Guidance

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

Updated 4 September 2020

Who this guidance is for

This guidance is for adults and children in England who are clinically extremely vulnerable.

If you’re clinically extremely vulnerable you should have received a letter confirming this or have been told directly by your GP or hospital clinician.

Introduction

If you’re clinically extremely vulnerable you were advised to take extra precautions during the peak of the pandemic in England. This is known as ‘shielding’.

The government is advising that you do not need to shield at the moment. This is because the rates of transmission of coronavirus (COVID-19) in the community have fallen significantly.

There is specific guidance on what will happen if there is a local lockdown in your area.

This guidance is government advice and it’s your personal choice whether to follow it.

What has changed

The guidance for the clinically extremely vulnerable is that shielding has been paused. This means:

• you do not need to follow previous shielding advice
• you can go to work as long as the workplace is Covid-secure, but should carry on working from home wherever possible
• clinically extremely vulnerable children should attend education settings in line with the wider guidance on reopening of schools and guidance for full opening: special schools and other specialist settings
• you can go outside as much as you like but you should still try to keep your overall social interactions low
• you can visit businesses, such as supermarkets, pubs and shops, while keeping 2 metres away from others wherever possible or 1 metre, plus other precautions
• you should continue to wash your hands carefully and more frequently than usual and that you maintain thorough cleaning of frequently touched areas in your home and/or workspace
• you will no longer receive free food parcels, medicine deliveries and basic care from the National Shielding Service

For practical tips on staying safe, see the guidance on meeting with others safely.

You will still be able to get:

• local volunteer support by contacting your local authority
• prescriptions, essential items and food you buy delivered by NHS Volunteer Responders
• priority slots for supermarket deliveries (if you previously registered for free food parcels)

If transmission of COVID-19 increases

You could be advised to shield again if the situation changes and there is an increase in the transmission of COVID-19 in the community.

Your name will be kept securely on the shielded patient list by NHS Digital. We will write to you if the advice changes. Any national changes will be reflected in this guidance.

In the event of a local lockdown, see the information below and visit your local authority’s website for further guidance.

If you’re clinically extremely vulnerable, you are advised not to enter any area where shielding advice is in place.

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 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)
• 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

You can find out more about who is classed as clinically extremely vulnerable on the NHS Digital website.

If you do not fall into any of these categories, but you are still concerned, you should discuss your concerns with your GP or hospital clinician.

Work and employment

You can go to work as long as the workplace is Covid-secure, but should carry on working from home wherever possible.

You may be able to take up an alternative role or change your working patterns temporarily.

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.

Employment rights

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, 0300 123 1100.

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

Statutory Sick Pay

As of 1 August, you are no longer eligible for Statutory Sick Pay (SSP) on the basis of being advised to shield by the government. Your employer should help you to transition back to work safely and support you to maintain good hand hygiene and distancing practice in your workplace if you are unable to work from home.

Support from NHS Volunteer Responders

NHS Volunteer Responders will offer support until at least December 2020 with:

• collecting shopping, medication (if your friends and family cannot collect them for you) or other essential supplies
• a regular, friendly phone call, either with someone else who has previously been advised to shield or with different volunteers
• transport to medical appointments

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

Help from carers

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.

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 provide unpaid care, see the Guidance for those who provide unpaid care for friends of family.

If you’re in a local lockdown area

If you’re clinically extremely vulnerable and live in an area where additional public health measures require you to resume shielding, the government will write to you and advise you to stay at home and shield.

If you’re unable to work from home or a location outside the lockdown area:

• your employer may be able to furlough you under the Coronavirus Job Retention Scheme if you have previously been furloughed for a period of at least 3 consecutive weeks taking place any time between 1 March 2020 and 30 June 2020. This scheme will run until the end of October 2020.
• you may be entitled to Statutory Sick Pay from your employer on the basis that you cannot work because you are shielding
• you may be eligible for benefits

In the event of a local lockdown, visit your local authority’s website for further guidance and follow the public health guidance for your local area.

If you work inside an area where clinically extremely vulnerable people are still being advised to shield, you are advised to work from home where possible, and not attend a workplace within the area where local restrictions are in place. If you live outside of that area, you may need to request a shielding letter as proof for your employer that you cannot attend your usual workplace.

Clinically extremely vulnerable children and young people

Specialists in paediatric medicine have reviewed the latest 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. In the future, we expect fewer children and young people will be included on the shielded patient list.

If a child or young person is removed from the shielded patient list, they will no longer be advised to shield in the future if coronavirus transmission increases.

To decide on whether a child or young person should be removed from the shielded patient list, you should talk to your paediatric specialist or GP. They will be in touch over the summer to discuss these decisions with you.

Annual flu programme

As part of the 2020 to 2021 flu vaccination programme, all other members of households of those who are identified as clinically extremely vulnerable at the time of the flu programme delivery are eligible for free flu vaccinations.

Most people who are clinically extremely vulnerable will already be eligible for a free flu vaccination.

Read further information about the annual flu programme.