Mandatory vaccinations and medical exemptions of care home workers – government u-turn or a temporary reprieve?

It has recently been reported that care home workers are able to opt-out of the mandatory COVID-19 vaccination requirement by self-certifying that they are medically exempt.

Thursday 16 September 2021 was meant to be the deadline for all carers to have received their first COVID-19 vaccination. This mandatory vaccine requirement for all care home staff has been a source of constant debate since it was announced, with growing concerns that a significant number of care homes may be forced to close and thousands of staff from an already depleted workforce risked losing their jobs if they declined to have the vaccine. The government has been lobbied by both providers and unions that care home workers had been “singled out” and the very real possibility of the doomsday scenario of a mass exodus of care home staff in England, so it perhaps does not come as a great surprise that Whitehall has taken some evasive action (perhaps with an indication as to how many staff had refused the vaccine). However, how effective will this self-certification opt out process be and is it only a temporary fix to what has become a polarising political issue.

Care home staff have been notified that they were required to be fully vaccinated against COVID-19 by 11 November 2021, which meant that Thursday 16 September 2021 was the last opportunity for a first dose unless medically exempt (Sajid Javid has indicated that it was highly likely that the mandatory vaccination policy would be extended to frontline NHS staff in the near future).

It had been reported that an estimated 7% of the total number of care home staff in England registered with the Care Quality Commission (CQC) intended to refuse the vaccine and would therefore no longer be able to care for residents after 11 November 2021. This works out at about 40,000 members of staff which, by any count, is a staggering number that would send shock waves throughout the entire sector and would deepen an already significant staffing crisis, leading to the closure of those care homes where it was determined that there was insufficient staff to maintain safety and quality of care. Some have called the closure of care homes inevitable, which is a very worrying thought, particularly for those staff who have accepted the vaccine but may lose their jobs in any event. This is with the backdrop of care home owners recently reporting concerns that they are struggling to find insurance against COVID-19 claims, which could itself lead to closures, resulting in calls for the government to provide an indemnity similar to that which protects the NHS.

The Department of Health and Social Care’s (DHSC) recent announcement is that care home workers can “self-certify” that they have a medical exemption in respect of accepting the vaccine, implemented so that those “not able to get the vaccine for medical reasons are not disadvantaged”. Exemptions include a terminal illness, a learning difficulty, autism or an allergy to the vaccine. A notable omission is depression and/or anxiety which is no doubt intentional, as this would surely make up the vast majority of those self-certifying. The DHSC states:

“Over 90% of care home staff have received their first dose of a Covid-19 vaccine ahead of the 11 November deadline and we encourage even more staff to get vaccinated to protect their colleagues and those they care for.

Temporarily, those who meet the criteria for a medical exemption will be able to self-certify until we introduce a new system. This will ensure those with medical exemptions can continue working in care homes.

Our message is clear: vaccines save lives and it is our responsibility to do everything we can to reduce the risk for vulnerable people in care homes”.

Although this will be considered a u-turn for some, the clear position is that the exemptions will be temporary, essentially providing only a short-term reprieve for those who intend to decline the vaccine. The plan is for the exemptions to last only until an NHS Covid Pass system is launched but the date of when this is likely to go live is yet to be confirmed and the self-certification form states that the temporary exemption will expire 12 weeks after this clinical review process goes live. The wording and the timing of the announcement suggest that no firm plans have been drawn up regarding this clinical review process which itself may be concerning to some, suggesting nothing more than a knee-jerk reaction to an impending crisis.

However, concerns have been raised about the practical effect of this latest announcement and who, if anyone, will be expected to enforce it. Concerns have already been circulating that a policing role will inevitably fall to care home managers but how they would be expected to do this is unclear.

Self-certification will almost certainly ease the pressure on an already strained sector but for how long? It may be that the government intends to increase its information campaign to encourage more workers to take up the vaccine but this would suggest a somewhat disingenuous approach and a concern for the sustainability of the sector under this policy direction as surely those with medical exemptions are not declining the vaccine out of choice. Time will tell.

It also appears that pregnant care home workers are able to self-certify which may be confusing for some as the current government guidance is that pregnant women should take up the vaccine.

The self-certification process requires the completion of a simple form, stating that the signatory meets the “medical criteria for exemption” but this will only be valid until 12 weeks after a clinical review process goes live, with the intention that once this new system is launched, care home staff must apply for formal medical exemptions through this new process. Therefore the cut-off date when care home workers are required to be fully vaccinated has merely been put back.

The form also states that “I acknowledge that providing false information may result in disciplinary action” but does not specify whether such action will be taken by care homes themselves (as many suspect) or the CQC, ignoring the logistical and cost impact of this and the obvious problem of how anyone would be able to check that false information had been provided, particularly given the numbers expected to self-certify.

This eleventh hour announcement has led some unions to conclude that the government has “fudged it”, calling it “cowardly, incompetent and inhumane”.

Whatever your view, the timing of this latest announcement and how it seems to offer only a temporary reprieve to some care home workers, combined with the lack of detail about the new system approving medical exemptions, suggest that this policy change may have been a quickly taken decision in response to a growing crisis in the care sector that otherwise could have had, and may still have, a significant (some might say, catastrophic) impact upon the entire industry.

Written by Associate Lee Biddle

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