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CHW202-Immunisation of People Policy

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Registration Number: {{org_field_registration_no}}

Immunisation of People Policy

1. Purpose

The purpose of this policy is to ensure that individuals supported by {{org_field_name}} are enabled and supported to access immunisation for which they are eligible, in accordance with current national immunisation programmes, clinical guidance and their individual health needs, wishes and circumstances. Immunisation is an important component of infection prevention, health promotion and preventative healthcare and can reduce the risk of serious illness, complications, hospital admission and outbreaks of vaccine-preventable infection within care settings.

This policy supports compliance with the Regulation and Inspection of Social Care (Wales) Act 2016; the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017, as amended, including the requirements relating to standards of care and support, access to healthcare services, hygiene and infection control and the maintenance of appropriate records; the Mental Capacity Act 2005; the Public Health (Control of Disease) Act 1984; and the Health Protection (Notification) (Wales) Regulations 2010, as amended.

{{org_field_name}} will have regard to current Welsh Government, Public Health Wales, NHS Wales and UK immunisation guidance, including the current edition of Immunisation against infectious disease (the Green Book), when supporting individuals to access vaccination.

The service recognises that people living in care homes may be at increased risk of serious illness from vaccine-preventable infections because of age, underlying health conditions, frailty or other clinical factors. Individuals will therefore be supported to receive accurate information, make informed decisions about vaccination and access vaccination services when eligible, while respecting their rights, wishes, consent and individual circumstances.

2. Scope

This policy applies to all service users receiving care and support from {{org_field_name}}, including permanent residents, individuals receiving respite or short-term care, and those under palliative or complex care arrangements. It also applies to care staff responsible for supporting residents in accessing health services, liaising with healthcare professionals, and recording immunisation history. While immunisation of staff is covered under our Occupational Health and Infection Control policies, this policy specifically relates to the immunisation of the people we support.

3. Related Policies

This policy should be read in conjunction with:
CHW11 – Safe Care and Treatment Policy
CHW13 – Safeguarding Adults from Abuse and Improper Treatment Policy
CHW17 – Infection Prevention and Control Policy
CHW18 – Risk Management and Assessment Policy
CHW34 – Confidentiality and Data Protection Policy
CHW36 – Initial Assessment and Care Planning Policy

4. Policy Statement and Implementation

4.1 Commitment to Preventative Care

{{org_field_name}} is committed to promoting and supporting access to preventative healthcare, including immunisation, as part of its responsibility to protect and promote the health, safety and well-being of the individuals receiving care and support.

People living in care homes may be at increased risk of serious illness from vaccine-preventable infections because of age, underlying health conditions, frailty or other clinical factors. Timely vaccination can reduce the risk of serious illness, complications, hospital admission and outbreaks of vaccine-preventable infection within the care home.

Individuals will be supported to access vaccinations for which they are eligible in accordance with current Welsh Government, Public Health Wales, NHS Wales and UK immunisation guidance, including the current edition of Immunisation against infectious disease (the Green Book).

{{org_field_name}} will ensure that individuals are not disadvantaged in accessing vaccination because of disability, cognitive impairment, communication needs, mobility difficulties or lack of family support. Reasonable support will be provided to enable individuals to understand information about vaccination, participate in decisions and access appropriate healthcare services.

Vaccination remains a matter of individual consent and clinical eligibility. No individual who has capacity to make the relevant vaccination decision will be required or pressured to receive a vaccination.

4.2 Initial Assessment and Consent

As part of the individual’s assessment and care planning arrangements, {{org_field_name}} will establish, so far as reasonably practicable, the individual’s known immunisation history and any information relevant to their access to preventative healthcare.

Relevant information may include previous vaccinations, known allergies, previous adverse reactions, current health conditions and any vaccination information available from the individual, their representative, GP, health record or other appropriate healthcare professional.

This information will be recorded within the individual’s personal plan and associated care records and reviewed where there is a change in the individual’s health needs or current national vaccination guidance.

Where an individual may be eligible for vaccination, the Registered Manager or designated member of staff will liaise with the individual’s GP, vaccination team, practice nurse, community pharmacy or other appropriate healthcare professional or vaccination provider so that eligibility can be confirmed and vaccination offered where appropriate.

Eligibility, timing, contraindications and clinical suitability for a particular vaccine will be determined by an appropriately qualified healthcare professional in accordance with current Welsh Government, Public Health Wales, NHS Wales and Green Book guidance. Care staff will not independently determine clinical eligibility or contraindications unless they are appropriately qualified and authorised to do so.

Valid consent must be obtained before any vaccination is administered.

The individual will be supported to receive information in a form and manner that they can understand. This will include, where appropriate, information about:

An adult must be presumed to have capacity to make the vaccination decision unless it is established otherwise.

Capacity is decision-specific and time-specific. A person must not be regarded as lacking capacity merely because of their age, diagnosis, disability, dementia, communication difficulty or because they make a decision that others consider unwise.

Where there is reason to doubt an individual’s capacity to make a particular vaccination decision, all practicable steps must first be taken to support the individual to make the decision themselves.

Where an individual aged 16 or over is assessed as lacking capacity to make the relevant vaccination decision, the Mental Capacity Act 2005 and its Code of Practice must be followed.

Any valid and applicable advance decision relevant to the proposed treatment must be considered. Staff must also establish whether another person has lawful authority to make the relevant decision, including an attorney appointed under a health and welfare Lasting Power of Attorney or a deputy appointed by the Court of Protection acting within the scope of their authority.

Where no person has lawful authority to make the decision on the individual’s behalf, any decision about whether vaccination should proceed must be made in accordance with the best interests requirements of the Mental Capacity Act 2005 by the person responsible for making the relevant treatment decision.

Family members, friends and advocates may be consulted as part of the decision-making process where appropriate, but they do not have authority to consent to vaccination solely because of their relationship with the individual.

The individual’s consent, refusal, capacity assessment where required, relevant legal authority and the outcome of any best interests decision will be appropriately documented.

4.3 Coordination with Health Services

{{org_field_name}} will work collaboratively with GPs, local health board vaccination teams, community pharmacies, district nursing services and other appropriate healthcare professionals to support individuals to access vaccinations for which they are eligible.

The service will maintain appropriate arrangements to:

Vaccination programmes relevant to individuals living in care homes may include, depending upon current national eligibility criteria and the individual’s age, health conditions and clinical circumstances:

For residents of care homes for older adults, the service will ensure that current national eligibility for influenza, COVID-19 and RSV vaccination is recognised and that eligible individuals are supported to access the relevant vaccination offer.

Other vaccines, including pneumococcal and shingles vaccination, will be supported according to the individual’s current age, health status and clinical eligibility.

The Registered Manager or designated member of staff will ensure that current Welsh vaccination guidance is checked when vaccination programmes, eligibility criteria or campaign arrangements change. The service will not rely solely on fixed age thresholds, vaccination dates or historic eligibility criteria contained within this policy.

Where an individual is unable to attend an external vaccination appointment because of their health, mobility or care needs, the service will liaise with the relevant healthcare or vaccination provider to explore appropriate alternative arrangements, including vaccination within the care home where available.

Where an individual misses an appointment or vaccination opportunity, appropriate follow-up will be undertaken with the individual and relevant vaccination provider.

Where an individual with capacity declines vaccination after being given appropriate information and an opportunity to make an informed decision, their decision will be respected and appropriately recorded.

4.4 Consent, Refusal and Best Interests Decisions

{{org_field_name}} respects each individual’s right to make decisions about vaccination.

No individual who has capacity to make the relevant vaccination decision will be vaccinated without their valid consent.

Individuals will be given, or supported to access, clear, accurate and accessible information about the vaccination being offered. Information will be provided in a manner appropriate to the individual’s communication needs, level of understanding, sensory needs and preferred language.

Where necessary, reasonable communication support will be provided to assist the individual to understand and participate in the decision.

An individual who has capacity is entitled to decline vaccination, even where healthcare professionals, family members or others consider vaccination to be beneficial.

A refusal will be respected and appropriately recorded.

Staff must not use coercion, undue pressure, threats, restraint or restrictive practices for the purpose of obtaining agreement to vaccination.

Where there is reason to doubt an individual’s capacity to make the particular vaccination decision, capacity will be considered in accordance with the Mental Capacity Act 2005.

Before concluding that a person lacks capacity, all practicable steps must be taken to support them to make the decision themselves.

Where the individual lacks capacity to make the relevant vaccination decision, staff will establish whether:

Where there is no person with lawful authority to make the decision, any decision to proceed with vaccination must be made in the individual’s best interests in accordance with the Mental Capacity Act 2005.

The best interests decision-making process must consider, where relevant:

Relevant family members, friends, advocates and professionals may be consulted where appropriate, but consultation does not itself give those persons authority to consent on the individual’s behalf.

Where there is significant disagreement about an individual’s capacity, relevant legal authority or what is in the individual’s best interests, vaccination will not proceed merely on the instruction of care-home staff or a family member. Appropriate advice will be sought from the responsible healthcare professional and, where necessary, legal advice or an application to the Court of Protection may be considered.

Consent, refusal, assessments of capacity, relevant legal authority, consultation and any best interests decision relating to vaccination will be appropriately documented in the individual’s records.

4.5 Record Keeping and Monitoring

Accurate and contemporaneous records relating to vaccination will be maintained within the individual’s care records.

Where information is available to the service, records should include as appropriate:

The service will not duplicate clinical records unnecessarily where the authoritative vaccination record is maintained by the NHS or another healthcare provider. However, sufficient information will be recorded within the individual’s care documentation to enable staff to understand their current vaccination status and any outstanding actions relevant to their care and support.

The Registered Manager or designated Infection Control Lead will maintain appropriate oversight of residents’ vaccination status so that vaccination opportunities and follow-up actions are not unnecessarily missed.

Immunisation information will be reviewed as part of the individual’s personal plan review where relevant and whenever there is a significant change in health status, vaccination eligibility or national vaccination guidance.

Vaccination information must be handled securely and confidentially in accordance with the service’s Confidentiality and Data Protection Policy and applicable data protection legislation.

4.6 Managing Vaccine Side Effects, Allergies and Clinical Concerns

Known allergies, previous significant adverse reactions to vaccination and other clinically relevant information will be recorded clearly within the individual’s care records and communicated to the vaccinating healthcare professional where appropriate and lawful.

Clinical decisions concerning:

will be made by an appropriately qualified healthcare professional.

Care staff will not independently determine that a vaccination is clinically contraindicated unless they are appropriately qualified and authorised to make that decision.

Following vaccination, staff will remain alert to any signs of an adverse reaction or deterioration in the individual’s condition in accordance with the individual’s needs, instructions provided by the vaccinating healthcare professional and the service’s clinical escalation procedures.

Possible reactions may include pain or swelling at the injection site, fever, rash, malaise or other expected side effects. Staff must also remain alert to signs of a severe allergic reaction or anaphylaxis.

Where there are signs of anaphylaxis, severe allergic reaction, breathing difficulty, collapse or another medical emergency, staff will immediately follow the service’s emergency procedures and obtain urgent medical assistance.

Where less urgent but clinically significant symptoms occur following vaccination, appropriate healthcare advice will be obtained promptly.

Any adverse reaction or clinical concern will be:

Any advice provided by the vaccinating healthcare professional about monitoring, treatment or follow-up will be incorporated into the individual’s care arrangements as necessary.

4.7 Infection Prevention During Vaccination Campaigns

Vaccination activity undertaken within the care home must be carried out in accordance with the service’s Infection Prevention and Control Policy and current infection prevention and control guidance applicable in Wales.

The Registered Manager or designated Infection Control Lead will liaise with the vaccination provider before an organised vaccination session to ensure that appropriate arrangements are in place for safe delivery of the vaccination programme.

Appropriate infection prevention and control precautions will be determined according to:

Appropriate arrangements will include effective hand hygiene and environmental cleanliness and, where indicated by current guidance or risk assessment, the use of personal protective equipment and other transmission-based precautions.

The area used for vaccination must be suitable for the activity being undertaken and must support:

A separate clinical area, personal protective equipment or cleaning between individual vaccinations will be used where required by current guidance, clinical direction or risk assessment rather than being applied automatically to every vaccination session.

Individuals who are acutely unwell, have symptoms of an infectious illness or have another clinical circumstance which may affect whether vaccination should proceed will be referred to the vaccinating healthcare professional for assessment.

Care staff will not independently determine whether an individual is clinically suitable to receive vaccination unless they are appropriately qualified and authorised to make that decision.

Where vaccination is postponed or cannot proceed, the reason will be documented where appropriate and arrangements will be made with the relevant healthcare or vaccination provider for review or a further vaccination opportunity when clinically appropriate.

4.8 Staff Roles and Responsibilities

The Registered Manager is responsible for ensuring that appropriate arrangements are in place to support individuals to access vaccination and preventative healthcare in accordance with this policy.

The Registered Manager will ensure that:

The Infection Control Lead, {{org_field_infection_control_lead_name}}, will support the Registered Manager with:

Care staff are responsible for:

Staff must not give clinical advice regarding vaccine suitability, contraindications, vaccine choice or eligibility unless this falls within their professional competence and authorised role.

Appropriate awareness of vaccination, consent, infection prevention and the Mental Capacity Act will be included within relevant staff induction, training, supervision and professional development arrangements according to staff roles and responsibilities.

4.9 Data Protection and Confidentiality

Information relating to an individual’s vaccination status constitutes personal health information and will be handled in accordance with the service’s Confidentiality and Data Protection Policy and applicable data protection legislation.

Vaccination information will only be collected, accessed, used, recorded or shared where there is an appropriate and lawful purpose.

Access to vaccination records will be limited to staff and professionals who require the information for legitimate care, treatment, safeguarding, public health, regulatory or service-management purposes.

Information may be shared with relevant healthcare professionals, vaccination providers, public health bodies, commissioners, regulators or other organisations where there is an appropriate lawful basis for doing so.

Information will not automatically be disclosed to relatives, friends or other representatives solely because of their relationship with the individual.

Where an individual has capacity, their wishes regarding the sharing of their health information will be respected unless disclosure is otherwise required or permitted by law.

Where an individual lacks capacity, decisions concerning the sharing of relevant information will be made in accordance with applicable data protection requirements, confidentiality obligations, the Mental Capacity Act 2005 and the individual’s best interests where relevant.

Vaccination records will be stored securely as part of the individual’s care documentation and retained in accordance with the service’s records management and retention arrangements.

4.10 Auditing and Continuous Improvement

The Registered Manager will maintain appropriate oversight of the implementation and effectiveness of this policy.

Vaccination arrangements will be reviewed as part of the service’s governance, infection prevention and control and quality assurance systems.

Monitoring may include, where relevant:

The purpose of monitoring vaccination uptake is to identify gaps in access, coordination, information or service processes. Vaccination uptake figures must not be used to place pressure on individuals who have made a valid decision to decline vaccination.

Where audits, incidents, complaints, outbreaks, healthcare advice or changes in national guidance identify concerns or opportunities for improvement, appropriate actions will be recorded, allocated to a responsible person, monitored and reviewed.

Relevant findings will contribute to the service’s wider quality assurance and Quality of Care Review arrangements where appropriate.

The service will make relevant records available to Care Inspectorate Wales where lawfully requested as part of inspection, monitoring or enforcement activity.

This section will be reviewed whenever there is a significant change in vaccination guidance, legislation, regulatory requirements or the nature of the service, and any necessary amendments will be incorporated into this policy.

5. Policy Review

This policy will be reviewed annually or sooner if changes are made to immunisation guidance by Public Health Wales, NHS Wales, or CIW. The Registered Manager is responsible for ensuring this policy reflects the most current clinical guidance and best practice.

Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
Reviewed on: {{last_update_date}}
Next Review Date: {{next_review_date}}
Copyright © {{current_year}} – {{org_field_name}}. All rights reserved.

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