Patient receiving COVID-19 vaccine

COVID-19 and mandatory vaccination

Your rights if you are considering refusing mandatory vaccination

Please see the RCN's position on mandatory vaccines

These FAQs form part of the wider COVID-19 and vaccination FAQs which include links to the current advice for pregnant women, support from religious organisation and wider medical exemptions. 

The RCN strongly recommends all members are vaccinated as soon as they can be. It is considered best practice to protect you, your patients, and clients, as well as friends and family. The vaccine reduces the individual’s risk of severe illness, it will also reduce the chance of you contracting the infection and thereby passing infection to others who are more vulnerable to serious disease as is evident from the emerging evidence from COVID-19 vaccine surveillance reports

It is important that nursing staff have easy access to the vaccines they need during the working day and have up-to-date information, so they can advise patients and the public on vaccination.

We have been clear that making vaccination compulsory could significantly undermine these approaches.

In January 2022, the RCN called on the Health Secretary to delay the implementation of the new law in light of major staffing pressures.

In England, staff working in CQC regulated nursing and care homes who are providing nursing or personal care, are now subject to the Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) Regulations 2021 that came into force on 11 November 2021. These make it a legal requirement for staff to be vaccinated as a condition of their deployment to work.

The government have announced, following further consultation, that this legislation will be extended to include all frontline staff in CQC regulated healthcare provision. This includes all NHS and independent health care services. Staff must be vaccinated with COVID-19 vaccines (unless a medical exemption applies) as a condition of deployment. It is expected that this will come into force from 1 April 2022, as such all staff will need to have had their first dose of vaccine by 3 February 2022 so they can be fully vaccinated by 1 April 2022. There are further resources and information on this from NHS England and Improvement.

The questions and answers below are intended to provide further information and assistance.  

RCN position on mandating vaccination for health and social care staff.

The RCN recognises vaccination as a key pillar in infection control and disease prevention in healthcare settings. Ensuring there are high rates of vaccination among staff is critical to limiting the spread of COVID-19, as seen in the PHE (2021) COVID-19 vaccine surveillance reports.

However, we have stated publicly that mandating vaccines as a condition of employment may further marginalise those who remain unvaccinated, rather than support them to access vaccination. We have also expressed our concerns around the potential impact of mandatory vaccination on many levels, not least on retention of staff which will put further pressure on service capacity during a highly pressured time for the health and care services.  

Here are our responses to the recent consultations for both social care and the NHS, and we did invite and receive feedback from members to inform our responses.  

The RCN believes more can be done to support employers and healthcare providers to address hesitancy using the knowledge and expertise of nurses working in vaccination. That does not detract from individual choice, the intention is to ensure employees get all the support they need to make their decision. There are a few people who will be clinically exempt, but most people can and are advised to have the COVID-19 vaccines. 

In our responses to the consultations, we clearly urged caution in relation to the introduction of an overarching and mandatory vaccination policy.  

Unfortunately, there are very limited legal remedies available for those who remain unvaccinated and do face the prospect of redeployment or dismissal as a result of the amended regulations. Also, two social care workers recently pursued a Judicial Review application in relation to the introduction of the regulations on the 11 November 2021 and that was unsuccessful. Part of their challenge related to human rights and equality issues. Therefore, these issues have been addressed in the courts.  

The RCN is concerned that already marginalised staff, including those with protected characteristics, may choose to leave employment rather than access vaccination, if mandated to do so. We have been clear that the government must mitigate and monitor the impact of implementation of mandatory vaccination on any specific staff groups disproportionately, or on workforce recruitment, retention, and planning more broadly for the delivery of safe and effective services, must also be closely and transparently monitored. We will follow this closely.  

We continue to work with other health unions on all the issues that have arisen around the vaccination programme, and we continue to support our members collectively and individually in their workplace where needed.

In January 2022, the RCN called on the Health Secretary to delay the implementation of the new law in light of major staffing pressures.

Under regulation 7 of the Control of Substances Hazardous to Health Regulations (COSHH) 2002, employers must ensure the exposure of employees to substances (including biological agents and pathogens) hazardous to health is either prevented, or where not reasonably practicable, adequately controlled. 

Under regulation 6 of the COSHH Regulations, an employer shall not carry out work which is liable to expose any employees to any substance hazardous to health unless it has:

(a) made a suitable and sufficient assessment of the risk created by that work to the health of those employees and of the steps that need to be taken to meet the requirements of the Regulations; and (b)implemented the steps referred to in sub-paragraph (a)

This includes taking steps to ensure all staff are protected, so far as is reasonably practicable including the provision of suitable and sufficient personal protective equipment (PPE) where identified by the risk assessment. 

The RCN recommends taking up vaccination as best practice and we also recognise there may be consequences for members at work if they have not been vaccinated.

Staff should however be able to make this decision in a supportive environment.

Staff must have access to the correct information, encouragement and clear explanation of the benefit and value of the vaccine and an opportunity to explore any reasons why an individual is hesitant. NHS England/NHS Improvement have produced some resources to support employers and organisations to have these conversations with staff. The RCN advice guide on the COVID-19 vaccines also provide useful sources of information.

There should be a clear and transparent risk assessment for staff and services impacted. Wherever possible redeployment OR the offer of a suitable alternative role within the organisation or wider health service should be offered.

Vaccines also need to be made easily accessible to staff during the working day. If this is not possible, staff should be paid full normal pay for their time and reimbursed for any travel costs where staff are not able to access vaccines during their normal working hours or at their workplace.

Employers must also monitor the impact of staff vaccination policies on staff recruitment and retention and any equality impact for staff in minority groups.

Similarly, employers need to monitor the impact to service users in terms of the care they can receive.

In their guidance to the COSHH regulations, the Health and Safety Executive (HSE) point out that immunisation should be seen only as a useful supplement to reinforce physical and procedural control measures, not as the sole protective measure.

The HSE advise that some employees may not wish to take up the offer of immunisation, or they may not respond to a vaccine and will, therefore, not be immune. Employers need to still consider the effectiveness of the other controls and consider whether any additional controls should be implemented to allow them to work safely.  In practice this will mean the continued provision of respiratory and other protective equipment, effective ventilation and, where the risk of harm remains high, potentially redeployment. See HSE guidance on Continuing to keep workplaces safe from coronavirus (COVID-19).

ACAS guide on working safely during coronavirus also provides information on occupational health vaccination specifically for COVID-19.

There is further information in Chapter 12 of the ‘Green Book’; immunisation of health care and laboratory staff in the department of Health immunisation against infectious disease.

As a health and social care worker do I have to have the vaccine?

No-one can be forced to have any treatment. In the case of vaccination, which serves to protect individuals but also reduce the burden of disease, it can also help stop transmission of infection. Vaccination may be considered necessary to work in some areas and settings to protect vulnerable patients and clients and to help slow transmission of infection. 

There is further information in Chapter 12 of the ‘Green Book’: immunisation of health care and laboratory staff.

The RCN recognise that there may be consequences for you at work if you have not been vaccinated.

Under the Health and Safety at Work Act 1974 and the UK Infection Prevention and Control (IPC) guidance, employers must ensure so far as is reasonably practicable, the health, safety and welfare at work of all their employees. This includes, carrying out suitable and sufficient risk assessments that reflect the specific context workers are operating in. Also, within the assessment of risk, employers must consider mitigations that will reduce those risks, and this could be the requirement for staff to be vaccinated when working with vulnerable groups and in front line roles. Vaccination however is just part of overall measures to protect staff and patients. It is essential control measures, identified from the risk assessment, such as suitable and sufficient personal protective equipment (including respiratory protective equipment) should also be in place.

Vaccination against certain diseases may be included in contracts of employment for new starters working in some roles and sectors. Every effort should be made to support staff to accept vaccination or deploy them to lower risk areas. This is similar to the policy for hepatitis b vaccine for health and social care workers which sits within the wider PHE, exposure prone procedures and blood born virus guidance.

The evidence for the COVID-19 vaccine is emerging all the time and available in COVID-19 vaccine surveillance reports.

Employers will need to review risk assessments and new starters who refuse vaccination may not be offered employment. In some circumstances it may be possible to consider employing new starters to work in a lower risk environment.

RCN members on existing contracts, who decide they do not want the vaccine, should have their employer explore their reasons with them. Where possible employers should consider redeploying staff to lower risk areas. However, it is acknowledged that for many providers this may not be feasible or practical. Where staff continue to refuse vaccination, they may face dismissal. (Also see section on CQC regulated health care in England). 

If your employer is taking disciplinary action against you for refusing to be vaccinated see our guidance on dismissal.

This may be included in contracts of employment for new starters working in some roles and sectors. Every effort should be made to support staff to accept vaccination or deploy them to lower risk areas. 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.

Staff who decline vaccination should not necessarily be denied employment if it is possible for staff to be employed or redeployment to low-risk areas. It is recognised however, that in smaller organisations it may not be possible or practical to facilitate. As a result, where individuals refuse the vaccines recommended, they may be refused employment.

For RCN members on existing contracts who decide they do not want the vaccine, see the section above and our guidance on dismissal.

In England, staff working in CQC regulated nursing and care homes providing nursing or personal care, are subject  to the Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) Regulations 2021, that came into force on 11 November 2021. These make it a legal requirement for staff to be vaccinated as a condition of their deployment to work. 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, health care workers providing care via NHS or other services, tradespeople, and volunteers.

The government have announced, following further consultation (see the RCN's response), that this legislation will be extended to include all frontline staff in all CQC regulated health care provision, this includes all NHS and independent health care services. Staff must be vaccinated with COVID-19 vaccines as a condition of deployment. It is expected that this will come into force from 1 April 2022. As such all staff will need to have their first dose of vaccine by 3 February 2022 so they can be fully vaccinated by 1 April 2022. There are further resources and information from NHS England and Improvement. The guidance document Vaccination as a condition of deployment (VCOD) for healthcare workers: Phase 1 - Planning and preparation, details the full scope of the requirements.

The Health and Social Care Act regulations are applicable to all ‘workers who have face-to-face contact with patients and/or service users and who are deployed as part of CQC regulated activity’ based on the department of health information. This includes students, bank and agency staff and those working in all NHS trusts and organisations, including primary care. There are some limited exemptions where workers can continue to be deployed without being vaccinated. These are:

  • people under the age of 18 
  • individuals who are clinically exempt, this needs to be demonstrated though the NHS COVID pass 
  • pregnant women, are strongly advised to be vaccinated (see the government advice for pregnant employees). They are however, exempt from the legislation temporarily until 16 weeks post-partum, to allow them to become fully vaccinated after child birth. 

There is further DHSC operational guidance for staff in health and social care.

The RCN will continue to work with employers to mitigate the impact on members’ employment as far as possible. The RCN recognises however, there may be consequences for members at work, if they have not been vaccinated, and their employer deems that vaccination is necessary (due to the law and/or health & safety risks present in the workplace). Please also see the section above on employers’ responsibilities.  

Under the amended Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) Regulations 2021 it is a legal requirement for all staff working in care homes to be vaccinated from 11 November 2021. The legislation will be extended to all workers in CQC regulated health and care services; this includes NHS and independent health care services where staff will need to be vaccinated from 1 April 2022.

See the DHSC operational guidance and NHS England and Improvement Vaccination as a condition of deployment (VCOD) for healthcare workers: Phase 1 - Planning and preparation, for the full scope and details of the requirements.

The legislation currently only applies in England. 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.

For RCN members on existing contracts who decide they do not want the vaccine their employer should explore their reasons with them. Where possible employers should consider redeploying staff to lower-risk areas. However, it is acknowledged that for many providers this may not be feasible or practical. 

Where staff continue to refuse vaccination, they are likely to face dismissal. Those who cannot be vaccinated for clinical reasons, and friends and family visiting are exempt from the regulations. The regulations do not provide an exemption for religious or philosophical beliefs.

The DHSC operational guidance and the NHS England and Improvement provides a letter and also FAQs for care homes and for deployed NHS staff into care homes.  Further guidance for the wider NHS expansion is also provided by NHS England and Improvement

The RCN will continue to work with employers to mitigate the impact on members’ employment, as far as possible. The RCN recognises however, there may be consequences for members at work, if they have not been vaccinated. Once the legislation is in force, there will be little the RCN can do unless there are clinical reasons why staff cannot have the vaccine, or the employer has not followed a fair dismissal process. There are limited legal remedies available for those who remain unvaccinated and staff will face the prospect of dismissal as a result of the amended regulations. There has been a judicial review application in relation to the introduction of the regulations on the 11 November 2021. This application included human rights and equality issues and it was unsuccessful. 

Also see our guidance on your employers’ responsibilities above.

If your employer is taking disciplinary action against you for refusing to be vaccinated see our guidance on dismissal.

 Check your sick pay entitlements as set out in your contract of employment. You should be paid statutory sick pay as a minimum, but your employer may try to argue that any additional element of your sick pay should be withheld. The RCN believes that you should be paid normal pay for absence to prevent cross infection. You should check your employment contract to determine what sick pay is owed to you contractually. If you are unable to resolve the issue, contact us. A claim for unlawful deduction of wages and/or discrimination may be considered.

Under the amendments to Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) Regulations 2021, it is now a legal requirement to check people’s COVID-19 status in certain settings, to ensure some people working in health and social care roles have been vaccinated against COVID-19. The Information Commissioners Office (ICO) has further details.

If you are working in, or deployed to, a care home in England, please see the 'general guidance on demonstrating evidence' section of the Coronavirus (COVID-19) vaccination of people working or deployed in care homes: operational guidance.

For health care staff within the NHS, please see Vaccination as a Condition of Deployment (VCOD) for health care workers planning and preparation (pages 11 and 18 are particularly relevant).

Vaccination information is classed as 'special category data' under data protection legislation - all employers must therefore comply with this. More guidance on this is available from the Information Commissioners Office (ICO). If you have any concerns about how your data is being gathered or used, please contact us

Where members COVID-19 vaccine records are not showing the correct information, they should contact the Vaccination Data Resolution Service (VDRS) by calling 119 and selecting option 4 from the automated menu. Also see the Covid-19 vaccination record service FAQs for further information.

In general the NHS COVID pass, or equivalent from NHS Scotland, NHS Wales or the Department of Health in Northern Ireland will be required by employers as proof of vaccination.

The EU Digital COVID Certificate or Centers for Disease Control and Prevention vaccination card, would also be appropriate.  Alternatively a certificate in English, French or Spanish issued by the competent health authority which contains: your full name, date of birth, the date of each dose of vaccination and the vaccine manufacturer. With the details of either the identity of the issuer of the certificate or the country of vaccination, or both would apply. Full details within the VCOD for Health care workers planning and preparation.

Could I be breaching the NMC Code of conduct if I decline to be vaccinated?

Under the NMC code all registered nurses midwives and nursing associates have a professional responsibility to preserve safety and to take all reasonable precautions necessary to avoid any potential health risks to themselves or others. 

In general, where staff are not vaccinated, they may need to be redeployed to areas with less vulnerable patients, undertake regular testing and have access to additional PPE . Provided that you co-operate with your employer to avoid exposing others to risk, you should be deemed compliant with the NMC code.

There are very few contraindications to vaccination. The RCN are clear that all members should be vaccinated as soon as possible.

What if I am refusing vaccination because of my religion and belief?

COVID vaccination is recommended by UK religious leaders they have a range of resources with useful information to help dispel some of the myths and provide advice for those who are hesitant.

NHS England guidance on supporting COVID-19 vaccine uptake during Ramadan.

Under the amendments to the legislation in England Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) Regulations 2021, there is no exemption for not being vaccinated for religious or philosophical belief reasons.

What if I am refusing the vaccination because I am pregnant?

Pregnant women are strongly advised to have COVID-19 vaccines as soon as they are able. Vaccination not only helps protect the mother but maternal antibodies to the vaccine will provide immediate protection to new born infants. See the guidance from the RCOG and RCN.

Individuals should discuss any concerns they have in relation to their medical history with their GP.

Under the legislation pregnant women can postpone vaccination temporarily until 16 weeks post-partum, to allow them to become fully vaccinated after birth.

What if I am refusing the vaccination because of a medical issue?

The Green book Immunisation against infectious disease Chapter on COVID-19 details the few medical contraindications to receiving the vaccine. There is further information on this guide, Temporary medical exemptions for COVID-19 vaccination of people working or deployed in care homes

Please also see our section on allergies in our COVID-19 and vaccination FAQs.

Anyone who is unable to get vaccinated for clinical reasons will have to use the NHS COVID Pass to show their exemption status, this is the only accepted proof allowed under the guidance

If you are subjected to a detriment as a result of a valid exemption from vaccination, or even dismissed and the reason for your refusal is related your medical condition and vaccination being contraindicated for you, you may have a disability discrimination claim for under the Equality Act 2010, provided your medical condition amounts to a disability. Employers are obliged to make reasonable adjustments for disabled workers if they are placed at a substantial disadvantage in the workplace.

Members who believe vaccination is contraindicated because of an existing medical condition should discuss this with their GP. As with any medical information, your medical reason for refusal should be treated in strictest confidence by your employer, following occupational health guidance.

What is the situation for student nurses on placement?

In England, the amendments to The Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) Regulations 2021 are applicable to student nurses or trainee nursing associates on placement, where there is face to face patient contact. 

Students on placements in nursing and care homes, or within teams who provide care through a wider commissioned service to care homes, have needed to be vaccinated since 11 November 2021.

Students on placements in any CQC regulated service will need to be vaccinated from 1 April 2022. The NHS England and Improvement  guidance advised those students who opt out of vaccination will need to discuss the impact of this to their programme, with the education provider. See our section on the situation for staff working in CQC regulated healthcare provision in England.

The RCN will continue to work with universities and employers to mitigate the impact on members’ employment as far as possible. The RCN recognises however, there may be consequences for students, if they have not been vaccinated.

What about RCN support?

If you intend to refuse a vaccine on medical grounds, please see our employment rights section above. If your refusal leads to a dispute with your employer, please see our guidance on dismissal and contact us for advice and support.

RCN support may be available to support members through a formal process. In England as a result of the regulations, if staff remain unvaccinated and there are no clinical reasons why they cannot have the vaccine, or a fair dismissal process has not been followed, while the RCN will continue to liaise and work with organisations, unfortunately there will be little the RCN can do. 

Looking for something else?

Please see our COVID-19 and vaccination FAQs for our most commonly asked questions about accessing and receiving the vaccine.

If you are a vaccinator, our clinical guidance may also be helpful.

Page last updated - 14/01/2022