Supporting our most vulnerable people

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

Employers should continue to implement health, safety and wellbeing measures, undertake and regularly review risk assessments  (where required) to support and protect staff, and ensure that all NHS staff follow guidance for social distancing and the use of PPE.  Employers should follow the national guidance effective from the 7 January 2021.

National guidance effective from 7 January 2021 

This guidance relates to staff who are at very high risk of severe illness from COVID-19 because of specific underlying health conditions. Staff in this group will previously have received a letter from the NHS or from their GP telling them this. They may have been advised to shield in the past.

The clinically extremely vulnerable will get priority access to vaccination against COVID-19 before the general population and in line with the priority ordering set by the Joint Committee on Vaccination and Immunisation (JCVI). Staff will be contacted directly again by the NHS with more information on when and how they will be invited to get the vaccine.

Everyone in England, including those who are clinically extremely vulnerable, is required to follow the new national lockdown guidance, which has been set out by the government and applies to the whole population.

The new information below includes additional guidance for clinically extremely vulnerable people, to help protect them from COVID-19. These new formal shielding measures will apply across the whole of England during the period of national lockdown.

Employers will not be told directly if their staff are in the clinically extremely vulnerable category so it is vital that managers check in with their staff regularly and ask if their circumstances may have changed, review any risk assessments undertaken, and provide the appropriate support to staff.

This section looks at:

Staff in the clinically extremely vulnerable (CEV) category  – updated 7 January 2021

People who are defined as clinically extremely vulnerable are at very high risk of severe illness from COVID-19. There are two they may be identified as clinically extremely vulnerable:
  1. They have one or more of the conditions listed below, or

  2. Their hospital clinician or GP has added them to the shielded patients list because, based on their clinical judgement, they deem them to be at higher risk of serious illness if they catch the virus.

If your staff think there are good clinical reasons why they should be added to the shielded patient list, they should discuss their concerns with their GP or hospital clinician.

People with the following conditions are automatically deemed clinically extremely vulnerable:

  • Solid organ transplant recipients

  • 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 that 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 drugs.

  • People with severe respiratory conditions including all cystic fibrosis, severe asthma, and severe chronic obstructive pulmonary disease (COPD).

  • People with rare diseases that significantly increase the risk of infections (such as severe combined immunodeficiency (SCID), homozygous sickle cell disease).

  • People on immunosuppression therapies sufficient to significantly increase risk of infection.

  • Problems with your spleen, eg, splenectomy (having your spleen removed).

  • Adults with Down’s syndrome.

  • Adults on dialysis or with chronic kidney disease (stage 5).

  • Women who are pregnant with significant heart disease, congenital or acquired.

  • Other people who have also been classed as clinically extremely vulnerable, based on clinical judgement and an assessment of their needs. GPs and hospital clinicians have been provided with guidance to support these decisions.


Staff in this category are strongly advised to work from home because the risk of exposure to the virus in their area may currently be higher. If they cannot work from home, then they should not attend work.

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.   

Staff members should be encouraged to discuss any concerns with their manager and employers should make every effort to make adjustments where possible.  Staff members should discuss any concerns with their manager and employers should make every effort to make adjustments based on individual circumstances. 

Line managers are encouraged to seek advice from their organisation’s occupational health service to help them to continue to support their staff.

Adjustments may include working from home or temporarily moving into hotel accommodation, however, accommodation costs must now be funded through your organisation. 

If staff need support to work at home, they can apply for Access to Work. Access to Work will provide support for the disability-related extra costs of working that are beyond standard reasonable adjustments an employer must provide.

Where 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 Joint guidance on shielding due to COVID-19 - 23 November 2020 and visit the Joint FAQs on pay protection due to COVID-19 – 11 August 2020.

CEV staff are strongly advised not to go to a pharmacy.  In the first instance, they should ask if any friends, family, or volunteers can collect medicines for them.  If friends and family are not able to collect their medicines for them, and they and/or the pharmacy are unable to arrange for a volunteer, then they will be eligible for free medicines delivery. They should contact their pharmacy to inform them that they are clinically extremely vulnerable and need their medicines delivered, and they will arrange this free of charge.

Protecting staff at risk from COVID-19

In addition to those in the extremely vulnerable category, the government advises that the people over the age of 60 or clinically vulnerable groups should:

  • be especially careful to follow the rules and minimise your contacts with others
  • continue to wash your hands carefully and more frequently than usual and maintain thorough cleaning of frequently touched areas in your home and/or workspace
Clinically vulnerable groups are described as:
  • 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).
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. Although national guidance is that individuals in the clinically vulnerable group may not necessarily be required to shield, employers should continue to check in with their staff and undertake an individual risk assessment, following our guidance, to support individuals and implement adjustments or redeployment for any staff in these groups if necessary.


What are NHS trusts doing?

Oxleas NHS Foundation Trust recognised it needed to support staff from all professions. By using ESR, the trust identified staff who needed to shield and could not work in any capacity from home, which increased numbers from under 50 to 140. The trust provided support to these staff by informing their equality lead and HR teams, developing clear guidance, and supporting managers through online sessions to help improve their understanding.


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