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03rd September 2021

Are the differences in England and Scotland’s IPC frameworks enough to prevent a marked rise in COVID cases this winter?

Britain could face a new wave of COVID-19 Infections. The reason? Professor Neil Ferguson, a leading epidemiologist, who issued the warning earlier this month[i], said that workers returning to offices and pupils to school in the coming weeks could lead to a significant spike in hospital cases. If scientists are proven to be correct, Scotland, where some pupils have already gone back to school, could be the first country in the UK to witness a steep increase in COVID-19 cases.

Any significant rise in cases will of course put Scotland’s Infection, Prevention & Control (IPC) measures, which are different to those in England and Wales, under the microscope once again. Critics and commentators alike will ask if they are stringent and robust enough to protect the most vulnerable in society, especially those living in social care. Equally, if there is no marked increase in cases, Scotland’s IPC practices may be heralded by the rest of the UK as a beacon of excellence.

So how does Scotland’s IPC regime compare with England’s and are the measures in place strong enough to safeguard both nations against a new wave of COVID-19 this winter? It is an area that Quality Compliance Systems (QCS), the leading provider of content, policies and standards for the social care sector, and the company that I work for, specialises in.

IPC differences: Scotland and England

In regard to how the two nations compare, there are two main differences. Firstly, in Scotland it is a legal requirement for the general public to wear a face covering in public places and on public transport, whereas in England, the government only expects and recommends that the public “wear face coverings in crowded and enclosed spaces” such as public transport. However, that said, many transport networks across the country have made face coverings mandatory.

The second major contrast in IPC policy revolves around vaccination. In England, from 11 November, anybody working, volunteering or entering a care home will need to be vaccinated, whereas Holyrood has no plans to introduce mandatory vaccinations in these settings. This is because figures published by Public Health Scotland (PHS) reveal that as of 16 June, one hundred percent of care home staff were fully immunised, whereas in England the government thinks that between 3 percent and twelve percent of care home workers might not  take up the offer of a vaccine by November.[ii]

That said, there are some caveats. In Scotland, professional carers who work for homes that have made vaccination a condition of work must be immunised.

There is much, however, that both nations agree on. Take the immunisation of younger age groups, for example. North and south of the border, 16 and 17 year olds were given the option of a COVID vaccine on 6 August. In England, at the time of writing, the NHS was hoping to offer everyone in this age group a single dose by 23 August.

Secondly, there were small contrasts regarding the number of days that a person who has been double-jabbed, pinged and is showing no symptoms of COVID-19 should spend in self-isolation. However, since 16 August both nations have decreed that anybody who finds themselves in this scenario no longer needs to self-isolate.

Are Scotland’s and England’s IPC policies enough to prevent a marked increase in cases?

Returning to the first question as to whether the current IPC practices will be enough to safeguard England and Scotland from a significant fourth wave of COVID-19, let’s begin by analysing the differences in IPC policy.

Take face coverings, for instance. We know that the wearing of masks does minimise community transmission. However, during the pandemic, we also discovered that wearing a face covering as part of a raft of IPC measures was by far the most effective way to contain the virus. In England, where masks are only recommended, the danger is that those who have been fully vaccinated will not wear them. When more people return to schools and the office in the autumn, some might say that this relaxation in IPC policy might remove an extremely effective IPC tool from the nation’s IPC armoury.


Regarding vaccinations, there are two points to consider. Firstly, the speed in which governments on these shores have vaccinated its people is nothing short of remarkable. But, just like the mask debate, we cannot assume that this insidious virus won't re-invent itself and mutate this winter. If it does, while vaccines will help to prevent deaths and reduce transmission in the community, it may also require a comprehensive range of IPC measures, to prevent people from being hospitalised.

The second question centres on whether or not should Scotland follow England’s example and make vaccinations mandatory for those working in care homes? While the PHS figures show a high level of coverage, they don't take into account the fact that care sector recruitment and retention patterns are very fluid. Coupled with the fast spread of COVID-19, the decision not to insist on compulsory vaccination could leave some care homes vulnerable to infection this winter.

However, I am reassured by the Scottish government’s strategy to review IPC guidance every three weeks leaves it room to make changes to mandatory guidance should it be necessary to do so.

Finally, in both countries, an equally controversial subject for both administrations has been the decision to start offering the vaccine to 16 and 17 year olds this month. We do not yet know the level of take-up or the impact that such measures will have on the level of COVID-19 transmission. But scientists hope that making the vaccine accessible to a wider tranche of age groups will help to drive numbers down.

To ensure that Professor Ferguson’s warning does not become reality, policymakers must not prioritise one IPC measure over another. Nor should they forget that IPC measures are most effective when utilised holistically in a programme that the public understands and buys into. That’s the biggest take-away for regulators to keep in mind as we head into the autumn.



[i] The Times

New wave of Covid infections possible when schools and office workers return, Professor Neil Ferguson warns

August 16, 2021

By Henry Zeffman and Steven Swinford


[ii] The Guardian

English care homes could lose 70,000 staff over mandatory Covid jab

By Rowena Mason


The article was first published in The Care Home Professional

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*All information is correct at the time of publishing. Use of this material is subject to your acceptance of our terms and conditions.

Senga Currie

Head of Care Development (Scotland)

Senga has been a registered mental nurse and registered general nurse for 38 years, working in various areas within the NHS, community nursing, the field of addictions and the private sector. Since 1998 she has been working with care homes, starting as a nursing sister and moving into roles of home manager, regional manager, care services manager and regulation manager. Read more

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