With the Government’s regulations on mandatory vaccination in care homes now approved, the countdown to implementation by 11 November 2021 begins. Much of the focus of the policy intent has centred on the staff employed within the homes, but it is important to recognise that the scope of the regulation goes well beyond staff. The policy relates to anyone entering a care home to demonstrate that they have had a complete course of doses of an authorised 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, under 18 year olds (unless they are staff) and people responding to emergencies/urgent maintenance).
The Impact Statement produced by the government in support of this policy outlined the potential impact on the care sector across all care homes. The statement itself was limited in detail and the full-scale analysis that backs it up is awaited. However, even with its summary assessment it is clear that even the lower level assumptions recognise the very significant and potentially catastrophic challenges for the delivery of care if the right level of guidance and support is not available.
This policy comes at the same time as increased pressure on staffing across all care services. Recent survey work with NCF members in early July showed that there were high levels of staff exits, with people leaving to join healthcare, retail and hospitality. Staff are citing stress, burnout and the opportunity to receive better pay, terms and conditions. By their own admission the government have determined that it is likely that 7% of the workforce will not be deployable as a result of this new regulatory requirement. The assessment claims that this is likely to mean that 40,000 staff are unlikely to be able to work in care homes any longer by the 11th November deadline. This feels an astonishing risk to a sector that already sustains over 100,000 vacancies on any given day. In addition, the statement identifies an associated cost of £100 million to recruit and train replacement staff. Yet, this assumption does not bear any reference to the costs of implementation of the policy itself, which includes consultation, interpreting exemptions and addressing individual situations and appeals.
The operational guidance to support this policy has now been published by the government and it provides some confirmatory clarity about some important parts of the policy, with sections for registered mangers, staff, residents, relatives and friends of residents, as well guidance for local authorities and visiting professionals, and their critical role in supporting this new policy. A number of important questions remain though, relating to the level of evidence that will be required, more detail on exemptions, what level of direct support will be offered to the sector to operationalise this policy, including financial support and legal and HR support. The CQC have also published a statement on their website about how they will monitor against the new regulations and again, more detail on a supportive & empowering regulatory approach is needed.
We all understand how important it is that we continue to raise the numbers of staff who are vaccinated within the care and support sector, and that our target should be to achieve the best possible coverage across each and every service – not just in care homes. Providers have been doing an incredible job, working in partnership with local authorities and health colleagues, to enable staff who are not confident around vaccination to have the information and support that they need to make the right choice. This has been done in a way that is respectful to individual rights, and at the same time continues to make the case that vaccination is a crucial part in the armoury against Covid. There has been great success with this approach, and there is so much more that can be done to strengthen the infrastructure of this local response to ensure that each and every person who wants to work in care, or is currently working in the sector can access that support to work through their own concerns and questions. People who work in care have been amazing through this pandemic. They have been consistent, they have often sacrificed time away from family and friends, they have shouldered an extraordinary burden. Surely we know enough about psychology of influencing to understand that the decision to take up vaccination at this point will be best premised by an approach centred around respect and support – not one which is underpinned by an imminent threat to livelihood hanging over an individual’s head?
Vic Rayner OBE, CEO of the National Care Forum – the leading association for not for profit care providers.