From last Thursday, the 11th November, the government mandated that care home workers who were not double vaccinated were no longer allowed to enter their place of work. This was in spite of the fact that care leaders, including Nadra Ahmed, the Executive Chair of the National Care Association (NCA) called on Sajid Javid to postpone the deadline to April, bringing it in line with the deadline for NHS staff to be double vaccinated. The government’s stubborn refusal marks the latest in a series of misguided Covid policy decisions spanning the entire pandemic.

The rigid adherence to the deadline seems particularly ridiculous considering that it is estimated that 30,000 care home staff are single vaccinated. Perhaps they are staff who needed more persuasion — after all, the government only gave sixteen weeks between the announcement and implementation of the mandate for care home staff to get both vaccines. Considering that an eight-week gap is required between them, that was not a lot of time for care homes to change the minds of their most vaccine-hesitant staff. Care homes have also been told to retain employees who are single vaccinated by redeploying them to non-patient-facing roles, or by placing them on paid or unpaid leave.

The former is unrealistic in most cases, and the latter option seems undesirable; you’re either paying a member of staff who wants to work not to — exacerbating staffing shortages — or you’re not paying them at all, so what are they supposed to live on? The Guardian estimates that care homes stand to lose up to 50,000 staff as a result of the mandate; Ahmed places this number at 70,000, taking into account those who left their jobs in the weeks before the mandate came into effect. This represents around 8% of care home staff. With between 100-120,000 vacancies even before the introduction of the vaccine mandate, the care sector has already been hit hard by Brexit and the loss of European staff (there are calls for emergency visas for care workers, as have been introduced for lorry drivers) and the gruelling demands of working during a pandemic, seeing residents and staff die. Morale is low, compounded by the fact that 7 in 10 UK care staff earn less than £10/hour. The care sector cannot afford to be haemorrhaging staff, especially going into winter with the threat of both Covid and seasonal flu.

“Vaccine refusal [is not] a reflection of the morality of these care staff”

Many believe that the decision not to get vaccinated, despite working in close contact with the elderly and vulnerable, is a reflection of the morality of these care staff, proving that they should be removed from a care setting. This is to some degree a compelling argument; as Kirsty Wark (speaking on Newsnight) posed to Vic Rayner, Chief Executive of the National Care Forum, perhaps it is the ‘moral duty’ of all care workers to be double vaccinated. The relatives of those in residential care are rightly concerned about the spread of Covid within care homes, fearing a repeat of the tragic scenes witnessed in the first months of the pandemic. However, vaccine hesitancy is a complex issue. Unvaccinated care workers cannot simply be explained away as ‘bad’ or selfish people. The testimonies that have appeared over the last few weeks illustrate how much many of these care workers love their jobs and the people they care for, and how much the residents love them in return.

In a survey of over 7,000 care workers, the most common reasons for vaccine hesitancy were fear of side effects (40%), concern about health risks (32%), a lack of confidence in the vaccine (28%), and concern about fertility (around 20%). In regard to the latter statistic, it seems relevant to point out that a high proportion of care staff are female, and that advice given early in the vaccination programme stated that pregnant women and those trying to conceive should not be vaccinated. Such advice has since been retracted, but it has created much anxiety and confusion. Furthermore, care staff are also more likely to come from BAME communities who have been disproportionately impacted by Covid, and shown higher levels of vaccine hesitancy throughout the vaccine rollout, attributed in part to mistrust of the government based on both historical and present-day institutional racism.

I am not seeking to defend the decision by care workers to refuse the vaccine, but merely to try and understand the reasons behind that refusal, as the government should be doing. Time and time again it has been stressed that the way to increase vaccination levels, including in care homes, is by listening to people’s concerns and gently challenging their assumptions, not by enforcing ultimatums.

It is also worth remembering that care home staff continue to be tested regularly, wear PPE and use infection control methods. A government report from April states that ‘SAGE has advised that an uptake rate of 80% in staff and 90% in residents [of a single dose of the vaccine]…would be needed to provide a minimum level of protection against outbreaks of COVID-19’, a threshold which has been surpassed.

Irrespective of what vaccine refusal may say about a person’s morality, the reality is that staff shortages caused by the vaccine mandate have the potential to severely compromise residential care within the UK. In the past two years, 2 million elderly and disabled people who need residential care have been unable to access it (Liz Kendall in Hansard, Social Care Reform debate, Parliament, 23 Jul 2021), a situation which has worsened in the weeks leading up to the November deadline. Staffing shortages have forced MHA, the UK’s largest charity care provider, to close seven homes to new residents; they estimate 750 care homes around the country may be in a similar position. In the past few months, Four Seasons Health Care has had to reject eighty NHS requests to discharge patients into their care as a result of the mandate. One impact of this will be longer stays in hospital for the elderly — beyond what is medically necessary — leading to greater pressure on the NHS. Figures obtained by the Telegraph show that 11,688 people who have died from Covid up to October probably or definitely caught it in hospital, so more time spent in hospital will increase the likelihood of catching Covid or other infections.

“The vaccine mandate will not just affect care but also professionals entering care homes”

There are also questions over whether care home staff will be able to provide adequate care to existing residents, let alone new ones. Nadra Ahmed’s comment that ‘we will not be able in some cases to provide services safely’ should be deeply worrying to everyone.

The vaccine mandate will not just affect care but also professionals entering care homes, such as hairdressers, beauticians and entertainers, who must all be fully vaccinated. Care workers also expressed concern that staffing shortages would lead to a restriction of activities available to residents, and Gyan Dass, the manager of a care home for women with learning difficulties in North London, said that her home may have to switch to frozen food for their residents, as the lack of staff means they do not have enough time to prepare fresh food.

These seem to be considerations that the government is not fully taking into account. In their recent report on the issue, there are some references to potential staff shortages, although they are normalised and presented as the responsibility of care homes to address, stating ‘care homes should already [i.e. without the context of the vaccine mandate] have contingency plans’ for shortages. On their part, the government are running a recruitment campaign, but it seems unlikely to bridge the gap, considering the low wages and physically demanding work that characterise jobs in the care sector, as well as the government’s recent track record on recruitment advertising (their advert suggesting that a ballet dancer’s ‘next job could be in cyber’ was the subject of ridicule).

By ignoring the advice of care leaders, the government has shown contempt for the sector, especially considering that the recent rather meagre pay rise announced for NHS staff does not extend to care home staff. With the hike in National Insurance contributions, care home staff actually stand to see their take-home pay decrease by 1.1%.


Mountain View

The vaccination race: is privilege prevailing over principle?

Sajid Javid’s comment that unvaccinated care workers ‘cannot be bothered to go and get vaccinated’ shows a fundamental misunderstanding of vaccine hesitancy which is extremely unhelpful. On the Today programme he addressed unvaccinated care workers, saying: ‘If you want to look after [residents], if you want to cook for them, if you want to feed them, if you want to put them to bed, then you should get vaccinated’. The condescension is barely disguised, provoking the outrage of care home manager Dawn Bunter, who saw Javid’s remarks as illustrating “The absolute LACK of understanding in relation to the skills and expertise these care staff require, in order to fulfil their roles.”

The government’s lack of understanding of the potential harm that could be done by the vaccine mandate, and their refusal to postpone the November deadline to soften the impact of the exodus of care staff demonstrates that this policy decision was poorly thought through. Surely the health and wellbeing of care home residents should be of paramount concern. The vaccine mandate may sound like it makes this a priority, but residents do not benefit if there are not enough staff to care for them. Families of elderly and disabled people do not benefit if they are forced to continue struggling to support their loved ones at home, unable to access residential care. Vic Rayner, responding to Kirsty Wark’s comment about ‘moral duty’, said that it is also a ‘moral issue’ if care is substandard, and not accessible to those who need it the most. That the government does not, or perhaps refuses to, realise this is a damning indictment of their treatment of the care sector.