Was the care sector surprised when the Government announced its consultation on mandating vaccination for care staff in older people’s care homes? Not really – the mood music around this was changing as the vaccination data from the Capacity Tracker was flowing in and indicating that, for some parts of the country, vaccine uptake rates in care staff were not accelerating as quickly as the Government would like.
Despite a promise from Prime Minister Boris Johnson in November 2020 that COVID-19 vaccination would not become compulsory, it was clear that the ministerial position was changing.
It’s worth reflecting for a moment on the ultimate aim here, and one which all of us involved in any way with the care sector want to see, which is the highest possible vaccine uptake in both staff and the people we support. The key question then, which is unfortunately missing from the Government’s consultation, is ‘will compulsory vaccination be the best way to achieve this aim?’ And what may be the unintended consequences of implementing such a policy?
At the National Care Forum, we represent the views of not-for-profit care providers, which are some of the many organisations and employers which will have to implement this policy if it goes ahead. We conducted our own survey to inform our consultation response: we asked our whole membership to consider the questions, not just those operating older people’s care homes, because there are such important principles in this debate. The survey ran for ten days with a 64% response rate, with respondents employing nearly 52,000 staff and supporting over 85,000 people.
Views are clearly divided. The following quotes illustrate the range of perspectives, from ‘The staff have a responsibility to protect the people they support’ to ‘We do not think mandating vaccination is necessary and believe staff, through gentle persuasion and educated discussion, can be encouraged to take up the vaccine. 89% of colleagues in our care homes have been vaccinated. Mandating vaccination would result in a loss of good staff.’ Some respondents support this policy, especially if it provides absolute clarity in terms of employers’ duties under the relevant regulations; for others, it is fundamentally not the right approach and is a step too far.
It is important to take a moment also to reflect that all our members have been working very hard to promote vaccine uptake across their staff and have used a whole range of techniques to do so. We heard from members about what had been working: ‘Education over vaccine, staff briefings/forums/one-to-ones, wellbeing champions, on-site vaccinations’; ‘Providing information from trusted and accredited NHS/medical/faith sources and combatting myths. Running Zoom Q&A sessions with health professionals where staff could send in specific questions in advance. Publishing videos of colleagues talking about their vaccination’; and ‘Paid transport to get people to hospital sites or vaccination hubs.’ Many of our members have very high rates of staff uptake, across all their services, including care homes for older people, so they are rightly asking why a blanket policy is being mooted. Some 77% of members running care homes for older people have over 75% vaccination rates among staff; 47% have more than 85% vaccination rates.
Our membership is united in the belief that targeting this particular subset of care staff (those who work in care homes that support anyone over 65) is fundamentally unfair and illogical. There is an important issue of fairness and equity across different groups of the workforce who work closely with vulnerable people over 65. If the key risk is close, frequent and prolonged contact with the most vulnerable Joint Committee on Vaccination and Immunisation (JCVI) priority group one, then many other settings involve this, so why are those workforces not included, such as NHS staff? In our survey, 65% of respondents felt that this subset of care staff should not be singled out for compulsory vaccination and 76% felt that this should also be applied to health professionals. 80% also told us that they thought their staff would feel unfairly treated if the policy only applied to those working in older adult care homes.
Thinking about health staff then, let’s consider a point often made in this debate, which is the view that compulsory vaccination already applies to some jobs, notably some health professionals, and therefore what’s the issue? It feels a little disingenuous to make such a direct comparison here. The vaccines that some health staff are required to have as a condition of employment generally have been around for a long time, are well understood and well accepted by the vast majority of the population. Side effects and risks have been thoroughly researched and there is a significant amount of support and resource within the NHS to help people access the necessary vaccines and address any hesitancy. If, for any reason, staff cannot have the particular vaccine, the NHS is a large employer with other options to deploy staff. None of this is true for the COVID-19 vaccines and the care sector. In addition, in health organisations, mandatory vaccination requirements have in general been introduced to new appointees to a role, rather than mandated across all the existing workforce.
The professional duty of care argument has also been made by some, with an apparent amnesia about the dedication and commitment of care staff over the last 15 months, who have been the stalwarts of the COVID-19 front line, 24 hours a day, seven days a week, continuing to provide care under the most challenging of circumstance. They have done this with compassion, providing a lifeline for the most vulnerable across all our communities. It is time to back up that call for professionalism with real action to invest in the social care workforce to create a professionally skilled, recognised workforce – properly valued, better paid, with more training and development. Any exhortation to take the COVID-19 vaccine would be much more credible to frontline care staff if it were accompanied by a proper package of professional recognition and reward.
If this policy is implemented, it is very clear that the sector will need an enormous amount of infrastructure resource and support to implement it, in the same way that the NHS receives significant infrastructure support for its vaccine uptake work. The Government’s consultation is silent on the practicalities of implementation, bar one rather bland question.
We have a long list of the things our members will need to support compulsory vaccination of care staff. They start with the very practical issue of guaranteed access to free COVID-19 vaccines and boosters for as long as needed. This would be an important step change, as at present each year we have the unhelpful flu vaccine debate as to whether it will be free or not for social care. Meanwhile, there is never any debate that it will be free for the NHS. If compulsory vaccination for any care staff is implemented, then the Government must guarantee that the COVID-19 vaccine now and in the future is free and prioritised for social care. This is crucially important given the high turnover of care staff (30% according to Skills for Care 2020 data; 22% in our NCF Personnel Survey 2020). We must be able to vaccinate new
Insurance and litigation also loom large here; this is already a huge challenge across the care sector, with eye watering increases in costs and worryingly low levels of COVID related cover. Remember that the Government indemnified the NHS against COVID-related claims in 2020 but, as yet, has failed to offer any help for the care sector, despite huge evidence of the ongoing problems and failure of the insurance market for social care. This policy cannot be implemented without Government indemnification of the care sector or absolute clarity that any associated litigation by staff during effective implementation must be addressed by the Government, not the providers.
The sector also needs practical resources and support, such as HR support and occupational health support to implement this policy, as employers will have to work it through with existing staff, help them to make the decision about the vaccine, look to renegotiate existing employment contracts and/or consider redeployment options if that is a possibility, and support to identify the medically exempt workforce and determine how that will work within this policy.
Hurdles to jump
Despite the relatively high level of concurrence with the principle of the policy, 70% of our respondents told us that a compulsory vaccination policy would be difficult to implement and one fifth told us it would be extremely difficult. It is clear that the sector is going to need significant infrastructure help from the Government to monitor ongoing vaccine status of staff, especially as presumably this will have to be tracked at individual care home level, with each care home with any adult over 65 needing to show all their staff are up-to-date with the COVID-19 vaccine or have an up-to-date medical exemption. Some respondents told us ‘keeping track of status is very challenging’ and a clear mechanism for evidencing vaccinations needs to be created’.
Finally, it is not yet clear about the impact of potential loss of care staff if this policy is implemented: just over a third of our respondents think up to 5% of their staff could leave; 23% think more than 10% of their staff could leave. While it is impossible to know at this point how many staff will decide to leave the sector if they face compulsory vaccination, can the sector and the people we support cope with that? Given that the sector already has 112,000 vacancies, is mandating vaccines the right approach?
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