Preserving and protecting the health, safety and wellbeing of staff and keeping them well is critical for the NHS as we respond to the COVID-19 outbreak.
It is essential that NHS organisations take every effort to support the physical and mental wellbeing of our people, to enable them to stay 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 in this period, encouraged to rest, take any regular and prescribed medication, and to look after themselves and their teams.
Staff with comorbidity and those who are extremely vulnerable.
The government is actively reviewing the advice to protect those people who are extremely vulnerable from COVID-19 due to underlying health conditions. Those deemed to be extremely vulnerable are listed below. The national guidance on shielding and protecting people should be referenced and applied to staff who are in these groups.
Comorbidity is a medical term that is applied when individuals have multiple health conditions that co-exist. People with comorbidity are more likely to develop complications with their health. Viruses can make chronic health problems worse and high-risk groups may experience a worsening of their conditions.
Staff in the extremely vulnerable category.
The NHS in England will now be directly contacting individuals who are deemed to be extremely vulnerable to recommend that they take more stringent measures to protect themselves due to specific clinical conditions.
Individuals will be contacted by the NHS over the next week with detailed advice on what steps they should take next and why. People who will be contacted are those who may be at particular risk due to complex health problems. The following list is current as at 21 March 2020 and will be updated regularly as the guidance changes.
Complex health problems include:
1. Solid organ transplant recipients
2. People with specific cancers:
- people with cancer who are undergoing active chemotherapy or radical radiotherapy for lung cancer
- 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 6 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.
For the small number of NHS staff in this category, there are ways that organisations can help:
- Advise them not to contact their GP or healthcare team and to wait until they are contacted directly. In this period, if staff identify to this category, they should be supported to work flexibly, remotely or be redeployed from any high-risk area.
- If staff have not been contacted by the NHS over the next week and think they may be at particular risk due to these specific health conditions, they should then get in touch with their GP practice for further advice.
- Where staff receive a call from the NHS Business Services Authority, they should then contact their line manager to discuss reasonable adjustments.
- Where staff are contacted and advice is provided to them, organisations should support them 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 all interaction between them and others. The national guidance strongly advises people with serious underlying health conditions (listed above), which put them at very high risk of severe illness from COVID-19, to rigorously follow shielding measures in order to keep themselves safe.
People in this category are strongly advised to stay at home at all times and avoid any face-to-face contact for a period of at least 12 weeks from the day they receive the letter from their GP or healthcare team. This period could change as circumstances progress.
For staff members in this category, the NHS will support staff to stay well and contributing to work, where national guidance allows and adjustments can be made to enable staff to work from home.
What should staff do if they live with someone who needs to shield themselves?
While the rest of your household are not required to adopt protective shielding measures for themselves, the guidance suggests that staff would need to follow the advice stringently on social distancing to minimise the risk of the virus spreading within the home.
This would include 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.
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.
Staff in at risk groups
In addition, advice from government confirmed that the following groups of people should take particular care to minimise their social contact:
- People over the age of 70.
- People with an underlying health condition.
- Pregnant women. We know The Royal College of Obstetricians and Gynaecologists will provide and regularly review/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 emphasis will be on both protecting individuals and redeploying any staff who need to be working from home in services such as 111, ambulance dispatch, and virtual patient consultations. Adjustments may include working remotely 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, where staff have underlying health conditions, how stable it is. Where a condition is unstable and there may be an increased risk to staff, 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 have to be 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.