This toolkit provides a step-by-step guide for managing the coronavirus in a care service following the publication of the Government’s “Living with Covid” strategy in March 2022 and the further easing of restrictions. It provides links to key information and template policies on Croner-i Navigate-Care. The information continues to be reviewed and updated.

SARS-CoV-2 and Covid-19

Coronaviruses (CoV) belong to a large family of viruses that cause illness ranging from the common cold to more severe diseases such as SARS (Severe Acute Respiratory Syndrome) and MERS (Middle East Respiratory Syndrome).

The cause of the recent pandemic is a new virus, SARS CoV-2, which was first identified in December 2019 in Wuhan, China, which results in the respiratory illness, Covid-19.

The main symptoms of Covid-19 include a high fever, a new, continuous cough and loss of, or change to, sense of smell or taste. Some infected people might not experience any obvious symptoms, others might suffer from a mild illness and recover easily, while in other cases infection can progress to pneumonia and serious illness. The adverse effects of Covid-19 can be short or longer term.

The people most susceptible to severe disease and death include the elderly, those with weakened immune systems, diabetes, cancer, morbid obesity and chronic lung disease. Symptoms can appear in as few as two days after infection or as long as 10 days.

SARS-CoV-2 is a rapidly evolving virus with many variants being identified over time, and it is likely to continue to evolve. Over 2021–2022 the UK has seen the emergence of the Alpha, Delta and Omicron variants, and now new variants of Omicron. Virus evolution has important implications for the public health interventions needed to control virus spread, vaccine development and of anti-viral therapies and the management of Covid-19.

Interventions can be broadly divided into two types.

  1. Non-Pharmacological Interventions (NPI): these were the main strategies used globally in the early stages of the pandemic with “lockdowns” being the most stringent of the NPI measures. With countries that have come out of “lockdown”, but where the virus still continues to circulate, NPIs continue to be needed in the form of:

    • keeping minimum physical distancing from other people who might be contagious

    • wearing suitable protective clothing including face coverings who might be contagious or who are known to be infected

    • observing good hand hygiene and other basic infection prevention and control practices

    • meeting in well-ventilated rooms and keeping buildings well-aired

    • testing programmes

    • continuous risk assessments and control plans based on assessment outcomes.

  2. Pharmacological Interventions: these have developed rapidly since the beginning of the pandemic and include both vaccines and anti-viral treatments. There are different types of vaccine and of anti-viral drugs, some but not all of which have been authorised for use in the UK.

    The vaccination programme, for which care service users and staff have been given high priority, is proving highly effective in protecting people against severe illness, hospitalisation and death from Covid-19. Vaccine “boosters” also offer some short-term protection against mild or moderate illness. Most importantly, in the long run vaccination should help to reduce virus spread as they suffer less from the illness even when infected.

    Key though they are, vaccines are not a substitute for NPIs, which should also continue to be used with the vaccines sensibly and proportionately in relation to the risks of people being exposed to and infected by SARS-CoV-2. This is recognised in “Living with Covid” but with the compulsory elements being removed, including the mandatory vaccination of health and care staff.

    It follows that care providers must develop and implement their own “Living with Covid” strategies similarly by using both NPI and Pharmacological interventions, as they go hand in hand.

Changes in government policy and guidance

1 April 2022 and dates around it represent a watershed in terms of the changes in government policy towards the coronavirus management in England with the other UK countries planning similar changes to take effect at slightly later dates. Although the Coronavirus Act 2022 has not yet been repealed, all of the regulations under it that apply to care providers and their services, and various pieces of statutory guidance issued under these regulations, which have been shaping care providers’ policies and procedures during the regulatory period of the pandemic, have been withdrawn.

Withdrawn guidance (March/April 2022)

  • Overview of Adult Social Care Guidance on Coronavirus (COVID-19)

  • Supported Living Services During Coronavirus (COVID-19)

  • Coronavirus (COVID-19): Admission and Care of People in Care Homes

  • COVID-19: Guidance for Care of the Deceased

  • Visiting Arrangements in Care Homes

  • Coronavirus (COVID-19): Providing Home Care

  • Coronavirus (COVID-19): Admission and Care of People in Care Home

  • Coronavirus (COVID-19) Testing for Homecare Workers

  • Coronavirus (COVID-19) Testing for Anyone Working in Adult Social Care Who Is Not Part of Regular Testing at Work

  • COVID-19: Management of Staff and Exposed Patients and Residents in Health and Social Care Settings

  • COVID-19: Guidance for Households with Possible Coronavirus Infection.

New or updated applicable guidance (from April 2022)

Employer duties

Care service employers should remember that they have a continuing duty of care towards their staff, service users and visitors, and should take reasonable steps to protect their health and safety, preventing them from exposure to unnecessary risk.

What should you do as a care service manager?

  1. “Living with Covid-19”. It is important to keep up to date with the latest information on the changes made as a result of the Government’s “Living with Covid-19” agenda, key points on which can be found in the introductions to the Coronavirus (Covid-19) Management of Care Homes Policy and the Coronavirus (Covid-19) Management of Domiciliary Care Policy. (See also Adult social care provider Covid-19 guidance updated.)

  2. Staff Vaccination. Although there is no longer a mandatory vaccination requirement for care staff, care providers should encourage and support their staff to be fully vaccinated against Covid-19 and other infectious illnesses and to follow recommendations for boosters. (See the Staff Vaccinations and Immunisations in Care Homes Policy and the Staff Vaccinations and Immunisations in Domiciliary Care Policy for policy guidance).

  3. Service User Vaccination Policy guidance can be found in the Coronavirus (Covid-19) Vaccination of Service Users and Staff in Care Homes Policy and in the Immunisation for Service Users in Care Homes Policy. Because most care service users remain vulnerable to suffering from serious illness with Covid-19 care managers and clinical staff should keep up to date with the availability of vaccines and anti-viral treatments and encourage and support their service users to be up to date with their recommended immunisations. Care providers should follow Mental Capacity Act procedures in respect of people who cannot consent to being vaccinated.

  4. Care Home Visiting. Government guidance that recommended various restrictions and measures to reduce infection risk during the pandemic have been withdrawn. Current guidance indicates that visits to and out of the care home is in principle unrestricted but care providers must still take a precautionary approach by following good IPC practice. Current policy guidance is set out in the updated Coronavirus (Covid-19) Visiting In and Out of Care Homes (England) Policy.

  5. Risk Assessments. Assessments and management of risks of infection and outbreaks of infectious illnesses continue to be central to Covid-19 management. While the virus is still circulating care providers might still want to use the risk assessment tools developed at earlier stages but taking into account the general lowering of the risk thresholds brought about by the vaccination programme and by following NPI principles. The coronavirus “rules” should still be followed but tailored to individual circumstances and situations in line with the assessed risks. Policy guidance can be found in the Risk Taking and Assessment for Service Users topic and tools in the Risk Assessment Templates section.

  6. Testing. Much of the testing guidance for the general population has been withdrawn along with testing facilities and resources. There is no longer any free supply of LFD test kits from the NHS for the general public. However, health and care services have been made an exception to this general reduction in testing services and supply. Care providers should follow current government guidance Coronavirus (COVID-19) Testing for Adult Social Care Services which has been incorporated into the Coronavirus (Covid-19) Management for Care Homes and the Coronavirus (Covid-19) Management for Domiciliary Care policies. The Coronavirus (Covid-19) Testing in Care Homes Policy is also based on the updated guidance.

  7. Use of Personal Protective Equipment (PPE). Care providers should use the Government’s PPE portal to obtain their (continuing to be free) supplies of PPE and existing guidance on its use. Procedures on when to use what PPE can be found in the Government’s Infection Prevention and Control: Resource for Adult Social Care with additional information in the Navigate-Care Infection Control Management and the Infection Prevention and Control Procedures topics, and corresponding policies and resources.

  8. Infection Prevention and Control. The Government is putting considerable emphasis on the rigorous application of standard IPC in order to contain further virus spread and Covid-19 outbreaks. This is reflected in the Government’s Infection Prevention and Control in Adult Social Care: Covid-19 Supplement and resource. Care providers are expected to implement this guidance, which is reflected in depth and detail in the topics in the Navigate-Care Infection Control section.

  9. IPC Governance and Management

    1. IPC Leadership. Care providers should have an IPC lead responsible for co-ordinating all infection prevention control measure being taken as recommended in the Infection Prevention and Control: Resource for Adult Social Care. This guidance also recommends that care providers should complete an annual statement to include information about:

      • outbreaks of infection and actions taken

      • audits and subsequent actions

      • training and education received by staff

      • reviews and updates of policies, procedures and guidance

      • risk assessments undertaken for prevention and control of infection.

      CQC currently asks for this kind of information in its Provider Information Return (PIR) under the section heading of Quality Assurance and Risk Management. Support to complete the relevant sections of the PIR can be found under Resources in the Inspection and Regulation topic.

    2. Auditing. This is vital to ensure that high IPC standards are being maintained in the “Living with Covid” era. It can be anticipated that the focus in inspections will shift away from preoccupation with Covid-19 to wider infection prevention and control standards. The Covid-19 audit tools filed under Self 5A in the Self Audit Tools section should still be referred to for the foreseeable future but increasingly in relation to a more general approach to IPC auditing, as set out in the self-audit for Safe 5 Infection Control and other relevant audit tools found in the Forms section.

  10. Outbreak Management. Further outbreaks of Covid-19 in the community and particularly in care homes will require providers to adopt specific measures in line with national and local public health advice and guidance. Guidance on the policies and procedures to be followed can be found in the Infection Prevention and Control Procedures topic and in the Coronavirus (Covid-19) Management for Care Homes and the Management for Domiciliary Care policies.

  11. Staff Recruitment. It is evident that currently care providers are facing staffing shortages, which is due to many factors, including the continuing impact of the virus. Care providers should now be adopting their pre-Covid staff recruitment and selection policies and procedures, though it is still possible to follow some of the Disclosure and Barring Service “fast checking” procedures that were introduced during the pandemic until suggested otherwise on the DBS website.

  12. Staff who are compromised by Covid-19

    • Implications of no Test and Trace. There is now no test and trace system although people might still receive notifications via the NHS App as close contacts if of others who have tested positive and voluntarily have registered the information. In general, people who have tested positive are advised but not legally required to follow the Government’s stay at home advice.

    • Implications for care providers. Because they are in regular contact with people who remain vulnerable to the more severe effects of Covid-19, care workers have less discretion than the population at large when being notified as a close contact or when testing positive for Covid-19, and are expected to adhere closely to their employers’ policies which should be based on Infection Prevention and Control in Adult Social Care: Covid-19 Supplement, and which is reflected in the corresponding Navigate-Care Coronavirus (Covid-19) Management policies and the Coronavirus (Covid-19) Testing in Care Homes Policy.

    • Sickness payments. As explained in the Management policies, the self-isolation support scheme has now finished, so care providers must decide how to treat staff who are self-isolating or who have tested positive. People who are unable to work because of illness with Covid-19 are of course entitled to statutory sick pay, otherwise wages for periods of self-isolation are made at care providers’ discretion.

    • Communication. Maintaining good communication with all concerned has been very important during the worst of the pandemic, particularly with the many changes in direction. Navigate-Care has a range of letter templates found under Resources in Emergency Planning in Care on different issues requiring formal communication between care providers and their staff.

    • Long Covid. The letter templates include guidance on how to communicate with care staff suffering from “Long Covid”, which is now recognised as a disabling health condition that might require action in line with the Equality Act 2010. Employers’ responsibilities are described in the Long Covid Policy.

    • Consent. Communication is also important in connection with the obtaining and giving of consent to various proposed actions. Consent can be verbal or written but however obtained should always be recorded. A range of model consent forms that could still apply in relation to Covid can be found under Resources for the Emergency Planning in Care topic.

    • Vaccination Awareness. With the dropping of the mandatory vaccination requirement for health and care workers, it is left to care providers to encourage and support their staff to get vaccinated if not already and to keep up to date with their vaccinations in line with public health advice. The Viruses, Vaccines and Vaccination Training Presentation is one resource that can be used for raising awareness of the importance of vaccination in controlling the spread of Covid-19.

    • Infection Control Training. It is also essential that care providers step up their infection control training to ensure high standards are maintained not just in relation to Covid-19 but all infectious illnesses that are likely to afflict a care home and care service users. Achieving Excellence in Preventing and Controlling Covid-19 Infections Training Presentation is one such resource available on Navigate-Care with other IPC training tools also available via the corresponding topics or in Training Resources and Training Presentations.

  13. Recovery Plans. Care providers should evaluate and learn from their experiences of managing Covid-19. The Coronavirus (Covid-19) Recovery Plan Policy provides a framework within which to carry out this work. Other tools that could be used include the Coronavirus (Covid-19): Impact Assessment and Planning Form and the Coronavirus (Covid-19) Management: Monitoring and Reviewing Form.

  14. Contingency and Emergency Planning. Covid-19 has highlighted the importance of having plans in place to address unforeseen or unanticipated events such as those described in the Emergency Planning in Care topic. Amongst the range of emergency planning tools, the Business Continuity Plan: Outbreaks of Infectious Illness might be used in relation to any further outbreaks.

Last reviewed 14 April 2022