Identifying and protecting vulnerable citizens

Identifying vulnerable citizens

The Shielded Patient List (SPL) identifies patients at the highest risk from COVID-19, based on criteria set by the Chief Medical Officer for England (CMO). Since 23 March 2020, NHS Digital has delivered weekly iterations of the SPL to partner organisations so support can be targeted to clinically extremely vulnerable people (CEV).

The list was significantly expanded on 15 and 22 February to include around 1.7 million people identified as being at increased risk from COVID 19 through a population level risk assessment using the QCovid risk prediction model. There are now around 3.8 million people on the SPL.

NHS Digital will continue to produce the list after the pause to national shielding advice on 31 March to enable ongoing support by partner organisations in health and local government and to facilitate future support for CEV, should this be required.

Communicating with vulnerable citizens

We've continued to issue advice and guidance to CEV with 2.3 million letters and 850,000 emails issued on 21 February to communicate the extension of national lockdown to 31 March. 3.8 million letters and 1.4 million emails were issued from 15 March to advise CEV about support that will be available once the national shielding advice pauses on 31 March.

Dashboards

The private SPL dashboards used by Directors of Public Health to support CEV on 18 February were expanded to include vaccination data. These dashboards provide views of first and second vaccination doses for CEV in a local area, broken out by age and ethnic category, enabling targeted interventions to support take up of COVID-19 vaccination by these patients.

Vitamin D

We completed matching of requests for free vitamin D supplements to people on the SPL. As of 22 February, when the scheme closed, around 460,000 validated requests had been referred to DHSC for fulfilment.

Get a Shielding Note

We implemented changes to the ‘Get a Shielding Note’ service to align with the end of shielding advice.

From 31 March, new ‘Shielding Notes’ can only be generated retrospectively and the service will be paused from 30 April. As of 26 March, the service has enabled over 15,000 CEV to generate a note for their employer or the Department of Work and Pensions confirming they had been advised to shield.

COVID-19 Population Risk Assessment

At the request of DHSC, NHS Digital has developed digital infrastructure to support a more sophisticated approach to identifying individuals with increased vulnerability to COVID-19, now that clinical determinants are better understood.

This infrastructure uses the University of Oxford’s QCovid risk prediction model, which assesses an individual’s risk based on a combination of characteristics (including age, sex, ethnicity, BMI, and specific medical conditions). DHSC commissioned Oxford University to develop the QCovid model and it has been validated by the Office for National Statistics (ONS).

We successfully used the new infrastructure for population level risk assessments for adults in England, identifying an additional 1.7 million people at increased risk of adverse outcomes from COVID-19 that were not previously included on the Shielded Patients List (SPL). This has enabled these individuals to be prioritised for vaccination as part of Cohort 6* and to be eligible for additional support through addition to the SPL from 14 February (vulnerable individuals below the age of 70) and 22 Feb (vulnerable individuals above the age of 70). These additions were then subject to review by GPs and trusts through standard SPL clinical review processes.

We delivered the COVID-19 Clinical Risk Assessment Tool for authorised users on 16 February, which is also based on the QCovid model. The tool generates absolute and relative risk scores for individuals to enable clinicians to hold tailored conversations with patients about their specific risks from COVID-19 and to facilitate clinical review of additions to the SPL COVID-19 Clinical Risk Assessment Tool NHS Digital.

Patients were added to the SPL when their risk assessment results placed them in the top 2% of people at highest risk of catching and dying of COVID-19. The threshold was agreed by England’s Chief Medical Officer, in consultation with senior clinicians, based on research conducted by the University of Oxford. To facilitate clinical review of patients whose predicted risk did not meet this threshold, NHS Digital delivered the COVID-19 Population Risk Assessment Viewer on 16 March, which enables GPs to view patients registered at their practice whose risk assessment results were below the agreed threshold.