It was a rather chaotic announcement of the government’s full response to the consultation on making vaccination a condition of deployment in care homes, with leaks the day before the actual announcement.
Interestingly, the response shows that the majority of respondents (57%) opposed the proposal and within the detail, respondents who were service users and relatives of service users were against the proposal (61%).
The government has broadened the scope of the policy very significantly beyond the original thinking; the policy will now apply to ALL CQC registered care homes (not just those for older people) and will cover ALL those who cross the threshold of those care homes.
Once the policy is enacted, anyone entering a care home will need to demonstrate that they have had both doses of a COVID vaccine (including all staff, volunteers, all visiting professionals, contractors and suppliers) unless they are in the small group of people to whom this policy does not apply (family & friends visiting a resident (including essential care givers), the medically exempt, anyone under 18 and people responding to emergencies/ urgent maintenance).
It’s worth reflecting for a moment on what we thought was the original aim of the consultation, which seemed to be to achieve the highest possible vaccine uptake in both staff and the people we support, based on the advice from the SAGE Care Working Group about needing a minimum 80% of staff & 90% of residents.
And it is also important to note that all of us involved in any way with the care sector want to see, and have been working hard to achieve, the highest possible vaccine uptake in all our staff and the people we support and many care homes have been achieving rates of 80% plus and 90% plus respectively.
The goalposts have moved, hugely, and the policy goes way beyond the advice from the SAGE Care Working Group. The sheer scale of what is being asked of care homes is extraordinary.
The draft regulations have been laid and will be debated and passed by the time Parliament stops for the summer recess (23 July at the latest). They will take effect 16 weeks from the date they are passed, which takes us to around the middle/ end of October 2021
The regulations require that care homes ‘secure that a person does not enter the premises’ unless they can provide acceptable evidence of two doses of the COVID vaccine, are medically exempt (as defined by the Green Book) or fit into the other exemptions. Care homes will need systems to record this evidence for all of those entering as the CQC will be inspecting this as part of their regulatory activity.
It is remarkable that, as yet, we had seen little consideration given to the huge practical and logistical issues this brings, as well as a notable silence on the resources and funding needed to operationalise the policy and on the anxieties about the wider impacts that this policy will bring.
Currently it feels completely unworkable; care homes have limited powers to force the vaccination of those beyond its immediate workforce and volunteers. While they can renegotiate the terms of their contracts with suppliers, they cannot force vaccination on visiting health professionals, whose presence is essential to the health and wellbeing of residents. This policy will need the active support of all those visiting professionals and who will make that happen? While the government intends to consult on widening the scope of the policy, to include COVID and flu vaccination and to extend it to wider health and care staff, this will not be in place by the end of October.
The timings of the implementation are very tight; employers must embark on consultation processes with existing staff, make vaccination a condition of employment and consider their legal dismissal and / or redeployment options if staff do not wish to be vaccinated. And employers may face legal challenges from employees, who feel they are being treated unfairly or discriminated against, and potential future challenges if workers feel compelled to take the vaccine and then develop significant reactions or long term problems.
There is also the potential impact on staffing levels as a result of the policy; when we asked our members about this, 96 % expected some impact: just over a third of respondents think up to 5% of their staff could leave; 23% think more than 10% of their staff could leave. This is a significant risk that the sector will struggle to cope with, especially as the sector already has 112,000 vacancies and is facing post-Brexit & Post- COVID recruitment pressures.
Essential support includes funding to implement the policy, insurance & indemnity cover, HR and legal support, support on evidencing & recording vaccine status, guaranteed, speedy ongoing access to the vaccine and support from all those responsible for visiting professionals to make the policy possible.
There is one opportunity here – the government is using the professional duty of care argument to explain the policy; now is the ideal 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. The policy would be much more credible to frontline care staff if it were accompanied by a proper package of professional recognition and reward.
Policy Director National Care Forum