Analysis: Mandatory NHS staff vaccination welcome but could be disastrous

Analysis: Mandatory NHS staff vaccination welcome but could be disastrous
Analysis: Could move disproportionately impact hospitals caring for deprived populations?

Ministers have confirmed they will press ahead with plans to bring in mandatory Covid vaccinations for frontline NHS staff from April next year.

But what will this mean for a health service facing a major workforce crisis and hospital bosses who fear tens of thousands of vaccine-hesitant staff voting with their feet?

The latest data suggests just over 100,000 NHS workers have yet to have their first dose of the Covid-19 vaccines – just under 10 per cent of the entire health service workforce.

A similar plan to enforce mandatory vaccinations in social care, which comes into force this week, has seen vacancies jump from six per cent to 10 per cent.

If the NHS saw similar levels of staff leaving it could trigger a patient safety disaster, coming on top of existing shortages of nurses, beds and doctors that has seen the service in crisis for most of this summer.

One saving grace is that the government have listened to NHS lobbying and will not bring the rules into force this winter – the care industry has not been so lucky.

While NHS leaders have largely welcomed the move towards mandatory vaccinations, the reality of implementing it over the next three months could be tricky.

Of the NHS workers yet to be vaccinated it is not clear where they work or what their roles are. Hospitals have differing rates of vaccination with some as low as 80 per cent and so if there is any exodus of staff this could disproportionately impact certain areas of the country.

It would be disastrous, for example, if hospitals serving patients with higher levels of deprivation loose more staff compared to others.

The chief executive of one NHS trust, which has lower staff vaccination rates, welcomed the move but warned there was a “stubborn” resistance to vaccination in some which is difficult to address.

The responsibility for carrying out the government’s rule will fall to trusts and the work will need to be carried out whilst hospitals are going through what could be the worst winter on record.

Professor Helen Bedford, professor of children’s health, at Great Ormond Street Institute of Child Health, said although mandatory vaccination can seem like the obvious solution it could “backfire” and make people who are just unsure more hesitant.

The definition of “face to face” contact may also be a tricky obstacle to manoeuvre. If taken literally this could mean anyone who has contact with a patient, which would include admin staff, NHS managers, cleaners, porters. These are all roles in which staff could encounter patients and the public and are all vital to running a hospital.

One specialist employment lawyer, Julian Cox, also warned mandating vaccination may have “serious implications for the NHS down the line.”

He explained there could be potential conflict between the health and safety argument for making vaccination mandatory and the current legal protections for employers under the Equality Act 2010, as well as European human rights laws.

The tensions, Mr Cox said, could lead NHS employers to be exposed to legal claims ranging from unfair dismissal to discrimination.

Although a firm decision has been made on Covid vaccinations the government has shied away from making a decision on mandatory flu vaccines.

This idea has been floated for years, since at least the reign of Jeremy Hunt, but has never been implemented. However, with the move towards enforced Covid vaccines the door has been left open.

In the face of further Covid-19 waves mandatory vaccination overall seems like a palatable solution to protecting patients and staff.

However, the test will be in the application of the rules over the next three months and if the government enforce a hard deadline from 1 April.