Supporting our most vulnerable people

COVID-19 health, safety and wellbeing

Preserving and protecting the health, safety and wellbeing of staff is critical for the NHS as we respond to the COVID-19 outbreak.

Employers should implement health, safety and wellbeing measures to support and protect staff , as well as ensuring all NHS staff to follow guidance for social distancing.

Employers and staff should follow specific guidance for staff who are in the extremely vulnerable or vulnerable 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.

People with the following conditions fall into the extremely vulnerable group. The list is current as 14 October 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. 

Government guidance on shielding  updated on 1 August paused shielding for clinically extremely vulnerable staff, nationally.   

Local COVID-19 alert levels - updated 14 October 2020

Shielding is currently still paused for all areas of England. If the government re-introduced shielding advice, staff in the clinically extremely vulnerable category would receive advice directly. Employers should still support clinically extremely vulnerable staff to work from home if possible, or should support them to return to the workplace safely where this isn’t possible, following our guidance on supporting staff to return to the workplace.  

Employers and staff should follow the latest government guidance for clinically extremely vulnerable people, based on the COVID-19 alert level system. Where a staff member travels between different areas for work, or lives in a different area to their workplace, the guidance for the higher alert level should be followed.

If national or local guidance changes require clinically extremely vulnerable staff to shield, the guidance below should be followed. 


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 who are required to shield due to the changes in national or local restrictions, should follow government shielding advice.

Where, due to local restrictions, clinically extremely vulnerable staff are required to shield and are unable to work from home, employers should follow the latest Staff Council guidance on pay and ensure staff receive full pay under the provisions of COVID-19 special leave. 

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.   

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 to 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
  • diabetes
  • 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.



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