Guidance

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

Updated 25 February 2021

Who this guidance is for

This guidance is for everyone in England 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 shielding guidance applies to clinically extremely vulnerable individuals only. Others living in a household with someone who is clinically extremely vulnerable are not advised to follow this guidance. They should instead follow the general advice and regulations set out in the national lockdown guidance that came into effect on 5 January 2021.

The clinically extremely vulnerable will get priority access to vaccination against COVID-19 before the general population and in line with the priority ordering set by the Joint Committee on Vaccination and Immunisation (JCVI). You will be contacted again by the NHS with more information on when and how you will be invited to get the vaccine.

The vaccine is likely to make an important contribution towards protecting you from COVID-19. Clinically extremely vulnerable people are expected to receive a vaccination against COVID-19 before the general population. Your local NHS will ensure that you can receive the vaccine as safely as possible, as well as any care and support needed. Even if you have had both doses of the vaccine, you should continue to follow this shielding advice, until further notice as we continue to assess the impact of vaccination among all groups. The people you live with should continue to follow the public health rules and guidance as long as they are in place, including if you have received the vaccine and also if they have received the vaccine.

What has changed

Whilst the national lockdown has been effective and cases of COVID-19 are now falling, the levels of infection in the community remain high and the virus continues to pose a high risk to people across the country.

Everyone in England, including those who are clinically extremely vulnerable, is required to follow the new national lockdown guidance, which has been set out by the Government and applies to the whole population. These restrictions:

1. Require people to stay at home, except for specific purposes.
2. Prevent people gathering with those they do not live with, except for specific purposes.
3. Close certain businesses and venues.
4. Support children and young people to learn remotely until 8 March, except for vulnerable children and the children of critical workers who may still attend school.

The new information below includes additional guidance for clinically extremely vulnerable people, to help protect you from COVID-19. We will also write to you with a version of this guidance.

These new formal shielding measures will apply across the whole of England until at least 31 March.

Socialising

The new national lockdown guidance, which applies to everyone, means that you must not leave or be outside of your home and garden, except for limited purposes which are set out in that guidance.

We are advising clinically extremely vulnerable people to stay at home as much as possible.

You can still go outside for exercise or to attend health appointments, but try to keep all contact with others outside of your household to a minimum, and avoid busy areas.

You can still meet with your support bubble – but you cannot meet others you do not live with unless they are part of your support bubble. Outdoors, you can meet one person from another household for exercise. This is part of the wider national regulations that apply to everyone.

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.

Work

You are strongly advised to work from home because the risk of exposure to the virus in your area may currently be 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 need support to work at home you can apply for Access to Work – this offers support for the disability-related extra costs of working that are beyond standard reasonable adjustments an employer must provide.

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 April 2021. You should have a conversation with your employer about whether this is possible.

As you are being advised not to attend work, you may be eligible for Statutory Sick Pay (SSP) or Employment and Support Allowance (ESA). The formal shielding letter you receive can act as evidence for your employer and the Department for 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, in line with the wider rules set out in the national lockdown guidance.

Education settings

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 clinically extremely vulnerable, your child should follow this shielding advice.

Under the current national lockdown, children will learn remotely until 8 March, except for vulnerable children and the children of critical workers who may still attend school.

Clinically extremely vulnerable children and young people should not attend school or other educational settings, because the risk of exposure to the virus in the community is now very high. Your school or college will make appropriate arrangements for you to be able to continue your education at home.

Travel

You are advised to stay at home as much as possible and not to travel unless essential (for example, to attend health appointments).

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, local volunteers or NHS Volunteer Responders).

You can register to request priority access to supermarket delivery slots, if you do not have someone you can rely on to go shopping for you. If you already have priority access to a supermarket delivery slot, 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. Once you have registered, in order to receive supermarket deliveries, you will still need to book the delivery slots yourself.

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

Guidance on accessing food and essential supplies during the coronavirus pandemic is available.

Medicines

You are strongly advised not to go to a pharmacy.

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 for 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.

Accessing care and support

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

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

We urge you to continue using the NHS and other health providers for your existing health conditions and any new health concerns.

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.

If you do need to receive care in person, you can. Your local NHS services are well prepared and will put in measures to keep you safe.

It is also really 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.

Any carers or visitors who support you with your everyday needs can continue to visit. This also applies for those of a child or young person in your care. They should follow social distancing guidance where close or personal contact is not required.

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, and transport to and from health appointments. Call 0808 196 3646 between 8am and 8pm to arrange support or visit NHS Volunteer Responders website.

You can also access additional support from your energy supplier. Energy suppliers are required by the regulator, Ofgem, to hold a register of customers in a vulnerable circumstance, called a Priority Service Register. If you are clinically extremely vulnerable you can be added to this register. For information about how to be added to the register and the additional services your supplier can provide you, please visit Ofgem’s website.

Registering for additional support

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 priority access to a supermarket delivery slot (if you have already got priority access that will continue – you do not need to do anything further)
• 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.

Definition of clinically extremely vulnerable groups

People who are defined as clinically extremely vulnerable are thought to be at very high risk of serious illness from coronavirus. There are 3 ways you may be identified as clinically extremely vulnerable:

1. You have one or more of the conditions listed below.

2. Your clinician or GP has added you to the Shielded Patient List because, based on their clinical judgement, they deem you to be at high risk of serious illness if you catch the virus.

3. You have been identified through the COVID-19 Population Risk Assessment as potentially being at high 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 national lockdown guidance for the rest of the population.

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 national lockdown 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, for example 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