Unvaccinated and working in social care? Who gets to choose?

I value my right to make unwise decisions and your right to hold (in my eyes) bananas opinions.

So I find myself in a real quandary today. An emerging question concerning choice that will challenge much of what Dimensions and so many social care providers hold dear. Is it right that government legislates to force people working in social care to receive the Covid-19 vaccine?

• Health inequality and learning disability in a post-pandemic NHS
• Man with severe learning disabilities should have the vaccine, judge rules
• People like me are six times more likely to die of Covid-19, so why can’t we get a vaccine?

Get vaccinated, even if you don’t believe in vaccination, or you will lose your job? Strange as that sounds – that could be where we all end up.

But is it really that strange? Dimensions has already taken the decision, subject to the Equality Act, for new support workers to commit to getting vaccinated. Requiring current colleagues to be vaccinated is at present not mandatory, so whilst we are encouraging vaccination vigorously and monitoring it closely, as of today we will not go further. 

Why has Dimensions taken this stance, and should we consider supporting any such future legislation – or should we lobby against it? There are no simple answers and this blog doesn’t reach a definitive position. Rather, I hope it nudges the conversation along a little.

First duty to keep people safe

A care provider’s first duty is to keep the people we support and our colleagues safe. Consider this – if we rota a colleague who doesn’t want to be vaccinated to support a person, and that person subsequently contracts and then dies from Covid-19 caught from that colleague – might people consider we’d failed in our first duty? Then again, no measures – vaccination, infection control etc – provide absolute safety. The world doesn’t work that way.

Chief Medical Officer Chris Witty certainly agrees with a robust stance, saying, “The professional expectation, very strongly in my view, is that professional medical and social care staff should be taking [the vaccine.]”

As an aside, isn’t it great to see Chris Witty using the term ‘professional’ in respect of care workers? I look forward to government applying this to their thinking universally from this point on. Care work is a profession. Government recognition of this will help us work towards improved pay, training, standards and funding. You can be sure I’ll be referring back to it.

The decision to require vaccination for new starters was relatively simple. If you’re unwilling or unsure about getting vaccinated, and you don’t have a compelling medical justification such as allergy or pregnancy, we respect your hesitancy but we cannot let that hesitancy put the lives of the adults you hope to support at risk.

Should we encourage or force social work colleagues to get vaccinated?

Unless the law changes or there is very clear evidence that the vaccine stops the transmission of Covid-10, we will continue to encourage but not force current colleagues to get vaccinated. I hope peer and societal pressures will play a part – for example I can see a day when:

• vaccinated colleagues don’t have to wear PPE whilst those not vaccinated have to
• vaccinated colleagues are reluctant to work alongside unvaccinated colleagues
• people we support and families are only prepared to be supported by vaccinated colleagues 

Imagine being unable to go to the pub because your support worker isn’t allowed in! I hope the term ‘reasonable adjustments’ figures prominently in policymakers’ minds as they work through this minefield.

Complications are everywhere:

• What if a person we support catches the virus when out and about, brings it home and infects those around them? Well, one of our underpinning beliefs is that the people we support have the right to make unwise decisions. Is there a double standard, if we do not apply the same right to those we employ? I would argue not – they can find work elsewhere. The people we support often have less control over who supports them.
• How do we account for the coronavirus mutating and requiring new vaccines to be produced and taken? Do colleagues then have to be off work until they’ve had the new vaccine? The impact on any care provider’s ability to deliver support could be immeasurable.
• On which note, our policy on vaccination will clearly have to extend to any agency workers we need to use – putting yet more pressure on rota management.
• Flu kills too. Twenty thousand people a year in fact. Why prioritise coronavirus vaccination? And where should we stop – people have always transmitted illnesses to each other. If you die of measles because I didn’t have an MMR vaccine, the outcome is the same as if I gave you a fatal infection of Covid-19.

After the last year none of us can be confident in our ability to predict how these complications will pan out. But I am clear that Dimensions will make decisions in line with our unambiguous commitment to keeping the people we support and our colleagues alive and well. We work hard to improve peoples’ health – we campaign on health inequalities, we train advocates and GPs, we produce, use and share resources, inevitably we get things wrong – but when we do we are committed to share what we learn even if it’s painful. Well-being matters to us. A lot.

Policy makers in this area have a very difficult job to do. I hope the above has provided a new angle or two. Dimensions stands ready to engage, constructively, to help shape this exceedingly delicate area.

Steve Scown, Dimensions Chief Executive