Gentle persuasion

The government has launched a consultation looking at requiring care home providers, caring for older adults, to use only workers who have received their Covid jab. Alistair Kleebauer finds out how this may impact the homecare sector further down the line

As frontline workers dealing with the most vulnerable people in society, much attention has been placed on care staff getting vaccinated against Covid-19.

So much so that in April, the government launched a consultation on making vaccinations mandatory for care home workers. It argues this would provide further protection to older people in care homes and that some providers are already introducing similar policies.

Health and social care secretary Matt Hancock told Parliament that older people in care homes are at the highest risk from Covid-19 and, therefore, vaccinations will not be compulsory for homecare workers though he urged all carers to get vaccinated.

Despite his comments, there are those who feel that, if mandatory vaccinations are introduced in care homes, this could later be applied to other care sectors.

As Colin Angel, the United Kingdom Homecare Association’s (UKHCA) policy director told CMUK, the consultation asks respondents whether its scope is right.

He said: ‘Reasonably you would expect some respondents to say “well, if it’s going to happen in residential care, it ought to happen in similar parts of the care sector”. And I’ve certainly heard people say, “well, why isn’t there a consultation about doing this in the NHS?”’

Education

By 18 April, 71.5% of total staff (304,000 workers) in independent domiciliary care providers in England were vaccinated with the first dose.

Martin Jones, Home Instead UK chief executive officer

Martin Jones, chief executive of domiciliary care company Home Instead, said that, as of late April, around 9,500 of its staff out of a total of around 12,500 had received their first vaccination.

He said the company has provided education and encouragement regarding the vaccine and practical support such as arranging transport and paid time off for staff to go to vaccination centres.

For those who are hesitant, it is a case of finding out why, including whether it is because of a medical issue or a lack of knowledge about the vaccine, he said.

‘Obviously social media, particularly in the early days, was putting out a load of nonsense, as we all know,’ Jones said. ‘If you’ve got medical reasons or it’s on some religious grounds, you have to be appreciative of that.

‘But, in the main, once you’ve talked to people and understood the rationale and done some education, most have been happy to have it.’

The UKHCA surveyed 579 of its members in March and found that 70% supported or strongly supported some form of legal requirement for vaccination of the homecare workforce.

The most common reasons were protecting the workforce, and, most frequently, protecting recipients of homecare, including those being cared for expecting it of their carers. Nearly a quarter (23%), opposed or strongly opposed this, giving reasons including it infringing workers’ rights and a negative impact on recruitment.

Jones does not rule out mandatory vaccinations on principle, but he added: ‘We should look at the whole of health and social care, not just pockets of different workers within it, to be truly effective.

‘An older person who’s at home will not just have the Home Instead caregiver coming in but probably three or four other health professionals depending on their conditions. If they’ve all not had the vaccine and I’ve enforced all my caregivers to have it, it makes no difference. The other three people going in could have Covid.’

Opposition

Unison will say it is strongly opposed to mandatory vaccinations for care home staff in its response to the government consultation, according to its national officer for community, Andrew Dobbie.

‘It’s completely alien to our British traditions to require medical treatment on any competent adult and this would essentially do that,’ he said.

‘It would tie their ability to work to their willingness to take on a medical treatment and that is really the top of a slippery slope that leads down to a very dark place.

‘You start with, “look here’s a group of people that we want to get vaccinated”. Then there might be a wider group of people who you decide it makes sense to compulsorily vaccinate and, in this context, it might be homecare workers. Once you’ve bridged that principle, a much wider set of discussions opens up about you can only do X if you’re prepared to undertake treatment Y.’

I think many care providers will be worried about their ability to retain staff and provide safe care if they are required to do this

He added that Unison is in favour of vaccinations as the way out of the Covid crisis and it has been encouraging its members to get inoculated, but that workers’ final decisions on whether to be vaccinated or not should be respected.

‘The government has to put some resources into it, they have to put some welly into it and they have to actually try and persuade people,’ he said.

‘If you instead say “we’re going to take a stick to you”, that doesn’t encourage people to think “actually I’m going to do this because it’s important to do it because it will protect me and it will protect others”. It just encourages them to think “I have now been forced into doing it.”’

The UKHCA survey allowed respondents to leave comments and a common thread, according to Angel, was that those receiving care may now expect their carer to be vaccinated.

It raises the prospect that, even without the law changing, the industry might demand its workforce is vaccinated because customers will insist upon it before they let someone through their front door.

Some care providers, including Barchester Healthcare, already require new starters to have the vaccine or be prepared to get one unless they have medical exemptions.
Jones said this could become a growing trend.

If, in future, an employer dismissed a worker because they refused to be vaccinated, those with less than two years’ service, which is commonplace in the homecare sector, normally cannot challenge it as unfair dismissal.

They might be able to argue it was discriminatory, depending on the circumstances.
Those with more than two years’ service could take their employer to a tribunal, where it would have to be established if a reasonable management request had been made, according to employment lawyer Adam Pavey from the firm Pannone Corporate.

He said: ‘If the government says that you have to have a vaccine to work in a domiciliary care business or to work in a care home, then that makes this argument about whether it’s a reasonable management instruction stronger.

‘Because the employer is just going to say, “well, it’s the government position, so how can it be an unfair dismissal case? We were just following government advice.”’

Alternative routes

For now, the outcome of the government’s consultation should be critical in shaping how the care sector treats the subject of vaccinations in future.

Colin Angel, policy and campaigns director, United Kingdom Homecare Association

Angel said the UKHCA’s response to the consultation is likely to say that, should the vaccination rate of social care staff not reach a level that provides sufficient protection to the workforce and those receiving care, it could be appropriate to require workers be vaccinated.

But he added: ‘I expect to be saying that we would want to see a bit more progress and to be reassured that other alternative routes – the more gentle persuasion – were not being effective before bringing in compulsion.’

Dobbie said he hopes it will be a genuine listening exercise by the government. ‘I think many care providers will be worried about their ability to retain staff and provide safe care if they are required to do this. So, I hope that they will listen carefully.’