Revised guidance for shielded patients unveiled for England-wide lockdown

The government is recommending a less strict approach to shielding during England's nationwide lockdown, which begins tomorrow, as the CMO acknowledged that there had been 'downsides' to the steps taken in the first wave of the pandemic.

England CMO Professor Chris Whitty said there had been downsides to shielding in the first wave of the pandemic (Photo: WPA Pool /Getty Images)
England CMO Professor Chris Whitty said there had been downsides to shielding in the first wave of the pandemic (Photo: WPA Pool /Getty Images)

Updated govenment guidance published today advises people on the shielded patient list to stay at home as much as possible, but says they can still go outside for exercise and to attend health appointments during lockdown, which is due to run from 5 November to 2 December.

Clinically extremely vulnerable patients who cannot work from home have been advised to stay away from their workplace during the lockdown, and may be entitled to benefits or to access the furlough scheme, the advice says.

The government is recommending that shielding patients do not to go into shops or pharmacies and avoid non-essential travel. Those who need extra support to access food, medicines or to attend healthcare appointments have been advised to contact NHS Volunteer Responders, or register for support from their council by using an online service on the government website.

The service will allow people to request priority delivery slots from supermarkets as well as inform their local authority that they need additional help.

The government has said that clinically extremely vulnerable patients should follow the new advice until 2 December, when it intends to return to a regional approach and will provide updated guidance.

Change in approach

The advice marks a significant shift in the approach to clinically extremely vulnerable patients compared with the first wave of the pandemic, where patients were advised to stay inside at all times and GPs were told to deliver all care via home visits.

On Tuesday, England's CMO Professor Chris Whitty admitted that there had been 'downsides' to the government's approach to shielding during the first wave of the pandemic.

Giving evidence to the House of Commons science and technology select committee he said that while there were obvious benefits of shielding in reducing the risks of people contracting COVID-19, 'the downsides of it were also clear'.

He said this included 'an increase of loneliness and increase of, in some cases, probably mental health issues'.

He added: 'In trying to work out the balance between [benefits and downsides] our impressionistic view is that shielding was useful but should be a less strict version of shielding in the next phase, to allow people a little bit more time outdoors. There was this real worry that people were feeling trapped in their houses and all the downsides that went with that.'

The DHSC said that the government would be providing over £32m to councils in England to support clinically extremely vulnerable patients over the next month. It added that it will be writing to everyone on the shielded patient list setting out the new guidance this week.

Changes to shielding list

The new guidance follows a letter to GPs from NHS England this week advising them that adults with Down's syndrome and those with stage 5 chronic kidney disease should be added to the shielded patient list.

GPs have also been told to also urgently review and remove all children who are no longer deemed to be clinically extremely vulnerable from the list.

The latest guidance for patients says that 'more evidence has emerged that shows there is a very low risk of children becoming very unwell from COVID-19, even for children with existing health conditions'. As a result, most children originally on the list will no longer need to follow shielding advice and can attend school.

However, those children who are still identified as clinically extremely vulnerable following a review should remain at home during the lockdown.

Deputy CMO for England Dr Jenny Harries said: 'With the prevalence of the virus continuing to increase across England and in places across the world, it’s right that we adjust our advice for the clinically extremely vulnerable accordingly so they can feel as safe as possible over the coming few weeks.

'Our guidance for this group of individuals has always been advisory, but I would strongly urge all those who are clinically extremely vulnerable to take these extra precautions to keep themselves as safe as possible.'

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