The much-needed guidance for care homes in the midst of preparing for the new mandatory vaccination rules has been published today.  

There is some helpful clarity in the guidance around some of the challenges for providers but little that is new to that which we have previously flagged in our earlier blog here. One of the most important points providers want to know more about is the process for establishing clinical exemptions. The guidance doesn't give an answer. The guidance states:

"There will be a clear process for staff to follow if they think they may have a clinical reason to be exempt. This process will be aligned with certification for domestic events, exemptions from self-isolation for confirmed contacts and travel. Guidance for certification is being developed and we will add a link to this guidance here as soon as it’s published.

We will be producing separate guidance for clinicians, which will align with guidance for vaccine certification in other public settings. This guidance will help clinicians to verify exemptions."

On Friday 30 July 2021 chapter 14a of the Green Book on Immunisation and Infectious Disease was updated. It has narrowed the group of people who can't be vaccinated. As a result, guidance on the clinical exemptions is all the more critical. Previously it appeared pregnancy would be an exception but the position is now less clear.

Other particular points to note from the guidance include:

• Evidence of vaccination can be demonstrated through the NHS App, the NHS website or the NHS COVID Pass letter. The NHS appointment card cannot be used.
• The registered person doesn't have to retain the evidence of vaccination. They have to retain a record of vaccination status and the date status was checked. You only have to check the evidence on the first occasion they attend the care home. On subsequent occasions, you can just check the records showing that status has previously been checked. It goes on to state "registered persons may choose to make a record of the evidence they have seen for their own internal staff employment record keeping." We consider that is a sensible approach for staff vaccination evidence provided appropriate data protection compliance is in place.
• For those who are clinically exempt the guidance recommends a risk assessment which might include a change in duties.
• On CQC inspection, CQC will look for evidence to confirm systems and processes are in place to comply with the requirement. Registered persons will not be required to show a record of the evidence itself. The provider information return (PIR) will be updated to include a question that asks ‘how are you assured that those you employ and deploy within your service have had their mandatory vaccinations?’
• Booster doses are not currently covered by the regulations but managers are strongly advised to encourage take-up of boosters and boosters may be added to the regulations in due course.
• In relation to recruitment, care homes should notify prospective staff of the requirement at the start of the application process and undertake appropriate checks, during the recruitment process.
• In relation to potential dismissals, the guidance contains a specific section for staff which provides "you should note that the regulations may provide a fair reason for dismissal if you are not vaccinated or medically exempt". The guidance highlights that redeployment to a role where vaccination is not required should be considered. From page 41 of the guidance, there is helpful employment law related advice to account for when having to consider dismissal of staff who cannot comply with the requirements.
• Many providers have already written to their contractors and other people who visit their homes. On this subject the guidance includes a helpful suggestion as follows: "Some people, especially those who do not visit care homes regularly, may not be familiar with the requirement to be vaccinated or medically exempt and may need time to obtain proof of vaccination or medical exemption. Therefore, when booking appointments or making arrangements for visits, it will be helpful to explain the regulations."
• There are also some helpful examples of what might amount to urgent maintenance work and the guidance says managers can use their professional judgment on this.  They will also need to keep a log of all urgent maintenance work during which people entered the home without showing proof of vaccination or medical exemption, and a short description of the incident for record keeping purposes.

For advice relating to mandatory vaccination or for more details of the mandatory vaccination toolkit please do get in touch.