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Could compulsory vaccinations in care homes be counterproductive?

The great news at the end of last week was that more than 50% of the English population have now been vaccinated, including 90% of those aged over 60. However, there is growing concern about the lack of take up by care home staff where 30% of them have failed to accept the offer.

The issue is giving the government such concern that they are now considering compulsory immunisation with care workers being legally required to have a Covid-19 vaccinations.

Heart of the matter

Central to the issue of vaccination of care workers is the choice of the care worker and the protection of those who use social care services.

On the one hand, Legally forcing workers to have a vaccine raises serious legal and ethical questions. Government ministers including Nadhim Zahawi, the vaccines minister, have previously called similar ideas mandating vaccination, including vaccine passports, “discriminatory”.

A previous report of a government plan to force all NHS and care staff in England to get vaccinated was criticised as “sinister” by Unison. “Forced vaccinations are the wrong way to go, and send out a sinister and worrying message,” said Christina McAnea, the general secretary of Unison, which represents about 100,000 NHS staff.

On the other hand, social care workers have a duty of care to protect people who use care services from infection. Indeed, in English Law. A duty of care is the legal responsibility of a person or organization to avoid any behaviours or omissions that could reasonably be foreseen to cause harm to others.

The Social Care Institute of Excellence emphasise that ‘exercising the duty of care is about acting as any other reasonable person in a responsible way towards others to keep them safe from immediate significant danger and protect from being put at risk of significant harm’.

Nor should we forget the human rights of residents who have a right to be protected from known disease that can cause them harm.

Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 17 Good Governance states that providers must have systems and processes that must assess, monitor and mitigate any risks relating the health, safety and welfare of people using services and others, that is not to say their human rights

Repercussions of a legally binding approach

According to details of a paper submitted to the Covid-19 operations cabinet subcommittee last week, the prime minister, Boris Johnson, and the health secretary, Matt Hancock, have agreed to the proposal in order to protect vulnerable residents.

The move would prove highly controversial and could result in legal challenges. The cabinet subcommittee paper warned a large number of social care workers may quit if the change is made and said that lawsuits on human rights grounds could be possible. A government spokesman insisted “no final decisions have been made” but did not rule out jabs being made compulsory for care workers.

If the change is approved it would affect most of the 1.5 million workers in England’s adult social care sector, who would be obliged by law to have a COVID-19 jab.

Actions taken by providers

Last month, one of the UK’s largest care home operators, Care UK, instituted a ‘no jab, no job’ policy, demanding that all new staff be vaccinated before starting work. The move followed Barchester, which said it would insist current staff are vaccinated, warning that if they “refuse on non-medical grounds they will, by reason of their own decision, make themselves unavailable for work”.

Warning against mandatory COVID-19 vaccinations

Some care home operators have warned that mandatory COVID-19 vaccinations for staff could worsen workforce shortages and threaten standards of care.

They said it was the wrong approach to tackling vaccine hesitancy, in particular among young women citing unfounded fears the vaccine could affect their fertility, as well as among some black and minority ethnic groups and among workers from the EU.

Vic Rayner, the chief executive of the National Care Forum, which represents charitable care operators, said legal enforcement posed a “real risk to the ongoing delivery of care”.

“It has the potential to drive people out of the profession and all of the pressure is going to be on managers and employers to do this,” Rayner said.

“We have a relatively older workforce and we really struggle to get young people to join and stay working in care, and there are concerns that this may present a further barrier for young people to join, particularly if this is not applied universally across health and care.

Summary

Embarking on the legal road to compulsory vaccination of social care workers is a threat to the social care industry that may have consequences for retaining and recruiting young people in the care industry. Potentially, this could be counterproductive. But providers have a legal obligation to the duty of care to their residents. This above all must be of paramount concern to all those who provide social care services.

Albert Cook BA, MA & Fellow Charted Quality Institute Managing Director Bettal Quality Consultancy

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