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In this article, William Lee, Policy & Parliamentary Executive at the British Healthcare Trades Association (BHTA), discusses how the government must back up its decision to introduce mandatory vaccination with economic support for health and social care providers in the event of disruption, and clarify some essential points.

On the 10th November 2021, the Department of Health and Social Care (DHSC) announced that – from 1st April 2022 – all frontline health and social care workers in England must be fully vaccinated against COVID-19 as a condition of deployment (unless medically exempt), after a consultation on the issue.

This extends a similar decision to make COVID-19 vaccination mandatory for anyone working or volunteering in a care home (again, unless medically exempt) from 11th November 2021.

To say that mandatory vaccination divides opinion is an understatement, especially since the debate is typically framed as a conflict between individual freedoms (to accept or refuse the vaccine) and collective protection. The public, and the healthcare workers who protect them, are at the lowest risk of serious illness when as many people as possible are vaccinated.

This debate is important, indeed it even divides opinion among individual NHS workers; however, to echo a position outlined in a recent British Medical Journal opinion, it is a luxury we cannot afford right now “…as this pandemic has shown, the problem with waiting for more information is that delaying action costs lives [and] there comes a time when a decision has to be made, even with imperfect or incomplete information.”

The BHTA understands the government’s decision to require mandatory vaccination, and we agree with the government’s desire to take all necessary steps to protect both healthcare workers and the public during this pandemic. However, the BHTA believes the government’s announcement only covers half the solution, and fails to address the important remaining half: support for any potential negative economic fallout as a result of the decision.

Luckily, the government does not have to look far for just such an example of a serious, sweeping, mandatory public health measure (lockdown) complemented by economic measures specifically designed to ensure its uptake/efficacy (the furlough scheme).

On behalf of all of our members in the health and social care sector, BHTA calls on the government to address the economic measures required and:

Respond to industry concerns around complex legal issues arising from workforce deployment effects of mandatory COVID-19 vaccination

Employers in the health and social care arena (including BHTA in its response to the consultation above) have warned the government of serious legal concerns regarding existing employees who refuse the vaccine. Ranging from employee claims of unfair dismissal to compulsory re-deployment to companies’ inability to meet contractual obligations due to ex-post-facto application of vaccine rules, however, these concerns have, so far, not been addressed. Clarity and support from the government on legal issues would allow health and social care employers – already struggling with soaring operating costs, increased tax and payroll bills, and loss of staff to other, less stressful employment – to plan for and operate in a “new vaccine normal.”

Commit to keeping COVID-19 vaccines free for as long they remain a condition of deployment in any setting/sector

Many employers are concerned that, in the future, they will have to bear the cost of vaccinating employees against COVID-19, and keeping them up to date with any recommended boosters. If the government decides to stop funding free vaccines, there must be assurances provided that COVID-19 vaccines will remain free and freely accessible to all employers whose staff are required to be vaccinated as a condition of frontline deployment.

Establish – or extend – financial support for health and social care businesses to deal with the workforce effects of mandatory COVID-19 vaccination

There will doubtless be some employees – hopefully, a very small proportion – who refuse the vaccine but still have experience and skills valuable to businesses in particular, and the health and social care sector in general. Again, in the mould of previous programmes aimed at providing financial support for businesses affected by COVID-19, health and social care businesses could better help the vast majority of frontline workers decide to get the vaccine – and continue to provide the best quality and quantity of frontline support to patients – if they themselves are supported in retaining vaccine-hesitant workers who can still contribute positively. With estimates of NHS vacancies at 90,000 and social care vacancies at up to c. 100,000, targeted financial support for health and care sector businesses to aid employee retention is sorely needed.

• Set out clearly why the government has not considered – or considered and decided against – alternatives to mandatory vaccination

Many of those opposed to mandatory vaccination (such as the Chartered Society of Physiotherapy) point to the existence of alternatives like daily lateral flow testing and ask why these are not deployed instead of mandatory vaccination. The government’s response to the consultation acknowledges these alternatives, but does not set out clearly why mandatory vaccination is the preferred option; doing so would clarify the choice for vaccination and further strengthen the argument for vaccine uptake that government is, in large measure, asking employers to make to employees on government’s behalf.

The BHTA and its members stand ready to support the government in its efforts to protect the public and frontline health and care workers. It is crucial that the government heeds, and addresses, the concerns raised to ensure that the impact of this decision does not hinder health and social care providers ability to deliver the best possible care to all.

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