The British Liver Trust has asked the Department of Health and Social Care (DHSC) a number of questions about what the latest lockdown means for those people who were previously advised to shield in England. You can see their responses below:
Which liver patients are considered clinically extremely vulnerable and were previously advised to shield??
NHS England has sent a letter to all of those previously identified as ‘clinically extremely vulnerable’ and advised to shield. If you believe you are in one of the categories below and have not been notified, please follow the 'clinically extremely vulnerable' advice and contact your supervising clinician/GP to clarify to ensure you have been added to the list if appropriate.
‘Clinically extremely vulnerable’ liver disease patients include the following:
1. Patients who are actively on the liver transplant waiting list or who have received a liver transplant.
Data: This is supported by data from NHSBT that indicates that patients who have had liver transplant have an unadjusted mortality rate of 25%. Patients who are on the transplant list could be called in any time and will not be transplanted if coronavirus positive.
2. Patients with chronic liver disease who are on immunosuppressants.
Data: There are as yet no large enough datasets to support/refute this approach and thus this is based on clinical judgement.
3. Other people who have also been classed as clinically extremely vulnerable by professional bodies including the British Association for the Study of the Liver, British Transplantation Society and NHS Blood & Transplant. This is based on clinical judgement and an assessment of their needs. GPs and hospital clinicians have been provided with guidance to support these decisions. If you fall into this group, please follow the advice for clinically extremely vulnerable group and contact your supervising clinician/GP to clarify and to ensure you have been added to the CEV list when appropriate and includes:
- Any patient with liver cirrhosis and decompensation or complication as defined by presence/recent history (within 12 months) of ascites, hepatic encephalopathy, hepatocellular carcinoma, variceal bleed or synthetic liver dysfunction.
Data: This is supported by data from the COVID-HEP registry that indicates that patients with decompensated liver cirrhosis have an unadjusted mortality rate 5-28 times higher than patients with liver disease without cirrhosis.
The Government has introduced new National Restrictions guidance, which will come into effect on 5 November and will apply until Wednesday 2 December. The advice for the clinically extremely vulnerable will cover this same period. At the end of the period, we will look to return to a regional approach, and we will issue further guidance at the time.
The new National Restrictions guidance announced on 31 October will protect everyone, including those who are clinically extremely vulnerable.
- We are introducing additional advice and support for clinically extremely vulnerable people to help further protect them. Whilst this does not go as far as previous shielding guidance, it does contain similar protections and support.
- Previous shielding advice introduced in March helped protect those most at risk from COVID-19, but many people told us they found this advice very restrictive. We have therefore made measured relaxations to the advice, such as advising clinically extremely vulnerable people to continue to go outside for exercise.
- The full new guidance for clinically extremely vulnerable people is published here.
- Translations and accessible formats of this guidance will also be made available in the coming days.
- We know that during the first period of national shielding between March and July, many people found the advice very restrictive. The new guidance acknowledges this and provides practical steps to help keep you safe while reducing some of the potentially harmful impacts on mental and social wellbeing of previous shielding guidance.
- While we are still advising clinically extremely vulnerable people to stay at home as much as possible, you can go outside to take exercise or to attend essential health appointments.
- There is also no need for self-isolation within your household, although you are advised to social distance where possible and follow the guidance of ‘Hands. Face. Space’
- The new guidance applies to individuals who have been deemed to be clinically extremely vulnerable, meaning that they face the highest risk of serious illness if they contract COVID-19. If you are in this group, you may have received a letter from the NHS or from your GP telling you this, and you may have been advised to shield in the past.
- Read the question titled ‘Which liver disease patients are considered clinically extremely vulnerable’ on our website here for more details about who is included in this group
As before, the guidance for the clinically extremely vulnerable is advisory, although you are strongly advised to follow the advice in order to keep yourself safe.
- Yes, we will write to everyone on the shielded patient list advising them of these changes. Guidance will also be available on the gov.uk website.
- If you do not receive a letter but think that you should be included please contact your clinician who can add you to the list
- It is important that you continue to receive the care and support you need to help you stay safe and well.
- You should continue to seek support from the NHS for any 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.uk/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.
- Any carers or visitors who support you with your everyday needs can continue to visit. They should follow social distancing guidance where close or personal contact is not required.
- Other members of your household are not required to shield and should follow the new National Restrictions guidance for the general population. That means they should continue to go to work and/or school.
- To further protect yourself from COVID-19, you should try to stay 2 metres away from other people within your household, especially if they display symptoms of the virus or have been advised to self-isolate. You should also follow the guidance of ‘Hands. Face. Space’.
- Everyone is advised to stay at home as much as possible, but you are still encouraged to go outside for exercise or to attend health appointments.
- If you do go out you should keep all contact with others to a minimum and avoid busy areas. You should also follow the guidance of ‘Hands. Face. Space’.
Children who live with someone who is clinically extremely vulnerable, but who are not clinically extremely vulnerable themselves, should still attend school.
You are advised to minimise all social interactions, including providing childcare, even if part of a childcare bubble.
- The shielded patient list is monitored regularly, and if scientific evidence shows that other groups face a very high risk of severe illness from COVID-19 then they would be added to the shielded patient list and informed of this.
- Clinicians can add people to the list so please speak to your doctor if you feel you should be included
Why is the Government announcing this now? Why is the advice for England different to the advice for other parts of the UK?
- The new guidance has been announced because coronavirus cases are rising rapidly across the country, and this advice is designed to further protect the most vulnerable. Each nation within the United Kingdom has a slightly different health system and this information only applies to those living in England. The new National Restrictions also only apply in England.
- Please look at this page on our website if you live in Scotland, Wales or Northern Ireland
This is a huge sacrifice for individuals - how confident are you that this is effective in keeping the clinically extremely vulnerable safe?
- We understand how hard these measures can be for individuals to follow, but we are confident that this advice strikes the best balance between preventing exposure to the virus with the potential negative physical and mental health consequences of asking people to isolate themselves.
- This guidance will remain in place for the 4 weeks up to 2 December.
This new guidance, as well as the new National Restrictions, will apply to the whole of England until 2 December.
Why didn’t you introduce these restrictions in tier 3 areas before? Is this the new guidance for tier 3 areas?
- When formal shielding guidance was introduced in March many people found it to be very restrictive. Since it was paused at the end of July, the Government has aimed to strike the best balance between preventing exposure to the virus with the potential negative physical and mental health consequences of asking people to isolate themselves. Unfortunately, Covid-19 cases are rapidly rising across the whole of the UK and it is necessary to now take further measures.
- The new National Restrictions and additional advice for clinically extremely vulnerable individuals is not the new guidance for tier 3 areas. It is new guidance that covers the whole of England from 5 November until 2 December. At the end of the period, we will look to return to a regional approach, and we will issue further guidance at the time.
Why are people being asked to follow this guidance even in areas previously categorised as ‘medium’?
Cases of COVID-19 are rising across the country, and even in areas where the level of incidence remains low, current scientific projections predict that hospital capacity would run out in the coming weeks unless action is taken. This is why the new National Restrictions measures have been implemented and why updated advice has been provided to further protect the most vulnerable.
- Yes, you are encouraged to continue to exercise outside because of the health benefits that this brings. You can go out for as long and as often as you wish, although you are generally advised to stay at home as much as possible.
- Everyone should avoid travelling in or out of their local area, and should look to reduce the number of journeys they make. Additional advice to clinically extremely vulnerable people is that they should avoid all non-essential travel by private or public transport, but can travel a short distance to exercise if this is necessary
- If you are clinically extremely vulnerable and you need support to access food, or you have other support needs to help you to stay at home as much as possible, you will be able to request support from your local council.
- Councils are being given funding to provide support to those Clinically Extremely Vulnerable people who need it. This can include help with shopping, securing a priority supermarket delivery slot, or signposting you to local support or befriending services.
- If friends and family are not able to collect your prescriptions or medicines for you, then you will also be eligible for free medicines delivery from your community pharmacy.
- If you cannot work, the Government has extended the Coronavirus Job Retention Scheme (furlough) until 2 December, which you may be eligible for if you were on payroll before 30 October 2020. Please speak to your employer if you think you are eligible.
Additionally, the letter you will receive can act as evidence for your employer to show that you cannot work outside your home until 2 December and that you are eligible for Statutory Sick Pay (SSP) or Employment Support Allowance (ESA), provided other eligibility criteria are also met.
- People in this group can use a new online service to register themselves, or on behalf of someone else, to:
- Request priority access to supermarket delivery slots (if you have already got priority supermarket deliveries, you’ll keep them).
- Tell your council if you need support in order to follow this guidance that cannot be provided by friends, family or other support networks.
- Update your details, for example, your address.
- This service can be found at https://www.gov.uk/coronavirus-shielding-support. You’ll be asked for your NHS number. You can find it on any letter the NHS has sent you, or on a prescription.
- If you need to register your needs by phone, or have an urgent need, you should contact your local council directly.
- Find out what help you is available from your local council at https://www.gov.uk/coronavirus-local-help.
- You are advised not to go to the shops. Use online shopping if you can, or ask friends, family or local charities to collect and deliver shopping for you.
- If you cannot access food, your local council can offer support. This may include helping you to request priority access to supermarket delivery slots (if you do not already have one) or help with shopping.
- If you need to register for help getting access to food you can go to https://www.gov.uk/coronavirus-shielding-support.
- NHS Volunteer Responders may also be able to help deliver your food shopping. To arrange support for yourself or someone else call 0808 196 3646.
- 7 of the UK’s largest supermarkets (Asda, Sainsburys, Tesco, Morrisons, Iceland, Waitrose, Ocado) are continuing to offer priority supermarket slots to Clinically Extremely Vulnerable people who need them.
- If you are already receiving priority access to supermarket delivery slots this will continue, you do not need to do anything further.
- You can use a new online service to register yourself, or on behalf of another individual, to request priority access to a supermarket delivery slot at https://www.gov.uk/coronavirus-shielding-support.
- Government will not be re-introducing nationally provided food parcels. We have moved to the locally led support model which recognises that councils are best placed to assess and meet food access needs with a focus on providing support in a way that encourages independence and choice.
- Use online shopping if you can, or ask friends, family or local charities to collect and deliver shopping for you.
- If you cannot access food, your local council can offer support. Local councils are now being funded to provide support to those Clinically Extremely Vulnerable people who need help to access food. This may include helping you to request priority access to a supermarket delivery slot (if you do not already have one) or help with shopping.
- Local councils are being given funding to provide support to those Clinically Extremely Vulnerable people who need it. This may include signposting you to local support or befriending services, or linking you up with volunteers who can help collect essential deliveries for you.
- If you need to register your needs by phone, or have an urgent need, you should contact your local council directly. Find out what help you might be able to get from your local council at https://www.gov.uk/coronavirus-local-help.
- NHS Volunteer Responders may also be able to help with their ‘check in and chat service’. To arrange support for yourself or someone else call 0808 196 3646.
The British Liver Trust is continuing to campaign on behalf of people with liver disease who are clinically vulnerable to try to improve the support that they are offered.
- If you are Clinically Extremely Vulnerable, you should not work outside the home until 2 December. Your employer is expected to help you to work from home.
- Employees or workers should talk to their employer as soon as they can about the new guidance.
- If you are unable to work in your normal role or do all of your usual tasks from home, you should discuss whether there are any alternative arrangements that can be made with your employer, including considering using the Coronavirus Job Retention Scheme (furlough).
- Everyone is being advised to work from home where they can.
- Where it is not possible to work from home, household members who themselves are not classified as Clinically Extremely Vulnerable can still go to work if they cannot work from home.
- Household members who live with clinically extremely vulnerable people should take extra care to follow the public health guidance on hand washing, social distancing, and complying with any Covid secure workplace guidance.
- You should try to remain two meters apart from each other, especially if household members display symptoms of the virus or have been advised to self-isolate
The Coronavirus Job Retention scheme has been updated to include guidance for employers and employees with regards to clinically extremely vulnerable scheme. It states the following.
If your employee’s health has been affected by coronavirus (COVID-19) or any other conditions
If your employee is:
- unable to work because they are clinically extremely vulnerable, or at the highest risk of severe illness from coronavirus and following public health guidance
- unable to work because they have caring responsibilities resulting from coronavirus (COVID-19), including employees that need to look after children
They are eligible for the grant and can be furloughed.
- The Government has extended the Coronavirus Job Retention Scheme (furlough) until 2 December which you may be eligible for if you were on payroll before 30 October 2020. Please speak to your employer if you think you are eligible.
- If you cannot work, you may be eligible for Statutory Sick Pay (SSP), Universal Credit (UC) or Employment Support Allowance (ESA). Eligibility criteria apply.
- The letter you will receive will act as evidence for your employer or the Department of Work and Pensions that you are advised to shield and may be eligible for SSP or ESA.
- SSP is payable for up to 28 weeks per sickness absence. If an individual has used up their SSP entitlement, they may be able to claim UC and/or ESA when their SSP ends, depending on individual circumstances.
- SSP is intended as a safety net for individuals who are clinically extremely vulnerable, in cases where their employer chooses not to furlough them under the Coronavirus Job Retention Scheme and does not have other suitable policies in place (e.g. the ability to work from home, or the provision of special leave).
- The Government recognises the continued impact that coronavirus (COVID-19) has had on the self-employed and has extended the Self-Employment Income Support Scheme (SEISS).
- The SEISS Grant Extension provides critical support to the self-employed in the form of two grants, each available for three month periods covering November 2020 to January 2021 and February 2021 to April 2021.
- Further information is available here: https://www.gov.uk/government/publications/self-employment-income-support-scheme-grant-extension/self-employment-income-support-scheme-grant-extension
- If friends and family are not able to collect medicines for you, then you will also be eligible for free medicines delivery.
- Please contact your pharmacy to inform them that you are clinically extremely vulnerable and need your medicines delivered, and they will arrange this free of charge.
- Anyone concerned about their mental health should speak to their GP or existing care team, or can access further advice via NHS.UK. Online self-referral options are commonly available for some services including children and young people’s mental health services, and psychological therapies services for adults with common mental health problems such as anxiety and depression.
- Every Mind Matters website is available for everyone with advice and practical steps that you can take to support your wellbeing and manage your mental health during this pandemic.
- You may also find helpful resources, including information on how to access counselling and psychotherapy, on the British Association for Counselling and Psychotherapy’s website (https://www.bacp.co.uk/).
- All mental health providers, including providers of psychological therapies services, have been issued with guidance to encourage them to deliver care remotely so that vulnerable groups, including those who are shielding, can receive care safely.
- Mental health trusts in England have been instructed to put in place 24/7 crisis lines for all ages so people can get urgent help whenever they need it. A national service finder for local urgent mental health telephone lines is now available on the NHS.UK website.
- If you or someone you care for are experiencing a mental health crisis, we urge you to make contact with a local health professional immediately.
- The mortgage holiday will be extended. Borrowers who have been impacted by coronavirus and have not yet had a mortgage payment holiday will be entitled to a six month holiday, and those that have already started a mortgage payment holiday will be able to top up to six months without this being recorded on their credit file.
- For borrowers who have taken six months’ holiday and continue to face ongoing financial difficulties, lenders should continue to provide support through tailored forbearance options. This could include granting new mortgage payment holidays. Home owners in this situation should speak to their lender to discuss their options.
- Measures to protect tenants during the COVID-19 outbreak remain in place.
- Landlords must provide a 6 month notice of evictions for all but the most egregious cases. Furthermore, no bailiff enforcement will occur during the national lockdown, in line with the existing position for tier 2 and 3 Local COVID Alert Levels.
- You do not have to stay in your home if you need to leave to escape domestic abuse.
- Any individual in danger and who is unable to talk on the phone, should call 999 and then either press 55 on a mobile when prompted or wait on a landline and you will be connected to a police call handler who will be able to assist you without you having to speak.
Children who live with someone who is clinically extremely vulnerable, but who are not clinically extremely vulnerable themselves, should still attend school.
Should staff who are clinically extremely clinical vulnerable continue to work in education and childcare settings?
- Government advice is that all CLINICALLY EXTREMELY VULNERABLE individuals should work at home where possible, regardless of which sector they work in. If you cannot work from home then you should not attend work.
- If you cannot attend work for this reason, you may be eligible for Statutory Sick Pay (SSP) or Employment Support Allowance (ESA). The letter you will receive will act as evidence for your employer or the Department of Work and Pensions that you are advised to shield and may be eligible for SSP or ESA.
- If you were on payroll before 30 October 2020 you may also be eligible for the Coronavirus Job Retention Scheme (furlough), which is being extended until 2 December. Please speak to you employer if you think you are eligible.
Should staff in education, health and childcare settings who live with someone who is clinically extremely vulnerable, stay at home?
Those who work in the education, health or childcare sectors who live with someone who is clinically extremely vulnerable can still attend work if they cannot work from home, in line with the wider rules set out in the new National Restrictions from 5 November.