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Flu vaccination for adult social care workers 2020/21

Contents



29 October 2020

Introduction§

This short Care provider Alliance (CPA) briefing aims to support care managers, occupational health leads, team leaders and care service owners to maximise take up of the flu vaccine by their eligible staff.

It covers both residential and community-based services that are regulated by the Care Quality Commission. Unregulated services may also find the briefing valuable.

This briefing should be read alongside Public Health England’s guidance on the adult social care flu vaccination programme.

We will review and update this briefing throughout the course of the winter flu programme.

Please send comments and enquiries about this document to info@careprovideralliance.org.uk. We will use these comments to update our briefing, and feed back to the Department of Health and Social Care on key issues for care providers.

Disclaimer§

The CPA assumes no responsibility or liability for any errors or omissions in the publication of this communication. The information contained in this update is provided on an “as is” basis with no guarantees of completeness, accuracy, usefulness or timeliness. It does not constitute legal advice.

 

Background§

The Department of Health and Social Care and Public Health England are encouraging all social care workers who are “in direct contact with patients and service users” to have the flu vaccination.

Staff in the residential and care home sector, staff providing care to people in their own homes, and Shared Lives carers are working with some of the most vulnerable in our communities, so it is important that they help protect themselves and service users against flu. The winter 2020/21 flu programme for the social care workforce aims to support all employers to increase staff uptake of the vaccination.  This includes the employer-led occupational health schemes, and the NHS complementary flu vaccination.

Employers should arrange for staff to be vaccinated through their own occupational health programmes.

Where this is not possible, the NHS complementary flu vaccination programme provides free vaccinations from GPs or pharmacies. The scheme is open to all health and care workers in direct contact with patients and service users in CQC-registered care homes, hospices, home care services (including home care within extra care housing and supported living schemes), Shared Lives Schemes or through Direct Payment (personal budgets) and/or Personal Health Budgets, such as Personal Assistants.

We are in anything but a typical year and this year’s flu season is likely to coincide with the continuing impact of COVID-19 on the population. There is a unique opportunity to be even more ambitious than previous years where on average the social care workforce have seen approximately 25% uptake in the flu vaccine.

Flu outbreaks also have a serious effect on the social care sector. Every year there are flu outbreaks within care homes despite high flu vaccination rates for residents. This is partly due to the age and medical conditions of the people in our care: they do not produce as good an immune response to vaccination. Vaccination against flu protects the people we care for and protects staff, their family and friends, helping to keep services running safely during winter.

The flu vaccine can also reduce sickness absence levels within the workforce. Recent evidence shows that people who had the flu and also contracted COVID-19 were at increased risk of serious illness or death.

Flu can cause severe complications, for which vaccination is the best protection. Whilst the threat may be invisible, the protection against it is clear and available.

The Care Provider Alliance (CPA) is working with Public Health England, NHSE&I and the Department of Health and Social Care to support the operational implementation of the flu vaccination programme for eligible staff. We will publish news, guidance and information on our dedicated web pages at https://careprovideralliance.org.uk/flu-and-winter


Complementary vaccination: eligibility§

All social care workers who are in direct contact with patients and service users should get the flu vaccine

This should – wherever possible – be:

“provided by their employer, in order to meet their responsibility to protect their staff and patients and ensure the overall safe running of services. Employers should commission a service which makes access easy to the vaccine for all frontline staff, encourage staff to get vaccinated, and monitor the delivery of their programmes.

“NHS England and Improvement (NHSEI) will continue to support vaccination of social care and hospice workers employed by registered residential or domiciliary care providers. The eligible groups have been expanded this year to include those health and social care workers, such as Personal Assistants, employed through Direct Payment and/or Personal Health Budgets to deliver domiciliary care to patients and service users. Vaccination will be available through community pharmacy or their registered general practice. This scheme is intended to complement, not replace, any established occupational health schemes that employers have in place to offer flu vaccination to their workforce.”

The national flu immunisation programme 2020 to 2021- update, DHSC and PHE, August 2020

Care workers are considered a priority and should be able to get vaccines now that the flu programme has started. Their role as a care worker will supersede any other criteria for getting a vaccine.

If you are unable to arrange an employer-led occupational health scheme, eligible staff can access the NHS complementary scheme by presenting at a GP or pharmacy and self-identifying as a social care worker.

The free flu vaccination programme covers CQC-registered services supporting all adults of all ages with personal care. The CPA’s assessment of this, is that it includes:

  • care homes (with and without nursing)
  • home care
  • Shared Lives carers
  • hospices
  • staff who are employed to deliver CQC-registered care within extra care or supporting living services
  • staff providing social care through Direct Payments or Personal Health Budgets.

Accessing vaccinations§

GPs or GP surgery staff (nurse practitioners), community pharmacists and peer vaccinators using registered nurses can administer the vaccine.

Employers should provide vaccinations for staff as part of their occupational health responsibilities and should continue to provide any schemes that they already have in place. The NHSEI complementary scheme offers a vaccination to those care staff who do not have an employer-led scheme in place.

Employers can arrange for pharmacists to deliver the vaccine onsite to both staff and residents at the same time as part of the complementary scheme.

The service can be offered through a range of models including onsite at a care home, through a mobile clinic, or at the GP clinic or pharmacy.

This year, GPs and pharmacies have been authorised to vaccinate both residents and staff on-site at care homes as part of the free flu service. (See Pharmaceutical Services Negotiating Committee – Flu Vaccination Service)

If you are unable to arrange an employer-led scheme, eligible staff can access the complementary scheme by presenting at a GP or pharmacy and self-identifying as a social care worker.

You can find local GPs and pharmacies at the following links:

Find a pharmacy

Find a GP

Their profiles should be updated to indicate if they are currently offering flu vaccines. You may want to pass this information to your staff:

Proof of status as a care worker

GPs and pharmacies have been informed that eligible social care workers can receive free vaccinations and do not need to present ID. However, it may be helpful to provide employees with a letter stating they are a social care worker.

We have developed a template Proof of employment status letter, and accompanying guidance, which you can adapt and send to your staff.

Public Health England has developed a similar letter for personal assistants and care workers employed directly by individuals.

Supplies of vaccines§

This year Public Health England has planned for the largest flu vaccination programme to be undertaken by GPs and pharmacists. We are advised there is enough vaccine purchased to vaccinate 30 million people.

It is usual for the vaccination supply chain to stagger deliveries through from manufacturers and wholesalers to communities as GP surgeries and pharmacies would not be able to safely store all of their local population stock requirements at once.

Uptake of the vaccination within communities this year has been very rapid and very early, leading some pharmacies and GPs to suspend or limit access until they receive their next supply. There are also different flu vaccines depending on your age. GPs and pharmacists will need to ensure they have the most appropriate vaccine for those who are requesting it. We understand that GPs have a higher proportion of the vaccine supplies.

This means that some people have been asked to wait until they get re-stocked with the appropriate vaccine.

There should be plenty of time for everyone who requires it to have the vaccine before flu season really starts - normally in December. But do bear in mind that it takes around two weeks for the vaccine to become active.

If the vaccine that your staff require is not currently in stock, you should continue to keep in touch with your GPs and/or pharmacists to:

  • ensure they are aware of your organisation’s requirements (e.g. how many eligible staff will require vaccines)
  • request them to make you aware of when stocks are available again
  • where possible, book in vaccination slots in advance, based on dates when slots are available again
  • remind them that eligible care staff is a priority group.

As an employer, you should also:

Escalation process

If you or your staff are continuing to experience difficulties accessing a vaccination, you should contact your local vaccinators (GPs or pharmacist) and try to resolve the issue locally.

If they cannot resolve the issue, you should:

The CPA, and our members, will be updating the Department of Health and Social Care on emerging issues. We will also update this briefing and producing an FAQ on the Flu and Winter pages of the CPA website.

Employers’ responsibilities§

As the employer and the provider of care to vulnerable people, you have a responsibility to keep your staff and the people in your care safe.

You should:

  • promote the benefits of vaccination to your staff. You can use PHE’s free campaign resources and the guidance for care workers
  • arrange vaccinations for staff through your own occupational health programme, where possible
  • encourage staff to request a vaccination via their own GP or pharmacy. You may wish to provide them with a Proof of status letter
  • monitor and report on uptake of vaccinations by care staff in contact with service users
  • report on barriers to take up of the vaccine.

Public Health England guidance says:

“Employers are responsible for ensuring that their employees are vaccinated. Some employers are able to do this by privately arranging for their staff to be vaccinated, for example by privately arranging for an occupational health service to vaccinate staff on site or by providing vouchers to staff.

“However, some employers do not have the resources to run a private vaccination scheme. In those circumstances, employers should arrange for their staff to receive the flu vaccination free of charge through the NHS Complementary scheme.”

This means that if your service or occupational health team can coordinate arrangements for your staff to be vaccinated, you should try to do this. Care homes in particular may be able to make onsite arrangements for their staff at the same time as residents are being vaccinated.

If this is not possible, you should encourage staff to access vaccinations via their own GP or local pharmacist. For staff who are based away from home, they should contact a GP or pharmacist in the area where they work.

Clear communication between your local GP and pharmacy services is critical. We have provided some key issues to consider during your discussions with them. See section on Local systems: key issues to consider.

Different care settings may wish to consider different arrangements – as outlined below. See also the Government guidance for care providers which includes advantages and considerations for different models.

Care providers can request local authorities to consider “paying care staff their usual wages in order to attend a GP or pharmacy to be vaccinated against flu outside of their normal working hours” out of the discretionary 20% within the Infection Control Fund Round 2 announced on 1 October 2020.

Employers should also monitor the level of take up of the vaccine amongst eligible staff, and report this using the new systems being established. See section on Monitoring and reporting for details.

It is important to note, however, that flu vaccination is not compulsory in any part of the UK, and therefore it is not expressly required for an existing or new member of staff to have the vaccine.

Staff are also under no obligation to tell you their vaccination status, and you should not discriminate against them based on their status or their willingness to provide information about their status.

Encourage employees to do so based on the benefits of getting vaccinated and the value of sharing information to support the wider vaccination programme.

Care homes

If you are a care home provider you may consider one or a combination of the following arrangements. Please be aware that there are different types of flu vaccines. Your GP or pharmacist are likely to need supplies of both if they are to vaccinate staff and residents at the same time, or they may need to arrange more than one session.

  • Peer to peer vaccination: training your own appropriate staff, such as nurses within a care home, to administer the vaccine to your staff. Given the limited time for training, you may have staff who were trained to deliver this service in previous years or through previous employers. For further details see Written Instruction for the administration of seasonal ‘flu vaccination (2020/21 version)
  • Onsite vaccination programme (residential settings): working with your local GP and/or pharmacist to visit your care home to vaccinate both residents and care staff. Due to COVID-19 restrictions, you may need to arrange different schedules or rooms to manage staff and residents separately. And of course residents may need to be vaccinated in their own rooms. You will need to negotiate this carefully with your GP and/or pharmacist including addressing the issue of visiting professionals being COVID-19 tested and following the homes infection prevention and control procedures. A timetable would need to be agreed with the vaccinators and your staff to work with their shifts. This may involve weekend or night shift staff coming in out of hours. You may wish to request funding to cover overtime payments as part of the Infection Control Fund Round 2.
  • Mobile vaccination units: working with your local GP and/or pharmacist to arrange for a mobile unit to visit your offices or services. As with onsite vaccinations, special arrangements would need to be agreed to support shift workers.
  • Encourage your staff to contact their GP or pharmacist: If you are unable to set up arrangements on site, or if not all your staff are able to attend a session, you should encourage staff to contact their own GP or local pharmacist. You may wish to provide them with a letter which confirms their employment status and eligibility for a free vaccine. (See our template letter).

Care services within extra care, supported living or retirement villages

If you employ staff who provide care within an extra care housing unit, retirement village or supporting living service, you should work closely with the managers of the accommodation. They may be arranging for tenants to be vaccinated onsite, so they may be willing to arrange sessions for your staff as well.

If not, and you are a local provider employing local staff, you may arrange for sessions with a GP or pharmacist at your offices. However, given COVID-19 restrictions, if your offices are closed, you should encourage staff to book a vaccination directly through their local GP or pharmacist. You could provide them with contact details for local services.

Home care

If you are a local home care provider, employing local staff, you may arrange for sessions with a GP or pharmacist at your offices or through a mobile unit.

However, given COVID-19 restrictions, if your offices are closed, you should encourage staff to book a vaccination directly through their local GP or pharmacist. You may need to provide them with contact details for local services.

If you provide home care services across a wide geographic area, you may not be able to arrange vaccination services yourselves. You should encourage staff to book a vaccination directly through their own GP or pharmacist.

You may wish to provide them with a letter which confirms their employment status and eligibility for a free vaccine. (See our template letter).

Shared Lives schemes

If you run a Shared Lives scheme, it is very likely that the people using the service – as well as the carer – will be eligible for free NHS flu vaccinations. You should encourage them to contact the local GP or pharmacist and arrange for vaccinations to be administer jointly. You may wish to provide them with a letter which confirms their employment status and eligibility for a free vaccine. (See our template letter).

Individuals employing care workers

For the first time, workers employed through Direct Payments and/or Personal Health Budgets to deliver care are eligible for free flu vaccinations. This means that, for example, personal assistants employed using Direct Payments and/or Personal Health Budgets are eligible. While CPA membership does not cover this group of staff, our advice would be that they should be vaccinated at the same time as the person they care for. Or go directly to their own GP or pharmacist to request a free vaccine. We would also encourage them to tell their GP or pharmacist that the main reason they are getting the vaccine is because they are a social care worker.

Temporary staffing agencies

Some care providers use temporary agency staff. They are not your employees, therefore you do not have formal responsibility for arranging their free vaccination. However, as they have access to at risk groups, you should strongly encourage them to get the flu vaccine if they have not already. In practice, if they are working only at your service, you should consider arranging for their vaccination through the same route as your permanent employees.

You may wish to ask the agency to confirm the vaccination status of the staff member you are employing and/or have this in the written in the terms and conditions of employment

The agency should also contact all of the eligible staff on their books and advise them of their eligibility. Locally-based agencies may arrange for vaccination at their offices or via mobile clinics, or as more likely to be the case, they may encourage their staff to contact their own GP or pharmacist.

The new flu questions on Capacity Tracker for care homes asks for information on the flu status of all staff and volunteers – including temporary or bank staff (see Monitoring and reporting – Capacity Tracker).

Introductory agencies

Some homecare providers act as introductory agencies (technically described as “employment agencies”) which introduce care workers or personal assistants to private individuals to be employed by them. The introductory agency does not employ the care worker, but it would be beneficial if they could encourage workers on their books to get vaccinated using the complementary scheme via GPs and pharmacists. Alternatively, the private individual who engages the worker should encourage take up of the vaccine.

Local arrangements: key issues to consider§

Local arrangements with GPs and pharmacists will vary from area to area. Clear communication between care providers and their local vaccination teams will be critical. We understand that GPs have the larger proportion of vaccine supplies.

All local areas based on either Clinical Commissioning Group, or local authority, should have a plan in place for free flu vaccinations.

You may wish to use the following questions to clarify local arrangements.

  1. Are there sufficient supplies to vaccinate all eligible groups – including care staff - in the area now? If not, when will stocks be replenished? Will residents be prioritised?
  2. How are future supplies being guaranteed?
  3. How can you report issues with access to vaccinations for your staff (and service users)?
  4. Is there training available locally for peer-to-peer vaccinators and if so, how can this be accessed?
  5. Do peer-to-peer vaccinators have to be registered nurses?
  6. What other equipment is available for peer-to-peer vaccinators (e.g. kits for anaphylaxis)?
  7. Are special surgeries for mass vaccination of staff being held either at surgeries, pharmacies or within care provider premises? If yes, what information is available about slots and how to book them?
  8. Are local GPs and pharmacists requesting ID to prove their eligibility for vaccination? This is not compulsory, but if local vaccinators are asking for this, you may need to provide your staff with a covering letter (see CPA template).

Monitoring and reporting§

Previous systems that have tried to collect data about the take up of flu vaccines by social care staff have been unreliable, but it is estimated that only 25 per cent of care workers took up the vaccine in previous years.

Due to the risks posed by seasonal flu – including the increased risk of severe illness in people with both flu and COVID-19 - the Government is aiming for a high level of flu vaccination uptake amongst eligible social care workers.

Therefore, all care providers are being asked to monitor and report data on levels of uptake. This anonymised data will be analysed by NHS E&I and shared with national bodies, including DHSC, Public Health England, Local Government Association and the Care Provider Alliance, in order to identify areas where uptake is low, why it is low, and what actions need to be taken in order to increase uptake. This may, for example, relate to poor levels of access to vaccines in particular geographical areas. This information will then be shared with regional NHS and Public Health Teams who will take action at a local level.

This season’s flu programme is also being used to inform the potential future COVID-19 vaccination programme and which vaccination models are most appropriate for adult social care.

Skills for Care Adult Social Care Workforce Data Set (for all care settings and services)

Skills for Care Adult Social Care Workforce Data Set (ASC- WDS) has been modified to enable vaccination to be recorded on this system.

All care services – including care homes and community-based services - should use this facility to record staff member’s vaccination status. This will allow all care providers to accurately manage their vaccination programme and be able to report the status of each member of staff without maintaining paper records.

The data will be used to provide DHSC and Public Health England (PHE) with a  better understanding of the take up of the flu vaccination by people working in adult social care. The information will be used to help DHSC boost the availability and take up of this key vaccination.

Skills for Care run a report on the last day of every month. Care providers are advised to update their data in time for this report.

The Skills for Care system asks:

Who has had a flu vaccination since 1 September 2020? 

Worker records can then be selected and updated.

Register for the ASC-WDS on the Skills for Care website.

Contact the ASC-WDS Team:

Email ascwds-support@skillsforcare.org.uk or call 0113 241 0969.

Capacity Tracker (for care homes)

New questions have been added to the ‘Costs, Vacancies and Business Continuity' section of the Capacity Tracker for care homes. This data should be updated at least daily. Care homes are also asked to complete the Skills for Care dataset.

The questions on the Capacity Tracker in relation to the seasonal flu vaccination are:

Number known to be immunised:

Residents

Directly Employed Staff

Agency/Bank/Volunteers

Number known NOT to be immunised (includes people who have not consented to be immunised)

Residents

Directly Employed Staff

Agency/Bank/Volunteers

Number where status is unknown (e.g. people not wanting to disclose their immunisation status or people who have not been asked)

Residents

Directly Employed Staff

Agency/Bank/Volunteers

Have you experienced any delays or issues accessing the vaccination for your residents/staff? 

Yes/No

Register for the Capacity Tracker

Contact the Capacity Tracker team:

Email necsu.capacitytracker@nhs.net or Tel 0191 6913729

Data management

Flu vaccination is not compulsory so you cannot insist that your staff have it. Your staff are also not required to tell you about their personal medical history.

It is, however, good practice for staff to have the jab, and for you to record this information – with appropriate consent from the employee. So you should encourage and reassure staff to take up the vaccine, and advise you if they have done so.

You must not show bias towards staff based on their vaccine status, or on their willingness to tell you about their vaccine status.

If you record their status on paper or electronic records, this must be done with appropriate consent, and must not be divulged in an identifiable way with any other member of staff, service user, family or any other authority.

Developing your flu vaccination programme§

The Government’s guidance for care providers incudes some tips on developing a multi-component approach to ensure staff can access the vaccination scheme.

NHS England also identify five key components of developing an effective staff flu vaccination programme that apply to both NHS trusts and social care organisations:

  1. committed leadership
  2. a balanced flu team
  3. a good communications plan
  4. easy access to vaccination
  5. the use of incentives and rewards.

NHS England’s information was published during the 2019/20 flu programme, but it may still provide you with useful tips on these key areas.

 

Promoting vaccination§

Public Health England has produced a range of promotional materials – including adaptable posters, leaflets, and digital resources to help you promote vaccination to your staff. It also includes a communications toolkit, and a social media toolkit.

The theme of the workforce campaign is ‘I’ve had my flu jab’.

You can download or order resources for free on the PHE campaign website.

And you can download PHE’s leaflet for social care workers.

Key messages

You may wish to use the following key messages – taken from Public Health England’s toolkit - to encourage staff to get vaccinated.

  • This is anything but a typical year and we all want to protect ourselves and those close to us. Flu can be deadly and is highly contagious
  • If you’re a frontline worker in social care, you’re more likely to be exposed to flu due to the nature of work.
  • You can have no symptoms but unknowingly spread it to your friends, family and patients / those you care for.
  • Being healthy doesn’t reduce your risk of getting flu or passing it on.
  • All frontline social care workers have FREE access to the best protection available, the flu jab.
  • To keep you, your family and patients / those you care for protected, get your free annual flu jab as soon as you can
  • Flu immunisation can reduce the rates of illness, reducing staff absence and pressures on our services.
  • People with flu and COVID-19 are more likely to get seriously ill, or even die.

 

Useful links§

Care Provider Alliance

Care Provider Alliance – Flu and Winter

Template letter: Proof of employment status (Word)

Guidance on using template letter: Proof of employment status

CPA members

Government departments and agencies

Public Health England – Flu immunisation programme for social care staff

This includes:

Public Health England – Flu vaccination: Why you are being asked to wait

Public Health England – Health and social care workers’ flu campaign resources

Public Health England – Flu immunisation training recommendations for 2020 to 2021

Public Health England and NHSE - Flu and flu vaccination 2020/21: A toolkit for care homes (South West)

Department of Health and Social Care and Public Health England - The national flu immunisation programme 2020 to 2021- update, August 2020

NHS England

Monitoring systems

Skills for Care – ASC-WDS

Capacity Tracker

Other

Find a pharmacy

Find a GP

Boots – Winter flu jab services

Lloyds Pharmacy – Flu vaccination

Well – Flu jab services

Contacts§

If you have comments about this briefing please contact us at info@careprovideralliance.org.uk.

If you have concerns about vaccine supplies and your pharmacist or GP are unable to resolve the issue locally, see Escalation process above.

If you are a member of a national trade association, contact details are available on the CPA website.