This guidance is for
everyone in England who has been identified as clinically extremely
vulnerable from COVID-19. This includes those people who have
been identified by the NHS as being clinically extremely vulnerable
and those identified through the COVID-19 Population Risk Assessment.
All of those identified have been added to the Shielded Patient
List, and more information on the criteria used is available
below. If you have been identified as being clinically extremely
vulnerable, you will previously have received a letter from
the NHS or from your GP telling you this. You may also have
been advised to shield in the past. This
guidance applies to clinically extremely vulnerable individuals
only. Others living in a household with someone who is clinically
extremely vulnerable are not advised to follow this guidance.
They should instead follow the advice and restrictions that
are in place for everyone in England.
Shielding is currently paused. Although
the advice to shield has been paused, clinically extremely
vulnerable people must continue to follow the rules that are
in place for everyone.
Although the vast majority of the population,
including the clinically extremely vulnerable, will be well
protected by the vaccine, no vaccine is 100% effective and
there is emerging evidence that suggests that some immunocompromised
and immunosuppressed individuals may not respond as well to
COVID-19 vaccines as others. However, all COVID-19 vaccines
should offer some degree of protection. Therefore, it is really
important that you have both your first and second dose of
the coronavirus vaccine.
If you have any questions or concerns about
what it means to be clinically extremely vulnerable and how
COVID-19 may impact your health condition, have a look at
the NHS
website.
If you are concerned about your general physical
and mental wellbeing or if you are immunocompromised or immunosuppressed
and have any concerns about what this means for you, then
please contact your GP practice or specialist who can provide
you with support and guidance on any further measures you
can take to further reduce your risk of infection.
Everyone on the Shielded Patient List should
already have been offered a COVID-19 vaccine. If you
have not yet received your first dose, please contact your
GP. If you have received your first dose, you should
still ensure you take up your second dose of the vaccine when
it is offered to you. Having two doses should further increase
your level of protection.
The JCVI’s interim advice, based on existing
evidence, is to offer COVID-19 booster vaccines to the most
vulnerable, starting from September 2021. The booster programme
will aim to provide additional resilience against variants,
and maximise protection in those who are the most vulnerable
to serious disease from COVID-19 ahead of the winter months,
when there is increased pressure on the NHS as non-COVID-19
emergency demand is at its highest.
A booster dose would be offered to groups in
2 stages and, if possible, delivered alongside the annual
influenza vaccination. In the first stage, a booster would
be offered to:
- Adults aged 16 years and over who are immunosuppressed
- Those living in residential care homes for
older adults
- All adults aged 70 years or over
Adults aged 16 years and over who are considered clinically
extremely vulnerable
- Frontline health and social care workers
As soon as practicable after the first stage,
the second stage would see a booster offered to:
- All adults aged 50 years and over
- Adults aged 16 to 49 years who are in an
influenza or COVID-19 at-risk group
- And adult household contacts of immunosuppressed
individuals
Further details of any booster campaign, including
when, for whom and which vaccine(s) would be used, will become
available once the JCVI has considered further evidence and
made its final recommendations.
No vaccine is 100% effective and therefore even
if you have had both doses, there is still no absolute guarantee
that you will not become ill from COVID-19. As such, you should
continue to take the extra precautions set out in this guidance
to help protect yourself.
We recognise that restrictions on socialising
with friends and family have been difficult for everyone,
especially for clinically extremely vulnerable people during
periods of shielding. Guidance on socialising inside and outside
of the home with your friends and family has been updated
for everyone. From 19 July, there are no longer any limits
on the number of people or households that you can meet with.
In addition, the requirement to socially distance from others
has ended, other than in a few exceptions.
Social distancing rules (2 metres or 1 metre
with additional mitigations) have been lifted. You should
continue to consider the risks of close contact with others,
particularly if you are clinically extremely vulnerable or
not yet fully vaccinated. The risk of catching or passing
on COVID-19 is generally higher:
- In crowded spaces, where there are more people
who might be infectious
- In enclosed indoor spaces where there is
limited fresh air
- When COVID-19 disease levels are high in
the general community
Everyone will only be required to socially distance
in limited circumstances, such as maintaining infection control
in health and care settings.
As someone identified as clinically extremely
vulnerable, we acknowledge that social distancing has been
particularly difficult for you, especially during periods
of shielding. Because clinically extremely vulnerable people
are at higher risk of severe illness from COVID-19, you may
wish to think particularly carefully about taking precautions
when meeting others you do not usually meet with in order
to reduce the risk of catching or spreading COVID-19. For
example, you could:
As someone identified as clinically extremely
vulnerable, it is important that you continue to be cautious
when meeting others. You should think about the risk of catching
or passing on COVID-19 both to yourself and to others before
meeting people you do not live with. You can take steps to
make meeting family and friends safer, such as:
- Meeting outside if possible, as the particles
containing the virus that causes COVID-19 are quickly blown
away which makes it less likely that they wil be breathed
in by another person
- Making sure the space is well ventilated
if you meet inside; open windows and doors or take other
action to let in plenty of fresh air
- Considering whether you and those you are
meeting have been vaccinated – you might want to wait
until 21 days after your second dose of a COVID-19 vaccine
before being in close contact with others
- Washing your hands regularly and avoid touching
your face
- consider continuing to practice social distancing
if that feels right for you and your friends
asking friends and family to take a lateral flow test before
visiting you
From 19 July, social distancing measures
have ended in the workplace and it is no longer necessary
for the government to instruct people to work from home.
However, employers still have a legal responsibility
to protect their employees and others from risks to their
health and safety. Your employer should be able to explain
to you the measures they have in place to keep you safe at
work. Some employers may request employees to undertake regular
testing for COVID-19 to identify people who are asymptomatic
If you need support to work at home or in the
workplace you can apply for Access to Work. Access to Work
may provide support for the disability-related extra costs
of working that are beyond standard reasonable adjustments
an employer must provide.
If you have access to occupational health and
employee assistance programmes in the workplace, these services
can also provide you with a range of health support and advice
for your physical and mental health needs.
The Coronavirus Job Retention Scheme (furlough)
has been extended until 30 September. You may continue to
be eligible throughout this period, even when shielding is
paused, providing your employer agrees. The Self-Employment
Income Support Scheme (SEISS) has also been extended until
30 September.
From 1 April you will no longer be eligible
for Statutory Sick Pay (SSP) or Employment and Support Allowance
(ESA) on the basis of being advised to shield, given the lifting
of shielding measures nationally. You may be eligible for
SSP or ESA if you are sick or incapable of work, either due
to coronavirus or other health reasons, subject to meeting
the eligibility conditions.
If you have concerns about your health and safety
at work then you can raise them with your workplace union,
HSE or your local authority. Where employers are not managing
the risk of COVID-19, HSE and local authorities will take
action which can range from the provision of specific advice,
issuing enforcement notices, stopping certain work practices
until they are made safe and, where businesses fail to comply
with enforcement notices, this could lead to prosecution.
The existing employment rights framework provides
protections against discrimination, unfair dismissal and detriment.
Specific guidance has been published for employers and workers
on work absences due to coronavirus (COVID-19).
The Citizens Advice Bureau also has information
about your rights at work and how to solve problems in the
workplace. If you have concerns you can also get advice on
your specific situation and your employment rights by visiting
the Acas
website or calling the Acas helpline on 0300 123 1100.
It is important that children attend school
for their education, wellbeing, mental health and long-term
development. Clinically extremely vulnerable pupils and students
should return to their school or other educational setting
from 1 April. This includes early years provision, wraparound
childcare and applicable out-of-school settings. Children
who live in a household with someone who is clinically extremely
vulnerable are not advised to shield and should have returned
to school or college on 8 March.
Where parents are concerned about their child’s
attendance, they should speak to their child’s school
about their concerns and discuss the protective measures that
have been put in place to reduce the risk. They should also
discuss other measures that can be put in place to ensure
their children can regularly attend school.
The use of rapid lateral flow tests allows us
to identify individuals with coronavirus (COVID-19) who do
not have symptoms, which make up around a third of all cases.
Finding asymptomatic cases, along with other infection prevention
and control measures such as social distancing, can help us
manage the spread of the virus.
To safeguard the health of the teaching workforce
and keep as many staff, pupils and students in school and
college as possible, we have made rapid lateral flow tests
available to schools and colleges. Lateral flow tests can
also be accessed directly for households, childcare and support
bubbles of primary and secondary school pupils and for households,
childcare and support bubbles of primary and secondary school
staff. This testing will also help keep safe those in the
community who are clinically extremely vulnerable and their
families.
All secondary schools and colleges are continuing
to put in place a range of protective measures to help minimise
the risk of spreading COVID-19. These include social distancing,
handwashing, use of face coverings in specific situations,
bubbles, enhancing cleaning, ventilation and managing confirmed
cases.
All education settings have implemented a range
of protective measures recommended by Public Health England
(PHE) which, when followed, create an inherently safer environment
for early years children, pupils, students, staff and families.
Whilst the legal requirement to wear a
face covering has been lifted from 19 July, the government
expects and recommends that people continue to wear face coverings
in crowded areas, such as public transport. Wearing a face
covering, especially when there is close contact between people
in enclosed and crowded spaces will still help to reduce the
risk of spreading COVID-19. It may also help those who are
clinically extremely vulnerable feel more relaxed. It is important
that face coverings fit securely around the face and safely
cover the mouth and the nose
Clinically extremely vulnerable people
are now advised to follow the guidance that applies to the
rest of the population. You may still wish to consider going
to the shops and pharmacy at quieter times of the day.
Priority access to supermarket delivery slots
using the Shielding Support website ended on 21 June. After
21 June, you can continue to book delivery slots in the usual
manner from a supermarket.
You can continue to ask for short-term help
from the NHS Volunteer Responder scheme with telephone support
if you are feeling lonely, or for help with collecting shopping
(if you are unable to use any of the online or telephone shopping
options now available through most supermarkets), medication
or other essential supplies that you need delivered to your
home
If you have already registered for priority
access to supermarket delivery slots using the Shielding
Support website or through your council by 31 March, then
we can confirm that the participating supermarkets will continue
to offer priority access until 21 June. After this date individuals
can continue to book deliveries from a supermarket..
The NHS Volunteer Responders programme is available
to help support those who need it. Volunteers can collect
and deliver shopping, medication and other essential supplies.
Call 0808 196 3646 between 8am and 8pm, 7 days a week to self-refer
or visit
NHS Volunteer Responders for further information.
It is important that you continue to receive
the care and support you need to help you stay safe and well.
Providers of social care and medical services are making every
effort to ensure services remain open and as safe as possible.
You should continue to seek support from the
NHS for your existing health conditions. You can access a
range of NHS services from home, including ordering repeat
prescriptions or contacting your health professional through
an online consultation. To find out more visit NHS
Health at home, or download the NHS App. If you have an
urgent medical need, call NHS
111 or, for a medical emergency, dial 999.
The measures you may have taken to respond to
COVID-19 may have triggered feelings of worry, distress or
loneliness. These feelings are a completely normal response
to an unprecedented period of disruption. As restrictions
ease and the economy is gradually and safely reopened, you
may find that your wellbeing improves as you reconnect with
family and friends, and return to routines and activities
that help to keep you well.
You can visit the Every
Mind Matters website for advice and practical steps that
you can take to support your wellbeing and manage your mental
health. If you are feeling lonely, the Let’s
Talk Loneliness website also has a variety of tips, advice
and further resources that you may find helpful. The NHS
Volunteer Responders programme also offers telephone support
through Check in and Chat Volunteers. Check In and Chat Plus
Volunteers provide a regular check-in by telephone to you
for up to 10 weeks, with typically 3 calls taking place each
week.
If you are struggling with your mental health,
you can reach out for support. Visit the Hub
of Hope to find local sources of mental health support
and services, both from the NHS and from other organisations
close to you. Your GP will be able to refer you to NHS talking
therapies, which can provide treatment for depression, anxiety
or post-traumatic stress disorder, or you can self-refer online.
If you or a loved one are experiencing a mental
health crisis, you can call a local
NHS mental health helpline for 24-hour advice and support,
or contact the Samaritans on 116 123 or through emailing jo@samaritans.org.
Any carers or visitors who support you with
your everyday needs can continue to visit. They should continue
to follow the guidance
on how to stop the spread of COVID-19 at all times.
You can also access additional support from
your energy supplier. Energy suppliers are required by the
regulator, Ofgem, to hold a register of customers in a vulnerable
circumstance, called a Priority Service Register. If you are
clinically extremely vulnerable you can be added to this register.
For information about how to be added to the register and
the additional services your supplier can provide you, please
visit Ofgem’s
website.
Telecom providers are also required by their
regulator, Ofcom, to support their vulnerable customers. For
information about the additional services your supplier may
be able to provide you as a vulnerable customer, please visit
Ofcom’s website.
If you are struggling as a result of Coronavirus
please visit www.gov.uk/find-coronavirus-support
or contact your local council to find out what support is
available.
People who are defined as clinically
extremely vulnerable are at very high risk of severe illness
from coronavirus. There are 3 ways you may be identified as
clinically extremely vulnerable:
- You have one or more of conditions listed
below, or
- Your clinician or GP has added you to the
Shielded Patient List because, based on their clinical judgement,
they deem to you be at higher risk of serious illness if
you catch the virus.
- You have been identified through the COVID-19
population risk assessment as potentially being at high
risk of serious illness if you catch the virus.If you do
not fall into any of these categories, and have not been
contacted to inform you that you are on the Shielded Patient
List, follow the general staying alert and safe guidance
for the rest of the population.
If you think there are good clinical reasons
why you should be added to the Shielded Patient List, discuss
your concerns with your GP or hospital clinician.
People with the following conditions are automatically
deemed clinically extremely vulnerable:
Solid organ transplant recipients
People with specific cancers:
- People with cancer who are undergoing active
chemotherapy
- People with lung cancer who are undergoing
radical radiotherapy
- People with cancers of the blood or bone
marrow such as leukaemia, lymphoma or myeloma who are at
any stage of treatment
- People having immunotherapy or other continuing
antibody treatments for cancer
- People having other targeted cancer treatments
that can affect the immune system, such as protein kinase
inhibitors or PARP inhibitors
- People who have had bone marrow or stem cell
transplants in the last 6 months or who are still taking
immunosuppression drugs
- People with severe respiratory conditions
including all cystic fibrosis, severe asthma and severe
chronic obstructive pulmonary disease (COPD)
people with rare diseases that significantly increase the
risk of infections (such as severe combined immunodeficiency
(SCID), homozygous sickle cell disease)
- People on immunosuppression therapies sufficient
to significantly increase risk of infectionproblems with
your spleen, for example splenectomy (having your spleen
removed)
- Adults with Down’s syndrome
- Adults on dialysis or with chronic kidney
disease (stage 5)
- Women who are pregnant with significant heart
disease, congenital or acquired
- Other people who have also been classed as
clinically extremely vulnerable, based on clinical judgement
and an assessment of their needs. GPs and hospital clinicians
have been provided with guidance to support these decisions
All links
come from trusted sources, however, if you are unsure about
them or any other medical concerns, contact your doctor
or pharmacist for further advice.
Website
updated on Friday 29th October 2021 |
