Covid 19: supporting the vulnerable during lockdown Contents


Once it had made the decision to advise the most clinically vulnerable people to shield, Government quickly drew up plans to identify and support some 2.2 million people at the greatest risk from COVID-19 with food, medicines and basic care. £308 million was spent on the programme. The Government’s response had to start from scratch, as there was no pre-existing plan for shielding the clinically vulnerable in the event of a pandemic, and we recognise the pace and urgency with which Government delivered the shielding programme. However, the programme suffered from the problems of poor data and a lack of joined up systems that we see all too often in government programmes. As a result, Government took too long to identify some clinically vulnerable people at a time when their need was urgent.

One consequence of inviting local clinicians to amend the nationally prepared list of clinically vulnerable people (the ‘shielded patient list’ or the list) eligible for support was the introduction of a postcode lottery. The scale of additions to the list ranged from 15% to 352% between different local authority areas with the list more than doubling in 33 authorities. While there was some challenge and oversight of these additions, the Department of Health and Social Care (DHSC) tells us that NHSE&I and NHS Digital consider that ultimately additions were a decision for local clinicians. However, the outcome was nonetheless an unacceptable level of variation in local additions. Once Government had identified those it considered in need of support it then struggled to contact them to offer support and register their needs. Government could not reach some 800,000 clinically extremely vulnerable, almost half of whom were unreachable because of missing or incorrect telephone numbers in NHS records. The Ministry of Housing, Communities & Local Government (MHCLG) still does not know whether local authorities have been able to reach these 800,000 people.

Clearly government has learned lessons which have fed into more recent iterations of shielding and we welcome the greater role that local authorities now play in supporting people without central direction. MHCLG is now confident that local authorities can support people in their area, having been initially unsighted as to whether local authorities had enough capacity.

DHSC has also acknowledged that its purely clinical approach to vulnerability omitted key characteristics such as ethnicity, postcode and Body Mass Index (BMI). As a result of its newly expanded approach, it classified an additional 1.7 million people as clinically extremely vulnerable in February 2021 and they were advised to shield as a result.

Published: 21 April 2021 Site information    Accessibility statement