to pharmacies. Where possible, you should consider shopping online. If you do need to go to the shops, try to do so at quieter times and maintain strict social distancing.

You are advised to ask people in your household or support bubble to collect food and medicines for you. If you need more help with accessing food or medicines, NHS Volunteer Responders are still available to assist you.

You can register to request access to priority supermarket deliveries, if you do not have someone you can rely on to go shopping for you. If you have already got priority supermarket deliveries, you will keep them. When registering you will be asked for your NHS number. You can find it on any letter the NHS has sent you, or on a prescription.

Registering on the site just gives you priority. It does not mean you’ll definitely get a delivery slot. If you want priority supermarket deliveries, you will also need to set up an account with at least one supermarket and book slots yourself.

If you require additional care and support

You should continue to receive care at home, either from professional social care and medical professionals, or from friends and family within your support bubble.

You should continue to access the NHS services that you need, and you should contact the NHS if you have an urgent or emergency care need.

If you need other forms of help, including support to register for priority supermarket deliveries, you should contact your local council directly. Find out how your local council can help.

Shielding

You are not advised to follow this revised shielding advice unless you receive a new shielding notification advising you to do so.

We may advise more restrictive formal shielding measures for the clinically extremely vulnerable in the worst affected Tier 3 areas, based on advice from the Chief Medical Officer. This will only apply to some Tier 3 areas, and the government will write to you separately to inform you if you are advised to shield.

Further support will be made available from your local council and community pharmacies to help protect you during this period of heightened risk.

Work

You are strongly advised to work from home because the risk of exposure to the virus in your area may be significantly higher. If you cannot work from home, then you should not attend work.

You may want to speak to your employer about taking on an alternative role or change your working patterns temporarily to enable you to work from home where possible.

If you cannot make alternative arrangements, your employer may be able to furlough you under the Coronavirus Job Retention Scheme, which has been extended until the end of March 2021. You should have a conversation with your employer about whether this is possible.

If your employer is not able to furlough you, you may be eligible for Statutory Sick Pay (SSP) or Employment Support Allowance (ESA). The formal shielding notification you receive will act as evidence for your employer of the Department of Work and Pensions that you are advised to shield and may be eligible for SSP or ESA.

Members of the household who are not clinically extremely vulnerable should continue to attend work if they are unable to work from home.

Education

As our knowledge of COVID-19 has grown, we now know that very few children and young people are at highest risk of severe illness due to the virus. Doctors have therefore been reviewing all children and young people who were initially identified as clinically extremely vulnerable to confirm whether they are still thought to be at highest risk.

If you have already discussed this with your child’s doctors and they have confirmed your child is still considered highest risk, your child should follow shielding advice and should not attend school, because the risk of exposure to the virus in your area may currently be very high.

Your school or college will make appropriate arrangements for you to be able to continue your education at home.

Children and young people in the household who are not clinically extremely vulnerable should continue to attend school. Children and young people whose parents or carers are clinically extremely vulnerable should also continue to go to school.

Socialising

You can go outside, but try to keep all contact with others outside of your household to a minimum, and avoid busy areas.

You are advised to stay at home as much as possible.

You can still remain in your support bubble, but you cannot meet with friends and family you do not live with unless they are part of your support bubble. This is part of the wider regulations in place in your area.

Try to stay 2 metres away from other people within your household, especially if they display symptoms of the virus or have been advised to self-isolate.

Travel

You are advised to stay at home as much as possible and not to travel unless essential.

Shopping

You are advised not to go to the shops. Use online shopping if you can, or ask others to collect and deliver shopping for you (friends and family, or NHS Volunteer Responders).

You can register to request access to priority supermarket deliveries, if you do not have someone you can rely on to go shopping for you. If you already have a priority delivery slot with a supermarket, that will continue – you do not need to do anything further. When registering you will be asked for your NHS number. You can find it on any letter the NHS has sent you, or on a prescription.

Registering on the site just gives you priority. It does not mean you’ll definitely get a delivery slot. If you want access to priority supermarket deliveries, you will also need to set up an account with at least one supermarket and book slots yourself.

If you need other forms of help, including support to register for a priority supermarket delivery slot, you should contact your local council directly. Find out how your local council can help.

Medicines

You are strongly advised not to go to a pharmacy because the risk of exposure to the virus is significantly higher in your area.

In the first instance, you should ask if any friends, family or volunteers can collect medicines for you.

If friends and family are not able to collect your medicines for you, and you and/or the pharmacy are unable to arrange a volunteer, then you will be eligible for free medicines delivery. Please contact your pharmacy to inform them that you are clinically extremely vulnerable and need your medicines delivered, and they will arrange this free of charge.

Care and support

You can still receive informal care at home from people within your support bubble.

You can still receive care at home from professional social care and medical professionals.

If you need additional help to follow this guidance, your local council may be able to help. If you are advised to shield you will be able to register yourself or someone else to:

• request access to a priority supermarket delivery slot (if you have already got priority supermarket deliveries, you will keep them)
• tell your council if you need support to follow shielding guidance, especially if you are unable to arrange this yourself or with the help of friends, family or other support networks
• make sure your details, such as your address, are up to date

When registering you will be asked for your NHS number. You can find it on any letter the NHS has sent you, or on a prescription. It is helpful if you register even if you do not have any support needs at this time. You can log in and update your needs if circumstances change at any time.

If formal shielding is introduced in your area, information on how to access support will be included in your shielding notification letter. 

Definition of clinically extremely vulnerable groups

People who are defined as clinically extremely vulnerable are at very high risk of severe illness from coronavirus. There are 2 ways you may be identified as clinically extremely vulnerable:

1. You have one or more of conditions listed below, or
2. Your clinician or GP has added you to the Shielded Patient List because, based on their clinical judgement, they deem to you be at higher risk of serious illness if you catch the virus.

If you do not fall into any of these categories, and have not been contacted to inform you that you are on the Shielded Patient List, follow the general staying alert and safe guidance for the rest of the population.

If you think there are good clinical reasons why you should be added to the Shielded Patient List, discuss your concerns with your GP or hospital clinician.

People with the following conditions are automatically deemed clinically extremely vulnerable:

• 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 that 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 disease)
• people on immunosuppression therapies sufficient to significantly increase risk of infection
• problems with your spleen, e.g. splenectomy (having your spleen removed)
• adults with Down’s syndrome
• adults on dialysis or with chronic kidney disease (stage 5)
• 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