Message from Dr Richard Harling, Director of Health and Care
(Director of Public Health and Director of Adult Social Services)
27 November 2020
It has been another busy week for COVID-19 related issues, but it remains vitally important that everyone in adult social care follows national guidance, especially relating to infection prevention and control. This briefing sets out the key issues for this week.
As we enter our final week of this period of national lockdown, key changes are being made to the three-tier restrictions in England which will come into effect from 00:01 on Wednesday 2 December 2020. Staffordshire and Stoke on Trent will be placed into Tier 3: Very High Alert alongside neighbouring Black Country local authorities and Derbyshire. This will be reviewed within a fortnight and we are keen to get the restrictions eased as quickly as possible.
This week, I would like to draw your attention to the following:
Infection prevention and control
1. With coronavirus cases remaining high, it remains crucial that you have a good foundation of effective infection prevention and control including regulatory requirements and national guidance. You can find tips and advice on our website to help you to think about areas of infection prevention and control that might be a weak spot in your service that you can strengthen – areas such as compliance by night staff; by staff travelling to and from work or during the time they spend together but not providing care; and social distancing for residents, including those who lack capacity.
2. We continue to ask home care and care homes contracted with the Council to accept new clients / residents safely and to do so in a timely manner to facilitate hospital discharges. This is more important than ever as the numbers of hospitalisations are now peaking.
3. COVID-19: management of staff and exposed patients or residents in health and social care settings guidance indicates that staff or residents who have been diagnosed with COVID-19 should not be included in repeat testing (as part of regular weekly staff or monthly resident testing or be included in the whole home test at 28 days after the last identified case) until 90 days following:
- their initial onset of symptoms
- or, if asymptomatic when tested; their positive test result
Any repeat testing over this 90-day time period in individuals who are no longer infectious can easily result in false positive tests where inactive protein fragments from the virus remain in the body for some time and are detected in tests. Organisations who retest this group of individuals during this period risk interpreting that positive test results mean continued infection, when that is not the case. Retesting is only recommended if new Covid-19 symptoms emerge over that time period (indicating new infection) or if you have been advised to do so by Public Health England, a medical practitioner or the Infection Prevention and Control Team.
4. I would also like to remind providers about Admission and care of residents in a care home during COVID-19 and the COVID-19 adult social care action plan. To minimise the risk to residents in care homes during periods of sustained community transmission, all residents being discharged from hospital or interim care facilities to the care home, and new residents admitted from the community, should be isolated for 14 days within their own room. This should be the case unless they have already undergone isolation for a 14-day period in another setting, and even then, the care home may wish to isolate new residents for a further 14 days.
5. Do remember though that once someone who has tested COVID-positive is beyond their infectious period, they may continue to test positive but you will be able to admit them from a hospital discharge pathway (or the community), as long as you can meet their other care needs in the normal way. There is a difference between “testing positive and in infectious period” and “testing positive but after the infectious period”. Just as for existing residents, if staff do not recognise the difference, then decisions will not lead to good care. I set this out in a letter attached to an email from our email@example.com mailbox entitled ‘Discharges from Hospital to Care Homes’ sent to care homes on 6 November. This is also available on our Information for care homes webpage under the heading ‘New admissions or returns from hospital’.
6. Shorter isolation periods of 10 days are appropriate for staff only – but on the other hand isolation for longer than 14 days for clients is only appropriate for those who remain clinically unwell and whose temperature has not normalised for a period of 48 hours without the need for medication. Note also that Covid-19 positive cases are considered to have been infectious from 48 hours prior to the point at which they have been swabbed (if they have not displayed symptoms) or 48 hours prior to the point at which they first displayed Covid-19 related symptoms.
7. It is worth considering very carefully where risks lie in relation to both residents and staff for your business during the period in which your staff and / or clients / residents are infectious. Remember that the infectious period includes the period before symptoms develop, when the virus is busy reproducing within the body. Individuals who show no symptoms at all are also infectious as are those individuals who do display symptoms – and this continues for a number of days, presenting a major opportunity for the virus to spread. The following are some key questions that relate to the potential for virus spread risk for you to consider and where we know providers can and do get caught out:
- Have there been any delays in isolating residents in their own rooms or cohorting residents to separate floors, corridors or units?
- Have you had residents who remain mobile and are infected and potentially coming into contact with other residents or touch points that other residents may also come into contact with?
- Have you supported visitors to follow appropriate infection control measures and are you regularly cleaning visiting areas and keeping those areas well ventilated?
- Are you dealing with residents for whom the use of PPE can be challenging or upsetting for them?
- Have staff been working between different cohorted areas, or been in close proximity to one another without wearing PPE or social distancing in the appropriate way in staff breaks or handovers? Does this change between your day staff and night staff?
- Are staff office or rest areas well cleaned, ventilated and do they and the use of them promote staff to sufficiently socially distance from one another?
- Have all staff and residents been tested in line with testing and retesting arrangements?
- Have any staff not followed national guidance outside of work or potentially shared transport to work without following national guidance?
- Do all staff (regardless including all non-care roles) follow your infection prevention and control procedures and wear PPE appropriately?
- Do staff remove PPE and eat with or near residents?
- Have you found it difficult due to constraints of building layout to separate staff or isolate / cohort residents?
- Have more than one resident or one staff member tested positive or shown symptoms on the same floor or in the same cohorted area? Have you considered that this could suggest a possible transmission and rechecked all possible routes of transmission to rule this out?
- Can you be assured of the Covid status of any new agency staff used, their ability to following good infection control procedures and their use of PPE?
- If you have any questions or concerns in any of these areas or if you need support on any of the above, please do not hesitate to email us using the firstname.lastname@example.org mailbox or telephone us on 0300 111 8050
8. Care homes are advised to note that in the adult social care winter plan 2020-2021, the Government committed to implementing new regulations to limit movement of staff providing personal care or nursing care between care homes, and between care homes and other health and care settings. This would mean temporarily modifying regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which deals with staffing. Where staff movement is still happening between care homes, we would highly recommend providers utilise your ICF2 grant funding to address this as soon as possible as we understand this will become a regulatory requirement before the end of December 2020.
9. Moving to Tier 3: Very High Alert levels does not change the local guidance in relation to Local visiting restrictions position regarding visiting within Staffordshire care homes. On 23 November, the new Local restriction tiers: what you need to know guidance outlined in its ‘all tier’ section that ‘visits to care homes can take place with arrangements such as substantial screens, visiting pods, and window visits. Regular testing will be offered to up to 2 family members or friends per resident by Christmas, which – when combined with other infection-control measures such as PPE – will support indoor visits with physical contact. Detailed guidance will be published shortly.’ We will update our local guidance in accordance with this and communicate changes to you as soon as we are able to.
Covid-19 Testing update
10. The Department of Health and Social Care (DHSC) has made regular weekly asymptomatic Coronavirus testing available to all registered home care workers (domiciliary care workers) from 23 November. The tests involve PCR test kits using combined throat and nasal swabs. All registered home care providers should now have received their unique organisation number (UON) by email from DHSC which they need to order their test kits. Under the scheme, home care workers are required to self-swab weekly, register their own test kits at home and post them via their nearest Royal Mail priority post box from Thursday-Sunday only each week with results expected back within five days. DHSC are running webinars on Tuesdays and Thursdays for the rest of the year which include a step-by-step walk through of the testing process and the opportunity to ask questions. Find out more about this new programme including a link to sign up to the webinar, tips from DHSC and links to guides on self-swabbing and how to register your test kits on our Testing for Home Care Workers page. If you a registered home care setting and have not received your UON, please call 119.
11. Lateral Flow Testing (LFT) or rapid testing is a new form of test which provides results in thirty minutes. Various plans are underway to roll this out:
- Care Homes: LFT for staff and visitors will be rolled out through a national programme starting on 2 December with the 385 largest care homes nationally. A second wave will commence on 7 December, with all care homes expected to be in receipt of LFT’s by the 21st December. DHSC are still working on the processes behind the roll out and we will know more about this over the next few days including timescales, process, training materials and support to deliver the testing.
- For other services: The Council will be making LFT available to all other care providers including Home Care, Supported Living, Extra Care and Day Opportunities. We intend to pilot this from next week and then rollout during December. Any providers who would like to take advantage of this offer should get in touch.
Further updates will be included in future editions of this update and on our Covid-19 testing pages.
Capacity Tracker update
12. Home care, extra care and supported living providers should have been contacted by CQC this week to inform them that as from Monday 30 November, they will transition across and need to start completing business continuity questions on the North of England Commissioning Support Unit’s (NECSU) Capacity Tracker. This means that they will now be joining care homes, substance misuse providers, hospices and community rehabilitation services on the system.
13. Those providers who are used to completing the CQC questions will see there is no change to the questions you need to answer initially. You should also find that registered managers who have completed CQC questions previously will be auto-approved onto the Capacity Tracker and shouldn’t need to do anything (unless you need a new registered manager to register on it and/or change their organisational approver).
14. We understand that infection control fund questions are currently being drafted with the intention that they will be included on the system shortly and we will communicate any changes to you as soon as we have further information to share.
15. Support will be available for new users of this system from NECSU and from the local authority. We have nominated staff to support you who will be trained imminently to help you through the process to ensure you can use the system as quickly and effectively as possible. Any updates will be sent to you from NECSU and through our email@example.com mailbox and we will build our website resource to support you and signpost you to that as we receive further information.
16. For care homes, if you are still not able to give assurance on any of the infection control questions on the tracker, SCC staff will be contacting you to explore what steps you can take to mitigate the risk. If you can give assurance, please update the questions now.
17. The web address for Capacity Tracker will be changing soon. All users (care homes and new users) should be automatically directed when this change occurs, so this will not require any action from you other than to save the new address once you are directed to it.
Mental health and wellbeing of the adult social care workforce
18. In recognition of the ongoing and substantial impact that the pandemic is having on the sector and particularly now that the increased pressures of winter months are in full swing, the Government has published its Staying mentally well: winter plan 2020 to 2021 which contains a specific section on supporting frontline health and social care workers.
19. Linked to the above, Skills for Care has issued a range of Skills for Care wellbeing support resources to support registered managers, managers, individual employers, personal assistants and the wider workforce, which we hope you will find useful.
20. Do visit our Other help for providers webpage, which contains a range of wellbeing support available nationally, locally and online and available to adult social care providers.
21. Please do make the most of these resources and encourage your staff to do the same.
22. Since the beginning of the Covid-19 pandemic, adult social care organisations have experienced significant changes to their operations to align with significant changes to national guidance which involves a continuous process of review and learning. Whilst these are not Covid-19 specific, Skills for Care has developed a set of ‘Learning from events’ to support you to run learning reviews, which we would see as particularly useful tool for providers to use at this time. The added benefit is that it’s free, only 35 minutes long and you can claim £100 from the Workforce Development Fund (which you would need to set up an account to access) to do this. For further information, please go to Skills for Care Learning From Events for further information.
23. If you want to check any of my previous updates, please use this Previous updates webpage link.
24. Please continue to contact us on our firstname.lastname@example.org mailbox or telephone us on 0300 111 8050 if you have any concerns or queries.
There is a range of national guidance documents available via the link below to support you in managing your service and supporting customers: