Last reviewed 2 September 2021
What is coronavirus and what can care providers do to keep their service users and staff safe? This article provides a round-up of essential information for care settings, including PPE, testing, high-risk individuals, visiting and social distancing.
What is coronavirus?
The World Health Organization (WHO) defines coronaviruses as a family of viruses that cause infectious illness ranging from very mild to very severe diseases such as Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV). Covid-19 is a new strain which originated in China at the end of 2019. It has since spread worldwide, initiating a global pandemic public health emergency.
How does coronavirus spread?
People can catch Covid-19 from others who are infected.
The virus moves from person-to-person in droplets from the nose or mouth which are spread when a person with Covid-19 coughs or exhales. In addition, the virus can survive for up to 72 hours out of the body on surfaces. People can become infected if they breathe in the droplets or touch infected surfaces and then touch their eyes, nose or mouth.
The incubation period of Covid-19 is believed to be between 2 and 10 days.
What are the symptoms?
The NHS recognise the main symptoms of coronavirus as:
fever and high temperature — people will feel “hot to touch” on their chest or back (37.8ºC or above)
new, continuous dry cough — the NHS define this as coughing a lot for more than an hour, or three or more coughing episodes in 24 hours (someone with an existing cough may find that it is worse than usual)
loss or change to the sense of smell or taste — the NHS defines this as someone noticing that they cannot smell or taste anything, or things smell or taste different to normal.
Most people with coronavirus have at least one of these symptoms. Other less common symptoms include aches and pains, nasal congestion, headache, conjunctivitis, sore throat, diarrhoea, or a skin rash or discolouration of fingers or toes.
Symptoms begin gradually and are usually mild. Most people (about 80%) recover from the disease without needing special treatment. A small percentage can become seriously ill and develop difficulty breathing. This is particularly dangerous for people with weakened immune systems, for older people, and for those with long-term conditions such as diabetes, cancer and chronic lung disease.
Some infected individuals may show no symptoms but are still able to pass on the virus, especially in the early stages of infection. This is described as asymptomatic spread.
How can people protect themselves?
Throughout the pandemic, Public Health England (PHE) has recommended the following general “handwashing and respiratory hygiene” precautions to help people protect themselves and prevent spreading the virus.
Cover the mouth and nose with a tissue or sleeve (not hands) when coughing or sneezing (Catch it. Bin it. Kill it).
Put used tissues in the bin straight away.
Wash hands regularly with soap and water for at least 20 seconds — use hand sanitiser gel if soap and water are not available.
Try to avoid close contact with people who are unwell.
Clean and disinfect frequently touched objects and surfaces.
Do not touch eyes, nose or mouth if hands are not clean.
In addition, by law people are required to “self-isolate” in certain circumstances.
Self-isolating is a key element in fighting the pandemic. It is understood that most people will no longer be likely to transmit the virus 10 days after the onset of symptoms. Self-isolation is therefore designed to slow down the spread of the virus and protect others whilst someone may be infectious.
People should stay at home and self-isolate as follows.
Those who have symptoms of infection and live alone should self-isolate by staying at home and not leaving their house for 10 days from when the symptoms started — they should arrange for a test to confirm that they have Covid-19.
Those who test positive for coronavirus should continue to self-isolate for 10 days from onset of symptoms, or 10 days from point of taking a positive test if they are asymptomatic — those who test negative can stop self-isolating as long as they are well.
Those who live with others and one person has symptoms should self-isolate as a household for 10 days from the day when the first person in the house became ill (if anyone else in the household starts displaying symptoms, they need to stay at home for 10 days from when the symptom appeared, regardless of what day they are on in the original 10-day isolation period).
Those who have been in contact of a person who has had a positive test result must self-isolate at home for 10 days from the date of their last contact.
People should self-isolate irrespective of whether or not they are vaccinated against Covid-19. Those who are contacted by NHS Test and Trace must follow isolation guidance provided by contact tracers. Individuals could be fined if they do not self-isolate following a notification by NHS Test and Trace.
It should be noted that the rules changed on 16 August 2021 to recognise the lower risk that fully vaccinated people have of passing on the virus. For instance, from that date individuals are not required to self-isolate if they live in the same household as someone with Covid-19 and they are fully vaccinated or below the age of 18 years 6 months. In this respect fully vaccinated means being vaccinated with an MHRA approved Covid-19 vaccine in the UK and at least 14 days have passed since receiving the second dose.
Stay at Home: Guidance for Households with Possible or Confirmed Coronavirus (COVID-19) Infection should be consulted for the latest information. Guidance for Contacts of People with Confirmed Coronavirus (COVID-19) Infection Who Do Not Live with the Person contains further information for people who have been notified by NHS Test and Trace that they are a contact of a person who has had a positive test result for Covid-19 and who is not from that person’s household.
If symptoms worsen during home isolation, or if they are no better after seven days, people should contact NHS 111 online. If without internet access, they should call NHS 111. For a medical emergency they should dial 999. Those who are worried about their symptoms should avoid going directly to their GP, to a pharmacy or to a hospital.
People should plan ahead and ask others for help to ensure that they can successfully stay at home. Where necessary, they should ask employers, friends and family to help them get the things they need.
National alert levels
The need for Covid-19 restrictions is based on the following national alert level system introduced by the Government in May 2020.
Level five (red) signifies a "material risk of healthcare services being overwhelmed" and requires extremely strict social distancing.
Level four signifies “a high or rising level of transmission” and requires enforced social distancing.
Level three (amber) describes the virus as being “in general circulation” but no longer high or rising exponentially — as a result social distancing can be relaxed.
Level two describes the number of cases and transmission as being low — minimal social distancing is required.
Level one (green) will describe a situation where Covid-19 is no longer present in the UK and social distancing will no longer be required.
The Joint Biosecurity Centre (JBC) has the task of recommending what the alert level should be.
Estimating the alert level involves calculation of an “R” value by public health experts. This value reflects the average number of people that a single person might infect on a daily basis.
The R value is typically expressed as a range. Therefore an R number between 1.1 and 1.3 means that on average every 10 people infected will infect between 11 and 13 other people. A growth rate between +2% and +4% means the number of new infections is growing by 2% to 4% every day.
The Government has stated that it wishes to keep the R value as close to 1 as possible. This means that the virus is not spreading and has been effectively suppressed.
Covid-19 public health restrictions
The Government response throughout the Covid-19 pandemic has been to take necessary public health action to limit transmission of the virus by imposing a series of restrictions whenever the R number has grown too high and the alert level has had to be raised. These restrictions have included:
regional and national lockdowns requiring people to stay at home, including working from home wherever possible
people observing “social distancing” and keeping at least two metres away from others not in the same household
restrictions on travel, especially trips in and out of lockdown areas and international travel
restrictions on gatherings and closures of places such as pubs, restaurants, cafes, schools and hairdressers
“shielding” for the most vulnerable members of society.
The restrictions have been supported by legal enforcement, including spot fines for transgression. In addition, mask wearing has become mandatory in many indoor areas and on public transport and has become commonplace elsewhere as people have grown to accept the restrictions and protect themselves.
The first lockdown was imposed in March 2020 following the initial “first-wave” of infection. After a brief summer respite, a “second-wave” of infection swept through the UK at the end of 2020 as people moved indoors in colder weather and new, more infectious Covid-19 variant strains emerged. NHS winter pressures exacerbated the situation and another national lockdown was announced from January 2021 following a dramatic increase in infection rates, hospitalisations and deaths. The lockdown was considered necessary despite the hopeful sign of vaccines becoming available and being rolled out across the country.
Roadmap out of lockdown 2021
In February 2021 the Government in England published a roadmap for coming out of the lockdown. The plan was based on falling virus transmission rates and a successful vaccination rollout which saw huge numbers of adults having their Covid-19 vaccines.
Stage 1 in March saw the lockdown “stay at home rule” ended. Schools and colleges reopened, people from different households were able to meet outside for recreation again and care home residents were allowed a nominated visitor indoors with whom they could hold hands.
Stage 2 in April and Stage 3 in May saw further restrictions lifted. Shops, hairdressers, gyms, restaurants and pubs were allowed to reopen and holidays and foreign travel resumed. People were allowed to meet in groups of up to 30 outdoors, and six people or two households to meet indoors. In care homes the nominated visitor scheme was extended.
Stage 4 applies from the 19 July and represents a relaxation of formal legal restrictions, including social distancing. It was delayed from June by a rise in infection and hospitalisation rates driven by a new, more transmissible Delta variant of the virus which has become established as the dominant strain worldwide. Despite this rise in infection the Government states that, with a significant proportion of the adult population already fully vaccinated, the balance of risks is such that a cautious return to near-normal life, without the majority of formal legal restrictions, is a reasonable position. However, people are still advised to be cautious.
Full details are provided on the GOV.UK webpage, Coronavirus: How to Stay Safe and Help Prevent the Spread.
While formal restrictions will end, the Government states that people must recognise that Covid-19 remains a threat, and urges them to be careful and to maintain some preventative measures. Therefore under Step 4 people are no longer legally required to adhere to safety measures. Instead the Government hopes that the majority of people will act sensibly out of informed choice and comply with sensible and proportionate public health recommendations.
The Government states that this will include the following:
wearing face coverings in crowded and enclosed spaces, such as public transport, and when mixing with people who do not normally meet
a gradual return to the workplace with employers following all necessary published guidance to keep people safe
organisations and large events being supported and encouraged to use the NHS Covid Pass in high-risk settings to help limit the risk of infection in their venues.
Positive cases and contacts of positive cases identified by NHS Test and Trace will still be legally required to self-isolate after the 19 July. However, to ease the pressure in the education sector, “school bubbles” will end and there will be an exemption for contacts of positive cases for under 18s and for double vaccinated adults from 16 August.
For international travel, quarantine rules will remain for all those travelling from a red list country, and for amber list countries unless double vaccinated.
The Government is urging people to:
get both doses of a vaccine when offered, and encourage others to do so as well
participate in local area surge testing as required, whether vaccinated or not
self-isolate immediately if symptomatic for Covid-19 (a high temperature, a new, continuous cough or a loss or change to your sense of smell or taste) or if testing positive for Covid-19.
Face covering requirements will remain in force in many indoor settings after 19 July, such as in shops and places of worship, and on public transport, unless people are exempt.
Some areas of the UK have particularly high rates of the Delta virus variant and may be subject to additional local public health measures. In these areas people are encouraged to keep on with social distancing and meet outside rather than inside.
It should also be noted that, while they have worked closely together throughout the pandemic, different rules have been applied in England, Northern Ireland, Scotland and Wales and the pattern of restrictions and easing of lockdown rules varies.
Clinically “extremely vulnerable” people
At the start of the pandemic the NHS identified certain people who were considered to be “high risk” from Covid-19 due to pre-existing health conditions. These people were described as “clinically extremely vulnerable” and advised to “shield” and take special precautions to protect themselves from the virus.
Extremely vulnerable (high-risk) people includes those who:
have had an organ transplant
are having chemotherapy for cancer, including immunotherapy
are having an intense course of radiotherapy for lung cancer
have a severe lung condition (such as severe asthma or severe COPD)
are taking medicine that makes them much more likely to get infections (such as high doses of steroids)
have a serious heart condition and are pregnant.
At the end of March 2021, the shielding scheme was paused as part of lockdown easing. From 19 July, as part of Stage 4 of the lockdown easing roadmap, the Government advises that, at the very least, clinically extremely vulnerable people should follow the same guidance as everyone else. In addition, the Government suggests that individuals may choose to limit the close contact they have with those they do not usually meet, particularly when Covid-19 disease levels in the general community are high.
Guidance on Protecting People Who Are Clinically Extremely Vulnerable from COVID-19 provides the latest information for England.
Everyone identified as vulnerable should already have been offered a Covid-19 vaccine and will hopefully be fully vaccinated. Such individuals are also urged to access a booster vaccine in the autumn when available.
Care home guidance
Admission and Care of Residents in a Care Home During COVID-19 was originally published by PHE in collaboration with the Care Quality Commission as a PDF document at the start of April 2020. It has since been kept updated as an online document.
The guidance covers:
admitting new residents
isolation requirements and procedures
caring for residents with Covid-19
reporting Covid-19 cases and outbreak management
providing end-of-life care and care after death
resilience, including advice on staff self-isolation and staffing shortage
supporting existing residents who may require hospital care.
Section 1 of the latest version of the guidance states that all newly-admitted residents to a care home, who have been discharged from hospital, an interim care facility or transferring from another care home, should self-isolate upon arrival for 14 days within their own room.
New residents admitted from the community do not need to self-isolate if they satisfy the requirements set out in section 1.4. This includes requirements to be fully vaccinated, to have had no known contacts with a Covid-positive person, and to be subject to a testing regime. For urgent admissions (regardless of symptoms) the individual should be tested upon arrival and care home managers should follow the isolation guidance.
PHE acknowledges that care home settings differ significantly and recommend that if a resident is being admitted from another care home or care facility, care home managers should undertake a risk assessment. PHE states that Covid-19 positive people should not be admitted into a care home other than in a designated setting. In addition, no care home should be forced to admit a new resident if they cannot safely care for the resident in self-isolation for the full isolation period.
Section 2 covers testing and provides links to testing regimes and how to access testing kits for the home. It also states how care homes can support the NHS Test and Trace service.
Section 4 covers access to general clinical support for care home residents during Covid-19, and guidance on how to care for people with individual needs. This includes supporting residents to attend medical and other professional appointments within and outside of the care home, professional visits in the care home and supporting existing residents who may require hospitalisation.
Caring for residents who have tested positive for Covid-19 is covered in Section 5, as are reporting requirements and details of how to deal with and manage outbreaks.
Guidance on the care of people at the end of life and after death is included in Section 6. This provides advice on ensuring compassionate visiting and the use of advance care decisions, including do not attempt cardiopulmonary resuscitation (DNACPR) decisions. PHE states in this regard that the care regulator, the CQC, will urgently raise cases of inappropriate use of DNACPR where reported by relevant bodies, including the General Medical Council, and take action where registered providers are responsible. They state that DNACPR decisions should always be made on an individual basis and fully discussed with the individual and their family.
Section 7 provides advice on keeping staff safe, including personal protective equipment (PPE), isolation periods for care home staff and requirements for staff who have symptoms and those who test positive without symptoms. The guidance also includes advice for care home managers on reviewing sick leave policies and occupational health support and providing appropriate training and support.
National support available to care homes is covered in Section 8, including information about the adult social care Infection Control and Testing Fund.
A number of annexes contain further details for providers on minimising risks.
Annex A sets out recommended isolation periods while Annex B sets out Covid-19 symptoms. Annex C provides definitions (eg definitions of “cases” and “contacts”) while Annex D describes necessary infection prevention and control (IPC) procedures; Annex E covers decontamination and cleaning processes. Annex F covers communications, Annex G covers compliance with the General Data Protection Regulation (GDPR) when storing Test and Trace data and Annex I describes the use of the “Capacity Tracker” which is used to support discharge planning by tracking care home vacancies. Finally, Annex J provides guidance on Covid-19 waste management measures and Annex K gives advice when moving from the community into a care home.
Home care guidance
Coronavirus (COVID-19): Provision of Home Care was updated by PHE on 17 May 2021 to replace earlier guidance.
The guidance states that if anyone being cared for by a home care provider reports developing Covid-19 symptoms they should be supported to contact NHS 111 via telephone, or online. Home care workers are advised to report suspected cases of Covid-19 to their managers who should work with community partners, commissioners and the person involved to review their care needs.
A considerable part of the PHE guidance concerns advice on dividing service users into “care groups” where a specific staff team is allocated to provide care to each. Thus “high-risk” service users might be placed in one group and their care provided by a certain cohort of staff, reducing the risk of virus transmission to a minimum.
The guidance states that home care providers should be working with other agencies to reduce the risks for high-risk individuals still further. This might be through identifying priority needs and coordinating care packages.
Where it is not possible to allocate specific care groups to specific staff subgroups, PHE suggests that it may be possible to schedule for shielded and at-risk individuals to be seen before people from other categories. PHE states that risks can also be reduced by reducing contact between staff, including replacing face-to-face meetings with remote communications, and by staggering times of entry to community bases.
The guidance provides further advice on:
hospital discharge and testing — including testing for home care workers and individuals receiving home care and testing for patients being discharged from hospital into the community
trusted assessor schemes — schemes to aid safe and timely discharges to care homes and care at home services
government and NHS support for social care
steps for local authorities to support home care provision.
Separate guidance covers personal assistants employed using direct payments from personal health budgets. This can be found here.
Guidance on the wearing and management of personal protective equipment (PPE) is included in the following PHE webpages:
Key guidance is contained in the following documents:
The guidance was originally published by PHE in June 2020 in PDF form. It has since been updated as an online document and the older PDF version withdrawn. The most recent update was posted in readiness for the July 2021 Stage 4 lockdown easing. PHE states that the guidance should be put into practice in the specific context of each organisation concerned and with reference to the fact that most legal restrictions to control the Covid-19 virus have been lifted.
Specific recommendations for care homes during sustained transmission periods are summarised in the guidance in 5 scenarios.
The first 3 relate to providing direct personal care to a resident. They apply to all staff and to essential care givers or visitors if they are carrying out personal care.
Table 1 provides PPE recommendations when within two metres of a resident and carrying out direct personal care (for example, physical care) to someone who is Covid-19 positive or who is isolating.
Table 2 provides PPE recommendations when within two metres of a resident and carrying out direct personal care (for example, physical care) where there is a risk of contact with respiratory symptoms or body fluids (for example coughing, sneezing, spitting), usually within the resident’s own room.
In both scenarios staff are advised to wear:
disposable gloves (vinyl, latex or nitrile)
a disposable plastic apron
a single use fluid-repellent surgical mask (Type IIR)
eye protection (single use or decontaminated as per manufacturer’s instructions).
Table 3 provides PPE recommendations when within two metres of a resident who has no symptoms and a negative test for Covid-19, and carrying out direct personal care (for example, giving physical care). Here the same requirements apply except that eye protection is not needed, unless indicated by a risk assessment, and the mask can be left on when the task is completed unless it has become contaminated.
Table 4 provides recommendations when within two metres of an individual but not carrying out direct personal care, for example, working in communal areas such as the lounge, undertaking a group activity, doing the tea round, delivering linen to client rooms, attending staff handovers, etc. In these situations only a Type I or II surgical mask or Type IIR mask is required. Eye protection is not required unless there is a risk of contact with body fluids, risk of contact from residents who may be coughing, sneezing or spitting or a risk of splashing from cleaning products.
Table 5 provides recommendations when more than two metres from a resident and undertaking domestic duties or other activities and not delivering personal care (for example cleaning, laundry, tidying). Here, again, only a Type I or II surgical mask or Type IIR mask is required. Gloves, aprons and eye protection may be required where indicated by a local risk assessment (eg risk of splashing body fluids).
The domiciliary care guidance presents two scenarios.
Table 1 provides PPE recommendations when within two metres of a client and carrying out direct personal care or domestic duties. In these circumstances PHE recommends wearing:
disposable gloves (vinyl, latex or nitrile)
a disposable plastic apron
a single use fluid-repellent surgical mask (Type IIR)
eye protection (where there is a risk of contact with body fluids).
The guidance applies to all direct personal care tasks and irrespective of whether the client has Covid-19 symptoms or has tested positive.
Table 2 provides PPE recommendations when more than two metres from a client and undertaking domestic duties and not delivering personal care. Here the recommendations are to wear disposable gloves (vinyl or nitrile) and either a Type I or II surgical mask or Type IIR mask. Eye protection is not considered necessary unless the client has had a positive Covid-19 test and is quarantining or has respiratory symptoms.
Disposable gloves and aprons are for single use only.
Type IIR surgical masks protect the wearer by providing a fluid repellent barrier between the wearer and the environment.
In a care home, after providing direct personal care to a resident with respiratory symptoms (for example coughing, sneezing) or who has had a positive Covid-19 test in the last 14 days, Type IIR surgical masks should be removed and disposed and a new mask put on before providing care for another resident or carrying out another duty. Where a resident has tested negative and does not have respiratory symptoms, and assuming the mask is not damp, soiled or worn for more than 4 hours, it can be worn for the next resident contact.
In domiciliary care a fluid-repellent surgical mask is single use and should be disposed of at the end of each homecare visit and a new fluid-repellent surgical mask applied when entering a different client’s house.
Reusable eye protection should be cleaned and decontaminated according to the manufacturer’s instructions. Any PPE should be changed if it becomes soiled, contaminated, damaged or uncomfortable to wear. Once masks are discarded they should never be reused. If eating or drinking staff are required to remove their mask, dispose of it and clean their hands. Once they have finished eating or drinking they should put on a new mask.
All staff should be trained in the safe use of PPE, including how to put PPE on and take it off. Usage should be monitored by line managers/supervisors. Posters demonstrating PPE requirements and showing how to put PPE on and take it off are available on the How to work safely web pages. Also available is a video for care homes.
Care managers are advised to use the Department of Health and Social Care PPE portal to support the procurement of Covid-related equipment. The online PPE portal can be found here. In an emergency situation, or where care providers have immediate concerns overs their supply of PPE, they are advised to contact a National Supply Disruption Response (NSDR) line on 0800 915 9964.
Visiting care homes
The latest guidance on care home visits in England can be found in the Department of Health and Social Care publication Guidance on Care Home Visiting. This was updated ready for Stage 4 of the 2021 lockdown easing roadmap.
DHSC state that visiting is considered to be a central part of care home life and that “safe visiting” should be supported wherever and whenever it is possible and safe to do so. In this respect they state that all care homes should offer the following.
Every resident can have “named visitors” who will be able to enter the care home for regular visits — there should be no limit on the number of named visitors that a single resident can have and no nationally set limit on the number who can visit in a single day.
Every care home resident can choose to nominate an “essential care giver” who may visit the home to attend to essential care needs — the essential care giver should be enabled to visit in all circumstances, including if the care home is in outbreak, but not if the essential care giver or resident are Covid-positive.
In-person visits for other friends or family members should be offered using Covid-safe arrangements such as outdoor visiting, substantial screens, visiting pods, or behind windows, etc.
Visits during exceptional circumstances, such as end of life should be offered at all times.
Alternatives to visiting should be facilitated, such as phone and video calls.
Visiting inevitably increases the risk of infection being introduced to a home. All visiting policies should therefore be informed by robust risk assessments and a consideration of local public health advice on virus transmission rates. In the face of new variants of the virus, DHSC warn that homes need to remain alert to protect those most at risk while allowing indoor visits to go ahead. They state that risks should be managed and mitigated and balanced against the importance of visiting and the benefits it brings to care home residents and their families.
Visiting should be supported by Covid-19 testing arrangements for visitors as set out in the latest DHSC guidance. Visitors should also wear appropriate personal protective equipment (PPE) as required by the home and follow all other infection control measures (which the care home should guide them on) during visits. Named visitors and residents are advised to keep physical contact to a minimum (excluding essential care givers) but the guidance states that physical contact such as handholding is acceptable if hand washing protocols are followed. Close personal contact such as hugging clearly presents higher risks but the guidance states that it will be safer if it is between people who are double vaccinated, without face-to-face contact, and if there is brief contact only.
The concept of “essential care givers” is that some residents have care and support needs that include tasks which cannot easily be carried out by a member of staff (or not without causing substantial distress). A family member, or another intimate person, is required instead and should be allowed to visit to provide the additional care needed.
End-of-life visiting should be enabled at all times (including in the event of an outbreak) and families and residents should be supported to plan visits. The guidance states that this does not only mean in the “very end” of life.
All visiting must happen within a wider care home environment of robust infection prevention and control (IPC) measures and management of risks. Providers should set out their visiting arrangements in a suitable policy which has been developed in collaboration with residents and families. The policy should be based on a “dynamic” risk assessment that is regularly reviewed and informed by advice from local directors of public health and public health teams. Alternatives to visiting, such as keeping in touch through phone and online video links, should be supported wherever possible.
While the Government strongly recommend that all visitors and residents take up the opportunity to be vaccinated when they are invited to do so through the national programme, the guidance states that it should not be a condition of visiting that the visitor or the resident should have been vaccinated.
Care homes should note that visiting guidance was updated on 16 August 2021. From this date those who have been fully vaccinated no longer need to self-isolate if they have been identified as a close contact of someone who has tested positive for Covid-19. However, due to the vulnerability of care home residents, the Government recommends that if a fully vaccinated essential care giver is identified as a close contact of someone who has tested positive for Covid-19, they do not visit the care home until they have received a negative PCR test, and test negative on a lateral flow test on the day of their visit.
It is also recommended that essential care givers who are not fully vaccinated should not visit the care home for 10 days following contact with a Covid-19 positive case. See the guidance for full details.
Visiting health and social care professionals should also be subject to testing in compliance with Testing for Professionals Visiting Care Homes, published by DHSC.
Note that the rules relating to care home visits may differ in other parts of the UK.
In Scotland Open with Care — Supporting Meaningful Contact in Care Homes: Guidance applies.
In Wales Visits to Care Homes: Guidance for Providers (Version 7) applies.
Separate guidance is available for Visits out of Care Homes.
Staff health and wellbeing
Health and Wellbeing of the Adult Social Care Workforce was updated by the Department for Health and Social Care on 17 May 2021. The document recognises the “dedication and commitment” shown by care workers and care organisations during the Covid-19 pandemic. It also recognises the costs, especially for staff who may also have families to support and high-risk dependents. Examples of costs include worry and anxiety.
The guidance includes tips, advice and toolkits that social care employers and managers can use to help build the resilience of their teams and address any concerns their staff may have.
In both residential care and home care, any member of staff who is concerned that they may have Covid-19 should stay at home and follow government advice for self-isolation. They should not attend for work or see service users.
Government support for adult social care
The Government has developed a range of support mechanisms for the adult social care sector. The support schemes recognise the importance of the sector and the pressures that managers and staff are under.
COVID-19: Our Action Plan for Adult Social Care sets out the actions taken since the start of the pandemic to help boost the resilience of the sector and to help providers cope with the intense pressures caused by the virus, including those relating to the social care workforce and to the availability of essential supplies, such as personal protective equipment and testing facilities.
The action plan has been backed by various support packages and funding streams. Latest sources of national support are listed in Section 8 of the Admission and Care of Residents in a Care Home During COVID-19 guidance. This includes links to the adult social care Infection Control and Testing Fund which has been extended until September 2021, with an extra £251 million of funding.
Details of previous funding support are published in Coronavirus (COVID-19): Care Home Support Package. Allocations of additional funding are set out in Coronavirus (COVID-19): Emergency Funding for Local Government in 2020 to 2021 and Additional Support in 2021 to 2022.
Testing, tracing and tracking
Testing is a key element in identifying who is infected or is carrying the virus.
Two main types of nasal/throat swab tests are available to confirm the presence of the virus in both symptomatic and asymptomatic individuals:
rapid lateral flow device (LFD) tests
polymerase chain reaction (PCR) tests.
Rapid lateral flow (LFD) tests are designed to give a quick result and are usually self-administered. A swab from the mouth and nose is dipped into a special fluid and drops are placed in a plastic tray supplied in the kit. After 30 minutes the result can be read. The test is particularly helpful in screening for asymptomatic carriers of the virus.
Polymerase chain reaction (PCR) tests are more accurate and mainly for people who have symptoms. They are usually administered in test centres, such as drive through sites, or self-administered using home kits. A swab from the nose and throat is sent to a laboratory for confirmation of infection. Results can take 1–3 days.
Guidance for adult social care can be found in the following documents:
Additional guidance is available in Scotland, Wales and Northern Ireland.
Both care homes and domiciliary care services must support the NHS Test and Trace system. Contact tracing is an established infection prevention technique that has long been used in combatting communicable diseases. It involves identifying and isolating people who are infected and then tracing those who may have been in contact with them. These people can then be tested and isolated as required.
Staff from NHS Test and Trace or other public health professionals may contact home care providers if one of their staff or service users has tested positive for coronavirus in order to alert those who have been in close contact with them. Home care providers can assist NHS Test and Trace by keeping a temporary record of their care staff and recipients of care.
In March, during the initial crisis stage of the Covid-19 pandemic, the Care Quality Commission (CQC) announced a temporary pause to inspections in England. An Emergency Support Framework (ESF) was developed to respond to the changing needs of the health and social care system during the pandemic period. This went live at the beginning of May and was designed to help the CQC identify problem areas and target support.
In September, the CQC announced that it was turning its attention to how it would regulate the health and social care sectors during the next phase of the Covid-19 pandemic. They have stated that they are not returning to any fixed timetable of regular scheduled inspections yet. Instead they will be using their “insight” model to monitor providers during a “transitional” period and reinstate targeted inspections for higher risk services. Where site visits are needed inspectors will adopt a “balanced” approach to limit any risk of spreading infection.
In addition to their regulatory activity the CQC has also conducted a review of infection prevention and control (IPC) systems in residential social care. To support this review the CQC have developed a new IPC inspection tool with updated and expanded key lines of enquiry. The tool can be used by providers who wish to strengthen their IPC processes and arrangements. It can be found on the CQC website.
Travelling is now much reduced due to countries around the world closing their borders to protect themselves against different strains of coronavirus being introduced into the country by international travellers.
Those that do travel are subject to a number of restrictions and rules, including requirements for testing and, where applicable, quarantine. Different rules cover different countries according to the perceived risk of Covid-19 transmission.
Up-to-date advice is available from the Department of Transport, Red, Amber and Green List Rules for Entering England. Employers should be aware of the latest quarantine rules if they have staff who are travelling abroad.
Research into Covid-19 vaccines has been carried out all around the world, the hope being that successful vaccines, in combination with more effective treatments for people who are infected with the virus, is the best way to help return the world to some form of normality.
Many vaccines have now been developed. In the UK, a number of vaccines have now been approved for use by the Medicines and Healthcare products Regulatory Agency (MHRA). These include:
a vaccine developed by the drug companies Pfizer and BioNTech in the USA/Germany
a vaccine developed by Moderna in the United States
a vaccine developed jointly by Oxford University and AstraZeneca.
The Pfizer and Moderna vaccines have both been shown to be about 95% effective, effectiveness being a measure of the vaccines ability to create an immune response and confer immunity against the Covid-19 virus. The AstraZeneca (AZ) vaccine has a 70–90% effectiveness depending on the dose.
The majority of adult social care staff and service users should have by now been offered vaccination.
A strategy setting out priority groups for the vaccination rollout was developed in December 2020 by the Joint Committee on Vaccination and Immunisation, the expert advisory group for vaccination in the UK. According to the strategy, Advice on Priority Groups for COVID-19 Vaccination, the most vulnerable were prioritised in Phase 1 of the vaccination programme, including care home residents. In addition to the most vulnerable, Phase 1 also covered all health and social care staff and all adults over 50. It was completed at the start of the summer 2021. Those remaining adults under 50 were covered in Phase 2 which was due to be completed by the end of the summer. Plans are being made for an autumn booster jab.
Adult social care staff were targeted for vaccination in the first weeks of the campaign using the Pfizer/BioNTech vaccine delivered from a limited number of hospital hubs. This was because the vaccine needed to be kept very cold. The AZ and Moderna vaccines are easier to deploy and have been rolled out through hospitals, community vaccination centres, GP practices and “mass vaccination” hubs. Vaccinations for care home residents have been largely carried out on-site by local vaccination teams and by primary care.
All of the currently used vaccines require two injections. People are not fully vaccinated until they have had both jabs. The vaccination plan supports the JCVI strategy for prioritising the first dose of the vaccines. It states that prioritising the first doses of vaccine for as many people as possible will protect the greatest number of people overall in the shortest possible time.
More information, and access to the national booking service, can be found on the NHS Coronavirus (COVID-19) Vaccine webpage.
Further information about the vaccination programme can be found in the UK COVID-19 Vaccines Delivery Plan.
Resources to support vaccination, especially for the vaccination of care home residents and staff, can be found on the COVID-19 Vaccination Programme webpage:
COVID-19: the Green Book, Chapter 14a — containing details of vaccines, precautions for use, side-effects, etc
COVID-19 Vaccination: Information for Healthcare Practitioners — containing details on the programme for GPs and other healthcare practitioners
COVID-19 Vaccination: Consent Forms and Letters for Care Home Residents
COVID-19 Vaccination: Guide for Older Adults — a public information leaflet
COVID-19 Vaccination: a Guide for Social care Staff — an information leaflet for staff
COVID-19 Vaccination: Care Home and Healthcare Settings Posters — including a poster for care homes
Priority Groups for Coronavirus (COVID-19) Vaccination — advice from the JCVI setting out the strategy for who should be vaccinated and when
COVID-19 vaccine product information — summary of comparative information about the Pfizer, AZ and Moderna vaccines
COVID-19 Vaccinations and Care Homes: Programme Launch — a letter to care home managers in England setting out how they should prepare for vaccinating their staff and residents
Training materials for staff involved in supporting the vaccination programme.
Care home managers should refer to the webpage for the latest versions of documents.
The website includes the latest safety details on the use of the AZ vaccine. The advice follows reports of an extremely rare adverse event of concurrent thrombosis (blood clots) and thrombocytopenia (low platelet count) following vaccination with the first dose of the AZ vaccine. This dented confidence in the vaccine and led to a number of countries temporarily pausing their programmes. The UK did not pause and the JCVI, MHRA and the WHO all concluded that the benefits of vaccination outweigh this small risk for adults aged 40 years and over. JCVI recommend that those aged under 40 should be offered an alternative to the AZ vaccine.
The UK vaccination programme is entirely voluntary. The WHO take the position that persuading people on the merits of a Covid-19 vaccine is far more effective than trying to make the jabs mandatory. Vaccination programmes are being rolled out around the world in the face of opposition from “anti-vaxxer” groups and social media misinformation which have increased fears and made some people hesitant and worried that a vaccine can be safe in the current pandemic. That said, the vaccine programme in the UK has proved very popular and in most areas uptake has been extremely high. Areas where compliance is low have been targeted with additional public health resources to ensure that local communities have sufficient factual information about the benefits of vaccination.
Care home staff vaccination
The Government have amended the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 so that all care home workers and other visiting professionals in England must be fully vaccinated against Covid-19 in order to enter the home, unless they have a medical exemption or in an emergency. Registered persons will be held responsible for implementing the change.
Full details can be found in the Department of Health and Social Care document: Coronavirus (COVID-19) Vaccination of People Working or Deployed in Care Homes: Operational Guidance.
The guidance sets out the following timeline:
the Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) Regulations 2021 were made into law on 22 July and a 16-week “grace period” begun
16 September is the last date for care home workers to get their first dose of vaccine so they are fully vaccinated by the time the regulations come into force (two doses of an approved vaccine are required to be fully vaccinated)
on 11 November the regulations come into force.
Therefore, from 11 November managers will need to ensure that they do not allow anyone entry into a care home unless they have evidence that they have had a complete course of an authorised vaccine or qualify for an exemption.
Evidence accepted will include the NHS COVID Pass service and the NHS App.
The vaccination requirement applies to all staff and visiting professionals and to those attending for job interviews. The law requires registered persons to ensure that such individuals do not enter the home unless they provide satisfactory evidence that they have been vaccinated with the complete course of an authorised vaccine or are exempt for clinical reasons. The requirement does not apply to visitors, including essential care givers, nor does it apply in emergencies or to people under the age of 18. It only applies to those who go inside a care setting and does not include any surrounding grounds. As long as someone is not entering the building, they do not need to show vaccination status.
DHSC confirm that emergency situations include healthcare emergencies and events such as fire and flooding. Those carrying out emergency maintenance work inside a care home are not required to show evidence of vaccination, however, those carrying out standard maintenance indoors will have to.
Compliance with the new regulations will be monitored by the Care Quality Commission as the relevant regulatory body. As guidance they have published a Statement on COVID-19 Vaccination of People Working/Deployed in Care Homes.
The CQC state that their inspectors will look for evidence to confirm that systems and processes are in place to comply with the new requirements.
Proposed Covid vaccine booster
Plans for a proposed autumn booster Covid-vaccine can be found in the document, JCVI Interim Advice on a Potential Coronavirus (COVID-19) Booster Vaccine Programme for Winter 2021 to 2022.
JCVI suggest the following “third dose” two-stage programme.
In Stage 1 the following persons would be offered a third dose Covid-19 booster vaccine and the annual influenza vaccine as soon as possible from September 2021:
adults aged 16 years and over who are immunosuppressed
those living in residential care homes for older adults
all adults aged 70 years or over
adults aged 16 years and over who are considered clinically extremely vulnerable
frontline health and social care workers.
In Stage 2 the following persons would be offered a third dose Covid-19 booster vaccine as soon as practicable after Stage 1, with equal emphasis on deployment of the influenza vaccine where eligible:
all adults aged 50 years and over
adults aged 16 to 49 years who are in an influenza or Covid-19 at-risk group (as defined in the Green Book)
adult household contacts of immunosuppressed individuals.
The JCVI state that, as most younger adults will only receive their second Covid-19 vaccine dose in late summer, the benefits of booster vaccination in this group should be considered at a later time when more information is available. The initial objective for winter 2021 to 2022, JCVI state, is for persons in booster Stages 1 and 2 to receive their influenza and Covid-19 vaccines in good time.
The proposals will be considered by the Government and final JCVI advice will be published before September. Further details of the 2021 flu vaccination programme will also be set out in due course.
Where can the latest information be found?
Care providers and managers should keep as up to date as possible and ensure that staff, service users and their relatives are kept informed.
The following official sources can be used:
People are warned to avoid misinformation and out-of-date information. Guidance has changed rapidly throughout the outbreak. It may also vary according to where in the UK people live. Always refer to the latest official government information.
The National Institute for Health and Care Excellence (NICE) have published a series of coronavirus guidelines. Further guidelines are in development and will be published on the Covid-19 section of the NICE website.