Updated: operational guidance on vaccination of people working in care homes

The Department of Health and Social Care has updated its operational guidance for care home providers to align with The Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) (No. 2) Regulations 2022 that were made on 6 January 2022 and will come into force on 1 April 2022.

Since 11 November 2021, all care home workers, and anyone entering a CQC registered care home in England (which provides accommodation for persons who require nursing and personal care) have needed to be fully vaccinated, unless they are exempt under the regulations.

Changes from 1 April 2022

The updated operational guidance sets out some changes that providers will need to take note of in two key areas:

Expansion of authorised vaccines

The definition that will apply is the definition in regulation 3A of the international travel regulations . The vaccines that fall within the scope of this definition are set out in this guidance. But as a reminder, individuals must provide the care home provider with confirmation that they:

• have been vaccinated with a complete course of doses of an authorised vaccine, as that term is defined in the international travel regulations
• have been vaccinated against coronavirus other than by being vaccinated with the complete course of doses of an authorised vaccine (for instance, if they have been vaccinated abroad with a vaccine that is not an authorised vaccine)
• if 10 weeks or more have passed since that vaccination, they must also provide the registered person with evidence that they:
  • have had a ‘top-up’ dose of an authorised vaccine
  • have been vaccinated with a vaccine listed in schedule 4A of the VCOD2 regulations, in accordance with the corresponding number of doses listed in that table
  • are medically exempt
  • are participating or have participated in specific clinical trials (more information about clinical trials can be found in the code of practice on the prevention and control of infections, which is currently being updated and will be published “as soon as possible”)

The guidance sets out clearly that in cases where an individual has been vaccinated with a vaccine not currently considered ‘authorised’, they must provide evidence to the registered person of this vaccination.

In circumstances where it has been 10 weeks or more since the date of that vaccination, the guidance provides that the individual should not be permitted to enter the care home unless they provide evidence that they have received:

• one ‘top-up’ dose of an authorised vaccine (as set out in the guidance on approved COVID-19 vaccines, and countries and territories with approved proof of vaccination)
• a vaccine listed in column 1 of the table in schedule 4A to the VCOD2 regulations, in accordance with the corresponding number of doses listed in column 2 of that table

The Government has also recently announced temporary changes to the Health and Care Visa which will mean social care workers, care assistants and home care workers will be eligible to work in the UK under this visa. This temporary measure will be in place for a minimum of 12 months and will take effect from 15 February 2022. This is a welcome announcement and will help care providers struggling to fill gaps caused by staff shortages within the social care sector.

End to temporary self-certification of medical exemptions

A temporary self-certification process was introduced in September 2021, with individuals able to self-certify until 24 December 2021, but this was subsequently extended until 31 March 2022.  

However after 31 March 2022, exemptions will need to be evidenced by the formal process and care workers will not be able to work in the care home beyond this date, without proof of vaccination or a formal exemption.

The guidance does include information on other methods of temporary exemptions to cover those individuals with Covid-19 who should not receive the vaccine until they have recovered, with vaccinations deferred until individuals are clinically recovered after four weeks.

For the purposes of the regulations, such individuals may be considered temporarily medically exempt from needing to demonstrate that they have received their first, second or ‘top-up’ dose of an authorised vaccine.

This temporary medical exemption will apply for a 28-day period, starting from an individual’s first confirmed positive test result plus an additional 14 days, which individuals can use to satisfy the vaccination requirements. This gives a total of 42 days.

The guidance explains that temporary medical exemptions based on recent infection can be evidenced in a different way to other medical exemptions. But further information about how temporary medical exemptions on the basis of recent infection with Covid-19 will work in practice, including how they relate to the different vaccination requirements under the regulations, will be published in separate guidance.