Identifying patients for inclusion in the initial List was carried out by NHS Digital using data we already hold as the national safe haven for health and care data in England. We also collected additional data from GP practices in England, Public Health England about those patients who were determined to be clinically extremely vulnerable. NHS Digital was asked to do this by the Chief Medical Officer for England as part of our legal functions to collect and analyse data under the COVID-19 Directions.
A list of underlying medical conditions which were considered to indicate extreme vulnerability to coronavirus was agreed with the Chief Medical Officers for the UK. This list identified the following pre-existing conditions which doctors consider will make those patients clinically extremely vulnerable in relation to coronavirus:
- Solid organ transplant recipients.
- People with specific cancers:
- people with cancer who are undergoing active chemotherapy
- people with lung cancer who are undergoing radical radiotherapy
- people with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage of treatment
- people having immunotherapy or other continuing antibody treatments for cancer
- people having other targeted cancer treatments which can affect the immune system, such as protein kinase inhibitors or PARP inhibitors
- people who have had bone marrow or stem cell transplants in the last 6 months, or who are still taking immunosuppression drugs
- People with severe respiratory conditions including all cystic fibrosis, severe asthma and severe COPD.
- People with rare diseases and inborn errors of metabolism that significantly increase the risk of infections (such as SCID, 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.
The health and care data NHS Digital held, and the data which we obtained from the other organisations identified above, was then analysed by NHS Digital with reference to these pre-existing medical conditions. This analysis identified those patients who are considered to be the most clinically vulnerable to coronavirus.
Read more details here about how this was done in the detailed algorithm methodology.
The shielded patient list is now being updated with information about those additional patients considered to be clinically extremely vulnerable who are also identified by their GP and by their hospital doctor. We are also collecting information from the Cabinet Office Extremely Vulnerable Person Service, about those individuals who have registered with the Service and who are not on the List, but believe that they should be on the List. We are sharing this information with the GP Practices for those individuals so that their GP can assess whether they are clinically extremely vulnerable.
The criteria for those additional patients who may also need to take shielding measures due to their pre-existing medical conditions will also be updated from time to time by the Chief Medical Officers in the UK.
We are also collecting information from the Health and Justice Information System (HJIS) to identify patients in detained and secure estates who may be clinically extremely vulnerable if they contract COVID-19. Information about patients who are on the List will then be provided back to healthcare clinicians by NHS Digital through identifying those patient records with a flag on the HJIS clinical system.
The List will also be updated to remove people from the List:
- who have died
- where a GP or hospital doctor tells us that a person is not clinically extremely vulnerable
- and to remove people from the List who have specifically asked to be removed from the List
You can request to be removed from the list by asking your GP. They will add a low or moderate flag to your record and you will be removed from the list.
For more information on what to do if you think you should be subject to shielding measures, or if you have received a letter from the NHS telling you to take shielding measures and you don’t think you need to do this, please see our Shielded Patient List webpages.
For more information about Shielding read the Guidance published by Public Health England on Shielding. For general advice on coronavirus please visit the NHS website.
Read more details here about the timings for information flows between patients page.