Mandatory COVID-19 vaccination: what you need to know, and could the flu jab be next?
Posted 12 November 2021 - 17:02
With the rule change means for nurses in England, the likely impact on NHS and care sector staffing, and how lingering vaccine hesitancy could be addressed
- Being double-vaccinated against coronavirus will be a condition of employment for nurses in England’s NHS from April 2022 – bringing them into line with staff in social care
- Failure to comply could result in redeployment or even dismissal
- Find out what the implications are of mandatory vaccination for your workplace, and whether rules in Scotland, Wales and Northern Ireland are likely to follow England’s lead
COVID-19 jabs will be mandatory for all patient-facing nurses and other staff in England’s NHS from April 2022.
Only staff who are medically exempt or have no face-to-face contact with patients will not be compelled to get the jab.
But how many nurses are actually unvaccinated? And what could the move mean for staffing levels?
Here, Nursing Standard looks at the key dates and implications for practice.
How many staff are currently unvaccinated?
The government’s impact statement on the measures suggests 73,000 NHS staff who have not yet had both doses of the vaccine.
However, there is only a small number of people for whom vaccination is contraindicated.
April 2022
Mandatory vaccines for all patient-facing NHS staff in England, unless medically exempt, comes into force
Why the April deadline for having both jabs?
Announcing the new rule in the House of Commons on 9 November, health and social care secretary Sajid Javid said the spring deadline would allow managers to plan and give NHS staff time to make ‘the positive choice’.
The move follows a consultation on compulsory vaccines in social care that resulted in it being made compulsory for care home staff to be double-jabbed by 11 November 2021.
An amendment to the Health and Social Care Act 2008 means care home providers and now NHS employers will only be able to deploy those staff who had the COVID-19 vaccination, or those with a legitimate medical exemption, in direct patient care.
What are the criteria for medical exemption from coronavirus immunisation?
Those most likely to apply to nursing staff are contraindications, including severe allergies to the vaccines. Criteria affecting the wider community include being at the end of life, or at risk of severe distress at receiving the injections, as a result of having learning difficulties.
The Green Book has a section on contraindications and precautions in relation to the coronavirus vaccines.
Will some staff leave rather than be compelled to accept vaccination?
Unions, healthcare leaders and nurses themselves have warned making jabs mandatory could lead to resignations. NHS Providers chief executive Chris Hopson previously called for any decision to make vaccines mandatory to be delayed until spring to allow for ‘supportive’ conversations with vaccine-hesitant staff.
He said making jabs mandatory before winter could result in resignations before a ‘very difficult’ winter ahead.
Unions, including the RCN, have warned that the policy could alienate staff and exacerbate workforce shortages. In response, Mr Javid said he didn’t want to see anyone walk away from the NHS because of the decision.
Could someone lose their job if they refuse to have the vaccine by April 2022?
RCN guidance states that where possible employers should consider redeploying staff to lower risk areas. However, it makes the point that for small providers, this may not be feasible, and staff who continue to refuse vaccination may face dismissal.
How else could it affect staffing?
In its response to the consultation, the government pointed out that a higher level of vaccination uptake was likely to reduce sickness absence.
Before the pandemic, staff absence levels were running at 4.1%, but reached more than 12% in the first COVID-19 wave in April 2020. As of 6 October 2021, there was an average of 74,863 sickness absences per day in England’s NHS, of which around 15,500 staff were absent for COVID-19 reasons, including the need to self-isolate.
What can nurses in Scotland, Wales and Northern Ireland expect?
The Welsh and Scottish governments have indicated they are currently no plans to explore mandatory vaccinations.
However, on 9 November Northern Ireland’s health minister Robin Swann announced a public consultation on a proposal for compulsory COVID-19 and flu vaccination for new health and social care workers.
Mr Swann said requiring existing staff to be jabbed could be counterproductive and could destabilise a workforce that is already severely depleted.
He insisted no option was ruled out and said he sympathised with the view that patients should only be treated by fully vaccinated staff.
Does this mean a compulsory flu jab for nurses in moving a step closer?
The government consultation also explored mandatory flu jabs for patient-facing staff. Flu jabs will not be mandatory, but the situation will be kept under review, according to Mr Javid.
Are any other vaccines currently mandatory for NHS staff?
During media interviews in March 2021, former health and social care secretary Matt Hancock claimed a precedent was set when doctors were required to be immunised against hepatitis B.
‘There are still avenues to explore to encourage staff to have the vaccine. Some managers think they have done everything. But they have to ensure people are being treated with sensitivity’
But while this vaccine is strongly recommended for healthcare staff by the Green Book, it is not mandatory. The Green Book states: ‘Hepatitis B vaccination is recommended for healthcare workers who may have direct contact with patients’ blood or blood-stained body fluids.’
However, some employers appear to insist that anyone at risk as a result of exposure-prone procedures be vaccinated before being offered employment.
Are COVID-19 vaccines mandatory for healthcare staff anywhere else in the world?
On 9 November Northern Ireland health minister Robin Swann announced a public consultation on proposals for mandatory COVID-19 and flu vaccination for new health and social care workers.
Ministers in Scotland and Wales indicated they have intentions to do likewise.
73,000
NHS staff who have not yet had both doses of the vaccine
In April 2021, Italy became the first country in Europe to make coronavirus vaccination mandatory for healthcare workers.
Health professionals who refuse to accept vaccination will have the option to be transferred to duties that do not risk transmission of the virus, otherwise be suspended without pay for as much as a year.
The move was backed by the Order of Doctors, Surgeons and Orthodontists at a time when Italy, which was severely affected by the virus, faced its third wave.
In September 2021, France made it mandatory for healthcare workers to be vaccinated unless medically exempt. By October all healthcare workers were expected to have been double-jabbed.
What approach is being taken with staff who are still declining the COVID-19 vaccine?
Guidance from NHS England suggests conversations about vaccine hesitancy could be undertaken with a line manager or another ‘person of trust’ such as a vaccinator, peer or chaplain.
Mr Javid told parliament the government would continue to encourage unvaccinated NHS staff to get the jab, including through engagement with communities where there is low uptake, and one-to-one conversations. He said unvaccinated staff should not be ‘scapegoated, singled-out or shamed’.
‘I refuse to get the jab. It’s my body, my choice and I will not be blackmailed’
Nurse’s post on Nursing Standard Facebook page
RCN general secretary Pat Cullen urged managers to use the time between now and April to continue engaging with nurses who have not yet had the jab.
‘This is vital to understanding their concerns, supporting them to understand the importance of the vaccine and to make that important choice.’
What is the position of nursing unions?
The RCN and Unison favour encouragement, not compulsion.
‘There are still avenues to explore to encourage staff to have the vaccine,’ says Unison national officer for nursing Stuart Tuckwood. ‘Some managers at trusts think they have done everything. But they have to ensure that people are being treated with sensitivity.’
Nurses had been under stress due to the pandemic, and that could affect their decision-making, Mr Tuckwood adds.
What does the nursing community think about mandatory vaccines in general?
Nurses shared their views on social media following the government announcement on 9 November. Some nurses agreed mandatory vaccines are necessary, while others feared the move would leave the NHS short-staffed.
15,500
NHS staff were absent for COVID-19 reasons, including having to self-isolate, as of 6 October 2021
(Source: Government response to vaccine consultation)
One nurse used Nursing Standard’s Facebook page to share her fear compulsory vaccinations would result in resignations, echoing earlier warnings from NHS Providers.
The nurse posted: ‘The small unit I work on will lose about ten members of its staff out of 30ish and we are already struggling staff wise.’
Another said: ‘I'm just waiting for this to happen in Scotland. I will be sacked as I refuse to get the jab. It’s my body, my choice and I will not be blackmailed into taking something.’
What does the Nursing and Midwifery Council (NMC) say?
The NMC says it would expect most registrants to be vaccinated because of the risk of spreading coronavirus to vulnerable people.
‘Our standards make clear that professionals have a responsibility to maintain their own level of health. And that they should take all reasonable personal precautions to avoid potential health risks to colleagues and people receiving care,’ the regulator says.
However, NMC chief executive Andrea Sutcliffe has said refusal to have the COVID-19 vaccine would not become a fitness to practise issue, rather it was up to employers to act if deemed necessary.
What do legal experts think?
The current approach with hepatitis B vaccination and the use of employers’ health and safety policies has not been tested in law, and does not necessarily represent legally-binding precedent, Isra Black, lecturer in law at University College London, says.
Mandatory vaccination interferes with the right to private life protected by the European Convention on Human Rights, so the relevant authorities would need to show that the interference is justified, he says.
Public bodies must also show they have taken into account the Public Sector Equality Duty, including that they eliminate unlawful discrimination, harassment and victimisation and other prohibited conduct.
They must also show that mandatory vaccination policies comply with the requirements of the Equality Act 2010. The situation is more complex for private providers.
‘The human rights and equality dimensions of mandatory vaccination cannot be avoided by the use of health and safety law,’ Dr Black says.
‘We might question the wisdom of the government’s proposal to use health and safety regulations, as proposed in consultation, to enact mandatory COVID-19 vaccination, rather than pursue primary legislation that would enable a robust justification for controversial policy to be offered in parliament.’
Further information
- Compulsory vaccination consultation overview
- Speech by health and social care secretary of state to House of Commons, 9 November 2021
- RCN guidance to employers
- Government response to public consultation on mandatory immunisation of healthcare workers
- Immunisation against infectious diseases, The Green Book
- Contraindications and precautions, The Green Book
- Italy the first country in Europe to make coronavirus vaccination mandatory for healthcare workers
- NHS guidance on supporting workforce coronavirus uptake
- European Convention on Human Rights
- Public Sector Equality Duty
- Equality Act 2010
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