Coronavirus and shielding of clinically extremely vulnerable people in England: 9 June to 18 June 2020

• Of the 2.2 million clinically extremely vulnerable (CEV) people, 63% reported completely following shielding guidance.

• The government, as well as communities, have provided support to enable CEV people to shield; the support mechanism that most people who had not left their home since receiving shielding guidance or in the last seven days found helpful was video or telephone calls with family and friends (74%), followed by prescription deliveries (59%) and food deliveries or food boxes (56%).

• CEV people who are currently or have previously received treatment for their mental health were more likely to report a worsening in their mental health since being advised to shield (68% and 56% respectively).

• CEV females were more likely to report a worsening in their mental health than CEV males, irrespective of age group.

Statistician's comment

“We see a continued trend in clinically extremely vulnerable people following the government guidelines, as the proportion of people who report completely following the shielding guidance remains just over 60%. Their main support has come from video or phone calls with family and friends, the ease of prescription deliveries, and food deliveries or food boxes.

“Overall the data paints a reassuring picture, showing us that despite the extra guidance in place for the clinically extremely vulnerable, over half (60%) of the shielding population report no change in their mental health since being advised to shield.

However, we recognise that the coronavirus pandemic and shielding has had an impact on the mental health of some of the shielding population.”

Tim Gibbs, Public Services Analysis Team, Office for National Statistics

Follow the Public Services Analysis team on Twitter: @HughStick

In England, 2.2 million people were identified as being vulnerable to severe impact from the coronavirus (COVID-19). These people were advised to shield from others to protect themselves from the virus. The guidance for clinically extremely vulnerable (CEV) people has changed over time with the latest change on 1 June 2020. More information on identifying this group of people, shielding guidance and collecting the data can be found in the Glossary and Measuring the data.

The latest data, collected from 9 June to 18 June 2020, show that 63% reported to be completely following shielding guidance (an estimated 1,423,000 people). This is broadly comparable with previous data collected, when 63% (between 14 and 19 May 2020) and 62% (between 28 May and 3 June 2020) reported completely following shielding guidance. The percentage who reported not leaving the house since receiving shielding advice or only leaving the house for exercise in the last seven days, at 64%, is very similar to the percentage that reported completely following shielding guidance. This appears to be consistent with those completely following the guidance.

Notes

1. The guidance for clinically extremely vulnerable (CEV) people changed on 1 June and advised that CEV people could leave the house for exercise. This change occurred mid collection of 28 May to 3 June 2020 data. For more information see Measuring the data.
2. Support with personal care could be provided by a family member or nurse, care or support worker.

Almost half (46%) of clinically extremely vulnerable (CEV) people had left the home within the last seven days. The most common reasons for leaving home in the last seven days were:

• for exercise (54%)
• for a GP or hospital appointment (26%)
• to shop for essentials (24%)

CEV people who had left home since being advised to shield were asked if they had access to services that would have enabled them to shield at home: food deliveries or food boxes; telephone appointments with their GP or hospital; prescription collections or deliveries; and space at home to take part in exercise. Approximately half (51%) had access to all four of the services that would help them shield.

Almost half (46%, an estimated 1,028,000) of CEV people had not left the home since they were advised to shield. The most common support mechanisms that have helped them shield effectively are:

• video or telephone calls with family and friends (74%)
• prescription deliveries (59%)
• food deliveries or food boxes (56%)
• telephone appointments with GP or hospital (51%)
• access to exercise at home, for example, online classes or a garden (50%)

Since being advised to shield, clinically extremely vulnerable (CEV) people have mostly reported that their mental health has stayed the same (60%). Others have reported that their mental health has got slightly worse (29%) or reported it had got much worse (7%). A small percentage (3%) of CEV people reported that their mental health had got much better since being advised to shield. (Percentages do not sum to 100% because of rounding.)

Of all CEV people, 10% reported currently receiving treatment (for example, medication or psychological therapies) for their mental health and 15% reported receiving treatment in the past. Over two-thirds of CEV people who reported currently receiving treatment for their mental health reported that their mental health had become either slightly worse (47%) or much worse (21%) since receiving shielding advice. Those who reported never having received treatment for their mental health were more likely to report no difference (69%) in their mental health since receiving shielding advice.

Of all CEV people, 3% preferred not to say whether they had previously received treatment. The majority (52%) who preferred not to say whether they had previously had treatment for their mental health reported no difference in their mental health since being advised to shield.

The changes in the mental health and well-being of clinically extremely vulnerable (CEV) people since they were advised to shield varied by gender and age group. The age group most likely to report a worsening in their mental health was CEV people aged between 50 and 59 years, irrespective of gender. CEV females were more likely to report a worsening in their mental health than CEV males, across all age groups considered. Approximately half of CEV females aged 20 to 49 years and 50 to 59 years reported a worsening in their mental health (49% and 52% respectively).

The majority of clinically extremely vulnerable (CEV) people had not experienced a worsening in their mental health or underlying condition since receiving shielding guidance (an estimated 1,249,000 people, 56%). An estimated 281,000 CEV people experienced a worsening in both their mental health and underlying condition (12% of all CEV people).

Regardless of any change in level of GP or hospital care a CEV person was receiving for their underlying health condition, the majority of CEV people reported no difference in their mental health. A higher proportion of CEV people whose access to some kind of care had stopped or whose care had increased reported their mental health had worsened (50% and 42% respectively), compared with those accessing no care or accessing their care as normal (37% and 32% respectively).

Clinically extremely vulnerable

Clinically extremely vulnerable (CEV) refers to members of the public who have been identified by health professionals as being CEV to severe complications of the coronavirus (COVID-19). The CEV individuals were identified based on the severity, history and treatment levels of their condition(s). More information can be found in Guidance on shielding and protecting people who are CEV from COVID-19. The NHS identified approximately 2.2 million people as being CEV.

Shielding

Shielding is a voluntary action that requires the individual to stay in their home or garden, except for exercising once a day, with no visitors (except from a nurse, support or care worker). If others in the household are not shielding, CEV individuals are advised to practise social distancing with those people. The CEV person should try to access services, like food and prescription delivery services, to minimise their need to leave their home. Those identified as CEV were advised to shield until at least the end of June 2020. The full guidance can be viewed in Guidance on shielding and protecting people who are CEV from COVID-19.

Prior to the new guidance issued on 1 June 2020, CEV people were advised to stay in their home or garden at all times.

Government support

The government advised CEV people who needed any additional support to shield to register for support. This support could include help with food and medicines. For more information, see Guidance on shielding and protecting people who are clinically extremely vulnerable from COVID-19.

Survey information

The Shielding Behavioural Survey was compiled rapidly in response to policy questions on whether the population who had been advised to shield were actually following shielding guidance and other information. It was produced, run and analysed in a collaboration between the Department for Health and Social Care (DHSC), Department for Work and Pensions (DWP), Government Digital Service (GDS) and Office for National Statistics (ONS).

This survey was specifically designed to obtain information on the people advised by the government to shield from the coronavirus (COVID-19). As with all surveys, the estimates included in this bulletin have an associated margin of error. ONS experts were consulted on questionnaire design. The survey respondents were selected using implicit stratification from a list of those identified as clinically extremely vulnerable (CEV) and were contacted by telephone (from the National Shielding Helpline).

The sample size was 4,083 out of 2,248,075, and survey weighting was used to weight the sample estimates to provide estimates for the population of CEV people. The estimates were weighted by taking the following into account:

• gender
• age group
• whether the respondent was registered and receiving support, registered and not receiving support, or not registered

The fourth wave of data was collected between 9 June and 18 June 2020. All answers are self-reported. Carers may respond on behalf of those they care for where appropriate, for example, for minors and those unable to answer themselves.

Identifying the clinically extremely vulnerable

At the start of the coronavirus pandemic, some members of the public were identified by health professionals as being CEV to severe complications of COVID-19. The CEV individuals were identified based on the severity, history and treatment levels of their condition(s). More information can be found in Guidance on shielding and protecting people who are CEV from COVID-19.

Those identified as being CEV were sent a letter and advised to shield until at least the end of June 2020. The following guidance was also received, stating that shielding is a voluntary action:

"Shielding is for your personal protection. It's your choice to decide whether to follow the measures we advise. For example, if you have a terminal illness, or have been given a prognosis of less than 6 months to live, or have some other special circumstances, you may decide not to undertake shielding. This will be a deeply personal decision. We advise calling your GP or specialist to discuss this." (Guidance has since been updated).

Differences between shielding and other Stay at home guidance

Shielding differs from guidance for self-isolation (self-quarantine because of displaying symptoms or someone in the household displaying symptoms) and guidance for social distancing (measures everyone should be taking to avoid social interaction with other households). Shielding requires the individual to stay in their house or garden with no visitors (except a nurse or support or care worker). More information is available in the Glossary.

Changes to the shielding guidance from 1 June 2020

The data collected 28 May to 3 June 2020 (in Table 1) was conducted over a period where government guidance for individuals shielding changed. The new guidance for those clinically extremely vulnerable (CEV) people who were shielding was released during the data collection for wave 3 (28 May to 3 June 2020). Despite the changes in guidance, the results remained consistent with previous data collection.

The main strengths of the Shielding Behavioural Survey include:

• it allows for timely production of data and statistics that can respond quickly to changing needs, as the questions included are reviewed for each wave

• robust methods are adopted for the survey's sampling and weighting strategies to limit the impact of bias

• quality assurance procedures are undertaken throughout the analysis stages to minimise the risk of error

The main limitations of the Shielding Behavioural Survey include:

• the survey asks whether the respondent received a letter or text advising them to shield; if the respondent did not receive a letter or text, they are asked exactly the same questions as those who did despite not knowing they were advised to shield

• in the case of minors or those who are unable to answer the survey themselves, other people can answer on their behalf; this is mainly a limitation on questions relating to well-being and mental health