As we start a new year, I wanted to write about an area of forward-looking practice development, maybe the new national nursing research strategy, or developments in nurse education or patient experience—but it is very difficult to get any headspace to consider much other than the continued response to COVID-19. This includes but is not limited to the impact of workforce absence, our aims to recover the elective care pathway, or our response to the urgent care pathway and patient flow constraints, as areas that are dominating most of our time.
However, I have taken some time to reflect, 1 year on from when I administered the first in the world out-of-trial Oxford Astra Zeneca vaccine. Looking back at the media coverage and response from colleagues and the public, it was a time of pride that a UK-based team had succeeded in developing a vaccine that was now licensed for use. In common with many colleagues, we had set up a vaccine centre, which offered vaccination in line with the national policy to health and social care colleagues and members of the public.
The demand was high, with queues around the block. Every person told a personal story of what the vaccine meant to them. At times, these short interactions between patient and vaccinator were very emotional. Members of the public who had been shielding, with little or no contact with their family, saw the vaccine as hope for a move towards some ‘normality’. Staff attended for their vaccine for increased protection as they continued to work in clinical settings, and there were those working from home following a risk assessment who were desperate to re-join their colleagues to deliver their substantive roles. There were tears, laughter and many uploads to social media platforms sharing vaccination status.
I wrote about this last year when there was a live national consultation to support a decision for NHS staff to be mandated to receive the vaccine—as passed by Parliament in December (Mitchell, 2021). On 9 November 2021, England's health and social care secretary, Sajid Javid, announced that all staff who work in health and social care settings regulated by the Care Quality Commission will have to be fully vaccinated by 1 April 2022.
Ahead of the formal legislation, NHS England/NHS Improvement (2021) issued planning guidance for employers, in preparation for vaccination as a condition of deployment (VCOD). Phase one aims to:
- Support compliance with the regulations
- Maximise vaccination rates
- Minimise the impact of the regulations on the NHS workforce capacity
- Provide a consistent approach in the planning and preparation for the regulations, with minimal operational differences between organisations, and
- Support employers ensuring the best protection for vulnerable patients and staff in healthcare settings.
Phase two of the guidance will focus on the safe transition of services and will cover the formal steps that should be considered when implementing the regulations.
As this guidance was issued, Kmietowicz (2021) reported that a House of Lords committee (The Secondary Legislation Scrutiny Committee) had raised several concerns about the proposed legislation to make vaccination mandatory for all NHS staff in England. The concerns included that, of the 208 000 NHS staff who weren't currently vaccinated, 54 000 (26%) would take up the vaccine under the law but 126 000 (61%) would leave their jobs.
The Committee said that the government's plans had not been thoroughly thought through, leaving the House of Lords unable to scrutinise the proposed legislation. It argued that the benefit of increasing the protection from vaccinating staff who had not yet taken up offers of the jab ‘may be marginal’ and that the government had failed to publish any contingency plans on how it would cope with the loss of staff who do not want the vaccine.
Although many people are happily coming forward for their booster there is also a group of people now coming for their first vaccine. Some are cross, feeling forced into taking up the vaccine as their only means of travel. Some are worried that the vaccine is ‘new’ and that there is ‘not enough known’. Some have come forward later due to not wishing to be vaccinated during their pregnancy, often citing that pregnancy was a contraindication a year ago, and are worried about the ‘U-turn’. Some point to their personal circumstances: ‘I am young and fit, I have had COVID and have antibodies.’ I have found it professionally and personally informative to hear the personal stories of either vaccine-hesitant or anti-vaccine individuals. These deeply held and personal views are dividing families, friends and workplace colleagues and are likely to have a significant impact on health and social care in the near future. Many of the actions in the planning guidance require our senior leadership and I will continue to promote the benefits of the vaccine to our staff and to our patients, while respecting the individual views of colleagues.