The Ward Round: Is a mandatory covid jab for staff inevitable?

Many readers of The Ward Round will be familiar with the peculiar case of Chelsea and Westminster Hospital Foundation Trust.

Earlier this month, HSJ published an exclusive story revealing trust CEO Lesley Watts had written a letter addressed to the trust’s staff, which said the covid jab would be compulsory for all its employees and this would be written into employment contracts.

However, just a few hours after our story went live, the trust denied there were plans to make the jab mandatory and said the letter had not actually been sent. This perhaps highlights how contentious the issue of a mandatory covid jab is.

Many would, quite rightly, point out frontline healthcare workers are required to have the Hepatitis B vaccine, in line with hospital trusts’ workplace health and safety and occupational health policies.

If someone is applying for a role that could involve “exposure prone procedures” — where a health worker could be in contact with sharp instruments, needle tips or sharp tissues, such as bones or teeth — they are required to have the Hep B vaccine, although the key difference is it is not written into law.

Although in some trusts over 90 per cent of staff have had their covid vaccine, the remaining 10 per cent or so is still concerning employers, because of the pressing need to protect staff and patients from nosocomial infection.

This exact problem has been emphasised in another HSJ story this week, in which West Midlands Ambulance Service University Foundation Trust board papers stated just 48 per cent of the trust’s staff from an ethnic minority background had been vaccinated, compared with only 77 per cent of the trust’s staff overall (although those figures are now a month out of date and HSJ understand both stats have increased since the papers were published). 

It is well known that some staff groups are more hesitant to accept the vaccine than others. A study published earlier this year in the BMJ emphasised the lack of trust in the vaccine from some ethnic minority groups comes from a historical mistrust of government and public health bodies that runs deep through communities. This sits alongside the spread of misinformation to capitalise on these worries.

No silly questions

So what is the solution to this? The WMAS’ answer was to hold one-to-one discussions with staff who have not had the vaccine and also use social media to promote vaccination, with a focus on employees from diverse backgrounds and women.

It said it did consider the option of a covid vaccine being made a condition of employment but decided this could risk the disengagement of the very staff who they want to encourage to have the vaccine.

This is echoed by Milton Keynes University Hospital Trust, whose chief executive Joe Harrison told me this week the trust has found the more open the communication channels, the better.

“It’s important people don’t feel silly for asking a question — that might be the one thing that stops them from getting their vaccination,” Professor Harrison said.

“We have held weekly Q&As with the executive team to pick up questions and provide information and reassurance on the vaccination programme and we have also held dedicated sessions for staff from ethnic minority backgrounds,” he said.

However, despite the emphasis on keeping up staff engagement and providing clear information, Professor Harrison said the trust would be watching the legal developments around whether or not to make the vaccine mandatory with interest.

NHS Confederation director of policy Layla McCay stressed this is a ”complex issue”, and said she believed health leaders were “unlikely to welcome a move to mandating the vaccine for NHS staff”.

Dr McCay suggested speculation around this is ”unhelpful” and added the preferred option was to encourage uptake through informed consent. 

New standards for providers?

When I took to Twitter this week, asking whether a mandatory vaccine was the way forward within NHS organisations, there was an array of different opinions, but a common thread was the need for a national decision.

Matthew Cooke, former government emergency medicine tsar, said a national decision would speed up the process and be more “equitable”.

Dr Cooke added there might be a need to talk about specific staff groups, defined by exposure risk, rather than all NHS staff. 

Laura Churchward, director of strategy at University College London Hospitals FT, said: “We probably have to accept it will have to become mandatory for roles with exposure to patients.”

“I do not think we can do [it] this year [but it] definitely needs to be a national decision,” she added.

As raised by Professor Harrison, many NHS organisations are looking to the ongoing consultation in the care sector, where there is a government proposal to impose a legal obligation on operators of older persons’ care homes to only deploy staff who have had the vaccine.

Andrea James, partner at law firm Brabners, said the requirement would be inserted in the Care Quality Commission fundamental standards, which form part of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014.

“These are the standards below which a provider must never fall,” Ms James said.

“So, if the proposal comes into effect, it really will be a mandatory requirement in terms of being both a legal obligation and the consequences of failing to comply being extremely serious,” she said. “The CQC will be able to use its civil and criminal enforcement powers against providers in breach, including cancellation of a provider’s registration.”

Ms James added her reading of the consultation was that employers would not be required to carry out a risk assessment for staff who refuse a covid vaccine, but instead the obligation would be on the employee to demonstrate they were medically exempt from vaccination.

Employers will clearly be watching the journey of the care sector proposals with great interest — the consultation is due to conclude near the end of May. But in the meantime, the onus is on individual employers to have open and judgement-free conversations with their staff, emphasising the jab will not only protect them, but their patients too.