Shielding clinically extremely vulnerable patients from coronavirus
Page updated: Monday 6 July 2020
Some people with cancer are more at risk of becoming seriously ill if they contract the COVID-19 infection. The Government has produced guidance for these 'clinically extremely vulnerable' people. It is also for their family, friends and carers.
People who are clinically extremely vulnerable should have received a letter telling them they’re in this group or have been told by their GP. Around 2.2 million people across the UK have been told they are ‘clinically extremely vulnerable’ and advised to shield.
If you have been told that you’re clinically extremely vulnerable, you should:
- follow the advice in the guidance
- register online even if you do not need additional support now
Who is ‘clinically extremely vulnerable’?
Clinically extremely vulnerable people may include the following people. Disease severity, history or treatment levels will also affect who is in the group.
- People with cancer who are undergoing chemotherapy treatment
- People who are having radical radiotherapy for lung cancer. This includes people with bowel cancer whose cancer has spread to the lung
- People with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage of treatment
- People receiving immunotherapy treatments or other continuing antibody treatments for cancer
- People having other targeted cancer treatments which can affect their immune system, for example protein kinase inhibitors or PARP inhibitors
- People who have had bone marrow or stem cell transplants in the last six months, or who are still taking drugs to suppress their immune system
The guidance also includes:
- Anyone who has ever had a solid organ transplant
- People with severe respiratory conditions including everyone with cystic fibrosis, severe asthma and severe chronic obstructive pulmonary disease (COPD)
- People with rare diseases that increase their increase the risk of infections (such as Severe Combined Immunodeficiency (SCID) and homozygous sickle cell)
- People on immunosuppression therapies sufficient to significantly increase risk of infection.
- Women who are pregnant with significant heart disease, congenital or acquired.
People who fall in this group should have been contacted to tell them they are clinically extremely vulnerable. If you’re still concerned, you should discuss your concerns with your GP or hospital clinician.
Changes have started to be made to the clinically extremely vulnerable from COVID-19 list, and a number of patients in England are now being advised by clinicians that they don’t need to be on it anymore. These decisions are being made, or will be made, following a review by a GP or specialist if they feel people are no longer in the category of clinically extremely vulnerable.
We’re aware that some people who have previously been advised to shield – people who have been receiving direct support with things like government food parcels - have been sent a text message before any conversation about these changes has taken place with their healthcare professional, which will understandably be worrying and potentially confusing. Please speak to your clinician to discuss this if you’re not sure why you’ve received the message or what it means.
The Government has given assurances that people who have previously been on this list can still access some forms of support, including supermarket priority delivery slots and the NHS volunteers network.
Check this is the right guidance for you
There’s different guidance if you are not clinically extremely vulnerable.
Follow the different guidance if any of the following apply to you:
- you do not have any of the conditions that makes you clinically extremely vulnerable
- you have not been told by your GP or specialist that you’re clinically extremely vulnerable or received a letter
Shielding guidance is advice and is not compulsory. Everyone’s personal circumstances are different, and you may find it helpful to review the advice with your GP or clinical teams and make decisions that work for you.
Shielding guidance for people in England will change in stages over the coming weeks.
You are able to meet in a group of up to 6 people outdoors, including people from different households, while maintaining strict social distancing;
- You will no longer need to social distance from the other people you live with
- If you live alone (or are a lone adult with dependent children under 18), you will be able to form a support bubble with another household, enabling you to spend time together inside each other’s home without needing to socially distance.
If you live in Leicester:
- you are strongly advised to stay at home as much as possible and keep visits outside to a minimum;
- if you wish to spend time outdoors this can be with members of your own household or, if you live alone, you may choose to spend time outdoors with one person from another household (ideally the same person each time). You should maintain social distancing and avoiding gatherings of any size; and
- You are advised not to be part of a support bubble with another household.
Everybody who is shileding in Leciester will receive a letter from Monday 6 July outlining these changes, and signposts to where you can access support if needed.
The shielding guidance for Leicester will be reviewed as part of a wider review into the local measures from 18 July. More information can be found here
From 1 August
The advice to ‘shield’ will be paused. Instead, the Government is advising you to adopt strict social distancing rather than full shielding measures.
- This means you may wish to go out to more places and see more people but you should take care to minimise contact with others outside your household or support bubble.
- You can go to work, if you cannot work from home, as long as the business is COVID-safe
- You can go outside to buy food, to places of worship and for exercise but you should maintain strict social distancing
You should remain cautious as you are still at risk of severe illness if you catch Coronavirus, so the advice is to stay at home where possible and, if you do go out, follow strict social distancing
The food and medicine boxes that are provided by the National Shielding Service will stop as of 1 August as people are advised they can visit shops and pharmacies.
- However, other forms of support – such as priority supermarket delivery slots and the NHS Volunteers Scheme, amongst a range of local volunteer schemes – will continue.
- If you are concerned about support available to you after 1 August, you should contact your local authority.
After 1 August the Government will continue to maintain the Shielded Patient List. They will monitor the virus over the coming months and if it spreads too much, they may need to advise you to shield again.
The Government will be writing to everybody in the ‘clinically extremely vulnerable’ from 22 June, outlining these steps.
You can go outside to exercise or be active
- You cannot enter other indoor areas
- Strict physical distancing and hand hygiene is strongly advised
- You can take part in non-contact outdoor activities such as golf, hiking, canoeing, outdoor swimming, fishing etc.
- You can meet one other household per day outdoors, as long as there are no more than 8 people in the group
- You cannot go inside other buildings or meet other people inside
It is really important that you keep a physical distance of two metres from others and practise strict hand hygiene
People should continue to shield until Friday 31 July 2020
- That is because, although infection rates are much lower than they were at the start of lockdown, the Scottish Government is not yet confident that it is safe enough to change their advice
- This will be reviewed, and potentially lifted earlier (if possible), should the evidence allow. An update will be provided by Friday 31 July at the latest
- There is no change to the support offered to those who are shielding. If you have been getting support or food deliveries this will continue until at least Friday 31 July.
The Scottish Government is working to develop tools to provide risk-based guidance for people shielding. This will take into consideration specific conditions, alongside other factors such as your age and ethnicity. There will be an update on this development in the coming weeks.
It is still recommended that you stay at home as much as possible.
- You can now go outdoors while maintaining strict social distancing with members of your household
- When you are outside your home, you cannot enter other indoor area and strict physical distancing and hand hygiene is strongly advised
- You should take extra care to minimise contact with others by keeping 2 metres apart, when you are spending time outdoors (ie not in other buildings, households or enclosed spaces).
- You hould remain vigilant when leaving home: washing your hands regularly, maintaining social distance and avoiding gatherings of any size.
- You should not attend any gatherings, including gatherings of friends and families in private spaces, for example, parties, weddings and religious services.
- You should strictly avoid contact with anyone who is displaying symptoms of COVID-19 (a new continuous cough, a high temperature, or a loss of, or change in, your sense of taste or smell).
You may also choose to remain in your own home at all times if you still do not feel comfortable going outside. When you are at home, you can continue to follow the previous advice by:
- trying to spend time with the windows open to let in the fresh air
- arranging spaces to sit and see a nice view (if possible) and get some natural sunlight
- getting out into any private space, keeping at least 2 metres away from your neighbours and household members if you are sitting on your doorstep.
However, prolonged shielding can have detrimental effects on both physical and emotional well-being and time outside in the fresh air is likely to make you feel better in yourself.
If you are shielding alone, you can also form a support bubble with one other household. Where you form a bubble:
- Social distancing is not required with the other household in your bubble; this will allow you to visit, stay over and spend more time with the second household
- The second household can be of any size; and
- Both households should not be part of more than one bubble and should continue to socially distance outside the bubble.
You can find more information on support bubbles here.
From 31 July
The advice to ‘shield’ will be paused. Instead, you’re advised to adopt strict social distancing rather than full shielding measures. This means you may wish to go out to more places and see more people but you should take care to minimise contact with others outside your household or support bubble.
- You can go to work, if you cannot work from home. If you can’t cannot follow guidance on social distancing at work or during travel to work, you should tell your employer you need to follow government advice and avoid these risks.
If you have previously registered your need for a food box through the Community Helpline you will automatically continue to receive this until 31 July 2020.
- If you are shielding and have not previously registered through the Community Helpline, contact the helpline now to register on 0808 802 0020, text: ACTION to 81025, or email: firstname.lastname@example.org
You can now leave home to exercise or meet outside with people from another household.
- You can leave your home as many times as you want to but please stay local and try to avoid busy places so you can keep 2 meters or three steps away from other people
- You can meet outside with people from another house locally if you want to but always keep 2 metres or three steps away.
- You should stay close to home so you do not have to use a toilet that is not your own and they should not go anywhere indoors other than your own home.
- You should practice good hygiene using a hand sanitiser and avoiding touching things touched by others.
- Try to keep 2 metres or three steps away from other people you live with. It will be difficult, but you should try to do it as best you can.
- You should not go out shopping. When arranging food deliveries, these should be left at the front door.
- You should not go to your GP, pharmacy or hospital without phoning first. You should speak to your pharmacy about how you can get your medicine.
- Do not go to your place of work if this is outside your home. You should only work if you can work from home.
Register for support
Everyone who has received a letter advising that they are clinically extremely vulnerable should register online if you need any extra support, for example, essential groceries delivered to your home.
If you haven’t yet registered, you may receive a call from the government call centre on 0333 3050466. The purpose of this call is to see whether you need support and to help you to register. Please note that this is an outbound call centre only. To speak to someone, call the number below.
Register even if:
- you do not need support now
- you’ve received your letter from the NHS
Register for support
- register online
- call 0800 028 8327
Have your NHS number with you when you register. This will be at the top of the letter you have received letting you know you are clinically extremely vulnerable or on any prescriptions.
Letters to clinically extremely vulnerable people
The NHS in England has contacted clinically extremely vulnerable people with the conditions listed above to provide further advice.
If you have not received a letter or you have not been contacted by your GP but you’re still concerned, you should discuss your concerns with your GP or hospital clinician.
If you develop symptoms
If you think you have developed symptoms of COVID-19 such as a new, continuous cough or fever, seek clinical advice using the NHS 111 online coronavirus service or call NHS 111. Do this as soon as you get symptoms.
In an emergency, call 999 if you’re seriously ill. Do this as soon as you get symptoms.
Do not visit the GP, pharmacy, urgent care centre or a hospital.
Prepare a single hospital bag. This will help the NHS provide you with the best care if you need to go to hospital as a result of catching coronavirus. Your bag should include:
- your emergency contact
- a list of the medications you take (including dose and frequency)
- any information on your planned care appointments
- things you would need for an overnight stay (for example, medication, pyjamas, toothbrush and snacks)
- your advanced care plan (only if you have one)
The guidance also includes information on:
- Help with food and medicines if you’re shielding
- Visits from essential carers
- If your main carer becomes unwell
- Living with other people
- If you do not want to be shielded
- Hospital and GP appointments if you’re shielding
- Looking after your mental wellbeing
- Staying connected with family and friends
- Unpaid carers who provide care for someone who is clinically extremely vulnerable
Getting extra support across the UK
If you received a letter from the government to say you fall into the shielding group, you can access government support services to help you with your food and medicines through:
- a text message service which you can use to arrange a weekly delivery of basic groceries or if you’re running low on medication. There is more information about this service in the letter you received.
- your local authority’s shielding support line, which will be able to arrange for food and medicine deliveries and signpost you to other support services
- a helpline – 0800 111 4000 – has been set up to provide essential assistance to those who don’t have a network of support, or who are at increased risk if they contract coronavirus. The line is open Mon-Fri, 9am-5pm.
This service is in addition to localised support already available for people who have received letters advising them to shield themselves. However, any of those in the shielding category who are not yet receiving assistance, who do not have a network of support and cannot get online can access support via this new helpline.
You should ask family, friends and neighbours to support you and use online services wherever possible. If this is not possible, contact your local authority for support (contact details are included in your letter). If you already receive support from health and social care organisations this will continue as normal.
Find more information about shielding in Wales on the Welsh Government website or visit Public Health Wales which gives the latest advice to people in Wales including how to look after your mental health.
You should ask family, friends and neighbours to support you and use online services wherever possible. If this is not possible, you may be able to get extra support from an organisation or local group in your area.
You can also contact the COVID-19 community helpline for Northern Ireland:
- Freephone 0800 802 0020
- Email email@example.com
- Text: ACTION to 81025
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