22nd June Updated Guidance For Shielding Patients

https://www.gov.uk/government/publications/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19

Click on the above link for a direct link to the Updated covid shielding information. A copy of it is placed below


What has changed

The government has updated its guidance for people who are shielding taking into account that coronavirus COVID-19 infection rates have decreased significantly over the last few weeks. This guidance remains advisory.

People who are shielding remain vulnerable and should continue to take precautions but may now choose to leave their home, as long as they are able to maintain strict social distancing. If you choose to spend time outdoors, you may do so with members of your own household. If you live alone, you can spend time outdoors with one person from another household. Ideally, this should be the same person each time.

If you do go out, you should take extra care to minimise contact with others by keeping 2 metres apart. This guidance will be kept under regular review.

On 22 June the government set out a series of steps for further relaxing shielding guidance which will come into effect on 6 July and 1 August.

From 6 July, the government will be advising:

  • you may, if you wish, meet in a group of up to 6 people outdoors, including people from different households, while maintaining strict social distancing
  • you no longer need to observe social distancing with other members of your household
  • in line with the wider guidance for single adult households (either an adult living alone or with dependent children under 18) in the general population, you may from this date, if you wish, also form a ‘support bubble’ with one other household. All those in a support bubble will be able to spend time together inside each other’s homes, including overnight, without needing to socially distance

From 1 August the government will be advising that shielding will be paused. From this date, the government is advising you to adopt strict social distancing rather than full shielding measures. Strict social distancing means you may wish to go out to more places and see more people but you should take particular care to minimise contact with others outside your household or support bubble. In practice this means that from 1 August:

  • you can go to work, if you cannot work from home, as long as the business is COVID-safe
  • children who are clinically extremely vulnerable can return to their education settings if they are eligible and in line with their peers. Where possible children should practise frequent hand washing and social distancing
  • you can go outside to buy food, to places of worship and for exercise but you should maintain strict social distancing
  • you should remain cautious as you are still at risk of severe illness if you catch coronavirus, so the advice is to stay at home where possible and, if you do go out, follow strict social distancing

The guidance for the clinically extremely vulnerable group remains advisory. More detailed advice will be updated in this guidance as the changes in advice come into effect on 6 July and 1 August.

Unless we see a significant rise in cases we expect the shielding programme to be paused on 31 July.

Those in receipt of centrally provided food boxes and medicine deliveries will continue to receive this support until the end of July if they want it.

Read further information on schools and the workplace for those living in households where people are shielding.

The guidance below applies until the 6 July 2020.

Who this guidance is for

This guidance is for people including children who are clinically extremely vulnerable. It’s also for their family, friends and carers.

People who are clinically extremely vulnerable are at high risk of serious illness from coronavirus (COVID-19) infection. They should have received a letter advising them to shield or have been told by their GP or hospital clinician.

This includes clinically extremely vulnerable people living in long-term care facilities for the elderly or people with special needs. If you have been told that you’re clinically extremely vulnerable, you should:

  • follow the advice in this guidance
  • register online or call 0800 028 8327 to get additional support if you need it, and before 17 July so that support can reach you in time

This guidance is still advisory. You will not be fined or sanctioned if you prefer to follow the guidance on staying alert and safe (social distancing). You may also choose to remain in your own home currently if you do not feel comfortable with any form of contact with others. However, careful time outside in the fresh air is likely to make you feel better.

Clinically extremely vulnerable groups

Expert doctors in England have identified specific medical conditions that, based on what we know about the virus so far, place some people at greatest risk of severe illness from COVID-19. Disease severity, medical history or treatment levels will also affect who is in this group.

Clinically extremely vulnerable people may include:

  1. Solid organ transplant recipients.
  2. 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 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 drugs
  3. People with severe respiratory conditions including all cystic fibrosis, severe asthma and severe chronic obstructive pulmonary disease (COPD).
  4. People with rare diseases that significantly increase the risk of infections (such as severe combined immunodeficiency (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.
  7. Other people 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.

For more information about who has been classed as clinically extremely vulnerable, please visit the NHS Digital website.

If you’re still concerned, you should discuss your concerns with your GP or hospital clinician.

Check this is the right guidance for you

You are not clinically extremely vulnerable if:

  • you do not have any of the conditions listed above
  • you have not been told by your GP or specialist that you are clinically extremely vulnerable or received a letter saying you are clinically extremely vulnerable

If you are not clinically extremely vulnerable you should follow the guidance on staying alert and safe (social distancing)..

Staying at home and shielding

People classed as clinically extremely vulnerable are advised to take additional action to prevent themselves from coming into contact with the coronavirus (COVID-19). If you’re clinically extremely vulnerable, you’re strongly advised to stay at home as much as possible and keep visits outside to a minimum (for instance once per day).

This is called ‘shielding’ and the current advice is:

  1. If you wish to spend time outdoors (though not in other buildings, households, or enclosed spaces) you should take extra care to minimise contact with others by keeping 2 metres apart.
  2. If you choose to spend time outdoors, this can be with members of your own household or you may choose to spend time outdoors with one person from another household (ideally the same person each time).
  3. You should stay alert when leaving home: washing your hands regularly with soap and water or hand sanitiser, maintaining social distance and avoiding gatherings of any size.
  4. You should not attend any gatherings, including gatherings of friends and families in private spaces, for example, parties, weddings and religious services.
  5. You should strictly avoid contact with anyone who is displaying symptoms of COVID-19 (a new continuous cough, a high temperature, or a loss of, or change in, sense of taste or smell).
  6. Although single adult households can form a ‘support bubble’ with one other household, people who are clinically extremely vulnerable are advised not to be part of a support bubble.

The government is currently advising people to shield until 31 July 2020, but gradually easing protection advice in the interim period, and is regularly monitoring this position.

Handwashing and respiratory hygiene

There are general principles you should follow to help prevent the spread of airway and chest infections caused by respiratory viruses, including:

  • washing your hands frequently with soap and water for at least 20 seconds or using a hand sanitiser. Do this after you blow your nose, sneeze or cough before you eat or handle food and always immediately when you return home
  • avoiding touching your eyes, nose, and mouth with unwashed hands
  • covering your cough or sneeze with a tissue, then throwing the tissue safely in a bin and washing your hands
  • cleaning and disinfecting frequently touched objects and surfaces in the home

Register for support

Everyone who has received a letter advising that they are clinically extremely vulnerable should register online if you need any extra support, for example, having essential groceries delivered to your home.

Register even if:

  • you do not need support now
  • you’ve received your letter from the NHS

Register for support:

Have your NHS number with you when you register. This will be at the top of the letter you have received letting you know you are clinically extremely vulnerable or on any prescriptions.

Help with food and medicines

Ask family, friends and neighbours to support you and use online services.

If you’d like help with your shopping, NHS Volunteer Responders are also here for you. You can choose what products you want and when you want them, and an NHS Volunteer Responder will then pick up and deliver your shopping to you. They can also pick up prescriptions or any other essentials you need. Call 0808 196 3646 (8am to 8pm) to arrange volunteer support.

If you cannot get the help you need, the government can help by delivering essential groceries and support. For further information about how to get food and other essential supplies, please see the guidance on accessing food and essential supplies. If you urgently need food or care, contact your local council.

Getting your prescriptions

Prescriptions will continue to cover the same length of time as usual.

If you do not currently have your prescriptions collected or delivered, you can arrange this by:

  1. Asking someone who can pick up your prescription from the local pharmacy (this is the best option, if possible).
  2. Contacting your pharmacy to ask them to deliver your prescription to you or to help you find a volunteer (who will have been ID checked) to deliver it.

You may also need to arrange for collection or delivery of hospital specialist medication that is prescribed to you by your hospital care team.

If you receive support from health and social care organisations, such as having care provided for you through the local authority or health care system, this will continue as normal.

Your health or social care provider will be asked to take additional precautions to make sure that you are protected.

Visits from essential carers

Any essential carers or visitors who support you with your everyday needs can continue to visit unless they have any of the symptoms of COVID-19.

Essential care is any activity that contributes to living as full life as possible in our society. Those activities vary according to the needs and preferences of the individual.

Essential carers coming to your home should follow advice on good hygiene:

  • wash their hands with soap and water for at least 20 seconds on arrival to your house and often while they are there (or use hand sanitiser)
  • avoid touching their face
  • catch any coughs or sneezes in a tissue (or their sleeve), and put used tissues immediately in the bin and wash their hands afterwards

They should keep 2 metres away where close or personal contact is not required and where this is possible.

If you need support from a carer to leave the house, you can still meet one person from another household (ideally the same person each time).

If your main carer becomes unwell

Speak to your carers about back-up plans for your care in case your main carer is unwell or needs to self-isolate.

You should have an alternative list of people who can help you with your care if your main carer becomes unwell. You can also contact your local council for advice on how to access care.

It may also be helpful to contact your local carers support organisation who can help with contingency planning. You can find out about local carer organisations at Carers UK.

Living with other people

The rest of your household do not need to shield themselves, but they should do what they can to support you in shielding and to carefully follow guidance on staying alert and safe (social distancing).

At home you should still:

  1. Minimise the time other people living with you spend in shared spaces such as kitchens, bathrooms and sitting areas, and keep shared spaces well ventilated.
  2. Keep 2 metres (3 steps) away from people you live with and encourage them to sleep in a different bed where possible. If you can, use a separate bathroom from the rest of the household. Use separate towels from the other people in your house, both for drying yourself after bathing or showering and for hand-hygiene purposes.
  3. If you share a toilet and bathroom with others, it’s important that they are cleaned every time after use (for example, wiping surfaces you have come into contact with). Consider drawing up a rota for bathing, with you using the facilities first.
  4. If you share a kitchen with others, avoid using it while they’re present. If you can, take your meals back to your room to eat. If you have one, use a dishwasher to clean and dry used crockery and cutlery. If this is not possible, wash them using your usual washing-up liquid and water and dry them thoroughly. If you are using your own utensils, remember to use a separate tea towel for drying these.
  5. Everyone in your household should regularly wash their hands with soap and water for at least 20 seconds, avoid touching their face and clean frequently touched surfaces.

You and the rest of your family or household should try to follow this advice as far as much as possible. There is no need for other members of your household to follow the shielding measures themselves.

If you develop symptoms

If you have any of the symptoms of COVID-19, (a new continuous cough, a high temperature, or a loss of, or change in, your normal sense of taste or smell), you must self-isolate at home and arrange to have a test to see if you have COVID-19 – go to testing to arrange or contact NHS 119 via telephone if you do not have internet access.

Do this as soon as you get symptoms. Do not visit the GP, pharmacy, urgent care centre or a hospital but if you need treatment, hospitals are still there to support and advise you.

In an emergency, call 999 if you’re seriously ill. Explain that you are clinically extremely vulnerable to coronavirus and are likely to get very unwell.

Prepare a single hospital bag. This will help the NHS provide you with the best care if you need to go to hospital. Your bag should include:

  • details for getting hold of your emergency contact
  • a list of the medications you take (including dose and frequency)
  • any information on your planned care appointments
  • things you would need for an overnight stay (for example, medication, pyjamas, toothbrush and snacks)
  • your advanced care plan (only if you have one)

Hospital and GP appointments if you’re shielding

Everyone should access medical assistance online or by phone wherever possible.

However, if you have a scheduled hospital or other medical appointment during this period, talk to your GP or specialist to ensure you continue to receive the care you need and determine which of these appointments are absolutely essential.

Your hospital may need to cancel or postpone some clinics and appointments. You should make contact to confirm appointments.

Looking after your mental wellbeing

The government has advised that those shielding can now spend time outdoors if they wish to do so. Despite these measures, continued social isolation, reduction in physical activity, and changes in routine can all contribute to increased stress.

Many people, including those without existing mental health needs, may feel anxious. Reasons for increased anxiety may include potential effects on support with daily living, ongoing care arrangements with health providers, support with medication and changes in daily routines. At times like these, it can be easy to fall into unhealthy patterns of behaviour which in turn can make you feel worse.

Constantly watching the news can make you feel more worried. If you think it is affecting you, try to limit the time you spend watching, reading or listening to media coverage of the outbreak. It may help to only check the news at set times or limit this to a couple of times a day.

What you can do

It is important that you take care of your mind as well as your body and that you get further support if you need it. Follow the advice that works for you in the guidance on how to look after your mental health and wellbeing during coronavirus (COVID-19).

Try to focus on the things you can control, such as where you get information from and actions you can take to help you feel prepared. The Every Mind Matters page on anxiety and NHS mental wellbeing audio guides provide further information on how to manage anxiety.

If you’re still struggling after several weeks and it’s affecting your daily life, contact NHS 111 online. If you have no internet access, you should call NHS 111.

If you are receiving services for your mental health, learning disability or autism and are worried about the impact of isolation, contact your key worker, care coordinator or provider to review your care plan. If you have additional needs, contact your key worker or care coordinator to develop a safety or crisis plan.

Staying mentally and physically active

There are simple things you can do that may help you to stay mentally and physically active during this time such as:

  • free 10 minute workouts from PHE or other exercise videos to try at home on the NHS Fitness Studio
  • spend time doing things you enjoy such as reading, cooking, other indoor hobbies or listening to favourite radio programmes or watching TV
  • try to eat healthy, well-balanced meals, drink enough water, exercise regularly
  • try to avoid smoking, alcohol and drugs

Spending time outdoors

You may now wish to leave your home to exercise, walk, or spend some time outdoors. If you do so, the best way to protect yourself is to:

  • keep the number of visits outside to a minimum (for instance once per day)
  • go on your own, or with members of your household or you may wish to spend time outdoors with one person from another household (ideally the same person each time)
  • go outside when there are fewer people around, such as early in the morning
  • ideally spend time in open areas
  • always keep a social distance of 2 metres
  • take particular care to minimise contact with others
  • do not share or exchange personal belongings (such as cups or water bottles) with others
  • avoid going into enclosed spaces and other households, shops and buildings
  • spend as long as you feel comfortable outside

If you would prefer not to spend time outside of your home, try spending time with the windows open to let in fresh air and get some natural sunlight. Alternatively, get out into any private space (such as a garden or balcony), keeping at least 2 metres away from your neighbours and household members at all times.

Staying connected with family and friends

Use support you might have through your friends, family and other networks during this time. Try to stay in touch with those around you over the phone, by post or online.

Let people know how you would like to stay in touch and build that into your routine. This is also important in looking after your mental wellbeing and you may find it helpful to talk to them about how you are feeling. Remember, it is OK to share your concerns with others you trust and in doing so you may end up providing support to them, too.

NHS Volunteers are also available if you would like a friendly chat or just want someone to talk to.

Work and employment for those who are shielding

If you usually work, you should talk to your employer as soon as possible if you:

  • have been advised to start shielding
  • think you might need to start shielding

You should make every effort to work from home and your employer is expected to help you to do this.

If you are unable to work from home, you should discuss and agree your options with your employer.

At times, it may be appropriate for you to take up an alternative role or adjust your working patterns temporarily.

Some employers may also be able to offer different types of leave. Beyond your statutory annual leave entitlement, this will be at the employer’s discretion.

If you were employed before 19 March 2020, you may be eligible for the Coronavirus Job Retention Scheme, under which you can be furloughed at 80% of your salary (maximum of £2,500 per month) up to the end of August after which time employers are paying an increased proportion of furloughed staff salaries until the furlough scheme ends, as currently planned, at the end of October.

Statutory Sick Pay is available as a safety net in cases where you are unable to work or to be furloughed under the Coronavirus Job Retention Scheme.

Employees have protections against unfair dismissal and may have certain entitlements around redundancy. It is breaking the law to discriminate, directly or indirectly, against anyone because of a protected characteristic such as age, sex or disability. Employers also have particular responsibilities towards disabled workers and those who are new or expectant mothers. Find out more about the rights you have at work.

To support the self-employed through the coronavirus outbreak the Government has announced the Self-employment Income Support Scheme.

Unpaid carers who provide care for someone who is clinically extremely vulnerable

If you are caring for someone who is clinically extremely vulnerable, there are some simple steps that you can take to protect them and to reduce their risk.

Ensure you follow advice on good hygiene:

  • do not visit or provide care if you are unwell and make alternative arrangements for anyone you care for
  • only provide care that is essential
  • wash your hands when you arrive and often, using soap and water for at least 20 seconds or use hand sanitiser
  • cover your mouth and nose with a tissue or your sleeve (not your hands) when you cough or sneeze
  • put used tissues in the bin immediately and wash your hands afterwards
  • provide information to the person you care for about who they should call if they feel unwell and how to use NHS 111 online coronavirus service and leave the number for NHS 111 prominently displayed
  • find out about different sources of support that could be used; further advice on creating a contingency plan is available from Carers UK
  • look after your own wellbeing and physical health during this time. Further information from Every Mind Matters

If the person you are caring for does not have coronavirus (COVID-19) symptoms (a new continuous cough, a high temperature, or a loss of, or change in, their normal sense of taste or smell), personal protective equipment (PPE) is not required if you are both or all following the stay alert guidance.

If the person you are caring for has COVID-19 symptoms, PPE is required to protect you, as the person delivering home care and is described in the domiciliary care guidance. For personal care, this would include using gloves, a plastic apron, fluid-resistant surgical mask and eye or face protection, dependant on the task. When delivering non-personal care but within 2 metres of the symptomatic individual, a surgical mask should be used.

We advise all carers to create an emergency plan with the person they care for, to use in circumstances where other people may need to help to deliver care (for example, if you fall ill). Depending on the circumstances, this could be help from family or friends, or a care provider.

Care support should be available with the involvement of the local authority or healthcare provider.

More information on providing unpaid care is available.

Additional advice for unpaid carers who are contacts of cases of coronavirus (COVID-19)

If you are notified by the NHS Test and Trace that you are a contact of a person who has tested positive for COVID-19:

  • you must self-isolate for 14 days
  • follow the advice in the NHS Test and Trace guidance
  • do not provide any further care for the clinically extremely vulnerable person and inform them, and their GP or hospital doctor, that you are a confirmed contact of a coronavirus (COVID-19) case

Advice for young carers supporting someone who is clinically extremely vulnerable

If you are a young carer supporting someone who is clinically extremely vulnerable, guidance for how you can help protect them is available.

Looking after your own wellbeing and physical health is very important during this time. There is more information and advice especially for young people at Rise Above and Young Minds.

Clinically extremely vulnerable people living in long-term care facilities, for the elderly or people with special needs

This guidance also applies to clinically extremely vulnerable people living in long-term care facilities for the elderly or people with special needs. Care providers should carefully discuss this advice with the families, carers and specialist doctors caring for such people to ensure this guidance is strictly adhered to. There may be additional specific measures in place in residential and nursing facilities to ensure all those being cared for are protected as much as possible.

Any assessment of a resident’s needs and subsequent decisions made must consider individual circumstances and ethical implications, ensuring that the resident is treated with respect so that their human rights, personal choices, safety and dignity are upheld.

Parents, or guardians, and schools with clinically extremely vulnerable children

This guidance also applies to parents or guardians and schools with clinically extremely vulnerable children. If you live with a child who is clinically extremely vulnerable you should try to follow the advice on living with other people and you should continue to have physical contact to provide essential care. Guidance on supporting children and young people’s mental health and wellbeing is available.


Letter to NHS

 

https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/06/C0624-shielding-letter-to-nhs.pdf

https://www.rcpch.ac.uk/resources/covid-19-shielding-guidance-children-young-people

https://digital.nhs.uk/coronavirus/shielded-patient-list#guidance-for-general-practice

 

C0624-shielding-letter-to-nhs

From the Chief Medical Officer & NHS Medical Director
22.06.2020
SHIELDING UPDATE

2
Updated advice to those shielding
Those who have been identified as clinically extremely vulnerable are thought to be at high
risk of developing serious illness following COVID-19 infection. On 23 March, the
Government advised all those considered to be clinically extremely vulnerable to shield at
home and avoid all face-to-face contact, in order to protect them from COVID-19. Initial
advice recommended shielding for a period of 12 weeks, which was expected to cover the
initial peak of the epidemic which happened in April. The advice was then updated to apply
up to 30th June. This guidance has always been, and will remain, advisory.
The latest evidence indicates that the prevalence of COVID-19 in the community has
continued to decline. As a result, the Government has reviewed its guidance on shielding.
We know that the advice to those shielding has been challenging to follow and that it will
take time for those affected to adjust and return to normal daily life. That is why the
Government advice to those who are considered clinically extremely vulnerable will be
relaxed in two stages:
• From 6 July, the clinically extremely vulnerable may, if they wish:
• meet in a group of up to 6 people outdoors, including people from different
households, while maintaining strict social distancing;
• no longer observe social distancing with other members of their household;
and
• in line with the wider guidance for single adult households (either an adult
living alone or with dependent children under 18) in the general population,
form a ‘support bubble’ with one other household. All those in a support
bubble will be able to spend time together inside each other’s homes,
including overnight, without needing to socially distance.
This is a small advisory change that brings those affected a step nearer others in their
communities. However, all the other current shielding advice will remain unchanged at this
time.
From 1 August, provided there are no significant increases in incidents, the guidance will be
further relaxed. Specifically:
• People can go to work, if they cannot work from home, as long as the
business is COVID-safe;
• children who are clinically extremely vulnerable can return to their education
settings if they are eligible and in line with their peers. Where possible
children should practise frequent hand washing and social distancing;
• people can go outside to buy food, to places of worship and for exercise but
should maintain strict social distancing; and
• people should remain cautious as they are still at risk of severe illness if they
catch Coronavirus, so the advice is to stay at home where possible and, if
they do go out, follow strict social distancing.
The current advice can be found on GOV.UK.
Government support for this group, including food box provision and free medicines
deliveries, will continue until the end of July to allow for a graduated return to normal life.
Patients can continue to access other support from local government and the NHS Volunteer
Responders past this point and seven supermarkets have given access to priority
3
supermarket delivery slots that will continue beyond the end of July for those already signed
up for support.
Over the next few days the Government will be writing to all patients who are currently on
the Shielded Patient List to inform them of these updates. The Government will also be
writing to all those who have been removed from the list by clinicians up to now, to ensure
they are aware they no longer need to shield. For this latter group this will be a permanent
change and their names will not be retained on the Shielded Patient List.
Clinical evidence for the new guidance
The Government’s shielding guidance is always led by the latest scientific evidence. The
clinically extremely vulnerable were advised to shield to prevent fatalities from COVID-19
during the initial peak of the epidemic wave in England. The initial period of approximately 12
weeks was set to cover the unmodified modelled peak until low disease rates were reestablished.
The current epidemiological survey shows that prevalence of disease in the community has
continued to drop over the last few weeks. On average, four weeks ago, one person in 500
was infected with COVID-19. Last week it was less than 1 in 1700.
Whilst it is not possible to completely remove the risk of infection from any individual in any
setting, the Government has concluded it is proportionate to recommend to those considered
clinically extremely vulnerable that easing their self-protection is an appropriate measure,
subject to the current epidemiology being maintained.
New clinical evidence on children
Recent experience and knowledge of the impact COVID-19 infection has on children and
young people with comorbidities suggests not all those on the Shielded Patient List need to
be shielding. RCPCH recently published updated guidance on which paediatric patient
groups they think should be advised to shield. They have identified three groups:
• children and young people who are cared for just in primary care are very unlikely to
need to continue to shield;
• a small group of children who are clinically extremely vulnerable due to their preexisting
condition will need to continue to shield; and
• a further larger group of children exists who due to their underlying condition may
need to shield and the decision to continue to shield would normally result from a
discussion between the clinician, the child and their family.
RCPCH expect that all patients who need to continue to shield will be seen in a specialist
centre before September 2020 (but not all those with specialist appointments will need to
shield). Decisions on shielding will generally be led by a specialist, balancing the clinical and
social impact of shielding. Patients should only be removed from the Shielded Patient List by
their GP or specialist following consultation with the child and their family, and other
clinicians where appropriate.
Further guidance on having conversations with children and families can be found on the
RCPCH website.
The Government works closely with the RCPCH and welcomes their valuable scientific input.
We recommend that clinicians follow up with children (and their parents) on the Shielded
Patient List to discuss what RCPCH guidance means for them.
4
Maintaining the Shielded Patient List
Whilst the prevalence of COVID-19 in the community is currently low, it may increase in the
future, at which point the Government may tighten shielding measures for the protection of
those who are considered clinically extremely vulnerable. We are therefore asking that
clinicians continue to maintain the Shielded Patient List in line with the instructions in the
NHS letter of 4 June.
Wherever a patient is newly identified as clinically extremely vulnerable, please have a
conversation with them about their risk of being severely ill if they catch COVID-19 and add
them to the Shielded Patient List by marking their healthcare record or adding them to your
Trust’s SEFT system. Please note, the last date for registering for government support is 17
July, letters that reference the Government support offer should therefore be stopped from 6
July, to allow for processing time.
Wherever you no longer think a patient should be considered clinically extremely vulnerable,
please have a conversation with them about their personal situation and if they agree they
should be removed from the list, remove them in a similar way.
The process for adding and removing categories of patients will continue if new evidence
comes to light. This will go through the UK clinical review panel, with a recommendation to
the UK Chief Medical Officers and any resulting changes will likely be implemented locally.
Details on the process for additions and removals can be found on the NHS Digital website.
Risk stratification
In March, based on the earliest available clinical evidence, we worked with senior clinicians
to identify a group of clinical conditions that were considered likely to increase an individual’s
risk of severe illness following infection with COVID-19.
To improve our understanding, NERVTAG (the New and Emerging Respiratory Virus
Threats Advisory Group) have been commissioned by the office of the Chief Medical Officer
to review national and international emerging evidence on COVID-19.
From this work, a team of leading academics have been working with senior clinicians to
develop a predictive risk model that reflects a wider range of factors such as demographics
alongside long-term health conditions, to better understand cumulative risk of serious illness
for individuals if they catch COVID-19.
The research protocol for this model has been published by The University of Oxford on 22
June 2020.
Options for applying this model across a variety of health and care settings, including
developing a tool to support conversations between patients and clinicians on individual risk,
are being considered. More information will be provided over the summer as this work
progresses.
We recognise that the significant new pressures the NHS is under and the changing pace of
guidance and requests that we make of you in support of your patients, are significant. The
current guidance is available here and some frequently asked questions are annexed to this
letter to support you in conversations with your patients.
5
Frequently Asked Questions
1. Is it really safe to stop shielding?
We have been clear that each step towards relaxing the shielding guidance should be taken
carefully. People classed as clinically extremely vulnerable are still at risk of severe illness if
they catch Coronavirus and should continue to take precautions, but the risk of catching
Coronavirus is now sufficiently low, the Government believe that the time is now right to
further relax the advice. The latest epidemiological data from the ONS COVID-19 Infection
Survey shows that the chances of encountering Coronavirus in the community has continued
to decline. Four weeks ago, on average only one person in 500 had the virus. Last week it
was less than one in 1700. In addition, a test and trace system is now in place, including
within schools, and there are robust measures in place to manage potential areas of higher
risk.
2. Can I keep shielding if I want to?
The guidance for those classed as clinically extremely vulnerable continues to be advisory,
and we have no plans to enforce it, so you can continue shielding if you want to. However,
centrally provided food boxes and the Medicines Delivery Service will only be available while
the advice is to shield, which is currently until the end of July.
Beyond July, NHS Volunteer Responders can continue to help with collecting food shopping
and medicines deliveries. Simply call NHS Volunteer Responders on 0808 196 3646 (8 am
to 8pm) to access this support.
3. Can I go to all my hospital appointments now?
The NHS is preparing to gradually increase some important face-to-face services, but only
where this can be done safely. Hospitals and other health facilities have been asked to put
extra planning and protection in place for people who are at highest risk from Covid-19.
These measures should be discussed with you in advance.
Where possible, appointments will be offered using remote services such as a video or
phone consultation. If you do need to attend hospital for planned (non-emergency) care, you
will be asked to take some steps to ensure you can get the care you need in an environment
that keeps you safe, as well as staff and other patients.
• Admissions (including day surgery): if you are being admitted to hospital, you and
any members of your household will be asked to isolate at home for 14 days prior.
Where possible, you may be asked to complete a test within 72 hours before going to
hospital. If you are unable to isolate effectively or be tested before coming to hospital,
your admission may be rescheduled. This will be determined by your care team using
clinical judgement and in consultation with you. Admissions teams will give you all
the information you need when booking you.
• Outpatient appointments: you should only attend your outpatient appointment if you
have no symptoms of Coronavirus. While at the hospital/health facility, it is important
that you comply with normal social distancing requirements.
4. Can I return to work?
Until the end of July, if you have been able to work at home, you should continue to do so. At
this time, we do not advise clinically extremely vulnerable individuals to attend their place of
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work (workplace/’onsite’) if this requires them to leave their home. This guidance remains
advisory.
From 1 August the Government is planning to further relax advice to those shielding,
bringing it in line with the advice to the clinically vulnerable group. This means that if they are
unable to work from home but can work on site, they should do so, provided the business is
COVID-safe.
5. What if I don’t want to return to work?
You should look to come to an agreement with your employer and understand their specific
policies around health and safety and workplace attendance, especially in relation to COVID-
19.
If you have concerns about your health and safety at work, you can raise them with any union
safety representatives, or ultimately with the organisation responsibility for enforcement in
your workplace, either the Health and Safety Executive or your local authority.
You can get advice on your specific situation and your employment rights by visiting the Acas
website https://www.acas.org.uk/contact or calling the Acas helpline, 0300 123 1100.
6. I still need help with my food shopping?
Those in receipt of centrally provided food boxes, who continue to need help, will receive this
support while they are advised to shield, until the end of July. This will give those shielding
the time to adapt to advice that visiting shops, including supermarkets, is likely to be as safe
as when they stopped these usual daily activities, provided they follow social distancing
advice.
Beyond July, NHS Volunteer Responders can continue to help with collecting food shopping.
Simply call NHS Volunteer Responders on 0808 196 3646 (8 am to 8pm) to access this
support.
The Government also continues to support the use of priority delivery slots to help the
clinically most vulnerable where possible. Priority delivery slots are at the discretion of
supermarkets, but we can confirm that seven supermarkets have given access to priority
supermarket delivery slots that will continue beyond the end of July for those already signed
up for support.
7. Can my children go back to school?
From 1 August the Government is planning to further relax advice to those shielding,
bringing it in line with the advice to the clinically vulnerable group. This means that children
can return to school/nursey. Where possible children should maintain social distancing and
try and practise good, frequent hand washing. The latest advice can be found on GOV.UK.
8. When might you bring shielding back?
The latest scientific evidence shows that the chances of encountering Coronavirus in the
community has continued to decline. The Government regularly monitors this position and if
the rates of infection in the community rise, then it may be necessary to advise that more
restrictive measures should be taken.
9. What is the guidance for the clinically vulnerable?
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Public safety throughout this period is the Government’s top priority – this includes keeping
safe society’s most vulnerable. We advise those who are clinically vulnerable to follow the
Staying Alert and Safe social distancing guidance available on the gov.uk website. The
advice is to stay at home as much as possible and, if you do go out, take particular care to
minimise contact with others outside your household or support bubble. By this we mean
always staying 2m apart from others outside your household or support bubble, avoiding
crowds, and keeping your hands and face as clean as possible.
10. Is the letter I’ve received real, telling me that I don’t need to shield anymore?
The letter you have received is from Government, signed by Matt Hancock and Robert
Jenrick. This letter will have arrived between 24 and 26 June. You can find a copy of the
letter online at gov.uk.
11. Where can I find accessible or alternative formats of my shielding letter?
Translated, BSL and easy read versions of the letter can soon be found at gov.uk. If a
patient is blind or partially sighted they can access audio or braille formats by calling the
RNIB helpline at 0303 123 9999.

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