Extending mandatory COVID vaccination throughout health and social care

How far does the extension go?

Mandatory COVID vaccination in care homes was implemented on 11 November 2021. Without a valid exemption, workers will not usually be permitted access to (or be able to work in) care homes.

On 9 November 2021, the government announced its response to the consultation on extending the mandatory vaccine regime. From 1 April 2022, mandatory vaccines will apply to most of the health and social care sector.

From April 2022 there will be two different mandatory vaccination schemes:

  • The care home scheme mandates vaccination for those working in a care home, regardless of their role or function. The scheme is wholly based upon entry to the care home. It applies not just to those who work for the care home, but also to other workers who need access to the care home, such as district nurses, GPs etc.
  • In contrast, the new wider scheme will be based on the deployment of workers who provide CQC regulated health or social care activities, rather than the care setting or workplace. It will apply to healthcare, home care, GP services, dental practices. It will apply to the NHS as well as private healthcare and healthcare services provided by the third sector. It will apply to privately operated social care, services provided by local authorities as well as services in the third sector.

To whom will it apply?

It is already well recognised that the new mandatory vaccination scheme will apply to all workers and volunteers who provide “front-line” services. Less well publicised is the application to “non-clinical workers not directly involved in patient care but who nevertheless may have direct, face to-face contact with patients, such as receptionists, ward clerks, porters and cleaners”. This will mean many support and administration staff will be caught too.

For most healthcare settings, it will usually be relatively easy to identify who will be caught. For instance the scheme will clearly apply to cleaners in hospital as well as reception and those administration staff who are likely to have contact with patients.

In social care, the full extent application of the proposed regulations is less clear. Hopefully greater clarity and guidance will follow, but for now we recommend keeping in mind that this scheme is based on the deployment of CQC regulated activities. Consider the nature of the CQC regulated activity itself, as well as the purpose of the regulations (to protect patients and services users). For personal care, this scheme will apply to domiciliary care, independent supported living and extra care. It may well capture some hairdressing activities and cleaning where that is part of the personal care or accommodation provided.


Exemptions are limited. It will not apply to workers and volunteers under 18 and there will still be exemptions for medical reasons.

In care homes there is currently a medical exemption self-certification scheme whilst the full 119/GP medical exemptions are being put into place.

Recognising that recipients of care in Shared Lives settings are living in the carer’s own home, mandatory covid vaccination will not apply to Shared Lives carers.

When does it start?

The new regulations are expected to be implemented from 1 April 2022. This means that for those that it affects, they will need to have had their first dose (where two doses are required) by 3 February 2022.

Is one dose enough?

Full vaccination is required. Currently and for most recognised vaccines this will be two doses. For new recruits, so long as a second dose (if that is what is required) is scheduled within the next 10 weeks, then that new recruit will still be able to be deployed to front-line activities.

Vaccination abroad

The care home self-certification scheme already provides for foreign vaccination, but more detail is expected to follow.


For now, neither booster or third doses are required, but the government response explicitly says it will keep this under review into 2022/23.

Planning for implementation

The clock is ticking and there is much to do:

  • Employers should look out for new guidance and revisions. Healthcare providers will likely have already received a letter from NHS England
  • Employers will almost certainly already have and be recording the vaccination status of staff. Any that do not, will now need to begin. This will be sensitive health data, so consider your data protection obligations. The NHS app is likely to be the easiest evidence of vaccine, but the forms of evidence can vary
  • Existing and future recruitment should refer to the anticipated need for COVID-19 vaccinations (including possibly booster vaccines). Consider revising contractual documents to reflect the changes
  • Consult with staff now. For those that have been reluctant to get their vaccines – we now have a deadline. If they require two doses, they’ll need to have had their first dose by 3 February 2022
  • In healthcare settings, employers should note that doctors’ professional obligations in Good Medical Practice include: You should be immunised against common serious communicable diseases (unless otherwise contraindicated).
  • Be prepared to consider the vaccine exemptions for staff. This could take some time if there are delays in receiving the exemption information or if the employee challenges any refused exemption.