The UK Health Security Agency (UKHSA) identify people who are at higher risk from COVID-19 and other respiratory infections as:
Organisations should consider these issues in relation to people in their workforce who may be at higher risk if they contract COVID-19. These issues, where identified, should always be discussed between those managing services and individual workers, who will take advice from occupational health and HR colleagues where necessary.
Employers will need to take into account government advice on vulnerable workers. All new staff should be encouraged to disclose any medical condition that might compromise their health. There may be particular concerns regarding the discussions between those managing services and their team members regarding their health conditions which would normally only be discussed with the worker’s primary care or occupational health advisor.
Those who were considered to be clinically extremely vulnerable including those with weakened immune systems will now follow the guidance contained in Coronavirus: how to stay safe and help prevent the spread.
Organisations will recognise that some team members will have health concerns that they may not wish to discuss with their manager. In this situation a review by the organisations occupational health team or other relevant person may be appropriate.
Age
There is evidence that COVID-19 has a greater impact in older age groups. Therefore, these staff may be more at risk as a result of increased age and likelihood of long-term conditions. Employers will need to consider this and take into account government advice on vulnerable workers.
Although the risks of severe COVID-19 increases with age, it should be noted adverse outcomes relating to COVID-19 occur at an earlier age in people from ethnic minority backgrounds. Employers should consider the intersectionality of their staff when carrying out risk assessments.
Pregnancy
Pregnant people, at whatever stage of pregnancy, are classed as at-risk and a risk assessment/risk assurance conversation is to be carried out. Previous government guidance has been withdrawn and has been replaced with guidance for people previously considered clinically extremely vulnerable from COVID-19
Further information:
The Equality Human Rights Commission (EHRC) Coronavirus (COVID-19) guidance for employers: Your duties on pregnancy and maternity guidance helps employers reduce the impact on pregnant workers or those on maternity leave. You can also find information in the COVID-19 chapter of the Green Book on the COVID-19 vaccination information for pregnant NHS staff.
Underlying health conditions
In supporting workers with underlying health conditions, please see our section on supporting vulnerable staff for further guidance on those classified at being at higher risk, those at increased risk due to complex health problems, and those with underlying health conditions. For these staff, undertaking a risk assessment will enable appropriate support and steps to be taken.
As well as the UKHSA list above, it is important to consider and support all your staff within your organisation and carry out suitable and sufficient risk assessments, where there is a risk to the health, safety, and welfare of employees when they are at work.
Ethnic minority staff
Evidence shows that ethnic minority groups are disproportionately affected by COVID-19, particularly those with comorbidities who are presenting adverse outcomes at a younger age. The reasons for this are not yet fully understood, but the health inequalities present for ethic minority groups have long been recognised.
Within the NHS, 40 per cent of doctors and 20 per cent of nurses are from ethnic minority backgrounds, as are substantial numbers of health care support workers and ancillary staff.
Organisations should ensure that line managers are supported to have sensitive and comprehensive conversations with their ethnic minority staff, recognising the long-standing context of the poorer experience of ethnic minority staff in all parts of the NHS. They should identify any existing underlying health conditions that may increase the risks for them in undertaking their frontline roles, in any capacity. Most importantly, the conversations should also, on an ongoing basis, consider the feelings of ethnic minority colleagues, particularly regarding both their physical safety, their psychological safety, and their mental health.
Vaccination hesitancy is much higher amongst people from some ethnic minorities. Line managers should be mindful and sensitive when having risk assessment conversations. The legitimate concerns and information needs of people from ethnic minority backgrounds should be listened to with respect, and practical support offered to any health care worker to help them decide on their vaccine uptake.
Weight
There is emerging evidence to suggest that one of the risk factors for becoming seriously unwell with COVID-19 is being obese. Some people, such as people from the Asian ethnic group and older people, have comorbidity risk factors that are of concern at different BMIs. Occupational health advice might be required when considering risk factors in these groups, even in people not classified as overweight or obese.
It is helpful for employers to ensure those managing services are aware of emerging evidence-based guidelines for them to be prepared to have sensitive conversations with staff where this is identified as a risk factor and anxieties exist.
NHS England are offering all England based NHS staff living with obesity a 12-week weight management programme to provide support needed to stay active.
Disability, health conditions or impairments that affect day to day living
In line with agreed policies and legal protections, many staff who have underlying health conditions or impairments may be able to continue successfully in work through the application of reasonable adjustments. Some of these adjustments will be formally agreed and some informally adopted by staff to suit their own circumstances. It is possible that the current situation of the COVID-19 pandemic could bring further challenges for some staff with health conditions and/or impairments in terms of amending/altering any reasonable adjustments. This should be assessed and explored as part of any risk assessment process.
Some staff with health conditions and/or impairments may have a weakened immune system, leaving them more vulnerable to getting an infection. There may be issues associated with personal protective equipment (PPE) and those with a mental health condition may feel increased levels of anxiety and stress.
Government advice on vulnerable workers should be followed and every effort made to encourage all staff to disclose any medical condition that might compromise their health. For existing staff, undertaking a risk assessment will enable mitigating factors and additional support to be explored.
Gender
There was some emerging evidence to suggesting that COVID-19 may impact more on people born to the male gender, so employers may need to review the approach they have taken in relation to risk assessment in light of this.
However, research also suggests that people born to the female gender are more susceptible to suffer from long COVID, which is a factor to be considered when female employees are returning to work. Our web page on supporting recovery after long COVID will help inform risk assessment considerations and reasonable adjustments to be made. The Faculty of Occupational Medicine (FOM) has updated their guidance aimed at managers and employers, to assist them in facilitating the return to work of staff members who were unable to work due to long COVID. This guidance includes a set of practical steps, a state of fitness for work, and supplementary policy and guidance documents.
Religion or belief
COVID-19 may continue to coincide with specific religious events – some of which may require staff to fast. This may have an impact on the ability of individual members of staff to perform their role fully, especially when wearing the highest levels of PPE. Those managing services should have a thorough and comprehensive conversation with individual staff about how they will cope in these circumstances and consider what adjustments could be made.
Employers should also consider the need for staff generally to be able to take time to conduct spiritual/religious reflection away from the frontline.