Preserving and protecting the health, safety and wellbeing of staff is critical for the NHS as we respond to the COVID-19 outbreak.
It's essential that NHS organisations enable them to stay mentally and physically healthy and protect themselves, their colleagues, patients and families as we continue to deliver services through this challenging period.
All NHS staff should be provided with supportive self-care advice, be encouraged to rest, take any regular and prescribed medication, and look after themselves and their teams.
Employers should support all NHS staff to follow guidance for social distancing, and specific guidance for staff who are in the extremely vulnerable or at-risk categories:
Staff in the clinically extremely vulnerable category
This guidance relates to staff who are at very high risk of severe illness from COVID-19 because of specific underlying health conditions. The government guidance on shielding should be applied to staff in this group.
People with the following conditions fall into the extremely vulnerable group. The list is current as per the government’s update on 1 June 2020 and will be updated if the guidance changes.
1. Solid organ transplant recipients.
2. People with specific cancers:
- people with cancer who are undergoing active chemotherapy
- people with lung cancer who are undergoing radical radiotherapy
- people with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage of treatment
- people having immunotherapy or other continuing antibody treatments for cancer
- people having other targeted cancer treatments which can affect the immune system, such as protein kinase inhibitors or PARP inhibitors
- people who have had bone marrow or stem cell transplants in the last six months, or who are still taking immunosuppression drug.
3. People with severe respiratory conditions including all cystic fibrosis, severe asthma and severe COPD.
4. People with rare diseases and inborn errors of metabolism that significantly increase the risk of infections (such as SCID, homozygous sickle cell).
5. People on immunosuppression therapies sufficient to significantly increase risk of infection.
6. Women who are pregnant with significant heart disease, congenital or acquired.
7. Other people who have been classified as clinically extremely vulnerable, based on clinical judgement and an assessment of their needs, by their GP or hospital clinicians.
The NHS in England has directly contacted individuals who are deemed to be extremely vulnerable to provide them with further advice. If a staff member believes that they fall into one of the able categories of clinically extremely vulnerable people listed above and have not been contacted, they should discuss any concerns with their GP or hospital clinician.
Where staff have been contacted to inform them that they fall into one of the extremely vulnerable categories , they should contact their line manager to discuss reasonable adjustments. Employers should follow our reasonable adjustments guidance. Organisations should support staff as much as possible to adjust to this and allow them time to make any necessary personal arrangements.
Shielding is a measure to protect people who are clinically extremely vulnerable by minimising the risk of coming into contact with the virus. People in this category are strongly advised to follow shielding guidance to stay at home as much as possible until 31 July 2020.
For staff members in this category, the NHS will support staff to stay well and contributing to work, where adjustments can be made to enable staff to work from home. Employers should follow our guidance on supporting staff to work from home and develop specific local support for those working from home during the pandemic.
Where employees are shielding and there is no prospect of them working from home, employers should follow the guidance on pay during shielding.
Recent changes to shielding guidance
The government has set out steps to relax guidance for those shielding in two stages, subject to clinical scientific and medical evidence.
From 6 July, clinically extremely vulnerable people who are shielding will be able to meet outdoors in groups of up to six and create a ‘support bubble’ with one other household. At this stage, people who are shielding should still maintain strict social distancing and minimise contact with others, and this includes not going in to work. Employers should continue to support people who are clinically extremely vulnerable to shield, including supporting them to work from home or, if there is no prospect of them working from home, following guidance on pay during shielding.
From 1 August, clinically vulnerable people who are shielding will be able to return to work if they cannot work from home. Employers should undertake an individual risk assessment, using our risk assessment guidance, to support individuals who are shielding to return to work and implement adjustments or redeployment for any staff in these groups.
For any NHS staff member concerned about returning to work, it is recommended they speak to their employer and line manager to understand their specific policies around health and safety and workplace attendance, especially in relation to COVD-19. This guidance will shortly be updated with further advice for employers on supporting staff to return to the workplace following shielding.
What should staff do if they live with someone who needs to shield themselves?
If living with someone who is advised to shield, other household members are not required to adopt shielding measures for themselves, however, the guidance suggests that they would need to stringently follow the advice on social distancing to minimise the risk of the virus spreading within the home. Staff members should discuss any concerns with their manager and employers should make every effort make adjustments where possible.
This includes minimising time in shared spaces, keeping shared spaces well ventilated, and keeping two metres away from people who you live with. For detailed information please see the guidance on shielding.
Staff members should discuss any concerns with their manager and employers should make every effort make adjustments based on individual circumstances . Adjustments may include working from home or temporarily moving into hotel accommodation. Where employees feel unable to attend work due to living with someone who is shielding, employers should follow guidance on pay for this situation .
For staff members in this category, the NHS will support staff to stay well, protect their families and continue to work where national guidance allows and where reasonable adjustments can be made where required. Some staff may also be carers for extremely vulnerable people, friends, family members or neighbours.
Staff in clinically vulnerable groups
In addition to those in the extremely vulnerable category, the government advises that the following groups of people should take particular care to minimise their social contact through social distancing:
- People over the age of 70.
- People with one of the following underlying health conditions:
- chronic (long-term) respiratory diseases, such as asthma, chronic obstructive pulmonary disease (COPD), emphysema or bronchitis
- chronic heart disease, such as heart failure
- chronic kidney disease
- chronic liver disease, such as hepatitis
- chronic neurological conditions, such as Parkinson’s disease, motor neurone disease, multiple sclerosis (MS), a learning disability or cerebral palsy
- problems with your spleen – for example, sickle cell disease or if you have had your spleen removed
- a weakened immune system as the result of conditions such as HIV and AIDS, or medicines such as steroid tablets or chemotherapy
- being seriously overweight (a body mass index (BMI) of 40 or above).
- Pregnant women. The Royal College of Obstetricians and Gynaecologists will provide and regularly review and revise the latest guidance and information. Specific information is provided in the guidance for healthcare workers who are pregnant. We therefore advise all staff who are pregnant to discuss their individual circumstances with their local occupational health department, so that the appropriate support/actions can be taken dependent on which trimester they are in, underlying health conditions and the nature of the roles they are undertaking.
- The Equality Human Rights Commission (EHRC) has recently issued Coronavirus (COVID-19) guidance for employers: Your duties on pregnancy and maternity to help employers reduce the impact on pregnant workers or those on maternity leave.
In addition to the list above, some staff members may be more at risk from the consequences of Covid-19, due to their race, age or disability. Employers should undertake an individual risk assessment, following our guidance, to support individuals and implement adjustments or redeployment for any staff in these groups. Adjustments may include working remotely, for example in 111 services, ambulance dispatch or virtual patient consultations, or moving to a lower-risk area.
Line managers should seek support on individual staff circumstances from the locally nominated emergency preparedness, resilience and response (EPRR) lead or, for example, medical/nursing director or chief operating officer, to make this happen. NHS organisations are encouraged to make it clear who the point of contact is.
Action to be taken for staff will depend upon their individual circumstances and the locally nominated lead should ensure that conversations are undertaken with those staff about what steps need to be taken to keep individuals safe, and specialist advice taken as required. In addition, they will continue to need the support of their line manager and local occupational health service.
Where staff are redeployed or work from home, consideration should be given to what duties they can continue to carry out, and what support they will need to do this. Assistance should be provided to those staff who can continue to work remotely by:
- ensuring they are aware of the Public Health England (PHE) guidance and how they can protect themselves
- seeking further advice from occupational health in the first instance, and, where required, further consultation with their specialist doctor regarding their underlying condition in order to optimise their condition where possible
- signposting to further areas of support such as employment assistance programmes (EAP) or counselling.
Our people are the most important consideration as they respond to the COVID-19 pandemic. In these unprecedented times, our people more than ever will be making every effort to care for patients and the population, and we must equal that with the care for them.