Coronavirus (COVID-19) vaccination of people working or deployed in care homes: operational guidance

Question 1

Overview

Accepted Answer

Throughout the coronavirus (COVID-19) pandemic, care home workers have done a phenomenal job to support and protect those most at risk from COVID-19. People across the sector have risen to this unprecedented challenge and gone above and beyond the call of duty to keep those they care for safe.

We value the incredible work that people in care homes have done over the last 18 months to care for some of the people who are most at risk from COVID-19. We want to ensure that care homes are as safe as possible for the staff working in them and the people they care for. We believe that the best way to do this is to ensure that everyone who can take up the offer of vaccination, does.

Vaccination offers the best protection against the virus both for staff and care home residents. Since 11 November 2021, all care home workers, and anyone entering a care home, have needed to be fully vaccinated, unless they are exempt under the regulations.

Vaccinations can be booked online through the national booking service or by ringing 119. It is also possible to visit one of hundreds of walk-in centres across the country without the need to book in advance.

Find your nearest walk-in vaccination centre

Question 2

Legislative stages and key dates

Accepted Answer

Stage 1

Amendments made by the Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) Regulations 2021 (the ‘VCOD1 regulations’) came into force on 11 November 2021.

Stage 2

Amendments made by regulation 3 of the Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) (No. 2) Regulations 2022 (the ‘VCOD2 regulations’) came into force on 6 January 2022.

Stage 3

Amendments made by regulation 4 of the VCOD2 regulations will come into force on 1 April 2022.

The amendments introduced at each stage are detailed below in the ‘The purpose of this guidance’ section.

Question 3

How to use the guidance

Accepted Answer

The purpose of this guidance

This guidance applies to regulated activity in a care home – that is, the provision of accommodation together with nursing or personal care.

It has been produced to help support the implementation of the VCOD1 regulations and VCOD2 regulations. These regulations require registered persons of all Care Quality Commission (CQC)-registered care homes (which provide accommodation together with nursing or personal care) to ensure that a person does not enter the indoor premises unless they have been vaccinated. This is subject to certain exemptions.

The VCOD1 regulations were laid in Parliament on 22 June 2021 and were made on 22 July 2021. They came into force on 11 November 2021 after a 16-week grace period. These regulations imposed the duty on registered persons to ensure, with a few exceptions, only those who can evidence vaccination or exemption would enter a care home.

Subsequent amendments were made by regulations 3 and 4 of the VCOD2 regulations. Regulation 3 came into force on 6 January 2022 and regulation 4 will come into force on 1 April 2022. These regulations made some changes to the original regulations to recognise vaccinations received outside of the UK and an exemption for participants in clinical trials, and permit new starters to be deployed following a first dose of a vaccination.

Who this guidance is aimed at

The guidance is aimed at service providers, registered persons, local authorities, workers (including agency staff) and residents of CQC-regulated care homes which provide accommodation for persons who require nursing and personal care.

This guidance also applies to all professionals and tradespeople who enter these settings.

Definitions used in this guidance

This guidance will refer to several terms which may require further explanation to limit ambiguity and to make it easier to use. These definitions aim to simplify the text used in the rest of the guidance.

Registered person

‘Registered person’ within this guidance refers to the person (individual, partnership or organisation) registered with the CQC as being responsible for the delivery and quality of a service providing CQC-regulated activity in England.

This term should not be confused with other usages of the term ‘registered person’ set out in other publications.

More information about CQC registration is available on their website.

CQC-regulated or registered

‘CQC-regulated’ or ‘CQC-registered care homes’ within this guidance refers to any of the listed regulated activities set out on the CQC’s website.

This guidance relates to the provision of accommodation for persons requiring nursing or personal care in a care home.

It does not relate to wider care settings such as non-residential social care settings that are also not healthcare settings, including home (domiciliary) care services, supported living and extra care housing.

Employed or engaged

‘Employed or engaged’ within this guidance refers to anyone providing CQC-regulated activity (as defined above) on behalf of a registered person (as defined above). This could therefore include someone who is a volunteer or on placement with a CQC-registered organisation but is not formally employed or contracted by the organisation, and agency workers, provided that they are delivering a CQC-regulated activity.

Resident

‘Resident’ will be used throughout this guidance as a substitute for the term ‘service user’, which is used in the regulations.

Vaccination requirements

The term ‘vaccination requirements’ is used to describe the requirements under these regulations, which are set out in the ‘Summary of the regulations’ section.

Authorised vaccine

Currently, this is defined in the VCOD2 regulations as a vaccination against coronavirus that is authorised in the UK.

However, from 1 April 2022, the definition of ‘authorised vaccine’ will be amended. The definition that will apply from then on is the definition in regulation 3A of the international travel regulations – see ‘Changes from 1 April 2022’ under ‘Summary of the regulations’ below for more details.

Top-up dose

If you’ve had a type of COVID-19 vaccination that’s not authorised in the UK, you can get a UK-authorised vaccination so that you meet UK vaccination requirements. In this guidance, we call that a ‘top-up dose’.

Booster

If you’ve had a complete course of UK-authorised vaccine, any additional dose of authorised vaccine you get is called a ‘booster’ in this guidance.

Question 4

Introduction

Accepted Answer

The vaccine roll-out

The roll-out of the COVID-19 vaccination to care homes has been phenomenal, thanks to effective leadership and collaboration across the social care sector and the NHS, in partnership with local authorities, as well as the dedication of care home managers in supporting and encouraging staff. More than 1.26 million social care workers in England are now fully vaccinated – an important step to protect themselves, their loved ones, and the people they care for, from becoming seriously ill or dying from COVID-19.

Why it is important to have a vaccine

Over the last year and a half, COVID-19 has sadly taken many thousands of lives, in particular, among older people, those with underlying health conditions and those who need the level of care provided in care homes.

The Scientific Advisory Group for Emergencies (SAGE) Social Care Working Group has highlighted that people living in care homes have been particularly impacted by the COVID-19 pandemic, due to a combination of a heightened risk of severe outcomes following COVID-19 infection and the risk of outbreaks in closed settings.

Since January 2021, care homes have tested staff over 21 million times and, since April 2020, over 2.6 billion items of personal protective equipment (PPE) have been distributed to care homes via the PPE Portal. Yet, despite this protection and the best efforts of committed staff, we have seen outbreaks in all towns across all regions and over 15,500 care home residents died of COVID-19 in 2021.

There is one thing now which is making a crucial difference, and which is saving the lives of care home residents and staff: vaccination.

Vaccinated people are better protected from severe illness and death as a result of COVID-19. Analysis carried out by the UK Health Security Agency (UKHSA) on the direct and indirect impact of the vaccination programme on infections and mortality, suggests the vaccination programme, as of 24 September 2021, has prevented 24.1 million infections and 127,500 deaths since the start of the vaccination programme.

There is evidence to suggest that the COVID-19 vaccine also prevents those who catch the virus from infecting other people. Research by Public Health England (now UKHSA) shows that those who do become infected 3 weeks after receiving one dose of the Pfizer-BioNTech or AstraZeneca vaccine were between 38% and 49% less likely to pass the virus on to their household contacts than those who were unvaccinated.

Even as the UK officially lifts most COVID-19 legal restrictions, the virus will remain in some shape or form and we will have to learn to live with it. It will continue to circulate, potentially evolving into new variants.

Although we have seen strong take-up of vaccination among care home residents, there are some who cannot be vaccinated and some for whom vaccination is less effective. Some residents will therefore continue to be at greater risk of the consequences of COVID-19.

Vaccination against COVID-19 is the best way that workers can keep themselves and those they care for safe from the effects of the virus. Sustaining high levels of staff vaccination now, and in the future, as people enter the workforce, is important to minimise the risk of outbreaks in care homes, which continue to be high-risk settings.

Where to find information about the COVID-19 vaccines

It is very important that we maintain our efforts to support and encourage care home staff to take the vaccine. We know that conversations with trusted peers or medical professionals can make a real difference. There are a range of published resources with information about the vaccine that can be used to support those difficult conversations, all of which are available in 19 different languages:

COVID-19 vaccination: guide for adults

COVID-19 vaccination: what to expect after vaccination

COVID-19 vaccination and blood clotting

COVID-19 vaccination: women of childbearing age, currently pregnant or breastfeeding

COVID-19 vaccination: easy-read leaflets

NHS England and NHS Improvement London: COVID-19 vaccine communication materials (videos in different languages)

The Department of Health and Social Care has produced a toolkit of resources that is tailored for the adult social care sector. The toolkit is regularly updated and includes:

a stakeholder Q&A on the COVID-19 vaccines
guidance and resources addressing common concerns about the vaccines, such as fertility, ingredients, allergies and speed of delivery
advice on how to reassure people about taking the vaccine
video clips of clinical experts discussing the vaccines
video clips and case studies of social care workers sharing their own vaccination stories

Support is also available through the Community Champions programme which has allocated £23.7 million of funding to 60 councils and voluntary groups across England. Community champions work directly with communities disproportionately impacted by COVID-19 to boost confidence in the vaccine. Alongside the NHS and public health teams, they work to answer questions and support informed decisions about the vaccine, to remove barriers to access.

More information on the programme of work underway to drive vaccine uptake, including actions to improve access and to address the concerns of those who may be hesitant to receive the vaccine, is set out in the UK COVID-19 vaccination uptake plan (published 13 February 2021).

Question 5

The policy

Accepted Answer

Summary of the regulations

The regulations require that all CQC-registered service providers (or registered managers) of accommodation for those who require nursing or personal care in a care home must ensure that a person does not enter the care home unless:

the person resides in the care home used by the registered person (a resident) – ‘registered person’ means person registered with the CQC as a manager or service provider in respect of a regulated activity – in this case, the regulated activity for the provision of accommodation for persons requiring nursing or personal care
the person has provided the registered person (or those acting on behalf of the registered person) with satisfactory evidence that, from 6 January 2022:
- they have been vaccinated with a complete course of doses of an ‘authorised vaccine’, which is, in summary, defined in the VCOD2 regulations as a vaccination against coronavirus that is authorised in the UK. The person will also be considered to be fully vaccinated if they have received one dose of an authorised vaccine and another dose of a different authorised vaccine. From 1 April 2022, the definition of ‘authorised vaccine’ is changing – see ‘Changes from 1 April 2022’ below
- if the person is a new starter who commences deployment after 6 January 2022, they have been vaccinated with one dose of an authorised vaccine at least 21 days prior to starting work and, within 10 weeks of receiving their first dose, can demonstrate that they have received their second dose – please see the section on ‘New starters’ below for further detail
it is reasonably necessary for the person to provide emergency assistance in the care home (further details below)
it is reasonably necessary for the person to provide urgent maintenance assistance to the care home (further details below)
the person is a member of the emergency services in execution of their duties (further details below)
the person is a friend or relative of the resident visiting the resident (further details below – this also includes unpaid carers or designated essential care givers)
the person is visiting a resident who is dying (further details below)
it is reasonably necessary for the person to provide comfort or support to a resident in relation to a resident’s bereavement following the death of a relative or friend (further details below)
the person is under the age of 18 (further details below)

The vaccination requirement only applies to people who go inside a care home setting (the definition of ‘care home’ does not include any surrounding grounds). As long as someone is not entering the building, they would not need to show vaccination status.

Changes from 1 April 2022

From 1 April 2022, the definition of ‘authorised vaccine’ will be amended. The definition that will apply is the definition in regulation 3A of the Health Protection (Coronavirus, International Travel and Operator Liability) (England) Regulations 2021 (the ‘international travel regulations’). The vaccines that fall within the scope of this definition are set out in this guidance.

The person must provide the registered person with satisfactory evidence that they:

have been vaccinated with a complete course of doses of an authorised vaccine, as that term is defined in the international travel regulations
have been vaccinated against coronavirus other than by being vaccinated with the complete course of doses of an authorised vaccine (for instance, if they have been vaccinated abroad with a vaccine that is not an authorised vaccine)

If 10 weeks or more have passed since that vaccination, they must also provide the registered person with evidence that they:

have had a ‘top-up’ dose of an authorised vaccine
have been vaccinated with a vaccine listed in schedule 4A of the VCOD2 regulations, in accordance with the corresponding number of doses listed in that table
are medically exempt (more information about medical exemptions is set out later in this guidance)
are participating or have participated in specific clinical trials (more information about clinical trials can be found in the code of practice on the prevention and control of infections, which is currently being updated and will be published as soon as possible)

New starters

New starters must provide evidence to the registered person that they have been vaccinated with one dose of an authorised vaccine (as set out in guidance on the approved COVID-19 vaccines, and countries and territories with approved proof of vaccination) at least 21 days before starting their employment or engagement, noting that this option only applies for a period of 10 weeks from the date when that person was vaccinated.

Once this 10-week period expires, the registered person must ensure that the new starter has provided evidence that they have satisfied the vaccination requirements, as out in the ‘Summary of the regulations’ above, before allowing that person to continue to be employed or engaged.

Care homes should notify prospective staff of the requirements at the start of the application process and undertake appropriate checks, during the recruitment process, to ensure the individual is eligible to work in the care home.

It will only be possible for a newly appointed member of staff to start working in the care home once they have provided evidence of their vaccination status, as stated above, or evidence of a medical exemption.

Registered persons

The registered person is responsible for ensuring that everyone who enters their care home is either vaccinated or exempt.

The registered person will be the person registered with the CQC as a manager or service provider.

Registered persons may make arrangements for another person to carry out certain tasks to help comply with the regulations. While this is acceptable, the registered person is the one who remains legally responsible for compliance with the regulations.

There is information on what this requirement means for registered persons in the ‘Guidance for registered persons’ section below.

Booster doses

Currently, COVID-19 booster doses are not included in the regulations. However, the government will review this regularly and seek to update the regulations through the necessary parliamentary process, if required.

Anyone eligible is recommended to take up the offer of a COVID-19 booster dose as soon as possible to enhance their protection from the virus.

If an individual has been vaccinated with a vaccine that is not currently ‘authorised’

Prior to 1 April 2022

In cases where an individual has been vaccinated with a vaccine not currently considered ‘authorised’, they may continue to rely on a temporary exemption obtained via the self-certification process. Guidance is available on temporary medical exemptions for COVID-19 vaccination of people working or deployed in care homes.

It will not be possible for an individual to rely on self-certification as means of evidencing exemption after 31 March 2022.

From 1 April 2022

In cases where an individual has been vaccinated with a vaccine not currently considered ‘authorised’, they must provide evidence to the registered person of this vaccination.

If it has been 10 weeks or more since the date of that vaccination, the individual should not be permitted to enter the care home unless they provide evidence that they have received:

one ‘top-up’ dose of an authorised vaccine (as set out in the guidance on approved COVID-19 vaccines, and countries and territories with approved proof of vaccination)
a vaccine listed in column 1 of the table in schedule 4A to the VCOD2 regulations, in accordance with the corresponding number of doses listed in column 2 of that table

Participants in clinical trials

If someone has participated in specific clinical trials, they are exempt from these vaccination requirements, but must provide evidence of their participation in the clinical trial.

More information about clinical trials can be found in the code of practice on the prevention and control of infections, which is currently being updated and will be published as soon as possible.

Residents

If someone is a resident or being admitted as a resident, they and an accompanying friend or relative will not require proof of vaccination.

We will, however, continue to encourage people living in care homes to take up vaccination as soon as possible, building on the repeat visits that NHS colleagues have already made to care homes.

The regulations require prospective residents and their families visiting care homes to provide evidence of vaccination or medical exemption. Care home managers may want to consider remote visits via video link for any prospective residents who are not vaccinated. We will monitor the impact of this restriction for prospective residents.

Emergency assistance

If someone is entering the care home for emergency assistance for an incident in the care home itself, or in relation to an incident in a neighbouring building (for example, if access is required to respond to a fire), they will not need to show proof of vaccination or medical exemption.

It is the registered person’s responsibility to use their professional judgement to determine whether a situation is an emergency in line with the guidance set out below. Registered persons will be expected to keep a log of all emergency situations, including details of the circumstances, during which people entered the home without showing proof of vaccination or exemption.

An emergency situation could include (but is not limited to):

members of the public assisting in the event of flood or fire
social workers responding to immediate safeguarding concerns

Emergency services

In addition to providing emergency assistance, emergency services staff attending the care home in the execution of their duties are exempt from the requirement.

This includes members of the:

fire and rescue services attending the care home to execute their duties
police service attending the care home to execute their duties
health service deployed for emergency response

Friends, relatives and essential care givers

Friends, family (who also may be unpaid carers) and essential care givers will not need to show proof of vaccination or medical exemption.

Visits from family and friends are vital for the health and wellbeing of people living in care homes. In the context of this policy, it would be unjustifiably detrimental to residents to deprive them of contact with, and care from, their loved ones.

Government guidance should be followed on the infection prevention and control measures that should be in place.

Urgent maintenance work

If work is only being done outside the care home and individuals carrying out maintenance do not need to enter the care home, then these individuals do not need to show proof of vaccination or medical exemption.

If work is required inside the care home, then individuals carrying out maintenance will need to show proof of vaccination or medical exemption.

However, if urgent maintenance work is required in the event of a risk to life or continuity of care, workers are exempt from these requirements. This could include (but is not limited to):

failure or breakdown of the gas, electricity or water supply
dangerous electrical fault
serious damage caused by fire, flood, storm or explosion
burst water service
serious roof leak
gas leak
any fault or damage in the care home that makes the care home unsafe or insecure
a serious fault in a lift or staircase

It is the manager’s responsibility to use their professional judgement to determine whether a situation requires urgent maintenance work. Managers will be expected to keep a log of all urgent maintenance work during which people entered the home without showing proof of vaccination or medical exemption, and a short description of the incident for record keeping purposes.

Death and bereavement

People do not need to show proof of vaccination or exemption if they are visiting a resident who is dying (that is in their last days of life) or they are providing comfort or support to a resident following the death of a relative or friend.

Those performing spiritual rituals for a resident would therefore also not need to show proof of vaccination status.

Funeral directors and their staff will have to show proof of vaccination or exemption when entering the care home.

Under-18s

Under the regulations, those under the age of 18 are not required to provide evidence of their vaccination status or that they are exempt.

However, as soon as an individual does turn 18, the registered person will need to ensure that they have provided this evidence. Those under 18 and working or volunteering in care homes should therefore plan to get vaccinated before they turn 18. This means booking their first vaccine dose at least 8 weeks before their 18th birthday.

Visiting professionals who are under 18 will be able to enter the care home without showing proof of vaccination status, but may need to demonstrate proof that they are under 18. As soon as they turn 18, they will not be able to enter the residence until they have satisfied the vaccination requirements set out above in the ‘Summary of the regulations’ section.

Skills for Care have further guidance on employing 16 and 17 year olds (under ‘Guidance on employing workers aged 16 and 17’).

Students

All students who enter the care residence as part of their studies will need to show proof of vaccination or exemption, unless they are under 18 or visiting as family or a friend of a resident.

Volunteers

All volunteers who enter the care residence will need to show proof of vaccination or exemption, unless they are under 18.

Staff travelling from non-care settings

Anyone who enters a care home as part of their professional responsibilities will need to show proof of vaccination unless they are exempt. Therefore, staff (such as trainers) who normally work in non-care settings (such as in the company headquarters) will still need to be vaccinated if they enter a care home.

This also includes staff who may work in the home on a part-time or occasional basis, to deliver non-care-related services, such as hairdressing, maintenance or activities.

Entering a care home for a job interview

Anyone who enters a care home for a job interview must show proof of vaccination unless they are exempt.

If someone intends to have the vaccination but is not yet vaccinated, the interview should take place outside of the care home or remotely (via video call or telephone).

Making postal, courier or other deliveries and collections

The requirement only applies to those entering the inside of a care home. As long as someone is not entering the building, those people making postal, courier or other deliveries or collections would not need to show proof of their vaccination or medical exemption.

If, for example, a postal employee must enter the inside of the care home, as the package is too heavy or large for a staff member to lift, then they must show proof of vaccination or exemption.

Devolved administrations

While the regulations apply to all CQC-registered care homes in England, people who live in Scotland, Wales or Northern Ireland but work in England must still show proof of vaccination or exemption in English care homes.

Question 6

General guidance on demonstrating evidence

Accepted Answer

Required evidence

In order to enter a care home, individuals must be able to demonstrate that they have received a complete course of their COVID-19 vaccination, unless exemptions apply. A complete course may refer to one or two doses of the vaccine, depending on the type of vaccine. It does not cover booster doses. Extending the policy to cover booster doses would require amending the regulations and be subject to parliamentary approval.

The registered person (or those acting on behalf of the registered person) at the care home needs to satisfy themselves of the identity of the person entering the care home and their proof of vaccination.

How to demonstrate evidence of vaccination

If the member of staff lives in England

Individuals that have been vaccinated by the NHS in England may demonstrate their vaccination status using the NHS COVID Pass service via the following 3 routes:

the NHS App
the NHS website – NHS.uk
the NHS COVID Pass letter

An individual’s NHS appointment card cannot be used as proof of vaccination status.

NHS App and NHS website

If an individual has been vaccinated by the NHS in England, they may demonstrate their COVID-19 vaccination status using the ‘View COVID-19 Records” function of the domestic NHS COVID Pass.

This is accessible within the NHS App and online NHS COVID Pass service – read more on getting a digital NHS COVID Pass. Individuals will need to have or create an NHS login to use the service.

A step-by-step guide is below:

Sign in to the NHS App. The first screen is your home screen, which will also display your name and date of birth.
Click on the ‘Get your NHS COVID Pass’ link. You may need to click ‘Continue’.
Select ‘Domestic’.
This will bring up the Domestic NHS COVID Pass screen with your name and date of birth, a 2D barcode and a green shimmer ‘valid’ banner. This is not valid for proving vaccination status under the regulations.
Scroll down to and select ‘View COVID-19 records’.
Individuals should show these COVID-19 vaccine records to their registered manager.

Those using the online NHS COVID Pass service via NHS.uk will see the same information and, after signing in, can skip straight to step 4.

Non-digital solution: NHS COVID Pass letter

An individual can get an NHS COVID Pass letter sent to them in the post, which shows that they have been vaccinated against COVID-19. They can do this by:

This letter can then be presented by the individual to the care home to demonstrate their vaccination status. Individuals may need to wait 5 working days to receive this and should account for this to ensure they are able to demonstrate vaccination status by the time the regulations come into force.

Individuals need to have an NHS number and have been vaccinated in England, but they do not need to be registered with a GP surgery or have an NHS login to get an NHS COVID Pass letter.

If the member of staff lives in Scotland, Wales or Northern Ireland

Individuals vaccinated in Scotland can find information on how to obtain a record of their COVID-19 vaccination status from nhsinformscot.

Individuals vaccinated in Wales can find information on how to obtain a record of their COVID-19 vaccination status from gov.wales.

Individuals vaccinated in Northern Ireland can find information on how to obtain a record of their COVID-19 vaccination status from health-ni.gov.uk.

If the member of staff has been vaccinated outside of the UK

Prior to 1 April 2022

If an individual has been vaccinated outside of the UK with a vaccine that is not an ‘authorised vaccine’ (in accordance with the definition of authorised vaccine as defined in the VCOD2 regulations), they should register a temporary exemption via the self-certification process – please see the ‘General guidance on medical exemptions’ section below for further details.

The self-certification process is only available until 31 March 2022.

From 1 April 2022

There will be a new definition of ‘authorised vaccine’, which is the definition in regulation 3A of the international travel regulations.

If an individual has been vaccinated outside of the UK, they should provide evidence of their vaccination status and, where necessary, have a ‘top-up’ dose with an authorised vaccine consistent with the previous ‘If an individual has been vaccinated with a vaccine that is not currently “authorised”’ section of this guidance.

If an individual has received COVID-19 vaccinations outside of the UK, they live in England and they wish to be able to use the NHS COVID Pass service, they can ask to have this added to their NHS vaccination record using the Tell the NHS about coronavirus (COVID-19) vaccinations you’ve had abroad service. Once it has been added to their record, they can get an NHS COVID Pass.

If a member of staff’s NHS COVID Pass has been deactivated

The digital domestic NHS COVID Pass (the NHS App or NHS.uk online service) will be deactivated temporarily following a positive test.

If you need to provide evidence of your COVID-19 vaccination status while your NHS COVID Pass has been deactivated, you can access your COVID-19 vaccination records by taking the following steps:

Sign in to the NHS App. The first screen is your home screen, which will also display your name and date of birth.
Click on the ‘NHS COVID Pass’ link; you may need to click on ‘Continue’
Select ‘Travel’.
Scroll down and select ‘View COVID-19 records’.
Individuals should show these COVID-19 vaccine records to their registered manager.

Please note that this method of showing COVID-19 vaccination records can only be accessed via the NHS App.

Further guidance

Further guidance for managers on how to check vaccination status can be found in the ‘Guidance for registered persons’ section below.

Further guidance for staff on how to demonstrate vaccination to their employers can be found in the ‘Guidance for staff’ section below.

Question 7

General guidance on medical exemptions

Accepted Answer

For a small number of people, vaccination is not appropriate due to clinical reasons. These people will be able to seek a clinically approved exemption from this requirement. Individuals should apply formally for a medical exemption – see further information on medical exemptions and how to apply for one.

A temporary self-certification process was introduced in September 2021. The original timeframe permitted self-certification to be used until 24 December 2021, but this was subsequently extended until 31 March 2022. Guidance is available on temporary medical exemptions for COVID-19 vaccination of people working or deployed in care homes.

After 31 March 2022, exemptions will need to be evidenced by the formal process. Those who wish to apply for a medical exemption should do so at the earliest opportunity as they will not be able to work in care homes beyond 31 March 2022 without proof of vaccination or a formal exemption, even if they have previously submitted evidence via self-certification.

Other methods of temporary exemptions

The UKHSA advises that individuals experiencing COVID-19 symptoms should not receive the COVID-19 vaccine until they have recovered, so vaccination should be deferred until individuals are clinically recovered after 4 weeks.

For the purposes of the regulations, such individuals may be considered temporarily medically exempt from needing to demonstrate that they have received their first, second or ‘top-up’ dose of an authorised vaccine. Temporary medical exemptions will apply for a 28-day (4-week) period, starting from an individual’s first confirmed positive test result plus an additional 14 days (2 weeks), which individuals can use to satisfy the vaccination requirements. This gives a total of 42 days (6 weeks).

Temporary medical exemptions based on recent infection with COVID-19 can be evidenced in a different way to other medical exemptions. Further detailed information about how temporary medical exemptions on the basis of recent infection with COVID-19 will work in practice, including how they relate to the different vaccination requirements under the regulations, will be published in separate guidance.

Groups that can get a medical exemption

There are a range of circumstances in which an exemption may be granted, which will reflect the green book on immunisation against infectious disease, chapter 14a, and clinical advice from the Joint Committee of Vaccination and Immunisation.

Other measures to reduce risk of transmission

It is important that all those entering care homes, including those who are exempt from vaccination, continue to follow infection prevention and control measures, including the correct usage of PPE, to reduce the risk of transmission. However, these measures are not a substitution for the requirement for individuals to be fully vaccinated, which applies to all persons entering a care home unless exempt.

A risk assessment should be undertaken for those who are exempt from vaccination, to reduce risk of transmission. This might include a change to their duties where such a change is appropriate. It should also be taken into account that those that are exempt from vaccination may also be in the clinically extremely vulnerable category.

Providers should continue to ensure that those working in care homes continue to use appropriate PPE and follow infection prevention control procedures.

Question 8

Guidance for registered persons

Accepted Answer

Overview

Since 11 November 2021, registered persons (the person registered with the CQC as a manager or service provider) must ensure that they do not allow anyone to enter the inside of a care home, unless they have had a complete course of doses of an authorised vaccine or fall into one of the exempt groups.

While checks may be undertaken by other members of staff acting under instruction of the registered person, registered persons are ultimately responsible for ensuring compliance with the requirements.

This section aims to give advice to registered persons on the implementation of the regulations. When deciding how to implement the regulations, the registered person must also refer to the code of practice on the prevention and control of infections, which we are currently updating and will publish as soon as possible.

Checking vaccination or exemption status

Registered persons (or those acting on behalf of the registered person) will have to check that all persons wishing to enter the care home have received a full course of vaccinations, unless they are exempt. This includes checking, for example, care home staff, health care professionals, CQC inspectors, tradespeople, hairdressers and beauticians.

The requirement only applies in respect of persons entering the inside of the care home premises and it will be up to the registered person (or those acting on behalf of the registered person) to identify the most appropriate procedures to check vaccination status.

Compliance with the regulations would be an appropriate reason for not granting entry to a CQC inspector or another individual, unless they are exempt.

In cases where care homes have multiple buildings, care homes may prefer to have checkpoints at the entrance of each building. Alternatively, registered persons may opt for there to be a single checkpoint to ensure that all individuals are verified as being vaccinated or exempt before proceeding to access other buildings.

The ‘Guidance on demonstrating evidence’ section above outlines which forms of evidence are acceptable as evidence to demonstrate vaccination or exemption status. An individual’s NHS appointment card should not be accepted as sufficient evidence.

We are aware some individuals will have been vaccinated outside of the UK – see ‘If the member of staff has been vaccinated outside of the UK’ for guidance on demonstrating evidence for those who received their vaccinations abroad.

It will be up to you, the registered person (or those acting on your behalf), to identify the most appropriate procedures to check the vaccination and exemption status of individuals. You may want to consider the UKHSA’s advice under the previous section ‘Other temporary methods of medical exemption’ when doing so.

As the registered person, you should note that you will be responsible for:

determining whether anyone you employ or engage is eligible for a temporary medical exemption
checking the evidence provided in support of this (that is their recent positive COVID-19 test result)
setting out the timelines in which such individuals should receive their next vaccination and provide their evidence

In practice, temporary medical exemptions will apply differently depending on individual’s circumstances.

To support you in this decision-making, further detailed operational guidance on how temporary medical exemptions will apply in practice will be published shortly.

Recording vaccination or exemption status

The registered person should keep a record of the vaccination or exemption status of:

staff members and the date that the status was last checked
those entering the care home and the date that the status was last checked

There is no requirement for registered persons to record the clinical reason behind the exemption – they should only record whether a person is medically exempt or not.

Except for new starters, pregnant individuals, those with temporary medical exemptions and those vaccinated other than with a complete course of doses of an authorised vaccine, individuals entering a care home only need to demonstrate vaccination status on the first occasion they enter or register, and the registered person should record their status on the care home’s local system (for example, IT system, paper file and so on). All subsequent checks of individuals who have previously demonstrated vaccination status can be carried out via the records, which will state the date and time the individual proved their status. Care homes will be able to use these records as proof of vaccination status to reduce the burden of having to re-check every individual. Care home managers can also decide to check more often, if preferred, but there is no requirement to do so. Records should be checked regularly to ensure they are up to date.

The registered person will be able to share these records with CQC to demonstrate they have checked third-party medical exemptions.

The regulations expressly state that a care home may process information about vaccination or medical exemption status, but this must be done in a way that is consistent with data protection legislation (see further below).

Example

A small care home provider that has limited technology for recording vaccination status may wish to use their manual visiting log to record the vaccination or exemption status of visiting professionals (people not employed directly by the care home).

This could be as simple as adding a column to the existing logbook and adding a signature to indicate that vaccination status has been confirmed.

Care homes must keep records to demonstrate compliance with the regulations.

Care homes need to ensure that they process information about vaccination or medical exemption in accordance with data protection legislation. All care homes should have existing data processing policies as part of their pre-existing data protection obligations, for example around privacy information. All existing data protection and privacy documentation and assessments should be reviewed and updated to ensure compliance with the regulations.

Data protection impact assessments and appropriate policy documents will need to be reviewed and updated with any additional lawful basis under articles 6 and 9 of UK GDPR identified for processing for this new process.

Data about vaccination or medical exemptions is health data and therefore special category data for the purposes of the data protection legislation including the Data Protection Act 2018 and the UK GDPR.

Data protection principles

Care homes should at all times ensure compliance with the applicable data protection legislation (article 5 of the GDPR and the Data Protection Act 2018). In line with existing requirements, it is important for the care home to have a policy document outlining procedures for securing compliance with data protection principles, and policies about retention and removal of personal data.

Care homes will need to consider:

who has access to the data
how much data they process
how long they retain the data for
how the data is stored
whether any privacy information needs updating
whether any data protection impact assessment requires updating
whether any appropriate policy documents require updating

Registered managers must at all times ensure that vaccination and exemption information they collect is treated confidentially.

Special considerations for visiting professionals

NHS England and Improvement have issued specific guidance for healthcare professionals who visit care homes so that they are aware of the implications of the regulations.

For visiting professionals contracted to the home, registered persons may decide that the best way to ensure that a person has been vaccinated or is exempt prior to entering a care home is to include the requirement in any contract for the provision of services provided by that person. Independent legal advice should be sought before entering into any contract. However, registered persons may also choose other methods to secure compliance with the requirements under the regulations.

The regulations provide an exemption where it is reasonably necessary for a person to provide urgent maintenance assistance (see section on ‘Urgent maintenance assistance’) with respect to the care home or emergency assistance.

Some people, especially those who do not visit care homes regularly, may not be familiar with the requirement to be vaccinated or medically exempt and may need time to obtain proof of vaccination or medical exemption. Therefore, when booking appointments or making arrangements for visits, it will be helpful to explain the regulations. A service provider can then ensure that they send a staff member who has proof of vaccination or medical exemption, or so that a sole trader can obtain proof of vaccination or medical exemption. For further guidance for visiting professionals see ‘Guidance for visiting professionals’.

Where a service provider is unable to provide services via a person who is vaccinated or medically exempt, and the services cannot be provided outside the care home, it may be necessary to make alternative arrangements for provision of the service.

The role of the CQC

The requirement forms part of the fundamental standards and will be monitored and enforced in appropriate cases by the CQC. The CQC has published a statement outlining their approach to:

registration
ongoing monitoring
enforcement

A summary of the statement is included below.

Registration

The CQC will seek assurance that those registering for the first time – or amending their registration with the CQC – have a robust governance process to:

monitor vaccination and COVID-19 status of staff
ensure staff maintain an up-to-date vaccination status (by providing guidance and assistance for staff to get vaccinated) and ensure staff maintain up-to-date best infection prevention and control (IPC) practice
monitor vaccination and COVID-19 status of personnel entering the care home
where applicable, make reasonable adjustments to ensure people using the service receive safe care and treatment

For new manager applications, the CQC will seek assurance that applicants are:

vaccinated or exempt exempt as per the requirement of the regulations
aware of their duties in relation to the new regulations regarding COVID-19 vaccination

Ongoing monitoring

The monitoring of the requirement is the responsibility of the CQC.

The CQC propose to add the following question to the provider information return (PIR) once the regulations are in force:

‘How are you assured that those you employ and deploy within your service have satisfied the vaccination requirements?’

The CQC will also build a similar question into their monitoring approach once this duty is in place. Further information will be provided in due course.

Inspection

On inspection, the CQC will look for evidence to confirm systems and processes are in place to comply with the requirement.

Registered persons will not be required to show a record of the evidence itself, but will need to provide assurance that systems and processes are in place to ensure that individuals who enter the premises are fully vaccinated or exempt. Registered persons may choose to make a record of the evidence they have seen for their own internal staff employment record-keeping.

If the evidence is collected and recorded, all personal data must be handled in accordance with UK GDPR. This includes providing individuals with privacy information at the stage their data is being collected. Please refer to the guidance from the Information Commissioner’s Office to ensure you have appropriate lawful basis, technical and security measures in place to protect personal data.

Enforcement

Any enforcement activity that is generated as a result of non-compliance with the amended regulations will be undertaken on a proportionate basis and, based on the CQC’s assessment of the impact on quality of care and people’s safety, in line with the CQC’s existing enforcement policy. The CQC will decide what action to take based on proportionality and in line with their normal approach to enforcement.

Read further information on CQC’s enforcement policy.

Support for managers and registered persons

This section outlines the resources that are currently available to registered persons to support them to comply with the regulations.

Resources to support communication with staff to encourage vaccine uptake

A range of resources is available to support registered persons and staff to have conversations about vaccine safety and efficacy, as well as financial support to access to vaccination. More information and links to these resources can be found in the ‘Introduction’ above.

Skills for Care platform

Skills for Care has developed a dedicated one-stop webpage that is bringing together a range of support, information and resources together to support social care employers to continue to recruit and retain their staff in a challenging environment.

Resources include:

workforce planning and commissioning
people performance management
supervision guide
wellbeing resources
values based recruitment and retention resources
workforce productivity model

Good employment practice

We have included guidance on good employment practice in ‘Annex A’.

Question 9

Guidance for staff

Accepted Answer

What the policy means for you

Anyone working or volunteering in a care home must meet the vaccination requirements outlined in ‘Summary of regulations’ above. For care home staff, this means you will only be able to continue to work inside a care home if you are vaccinated, unless you are:

under the age of 18
medically exempt

There are other groups of people who may enter the care home and may not have to show that they have been vaccinated.

How to demonstrate your vaccination status

If you were vaccinated in England

If you have been vaccinated by the NHS in England you can demonstrate your COVID-19 vaccination records using the NHS COVID Pass service via the following 3 routes:

the NHS App
the NHS website – NHS.uk
the NHS COVID Pass letter

See ‘How to demonstrate evidence of vaccination’ in the ‘General guidance on demonstrating evidence’ section above for more information on getting a digital NHS COVID Pass or letter and what to do if your NHS COVID Pass is deactivated.

The government does not consider the NHS appointment card to be valid proof of vaccination status.

If you were vaccinated in Scotland, Wales or Northern Ireland

If you have been vaccinated in Scotland, you can find information on how to obtain a record of your COVID-19 vaccination status at nhsinform.scot.

If you have been vaccinated in Wales, you can find information on how to obtain a record of your COVID-19 vaccination status at gov.wales.

If you have been vaccinated in Northern Ireland, you can find information on how to obtain a record of your COVID-19 vaccination status at health-ni.gov.uk

The government does not consider the NHS appointment card to be valid proof of vaccination status.

If you were vaccinated outside of the UK

We are aware some individuals will have been vaccinated outside of the UK – see ‘If the member of staff has been vaccinated outside of the UK’ for guidance on how to evidence that you have received your vaccinations abroad.

If you have received COVID-19 vaccinations outside of the UK, you live in England and you wish to be able to use the NHS COVID Pass service, you can ask to have this added to your NHS vaccination record using the Tell the NHS about coronavirus (COVID-19) vaccinations you’ve had abroad service. Once it has been added to your record, you can get an NHS COVID Pass.

Responsibility for checking that people are vaccinated or exempt

Registered persons (the person registered with the CQC as a manager or service provider) are ultimately responsible for ensuring that everyone who enters the care home is vaccinated or exempt. They are advised to use their professional judgement when delegating these checks to other members of staff.

If you are exempt, the registered person will not know the reason for your exemption, only the fact that you are exempt.

Exemptions

Vaccination may not be appropriate for you due to clinical reasons. In this case, you should apply formally for a medical exemption – see further guidance on medical exemptions and how to apply for one.

A temporary self-certification process was introduced in September 2021. The original timeframe permitted self-certification to be used until 24 December 2021, but this was subsequently extended until 31 March 2022. Guidance is available on temporary medical exemptions for COVID-19 vaccination of people working or deployed in care homes.

After 31 March 2022, exemptions will need to be evidenced by the formal process.

Those who wish to apply for a medical exemption should do so at the earliest opportunity as they will not be able to work in care homes beyond 31 March 2022 without proof of vaccination or a formal exemption, even if they have previously submitted evidence via self-certification.

Managers should do a risk assessment for those who are exempt from vaccination. This means they will evaluate the potential risk to the spread of COVID-19 caused by unvaccinated (but exempt) members of staff entering the care home. They may put in place measures to help reduce this risk – for example, by asking exempt members of staff to wear more or different PPE, or by suggesting a change to their duties.

If you have recently been infected with or recovered from COVID-19

As set out earlier in this guidance, UKHSA advice is that individuals experiencing COVID-19 symptoms should not receive the COVID-19 vaccine until they have recovered, and so vaccination should be deferred until individuals are clinically recovered at 4 weeks.

If you have recently been infected with or recovered from COVID-19, you may be eligible for a temporary medical exemption from the vaccination requirements. Further information about temporary medical exemptions is set out earlier in this guidance in the ‘Other temporary methods of medical exemption’ section, and further detailed operational guidance on how they will work in practice will be published shortly.

The relevant registered person at your organisation will be responsible for determining:

whether you are eligible for a temporary medical exemption
what evidence you will need to supply in support of this
the timelines for doing so

Redeployment

If you are unable to provide proof of vaccination or exemption, then your manager should explore all options available to you. This could include moving you to an alternative role for which vaccination is not required. You should speak to your manager about your options as soon as you can. You should not assume that it will be possible for you to be redeployed.

Dismissal

If you are unable to provide proof of vaccination or exemption, then your manager should explore all options available to you. However, you should note that the regulations may provide a fair reason for dismissal if you are not vaccinated or medically exempt.

Concerns about staffing levels in care homes

Care homes should already have contingency plans, which cover events that may affect the safe running of the service. This would normally include staff shortfalls.

Wherever possible, we would expect the registered person to take reasonable steps to cover the staff shortfalls themselves in the short term through the use of bank or agency staff. If this option is not available to them, they should flag this with the local authority who may be able to offer or signpost the registered provider to sources of assistance. Guidance for local authorities is set out in ‘Guidance for local authorities’.

If the registered provider has concerns that staffing levels affect their ability to operate the service safely, they are required to notify the CQC under Regulation 18(2) (g) of the Care Quality Commission (Registration) Regulations 2009:

any event which prevents, or appears to the service provider to be likely to threaten to prevent, the service provider’s ability to continue to carry on the regulated activity safely, or in accordance with the registration requirements, including an insufficient number of suitably qualified, skilled and experienced persons being employed for the purposes of carrying on the regulated activity.

The CQC has provided further information on statutory notifications.

The Advisory, Conciliation and Arbitration Service (ACAS) has produced guidance on raising issues with your employer.

Other measures (besides vaccination) your employer should have in place

It is important that all those entering care homes continue to follow infection prevention control measures to reduce the risk of transmission.

Guidance on how to work safely with PPE is available.

Guidance on how to access test kits and how to use PCR and lateral flow test kits is available.

Guidance on how to claim statutory sick-pay if you are self-isolating is available.

What support is available

If you are concerned or have any queries about getting vaccinated, we encourage you to have a conversation with your registered manager or your clinician to help you make an informed choice. The government has produced a range of resources, all of which are available in 19 different languages. Links to these resources can be found in the ‘Introduction’.

How to get the vaccine

Guidance on COVID-19 vaccination: booking an appointment is available.

Scenario 1: if you are under 18

You will not have to show proof of vaccination or exemption if you are under 18. However, once you turn 18, you will not be able to continue working in a care home if you are unvaccinated. You should therefore plan to get vaccinated before you turn 18 – this means booking your first vaccine dose at least 8 weeks before your 18th birthday.

Scenario 2: if you live in Scotland, Wales or Northern Ireland but work in England

As this law applies to anyone entering a care home in England, you will have to be vaccinated.

Individuals vaccinated in Scotland can find information on how to obtain a record of their COVID-19 vaccination status from nhsinform.scot.

Individuals vaccinated in Wales can find information on how to obtain a record of their COVID-19 vaccination status from gov.wales.

Individuals vaccinated in Northern Ireland can find information on how to obtain a record of their COVID-19 vaccination status from health-ni.gov.uk.

Question 10

Guidance for local authorities

Accepted Answer

Anyone working or volunteering in a care home must meet the vaccination requirements outlined in the ‘Summary of the regulations’ section above. Further details of the policy are set out in the section on ‘The policy’, details of the evidence required is in ‘General guidance on demonstrating evidence’, and more information on medical exemptions is in ‘General guidance on medical exemptions’. Local authorities have an important role to play in the implementation of these regulations.

Throughout this pandemic, local authorities have taken on extra responsibilities with dedication and compassion. They have played a vital role in rolling out vaccination in care homes and supporting providers to ensure care homes are as safe as possible.

As employers who run care homes, the guidance set out in ‘Guidance for registered persons’ applies to local authorities.

As employers, and contractors, of visiting professionals, the guidance set out in ‘Guidance for visiting professionals’ applies to local authorities.

As commissioners of care homes, local authorities should continue to work closely with care homes in order to help them build confidence in the vaccine. They should also help ensure access to rapid vaccination for those who decide to take up the offer. Examples of this work include:

This work is consistent with the role of local authorities as providers of the local public health function. Local authorities play an important role as a source of advice to care homes on infection control and supporting take-up of vaccination.

Local authorities should also be working with care homes to support them to review and strengthen their business continuity plans. Local authorities should also be reviewing their own continuity plans to be clear on the potential impact on services locally and be able to respond – for example, by exploring emergency deployment of staff and mutual aid to resource care homes in the event of staff shortages.

As noted previously, local authorities should work to ensure private providers and their own care homes are able to meet the vaccination requirements outlined in the ‘Summary of regulations’ section above.

Targeted support for local authorities

We are working with Skills for Care to ensure that resources are in place. This includes guidance and best practice to support providers and local authorities with capacity and workforce planning, recruitment and wellbeing. Skills for Care will also provide local and national workforce support to local authorities and employers.

We will continue to work with local authorities to drive uptake and ensure access to vaccines, particularly in areas with the lowest uptake. We will continue to review the need for further support. Skills for Care resources are available.

Further support

Local authorities can seek further support from the Local Government Association and the Association of Directors of Adult Social Services in England (ADASS).

Question 11

Guidance for residents, and relatives and friends of residents

Accepted Answer

Key changes

With a few limited exceptions, anyone entering a care home must meet the vaccination conditions outlined in the ‘Summary of regulations’ section above. These vaccination requirements do not apply to:

residents
individuals providing emergency assistance and members of the emergency services
individuals providing urgent maintenance assistance
friends or relatives of the resident
individuals visiting residents who is dying or offering bereavement support
under-18s
participants in clinical trials

Further details of the policy are set out in the section on ‘The policy’, details of the evidence required is in ‘General guidance on demonstrating evidence’, and more information on medical exemptions is in ‘General guidance on medical exemptions’.

How these changes affect you

This policy has been introduced to ensure the safety of you, other residents and staff to reduce the risk of COVID-19 spreading in the home.

For more information on why vaccination is important please see the ‘Introduction’ of this guidance.

What will happen to your care if the people who care for you are not vaccinated

We are working with care providers to help them support all their staff to take up the opportunity to be vaccinated. Workers need to provide proof of COVID-19 vaccination or medical exemption. If a staff member cannot provide this, they may begin working in another role and no longer work with you. If you are worried or have questions about this, please speak to a staff member or the manager of your care home.

If any staff members do leave the sector, guidance and resources will be in place for providers. This will ensure they can recruit a suitable replacement who can provide the care that you need.

As medical exemptions apply, not all staff members will have received a vaccine as some may have a health-related reason not to. If you are worried about this, you can speak to a staff member or the manager of your care home.

Visiting loved ones in a care home

The policy does not apply to family and friends of care home residents.

Visitors who are not family or friends

If you are inviting professionals (for example, hairdressers) into the care home, the requirement will apply to them. You should speak to a member of staff or your care home’s manager to discuss how they can comply with the requirement.

Support available if the care home does not have enough vaccinated staff

It is unlikely that a care home will be affected in this way. We gave care homes 16 weeks’ notice (the grace period) to allow them time to work with staff who are unvaccinated. This will help to make sure they can meet their legal requirements as a provider of your care. We know many care homes continue to actively recruit staff who have had the vaccine to join their teams.

There is support in place where care homes have concerns about their ability to safely staff the service. This includes care homes raising their concerns with the local authority and the CQC. Care homes should also work with colleagues in the sector to make sure they can continue to care for you safely.

If you have any other questions about this policy and how it might impact you and other residents, please speak to a staff member or your care home’s manager.

Question 12

Guidance for visiting professionals

Accepted Answer

Since 11 November 2021, care homes must only allow individuals who are fully vaccinated against COVID-19 (or exempt) entry inside of a care home. This requirement will apply to those visiting a care home in a professional capacity unless exempt.

Further details of the policy are set out in the section on ‘The policy’, details of the evidence required is in ‘General guidance on demonstrating evidence’, and more information on medical exemptions is in ‘General guidance on medical exemptions’.

Scope

A wide range of people not based in a care home may need to enter a care home as part of their work. This includes public servants, including visiting healthcare professionals or social care workers, as well as those delivering non-care services such as hairdressing, maintenance or activities.

Please go to ‘The policy’ section to see if it applies to you.

Emergency visits

The regulations provide an exception, where it is reasonably necessary, for someone to provide urgent maintenance or emergency assistance with respect to the care home.

The registered manager of the home will be able to determine what would constitute an emergency for their own setting. The exemption applies to:

all emergency services staff attending the care home in the execution of their duties
someone who is entering the care home for emergency assistance for an incident in the care home itself

We expect urgent maintenance assistance to only apply where there is a significant impact on the quality of care of residents or risk to life.

Exemptions

Exemptions to the requirement can only apply for a person to provide urgent maintenance or emergency assistance with respect to the care home. It is for the registered manager of the care home to make that decision.

Evidence

Please refer to ‘General guidance on demonstrating evidence’ for further details on providing evidence of vaccination and ‘General guidance on medical exemptions’ for more information on providing evidence of a medical exemption.

Responsibility

It is the responsibility of the registered manager to confirm that those entering have correct proof of vaccination or exemption. However, you should ensure you and your staff have the correct proof or you may not be able to enter the care home.

The registered care home manager may also request that this requirement is included in any contracts between the care home and your employer.

Apprentices (potentially under-18s)

Under the regulations, apprentices under the age of 18 are not required to provide evidence of their vaccination status or that they are exempt.

However, as soon as an apprentice does turn 18, the registered person will need to ensure that they have provided this evidence. Apprentices under 18 should therefore plan to get vaccinated before they turn 18 – this means booking their first vaccine dose at least 8 weeks before their 18th birthday.

Skills for Care have further guidance on employing 16 and 17 year olds (under ‘Guidance on employing workers aged 16 and 17’).

Surrounding grounds of the care home

The regulations will not apply to any surrounding grounds of the care home. Any visiting professionals who are only working in the grounds and not entering the building will not have to show proof of vaccination or exemption.

However, if you are regularly visiting a care home, we would recommend you obtain correct proof of vaccination or exemption. This is because you may come into regular contact with service care users and staff, and you will be asked to provide proof before entering.

PPE

Infection prevention control measures such as PPE are still required in residential care settings. PPE requirements will remain in line with current government guidance on how to work safely in care homes. We would advise you to check this beforehand to ensure correct compliance.

Question 13

Annex A: good employment practice

Accepted Answer

Advice on retention and recruitment – Skills for Care

Skills for Care has developed a dedicated one-stop webpage. This brings together a range of support, information and resources to support social care employers to retain staff and, where needed, to recruit new staff.

This includes case study examples where employers have successfully encouraged their staff to take up the vaccine ahead of this policy being implemented. These will help share good practice from across the sector.

Policy

Care homes should consider adopting a written vaccination policy. This might cover matters, such as:

whether staff over 18 are entitled to time off work (with or without pay) to be vaccinated or obtain evidence of medical exemption
the time by which a care home will expect evidence of vaccination or exemption – this will ensure it can plan its workforce and take formal steps in relation to staff over 18 who are neither vaccinated nor medically exempt
any arrangements relating to leave if staff experience side effects from vaccination – for example, it may be preferable to avoid a large number of staff being vaccinated on a single day
how data about vaccination or exemption will be processed
how any formal policies will apply to staff who cannot comply with the requirement
how vaccination requirements of new recruits and agency staff will be addressed
any equality issues that arise from complying with the regulations (see section below on ‘Equality Act 2010’)

Guidance from ACAS

ACAS has produced a range of guidance. This should be useful for employers when considering good employment practice as part of implementing vaccination as a condition of deployment.

Getting the coronavirus vaccine for work

Advice on dismissals

Disciplinary and grievance procedures

How to raise a problem at work

Dealing with a problem raised by an employee

Tailored support for your workplace

Informing and consulting employees

Notice periods

Pay during the notice period

Discrimination, bullying, and harassment

Reasonable adjustments

Hiring someone

Collective engagement

There might be a duty to consult with a recognised trade union or employee representatives. This is because any measures may affect the health and safety of staff.

Collective consultation with the recognised trade union or employee representatives can help with:

consulting, understanding and addressing any collective issues
discussing practical and operational issues

Before and or after any collective engagement, it may be helpful to provide a written summary to staff. This can be used to explain the requirement and what it means for them. This may avoid misunderstanding about what is required, and what it means for staff.

Individual engagement

Individual engagement and information gathering should also be used to identify those who:

have been vaccinated or are medically exempt, or are under 18, and can evidence it
have been vaccinated or believe that they may be medically exempt but cannot evidence it
have not yet been fully vaccinated but will arrange to be fully vaccinated in time
have not yet been fully vaccinated and are unlikely to be fully vaccinated in time
are over 18 and not medically exempt, but do not wish to be vaccinated

Care homes can then start to arrange their records to show which people have satisfactorily evidenced vaccination or exemption.

It is recommended that any concerns raised by an individual should be explored. Staff should be provided with a reasonable opportunity to be vaccinated or obtain evidence they are exempt before any formal action is taken. The consequences of not complying with the requirement should be clearly explained. This should include when the requirement must be complied with, and what steps will be taken if it is not complied with.

Care homes will also need to consider their staffing levels in light of individual consultation. A care home will need to consider whether to replace staff or make other arrangements to operate appropriately if unable to deploy existing staff.

Where staff are away from work – for example, on maternity leave, sabbatical or long-term sick leave – care homes should make appropriate arrangements in good time. This is to avoid lack of knowledge of the requirement being a barrier to returning to work on time.

Care homes will also need to plan for staff who were under the age of 18 on 11 November 2021 but will turn 18 later. This is because the requirement to be vaccinated or medically exempt will apply when a staff member reaches the age of 18.

Staff who are not vaccinated or exempt

Where a member of staff is not vaccinated and cannot provide evidence that they are exempt, care homes should explore all options. This includes redeployment into any alternative role where vaccination or medical exemption is not required. This could include roles without direct contact with residents outside of the care home (for example, at a head office).

Care homes might also need to consider paid or unpaid leave for their staff. This cannot be a long-term solution, because the regulations do not have a time limit. Leave may be considered appropriate where there are delays in obtaining evidence of medical exemption.

Care homes should communicate the timescales they will adopt as early as possible and be clear about what will happen if workers miscommunicated timescales. Timescales will need to allow for any formal process to be followed and for notice of termination to be given if necessary.

Some care homes – having exhausted alternative options – may have to consider dismissing employees or terminating contracts of workers. This should only apply to those over 18 who are not vaccinated and have not obtained a medical exemption. Where this is the case, care homes must comply, at all times, with employment and equalities law, and adhere to good employment practice.

Fair dismissal

Employees who have been continuously employed by their employer (or by associated employers) for 2 years usually have the right not to be unfairly dismissed.

Workers do not have the same unfair dismissal protection, but both workers and employees are protected under the Equality Act 2010 (see ‘Equality Act 2010’ section below).

An employee may be fairly dismissed if:

there is a potentially fair reason to dismiss
the reason is sufficient to justify dismissal
the employer has followed a fair procedure

Fair reasons to dismiss staff who do not comply with the regulations

The regulations may provide a fair reason to dismiss an employee over 18 who is not vaccinated or medically exempt.

A potentially fair reason could be:

the employee cannot continue to work in their position without the employer contravening a duty or restriction imposed by or under an enactment
some other substantial reason of a kind as to justify the dismissal of an employee holding the position which the employee held

Where it is possible, under the contract of employment, to redeploy an employee, these reasons for dismissal may not be applicable. This would be the case when the employee can be redeployed to other duties where vaccination is not a requirement.

Where an employer continues overall to need the same number of employees to carry out the work in question and cannot redeploy everyone who is neither vaccinated nor exempt, this will not amount to a redundancy situation. The reason for termination of employment will be dismissal, not redundancy, and dismissed employees will not be entitled to a redundancy payment. However, in these circumstances, the employer will need to consider how it fairly selects employees for redeployment or dismissal. Selection criteria should be objective and non-discriminatory.

Other reasons for dismissal may arise with the introduction of the requirement. For example, if an employee dishonestly provided false evidence of vaccination, this is likely to amount to misconduct and may even amount to gross misconduct.

However, not being vaccinated or medically exempt will not in itself amount to misconduct.

Care homes must act reasonably and fairly

Where a care home is contemplating dismissal for a potentially fair reason they must also:

follow a fair procedure
act reasonably in treating the potentially fair reason as a sufficient reason for dismissal

Steps that a care home should consider taking before dismissing an employee include (note these are non-exhaustive):

consulting the employee (see ‘Individual engagement’ above)
warning the employee of the risk of dismissal if they do not evidence they are vaccinated or exempt within specified timescales
giving the employee an opportunity to explain their circumstances and any reasons they should not be dismissed – this should usually be at a meeting, but this can be held virtually or if necessary by telephone
allowing the individual to be accompanied by a trade union representative or work colleague
taking and sharing notes of any formal meetings to avoid misunderstandings or disputes about what was said
exploring alternatives to dismissal – for example, redeployment opportunities where vaccination is not required
acting consistently where cases are alike, but also considering relevant differences between cases
deciding on an outcome and communicating the outcome to the employee
providing a right of appeal against dismissal

Care homes should consider and publicise their policy if a dismissed employee appeals against dismissal and completes a vaccination course or obtains a medical exemption after dismissal, but before the appeal is heard. Care homes will need to consider whether they will reinstate employees in such circumstances, and whether they will pay back pay on reinstatement. Again, the employer should act consistently and fairly.

Leave may be an appropriate alternative to dismissal where a worker demonstrates intent to get fully vaccinated or obtain evidence of medical exemption. This may also justify a delay in giving notice.

Notice pay

It is recommended that any staff whose contracts are terminated because they do not comply with the regulations are given their minimum statutory notice. They should also be given any additional contractual notice or, where appropriate, pay in lieu of notice.

Ordinarily, not meeting the requirement to be vaccinated or have a medical exemption will not justify dismissal without notice.

Equality Act 2010

It is against the law to discriminate against anyone because of:

sex
race
religion and belief
disability
age
pregnancy and maternity
sexual orientation
gender reassignment
marriage and civil partnership

These are known as ‘protected characteristics’ under the Equality Act 2010.

Unlawful discrimination can include (among other things):

direct discrimination – treating someone with a protected characteristic less favourably than others because of a protected characteristic
indirect discrimination – putting rules or arrangements in place that apply to everyone, but that put someone with a protected characteristic at an unfair disadvantage and which cannot be justified (pregnancy and maternity is not a relevant protected characteristic in relation to indirect discrimination)

Direct discrimination cannot usually be justified. However, in very limited circumstances direct discrimination because of age may be justifiable.

Indirect discrimination can occur where an unjustifiable requirement is placed on everyone before they can enter a care home, such as to be vaccinated or subject to medical exemption, but it has a worse effect on people with a particular protected characteristic.

However, where that requirement is capable of justification, there is no indirect discrimination. Justification involves showing that the rule is a proportionate means of achieving a legitimate aim. The same tests apply to the dismissal of a worker because of the requirement not to allow an unvaccinated person to enter a care home unless they are exempt.

The regulations and discrimination

The regulations require care homes only to allow those who are vaccinated or medically exempt workers, or those under 18 to enter a care home. As such, a care home will be able to take advantage of an exception to the usual rules prohibiting discrimination.

The care home will also not contravene the Equality Act 2010 in relation to work if the care home does anything it must do pursuant to the regulations. This is in so far as it relates to age, disability, religion or belief.

The exception sets out that it will not be unlawful discrimination in relation to age, disability, religion or belief for a care home to ensure that a person over 18 who has not been vaccinated and is not medically exempt does not enter the care home.

This exception to equal treatment does not extend to race, sex, sexual orientation, pregnancy and maternity, gender reassignment, marriage and civil partnership. However, please note, indirect discrimination in relation to these protected characteristics might still be capable of justification (see above and below).

For example, a care home that chose to dismiss only the disabled staff because they were disabled would not be able to claim the benefit of this exception. This is because the regulations do not force the care home to choose to dismiss only disabled staff.

However, where a care home must dismiss some staff as a result of the regulations, and selects staff in a fair and non-discriminatory manner, the exception may be available because of the requirement of the regulations.

In the event that there was evidence that the requirement imposed by the regulations on those over 18 to be vaccinated or medically exempt put people at a particular disadvantage by reference to a protected characteristic, then a care home may, subject to the exception above, have to justify that treatment.

Compliance by a care home with the regulations is very likely to be a legitimate aim. As long as a care home cannot take other reasonable steps to avoid dismissing staff (for example, redeployment to a head office and so on), it is likely to be able to show that dismissal is a proportionate means of achieving a legitimate aim such that the justification will prevent there being any indirect discrimination.

A vaccination policy and the decisions made under it must not discriminate against workers.

For example, a care home that redeployed unvaccinated white employees to other work, and dismissed unvaccinated black employees on the basis of race would contravene the Equality Act 2010. Or a care home that provided a right of appeal against dismissal to heterosexual employees but not to homosexual employees would contravene the Equality Act 2010.

However, most unlawful discrimination is less obvious than this.

Example 1

A criterion for deciding which unvaccinated employees should be redeployed to other work might indirectly discriminate against people in relation to religion if it prioritised people who could work on Sundays and particularly disadvantaged Christian workers. Such a criterion would need to be justified as a proportionate means of achieving a legitimate aim to avoid contravening the Equality Act 2010.

Example 2

A disabled employee may have difficulties getting vaccinated in a specified timescale because of limited mobility, or may be less able to take part in a formal hearing by telephone.

In these circumstances, a care home will need to consider whether reasonable adjustments need to be made to avoid putting the disabled person at a disadvantage. If the care home fails to make reasonable adjustments, it may contravene the Equality Act 2010 in relation to the disabled employee.

Collective and individual engagement can be good ways to identify and address potential contraventions of the Equality Act 2010.

Further information on the Equality Act 2010 can be found on the Equality and Human Rights Commission website: Equality human rights – employment statutory code of practice.

The information set out above is for guidance only. The legal position can only be assessed by reference to the specific circumstances that apply. Care homes should consider taking their own independent legal advice.

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This guidance was withdrawn on 15 March 2022

Applies to England

Overview

Legislative stages and key dates

Stage 1

Stage 2

Stage 3

How to use the guidance

The purpose of this guidance

Who this guidance is aimed at

Definitions used in this guidance

The VCOD1 regulations

The VCOD2 regulations

The international travel regulations

Registered person

CQC-regulated or registered

Employed or engaged

Resident

Vaccination requirements

Authorised vaccine

Top-up dose

Booster

Introduction

The vaccine roll-out

Why it is important to have a vaccine

Where to find information about the COVID-19 vaccines

The policy

Summary of the regulations

Changes from 1 April 2022

New starters

Registered persons

Booster doses

If an individual has been vaccinated with a vaccine that is not currently ‘authorised’

Prior to 1 April 2022

From 1 April 2022

Participants in clinical trials

Residents

Emergency assistance

Emergency services

Friends, relatives and essential care givers

Urgent maintenance work

Death and bereavement

Under-18s

Students

Volunteers

Staff travelling from non-care settings

Entering a care home for a job interview

Making postal, courier or other deliveries and collections

Devolved administrations

General guidance on demonstrating evidence

Required evidence

How to demonstrate evidence of vaccination

If the member of staff lives in England

NHS App and NHS website

Non-digital solution: NHS COVID Pass letter

If the member of staff lives in Scotland, Wales or Northern Ireland

If the member of staff has been vaccinated outside of the UK

Prior to 1 April 2022

From 1 April 2022

If a member of staff’s NHS COVID Pass has been deactivated

Further guidance

General guidance on medical exemptions

Other methods of temporary exemptions

Groups that can get a medical exemption

Other measures to reduce risk of transmission

Guidance for registered persons

Overview

Checking vaccination or exemption status

Recording vaccination or exemption status

Example

Keeping written records and General Data Protection Regulation (GDPR) compliance

Data protection principles

Special considerations for visiting professionals

The role of the CQC

Registration

Ongoing monitoring

Inspection

Enforcement

Support for managers and registered persons