Key point: Guidance recommends redeployment of staff at highest risk.
Staff with comorbidity and those in higher risk groups
The government is actively reviewing the advice to protect those people who are at significantly increased risk from COVID-19 due to underlying health conditions. The staff groupings can be seen at point 1 below. The national guidance should be referenced and applied to staff who are in these groups.
Comorbidity is a medical term that is applied when individuals have multiple health conditions that co-exist. People with comorbidity are more likely to develop complications with their health. Viruses can make chronic health problems worse and high-risk groups may experience a worsening of their conditions.
Staff in the most at risk groups
The following list is current as at 21 March 2020 and will be updated regularly as the guidance changes.
The NHS in England will now be directly contacting individuals who are deemed to be high risk to recommend that they take more stringent measures to protect themselves due to specific clinical conditions.
The emphasis will be on both protecting individuals and redeploying any staff who need to be, into services, such as 111, ambulance dispatch, and virtual patient consultations. Individuals will be contacted by the NHS over the next week and they will provide detailed advice on what steps individuals should take next and why. People who will be contacted are those who may be at particular risk due to complex health problems. The following list is current as at 17 March 2020 and will be updated daily as the guidance changes.
Complex health problems include:
1. Solid organ transplant recipients
2. People with specific cancers:
- people with cancer who are undergoing active chemotherapy or radical radiotherapy for lung cancer
- 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 which 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 drug
3. People with severe respiratory conditions including all cystic fibrosis, severe asthma and severe COPD.
4. People with rare diseases and inborn errors of metabolism that significantly increase the risk of infections (such as SCID, homozygous sickle cell).
5. People on immunosuppression therapies sufficient to significantly increase risk of infection.
6. Women who are pregnant with significant heart disease, congenital or acquired.
For the small number of NHS staff in this category, there are ways that organisations can help:
- Advise them not to contact their GP or healthcare team and to wait until they are contacted directly. In this period, if staff identify to this category, they should be supported to work flexibly, remotely or be redeployed from any high-risk area.
- If staff have not been contacted by the NHS over the next week and think they may be at particular risk due to these specific health conditions, they should then get in touch with their GP practice for further advice.
- Where staff receive a call from the NHS Business Services Authority, they should then contact their line manager to discuss reasonable adjustments.
- Where staff are contacted and advice is provided to them, organisations should support them as much as possible to adjust to this and allow them time to make any necessary personal arrangements.
Staff in at risk groups
In addition, advice from government confirmed that the following groups of people should take particular care to minimise their social contact:
- People over the age of 70.
- Other adults who would normally be advised to have a flu vaccine (such as those with chronic disease).
- Pregnant women. We know The Royal College of Obstetricians and Gynaecologists will provide and regularly review/revise the latest guidance and information. Specific information is provided in the guidance for healthcare workers who are pregnant. We therefore advise all staff who are pregnant to discuss their individual circumstances with their local occupational health department, so that the appropriate support/actions can be taken dependent on which trimester they are in, underlying health conditions and the nature of the roles they are undertaking.
For staff members in this category, the NHS will support staff to stay well and at work, where national guidance allows. NHS organisations should make adjustments to enable this wherever possible, informed by national guidance. Adjustments may include working remotely or moving to a lower-risk area. Line managers should get support from the locally nominated emergency preparedness, resilience and response (EPRR) lead or, for example, medical/nursing director or chief operating officer, to make this happen. NHS organisations are encouraged to make it clear who the point of contact is.
Action to be taken for staff will depend upon their condition and how stable it is. Where a condition is unstable and there may be an increased risk to staff, the locally nominated lead should ensure that conversations are undertaken with those staff about what steps need to be taken to keep individuals safe, and specialist advice taken as required. In addition, they will continue to need the support of their line manager and local occupational health service.
Where staff have to be redeployed or work from home, consideration should be given to what duties they can continue to carry out, and what support they will need to do this. Assistance should be provided to those staff who might be working or deployed in higher-risk areas by:
- ensuring they are aware of the Public Health England (PHE) guidance and how they can protect themselves
- talking to them about their role and any elements which may put them at greater risk
- discussing and developing a plan to implement any reasonable adjustments where required, for example redeployment into less high-risk areas, reduced travel, working from home
- seeking further advice from occupational health in the first instance, and, where required, further consultation with their specialist doctor regarding their underlying condition in order to optimise their condition where possible
- signposting to further areas of support such as employment assistance programmes (EAP)or counselling.
Our people are the most important consideration as they respond to the COVID-19 pandemic. In these unprecedented times, our people more than ever will be making every effort to care for patients and the population, and we must equal that with the care for them.