Analysis

Nurses divided over mandatory flu jab, and the right to refuse it

Leading doctors are calling for a debate on mandatory flu vaccinations for NHS staff, but many nurses are opposed, and a change in the law might be needed to enforce it

Leading doctors are calling for a debate on mandatory flu vaccinations for NHS staff, but many nurses are opposed, and a change in the law might be needed to enforce it

  • Senior doctors want debate on mandatory flu vaccination before next winter
  • RCN encourages nurses to have the jab but says they shouldn’t be forced
  • Debate comes amid winter pressures, spike in flu patients in intensive care

Richard Parker, a registered nurse who is chief executive of Doncaster and Bassetlaw
Teaching Hospitals NHS Foundation Trust, carrying out flu vaccinations for staff
as part of the trust’s campaign.

Mandatory flu vaccinations for NHS staff have become the topic of a hot debate among nurses following suggestions by leading doctors of such a dramatic move on the issue.

NHS England medical director Sir Bruce Keogh and England’s chief medical officer Dame Sally Davies have raised mandatory vaccination as a potential option to increase uptake of the vaccine among staff.

Bruce_Keogh©TG
Sir Bruce Keogh wants a debate
on mandatory vaccination.
Picture: Tim George

In a comment on Twitter, Sir Bruce said: ‘Vaccine still best protection for NHS staff and patients. I think a serious debate around mandatory flu vaccination is inevitable before next winter.’

Asked if vaccination should be made compulsory for staff, Dame Sally said: 'I welcome anything that increases vaccination rates of healthcare staff, because we have this duty of care to protect our patients.

'If that raises rates, then I'm happy with it.'

Choice and risks

There are a number of flu strains circulating this winter, including A(H3N2), known as Aussie flu, A(H1N1) or swine flu and Flu B.

NHS Employers has been providing advice and guidance to support local staff flu vaccination campaigns.

Nursing Standard readers were asked in a Twitter and Facebook poll whether flu vaccinations should be made mandatory for front-line health staff.

The 560 responses are more or less split down the middle – 282 rejected the idea, and 278 were in favour.

59.3%

flu vaccine uptake among front-line healthcare workers at NHS trusts from 1 September-30 November 2017.

Source: Public Health England

On Nursing Standard’s Facebook page, one person argued that the flu vaccination is a very different issue to the mandatory vaccinations that trusts ask for, such as hepatitis B.

‘These are long-standing, proven vaccinations that provide long-term immunity, protecting the recipient from a life-changing illness. The flu jab is different – there is no long-term data and can never be, as it’s changed every year, effectively making the recipients guinea pigs.' they said.

Another said: ‘If they were mandatory and it turns out later there are health risks with regular injections, the NHS might become liable for damages. As long as we make a choice then it is for us to take the risks.’

An individual decision

RCN professional lead for public health Helen Donovan, who has blogged about the critical importance of nurses getting the flu vaccination, says: ‘It helps reduce the chances of the virus spreading to vulnerable people who are more likely to become seriously ill, and it helps in preventing sickness absence.

‘The RCN actively encourages all nursing staff to have it, but it should be an individual decision and not forced on people. Employers should make the vaccine easily accessible to their staff.’

583,836

seasonal flu doses have been given to front-line healthcare workers since 1 September 2017.

Source: Public Health England

Nursing Standard columnist Marc Cornock, a nurse, academic lawyer and senior lecturer at the Open University, says making the flu vaccination mandatory could ‘open a can of worms’.

‘I’m not sure how it would work and whether you can actually make someone have the flu vaccination. There would need to be a change in law,' he says.

‘I can see why it makes sense to ensure nurses are not off with flu and also to protect patients, but the person having the vaccine needs to give consent.

'Additionally, the person giving the vaccine – if they are a nurse, for example – would need to abide by the Nursing and Midwifery Council code stating the person they are giving the vaccine to must have given consent.

‘There are no guarantees that the flu vaccine will protect against every virus strain. Perhaps rather than making it mandatory, NHS trusts could concentrate on even stronger marketing campaigns encouraging staff to take up the vaccine.’

Safety compromise

The debate comes as the NHS struggles with winter pressures. The number of people admitted to intensive care due to flu rose by 65% in the first week of the year, according to Public Health England.

Statistics also show a 78% increase in the GP consultation rate for flu-like illness and a 50% increase in the rate of hospital admissions.

A letter from the heads of more than 60 emergency departments (ED) in England and Wales to prime minister Theresa May, leaked to Health Service Journal, warned that the ‘current level of safety compromise is at times intolerable’.

63%

of front-line healthcare workers at all NHS trusts in England received the flu vaccination in 2016-17.

Source: Public Health England

Concern about immunity

Emergency nurse consultant Cliff Evans, who has been instrumental in turning around Medway NHS Foundation Trust’s emergency department, decided to have the vaccination this year.

He says: ‘I’ve had the vaccination for a few years now, but those who don’t may be concerned about it suppressing their immunity and what’s actually in it. When you are in the ED, there are a lot of people with cold and flu-like symptoms coming in. Any pre-existing respiratory problems in patients will be exacerbated by the flu.

‘We’ve been seeing a growing number of younger patients aged 18-30 with flu-like symptoms and they’ve been streamed into primary care, as we have a 24-hour GP service located on site.

‘They know they probably won’t be given antibiotics, but are seeking reassurance. We have been well staffed compared with previous years during the winter, but there is still staff sickness as you would expect when in contact with people who have the flu.’

Not enough evidence

A matron at the trust, who did not want to be named, said she had never had a flu vaccination in her 23-year career.

‘I don’t believe in it, despite any education teaching otherwise. I live a healthy lifestyle with a good diet. My reasoning may sound old-fashioned, but I wouldn’t force the vaccination on any of my staff because I don’t believe I have the right to,' she says.

‘One could argue that it is putting others at risk by not having the vaccination, but it doesn’t cover all flu strains and I’m not certain there is enough evidence.’

Fired for refusing

An American nursing association said last year it would file grievances over claims by nurses that they had been fired for not participating in a mandatory flu vaccination programme.

The Minnesota Nurses Association (MNA) said it would fight to win back the jobs and wages of registered nurses over the policy at Essentia Health.

Essentia Health runs a network of hospitals, clinics and related healthcare facilities in Minnesota, North Dakota, Wisconsin and Idaho.

‘Bulletproof’ mentality

A spokesperson for the MNA said: ‘While nurses are advocates for flu shots, voluntary and/or incentivised programmes have been shown to increase participation much more effectively.’

He says mandatory flu vaccinations create a ‘bulletproof’ mentality meaning healthcare organisations can see a drop in other flu prevention procedures such as simple hand washing.

An Essentia Health spokesperson said it was mandatory for all employees to have the flu vaccination, but could not discuss details about specific employees.

Flu drive succeeds with Star Wars theme

Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust was the first acute trust in England to vaccinate 75% of front-line staff against the flu in 2017, as it was in 2016.

The trust’s chief executive Richard Parker is a registered nurse who personally gave the vaccination to a number of staff. Over the past two years the trust has run a light-hearted advertising campaign encouraging staff to be vaccinated.

Costumes and film posters

In 2016, the trust’s Flu Busters campaign was themed on the 1980s comedy film Ghostbusters and in 2017 it was called Flu Wars, with a Star Wars film theme and members of staff posing for pictures in costume. The campaigns also had a parody film trailer, which members of the vaccination team took part in, as well as mock film posters.

Mr Parker says more than 3,400 members of staff have had the vaccination.

‘Ensuring members of the team get their flu jab is very important to us as an organisation, and is just one more precautionary step our clinicians and medics can take in helping to keep both patients and colleagues safe,' he says.


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