Lords: Evidence to Support Mandatory COVID-19 Jabs for NHS Staff ‘Not Good Enough'

Priscilla Lynch 

December 02, 2021

The Department for Health and Social Care's (DHSC) evidence to support compulsory COVID-19 jabs for frontline NHS staff is insufficient and "superficial", according to the House of Lords Secondary Legislation Scrutiny Committee.

COVID-19 vaccination is set to become mandatory for all NHS workers working 'face to face' with service users in England from April 1 and follows the recent introduction in England’s care sector. An estimated 10% of NHS staff are not yet fully vaccinated.

The House of Lords Secondary Legislation Scrutiny Committee has now published a report on the proposed legislation, which raises several concerns about the quality of the DHSC’s supplied evidence to support mandatory COVID-19 vaccination of healthcare staff, and criticises the lack of clarity about how key expressions used in it are to be applied in practice.

Issues raised include: 

  • The lack of a thorough and detailed Impact Assessment to accompany the legislation. The explanatory material provided by DHSC does not include the level of detail required to enable Parliament and the wider public, including those directly impacted, to understand the effects of the legislation on the operational effectiveness of the healthcare system, according to the report. While there are clear societal benefits from the vaccination programme, the increase in protection from vaccinating the last 8% of health workers may be marginal and the explanatory notes that accompany the legislation are silent on any contingency plans to cope with the 5.4% NHS staff losses that may result when the Regulations take effect in April 2022.

  • Whether the benefits are proportionate. DHSC figures estimate that of the 208,000 currently unvaccinated workers in the sector, this legislation will result in 54,000 (26%) additional staff being vaccinated and 126,000 (61%) losing their jobs because of non-compliance with the requirement to be vaccinated. Given the legislation is anticipated to cause £270 million in additional recruitment and training costs and major disruption to the health and care provision at the end of the grace period, very strong evidence should be provided to support this policy choice. DHSC has not provided such evidence, the report says.

  • Lack of clarity on key expressions. The Committee’s report criticises the DHSC for failing to include in the legislation practical detail about how key expressions such as 'face to face' or 'otherwise engaged' will be applied, but instead referring to guidance to be produced in the future. DHSC indicates, for example, that those who do voluntary work within the health and social care sector, and those who do maintenance work separate from providing healthcare such as installing IT equipment will also need to be vaccinated.  

Lord Hodgson of Astley Abbotts, Chair of the Secondary Legislation Scrutiny Committee said: “In our 10th report on the preceding Care Homes Regulations, we said that if the Department of Health and Social Care decided to extend its mandatory vaccination policy, we would expect to see a more effectively argued case for it: unfortunately, the Explanatory Memorandum accompanying this instrument is just as superficial."

"DHSC has published a very broad-brush document they call an Impact Statement, but this is no substitute for a thorough Impact Assessment which should have been integral to the policy development process."

He added that, while the committee fully supports high levels of vaccination, the DHSC is accountable to Parliament for its decisions and needs to give a clear statement of the effect of these Regulations, the effect of doing nothing and any other solutions considered, so Parliament fully understands all the consequences of what it is being asked to agree to. This is particularly important when the NHS is already under such pressure, he added.

"DHSC has provided no single coherent statement to explain and justify its intended policy, and this undermines the ability of the House to undertake effective scrutiny of the proposed legislation."

The British Medical Association (BMA) opposes mandatory coronavirus vaccination for doctors and health care workers saying it could have a "devastating" impact on staffing levels.

In Europe, France and Italy have already made COVID-19 vaccination mandatory for all healthcare workers, while in Ireland similar proposals are now being considered by the country’s national COVID-19 advisory body.

House of Lords Secondary Legislation Scrutiny Committee. 21st Report of Session 2021–22. Drawn to the special attention of the House: Draft Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) (No. 2) Regulations 2021. 2021 November 30.


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