RCN position on mandating vaccination for health and social care staff

Published: 22 September 2021
Last updated: 11 November 2021
Abstract: RCN position on mandating vaccination for health and social care staff

The RCN recognise that vaccination is a key pillar in infection control and disease prevention in healthcare settings. Ensuring there are high rates of vaccination among staff will be increasingly critical to limiting the spread of COVID-19 as seen in the COVID-19 vaccine surveillance reports.

The fundamental position of the RCN is that all members of the nursing team should have any vaccine deemed necessary to help protect themselves, patients, colleagues, family members, and the wider community. We consider this to be best practice. It is enshrined within the NMC code that getting vaccinated is the right thing to do for professional practice for all registrants.

All RCN members should take up the offer of vaccination. Employers across all settings are responsible for ensuring their staff know how and where to access the vaccine.

The RCN has significant concerns that mandating vaccines will further marginalise those who are currently vaccine hesitant and put further pressure on a hugely depleted workforce by forcing people out of employment.  Evidence is already emerging of unvaccinated staff being put at risk of redundancy in care settings following recent changes to the legislation.

Recent surveys have suggested some staff may feel further marginalised if forced to have vaccines. See: London School of Hygiene and Tropical Medicine (2021) COVID-19 vaccination beliefs, attitudes, and behaviours among health and social care workers in the UK: a mixed methods study.

Like the wider population, health and care staff are a diverse group and there are both physical and societal barriers for some vaccine uptake. This needs to be addressed by all organisations and employers, who need to take a proactive approach, which includes:

  • Ensuring staff have easy access to the vaccines they need within the working day.
  • Providing staff with access to clear information about the risks and how to overcome or manage those risks, as well as information about the value and benefits of vaccination.
  • Providing confidential support to staff who have any vaccine related concerns

These measures will help to achieve a high vaccine uptake, as demonstrated by the Tackling Vaccine Hesitancy WHO 2014 report.

Under the Health and Safety at Work Act (1974) employers must ensure, so far as is reasonably practicable, the health, safety and welfare at work of all their employees.  This includes, conducting appropriate risk assessments that reflect the specific context workers are operating in.  Within the assessment of risk, employers must consider mitigations that will reduce those risks, and this could require staff needing to be vaccinated when working with vulnerable groups and in front-line roles or redeployed to another area. No vaccine however, will provide 100% protection. It is therefore essential that staff are also protected by adequate respiratory personal protective equipment (PPE) and work within well ventilated environments with appropriate provision for breaks and rest as per the RCN healthy workplace guidance.

The requirement to have certain vaccines may be included in contracts of employment for new starters working in some roles and sectors which should be read thoroughly before signing to ensure employees are aware of these requirements as they commence their roles. Every effort should be made to support staff to accept vaccination or deploy them to lower risk areas if this is possible. This is similar to the policy for hepatitis b vaccine for health and social care workers which sits within the wider guidance to minimise the risk for staff in exposure prone procedures and blood born virus.

Changes to legislation on mandatory vaccination in England

For staff working in CQC-regulated care homes providing nursing or personal care in England, amendments to the Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) Regulations 2021 came into force on 11 November 2021. The regulations apply to those directly employed within care homes. They also apply to those coming into care homes to do other work, for example, healthcare workers, contractors, and volunteers.

The legislation currently only applies in England and to staff working in all CQC registered nursing and care homes, either as direct employees or providing commissioned care via the NHS or other agencies to residents in the nursing and care homes.

Following further consultation (see the RCN's response here) the government have announced that they will be extending legislation for all frontline staff in CQC regulated healthcare provision to be vaccinated with COVID-19 vaccines as a condition of deployment. It is expected that this will come into force from 1 April 2022. See: Consultation outcome overview - Making vaccination a condition of deployment in the health and wider social care sector.

The devolved administrations currently have no plans to introduce similar legislation, however, where organisations have provision in England but also have services in the devolved nations, they may apply an organisational policy to meet the amended legislation in England. As such this could impact members working for these organisations in other countries. A separate consultation is being considered in Northern Ireland for staff entering new contracts of employment.

The current legislation, applicable to social care staff, provides an exemption for those who cannot be vaccinated for clinical reasons, see ‘Immunisation against infectious diseases, COVID-19 vaccine chapter’. There are very few people for whom vaccination is contraindicated. The regulations do not provide an exemption for religious or philosophical beliefs.

Friends and family visiting a resident are exempt from the regulations. Those needing to provide emergency care or contractors needing to carry out emergency repairs are also exempt.

The DHSC operational guidance and the NHSE/I letter and FAQs to providers details the requirements for staff and employers.

For RCN members on existing contracts who decide they do not want the vaccine, their employer should explore their reasons with them. Employers should consider redeploying staff to lower risk areas if possible. However, it is acknowledged that for small providers this may not be feasible or practical. Where staff continue to decline vaccination, without a medical exemption and they are employed in a care home setting without redeployment options in England, employers may have no option other than to follow their disciplinary processes which could result in dismissal.  Employers will need to take this action based on the change in the law if staff remain unvaccinated. The RCN will be able to support members through the process.

RCN action

The RCN will lobby the DHSC make sure there is robust evaluation on the impact of these regulations. This evaluation needs to consider the impact:

  • on vaccine uptake
  • on any reduction or change to the care available to residents in social care settings
  • and to staff recruitment and retention.
  • The RCN will also expect the DHSC to carry out an equalities impact assessment of these legislative changes.

The RCN FAQs on COVID-19 and the COVID-19 vaccination programme provide further detail.

Influenza vaccine: The RCN position on vaccination for staff having the influenza vaccine is clear and available on the RCN ‘Winter wellness’ resources and campaign page.

Review date: 31 December 2021