As I braced the frosty morning today, defrosting the car windscreen, navigating the icy yard where my horse stood, breaking the ice on the water troughs and trying not to slip and slide I popped the radio on and caught a news piece that was coming on Women’s Hour. What grabbed my attention was that they were going to be interviewing a midwife who was refusing the vaccine and was one of 37 other midwives at the same unit who were also unvaccinated.  I’ve always steered clear of any of these items as inevitably they only lead to lots of disputes with friends, family and colleagues but I was drawn to this – fascinated by it. How could so many be working and not be vaccinated? What were their reasons? How was management dealing with it? Did the birthing parents know?

As the midwife explained her standpoint, she was extremely eloquent about why she had made the decision she had. She wholeheartedly agreed with vaccinations and their importance in protecting patients and the public alike. However, she had clear reasons why she had not chosen to have it – previous covid, medical history, not making her vulnerable but impacting her decision, taking regular lateral flow tests like many of us, and being part of the Siren study which involves having regular antibody level testing and many more valid reasons. She also said that no parents had asked about her vaccination status. She ended clearly very upset in expressing her incredible sadness that her career may prematurely end after 23 years in the speciality she loved.

Vaccines are vitally important in infection control and disease prevention in healthcare settings. Ensuring high rates of vaccination among staff means the potential of limiting the spread of COVID-19 is increased as seen in the COVID-19 vaccine surveillance reports. All healthcare professionals understand this and understand the implications of our Code of Conduct in regard to avoiding unnecessary harm to our patients. However nurses, midwives and nursing associates are people too, and just as vulnerable to anxieties and concerns as any member of the public – they equally have the right to be vaccine hesitant if they wish. Will mandatory vaccination change that – most likely not?

My husband, 18 and 16-year-old sons and I have been double vaccinated and had our boosters. My 15-year-old daughter has had her first vaccine but unfortunately, my 12-year-old has not, due to contracting Covid the day before she was due to have the vaccine at school! But she will have it. I encourage all those around me to have it. For us and most of my friends, it was an easy choice with no hesitancy. But as a community, we have the right to freedom over our thoughts, decision-making and speech as long as none of them causes harm to others. But there lies the conflict, potentially there is a risk if you are not vaccinated that you MAY infect someone with devastating consequences.

The RCN say their “fundamental position is that all members of the nursing team should have any vaccine deemed necessary to help protect themselves, patients, colleagues, family members, and the wider community. We consider this to be best practice. It is enshrined within the NMC code that getting vaccinated is the right thing to do for professional practice for all registrants.”

Mandatory vaccination for NHS staff is proposed to be implemented from 1st April but the RCN has called to delay the implementation of the new law in light of major staffing pressures. They have said that the risk assessment during the planning of this policy showed a potential for 73,000 HCPs in England to be lost to the profession if the mandatory rule proceeds. She explained that with more time and one-to-one support, those with anxieties about vaccination and their specific concerns could be addressed rather than the reaction that many employers have already started of “no vax no job”. The RCN has provided lots of information on their standpoint on this issue. 

As healthcare professionals, we are constantly aware of the importance of informed consent. We advocate for our patients to ensure their needs and wishes are upheld and will advocate for them if they are feeling they are not at the centre of decision-making about medications, treatment and such that they undertake. We are all aware, however, that many patients will hand over the responsibility of decision-making to the healthcare professional with an attitude of “they must know best”. There is a difficult balance to be had in gently encouraging a patient to explore all aspects of their care and treatment rather than passively accepting everything they are told, whilst ensuring the practitioners around them advising them of their options are appropriate presenting the facts and explaining them clearly.

So it is interesting to see a policy being proposed that potentially does not allow for informed consent or advocacy and support.

With services already struggling, staffing levels at an all-time low and morale rocking and rolling, it is difficult to see how adding more pressure and stress on staff that are already struggling immensely, will end in anything but tears. The role of a midwife or nurse is not a role that can be dropped and forgotten, it is not a role that means you can “just do something else”. Years of training, learning, developing and improving in a continuous circle can not just be wiped out. It may be true perhaps some of these professionals may be looking to end their careers anyway and this is an opportunity to do so. It could be true that when the policy comes in the majority of them may just take the vaccine for fear of losing their jobs. It may be true that some are kicking back against the establishment because nobody likes to be told what to do. Whatever the reason, whatever the cause, mandatory vaccination may be the proverbial straw. In discussions with colleagues the very valid point is raised that we have vaccinations already, which we are required to have before starting work in a healthcare setting,  so why should Covid be any different? Why is it becoming so different this time?

I’ve been involved in flu vaccination clinics over the years and many different professionals showed hesitancy about having their annual vaccine. But with gentle discussion, listening and giving validity to their concerns the majority returned for it before the program was completed.

The only thing that is guaranteed is that conflict will rise between colleagues,  managers and peers which if far from good for patients or the individual’s concerns. There will no doubt be more referrals to the NMC, resignations and further job losses and again the patients will suffer.

Responding to the Department of Health and Social Care’s (DHSC) decision on mandatory vaccinations for care home staff, Andrea Sutcliffe CBE, Chief Executive and Registrar for the Nursing and Midwifery Council, said:

“We are incredibly proud of the nearly 732,000 nursing and midwifery professionals across the UK on our register, who despite facing significant demands and pressures during the coronavirus pandemic, have provided safe, kind and effective care that has undoubtedly saved many lives. “Our Code clearly sets out what we expect from our professionals in terms of protecting the people they care for, and we know the Covid-19 vaccine helps to keep us safe. “That’s why we support efforts to increase vaccination uptake and we will continue to work with the Government, employers and the wider health and care sector to understand and address the reasons for vaccine hesitancy. “By working collaboratively with our partners we will be able to provide better support and guidance for all of our professionals. It is our expectation that if concerns are identified around vaccinations, employers should be able to resolve these locally. “We look forward to contributing to the consultation on proposed mandatory vaccinations for all NHS staff.”

A nurse was struck off the register for her strong anti-tax campaigning and views, but this was an extreme case and the majority of those who are vaccine-hesitant are not anti-vaxers. Therefore, caution must be used to distinguish between the two groups. There is a huge difference between saying you are worried about the vaccine having not had it yet, to saying you believe the vaccine is dangerous and will never be persuaded to comply.

The NMC has outlined, however, that it is a local employer-level issue if staff refuse the vaccine and not for the regulator to investigate individual cases referred purely on refusal of having the vaccine only. But the reality is when referring practitioners to the NMC, the referrer will often add other concerns to bolster the genuineness of the referral, in which case the NMC will have no choice but to investigate.

There are no easy solutions but the RCN representative on the show this morning made so much sense; let’s slow down and take time to talk to these professionals, go through hard facts, look at their concerns and review the INDIVIDUAL issues that have led them to this decision.

The question will be – will employers have time to invest in this additional support and how many units will close as a result of staffing levels further knocked?

Sadly we already have a number of practitioners in our group who have been referred for just this issue and suspect we will see more.

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