On 14 April, we informed the House of our intention to consult on a proposal to amend regulations to require care home providers, with at least one resident over the age of 65, to deploy only those workers who have received both doses of their covid-19 vaccination (or have a legitimate medical exemption from vaccination).
An extensive six-week consultation, addressing both whether this change should be made and how, has now been completed. We have seen a substantial level of engagement with the consultation with care home staff, providers, wider stakeholders, residents and their families, in addition to the general public, making their views known. We have received over 13,500 responses to the consultation. We are very grateful to all those that took part. These contributions have been comprehensively analysed and carefully considered, and I now wish to inform the House of the Government’s response.
The Social Care Working Group of the independent Scientific Advisory Group for Emergencies (SAGE) has advised that a vaccine uptake rate of 80% in staff and 90% in residents, in each individual care home setting, would be needed to provide a minimum level of protection against outbreaks of covid-19.
The current overall figure of 84% for staff uptake and 95% for residents masks significant variation at a regional, local and individual care home level. As of 13 June, only 65% of care homes, with residents over 65, in England, are currently meeting this dual threshold for the first dose, and the proportion is lower in London with only 44% reaching the dual threshold. And—while the SAGE working group advice is specifically about first doses—it should be noted that, for second doses, only 41% of homes are reaching this 80% to 90% level of coverage, with London having furthest to travel on only 23%. Therefore, there is a strong case for introducing a new requirement, in order to make these very high-risk environments as safe as possible from the devastating effects of covid-19.
While a majority of respondents to the consultation did not support the proposal, the responses from the adult social care sector were mixed, with some groups (e.g. care home providers) supporting the proposed legislative change while others (e.g. members of the adult social care workforce) were opposed. While some of those who receive care and their relatives have expressed caution about vaccination as a condition of deployment, many have told us that they want themselves (or their relative) to be cared for by someone who is fully vaccinated.
We see a clear public health rationale for driving vaccination uptake in care homes. It should also be noted that significant parts of the adult social care sector (providers and workforce) do support the proposal. It is our view that the combination of consultation responses and public health evidence provides a strong foundation on which to proceed with the policy. This is based upon minimising transmission of covid-19 and protecting residents in high-risk settings who are most vulnerable to severe illness and death as a result of contracting the virus.
We will be making three key changes to the proposals set out in the original consultation document. These changes are in response to views expressed in the consultation and are made with the intention to best protect all care home residents who are clinically vulnerable to covid-19.
Extend the scope of the policy to all CQC-registered care homes in England providing accommodation for persons who require nursing or personal care, not just care homes which have at least one person over the age of 65 living in their home. This will bring into scope care homes for working age adults.
Extend the condition of deployment to include all persons working in a care home, regardless of their role (excluding residents of the care home; friends and family of residents; those entering to assist with an emergency; those undertaking urgent maintenance work; and those under the age of 18). The condition will apply, for example, to healthcare professionals, hairdressers, tradespeople and CQC inspectors. The requirement will not apply to the outdoor surrounding grounds of care home premises.
The initial proposals set out that individuals would be exempt from the requirement if they have an allergy or condition that the Green Book lists (chapter 14a, page 16) as a reason not to administer a vaccine. We will additionally provide exemptions for those under the age of 18; those who are clinical trial participants; and, in exceptional circumstances, where a person has a medical reason not to be vaccinated. Guidance will give more detail about exemptions, which will reflect the Green Book on immunisation against infectious disease (covid-19: the Green Book, chapter 14a) and clinical advice from the Joint Committee of Vaccination and Immunisation (JCVI).
The Government’s intention is to bring an amendment to the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 legislation to the House, at the earliest opportunity. If approved by Parliament, there will be a 16-week grace period from when the regulations are made to when they come into force, to enable staff who have not been vaccinated to take up the vaccine.
A copy of the Government’s response to the consultation will be deposited in the Libraries of both Houses.
Intention to launch a wider consultation
The responses to this consultation made a clear case for extending this policy beyond care homes to other settings where people vulnerable to covid-19 may also receive care.
We will therefore launch shortly a further public consultation on whether or not to make covid-19 vaccination a condition of deployment in healthcare and the wider social care sector, to help protect patients and the people they care for from becoming seriously ill or dying from the virus.
The consultation will also explore whether flu vaccination should be a condition of deployment in the health and social care sector. Flu is a serious illness for vulnerable cared-for people who may suffer serious complications from infection, including death. Outbreaks of flu in care settings are common most winters and it is important we explore this option to protect those at risk.