Coronavirus updates for Somerset Adult Care Providers

Guidance on the Coronavirus is changing on a very frequent basis to reflect the latest advice and developing situation.

All Government updates can be found here:

• https://www.gov.uk/coronavirus

Further information of particular interest and relevance to adult social care providers is listed here:

• Guidance on shielding and protecting people defined on medical grounds as extremely vulnerable from COVID-19 (Public Health England and Department of Health and Social Care, updated 30/04/2021)
• COVID19: ethical framework for adult social care (28/04/2021)
• Using direct payments during the coronavirus outbreak: full guidance for people receiving direct payments and personal assistants (Department of Health and Social Care, updated 27/04/2021)
• Guidance for local authorities and clinical commissioning groups in the delivery of direct payments and personal health budgets (Department of Health and Social Care, 27/04/2021)
• Guidance for care of the deceased with suspected or confirmed coronavirus (COVID-19) (22/04/2021)
• Overview of adult social care guidance on coronavirus (COVID-19) (Department of Health and Social Care, updated 01/04/2021)
• Coronavirus (COVID-19): support for care homes (updated 01/04/2021)
• Coronavirus (COVID-19): providing home care (Department of Health and Social Care, updated 01/04/2021)
• Getting help with daily activities outside your home during coronavirus (Department of Health and Social Care, updated 31/03/2021)
• Restricting workforce movement between care homes and other care settings (Department of Health and Social Care, updated 03/03/2021)
• Adult social care: our COVID-19 winter plan 2020 to 2021 (Department of Health and Social Care, updated 14/12/2020)
• Coronavirus (COVID-19): reducing risk in adult social care (01/12/2020)
• Leaflets for social care staff to support the annual flu programme (Public Health England, updated 19/11/2020)
• Social Care Sector COVID-19 Support Taskforce: report on first phase of COVID-19 pandemic (Department of Health and Social Care, updated 12/10/2020)
• Coronavirus (COVID-19): reuse of medicines in a care home or hospice (Department of Health and Social Care, NHS England, and NHS Improvement, updated 02/09/2020)
• Joint statement on personalised approaches to care and treatment (20/05/2020)

Public Health England Resources

• Coronavirus (COVID-19) Resource Centre This is a repository of resources and communications toolkits coving all areas of the response to COVI-19, including infection prevention and control and vaccinations produced by Public Health England that is regularly updated, including some in partnership with other organisations including Carers UK, Rethink, the Stroke association and Mencap.
• COVID-19 Resource Pack.  This will download a zip file that contains posters, letter templates and other resources produced by Public Health England
• Community asymptomatic testing poster

Staff Vaccinations

As you will all be aware, the provision of three vaccines against Covid-19 has now received approval from the Medicines and Healthcare Products Regulatory Agency (MHRA), and as such we are now in the process of undertaking vaccination programme in Somerset.  A link to the regulatory approval for each vaccine has been included below:

• Regulatory approval of COVID-19 Vaccine Moderna (Medicines and Healthcare Products Regulatory Agency, updated 19/04/2021)
• Regulatory approval of COVID-19 Vaccine AstraZeneca (Medicines and Healthcare Products Regulatory Agency, 15/04/2021)
• Regulatory approval of Pfizer/BioNTech vaccine for COVID-19 (Medicines and Healthcare Products Regulatory Agency, updated 31/03/2021)

Amongst our highest priority is the delivery of the vaccines to care home staff.  Through vaccinating all our staff, we aim to help protect individuals from becoming unwell with, or dying from, Covid-19 disease, and it is therefore vital that we communicate the importance of this programme with staff who work with some of the most vulnerable members of the community. Vaccination is key to reducing the risk of Covid-19 outbreaks occurring in the home.

Through the clinical trials on many tens of thousands of people people there were no significant adverse events.  Some people did experience a painful or heavy arm where they had the injection, felt tired or had a mild fever for a couple of days. These are common side effects following any vaccination, and staff in the vaccination centres will be mindful of these and do all they can to help staff remain as comfortable as possible following their vaccination.

During the vaccination delivery the vaccination teams will maintain the full range of measures to keep everyone safe from Covid-19, staff giving the vaccine will be wearing personal protective equipment and will abide by all the necessary cleaning and disinfection requirements.

We have included links bellow to the patient leaflets for you to share with your staff, these should address most of the questions that staff may have.  Vaccination is not mandatory, but we urgently need your help to encourage everyone to accept the vaccination, it not only protects them, but it significantly helps us all keep those most vulnerable in Somerset safe.

Social care workforce vaccinations

We are very pleased to say that the vast majority of social care workforce vaccinations are now complete for first dose, and want to say a huge thanks to you all for making this possible.  We do apologise for some cancellations that required us to rebook, but this was due to circumstances beyond our control with supply of vaccines.  As we approach the end of first dose vaccinations we are continuing to have to react to availability of vaccine and vaccinators and as such are now having to cancel appointments made at Musgrove Park Hospital for the 13^th and 14^th February.  We are though opening up availability for those staff to be vaccinated at the Taunton Racecourse, and all those affected have been emailed and a text sent to the mobile number provided.

In order to pick up the remaining staff who have yet to be vaccinated we are opening up provision through both the Taunton Racecourse and the Bath and West Showground.  Staff can self present once they have completed the request form at the link below.  We would ask that staff allow at least 24hrs between submitting the request and attending the two sites.  They will also need to provide ID which will be checked against the report that we will provide to the site on a daily basis.

Further information about booking a vaccination at Taunton Racecourse and the Bath and West Showground

If you have any questions or issues regarding vaccination please contact us at ASCCovid19@somerset.gov.uk and we will do all we can to support you.

Poor Vaccination Recording

We are rightly very proud of the joint working that has enabled us to achieve a very positive first dose vaccination programme.  However what is being reported nationally does not reflect this.  We have 27 homes who are reporting via the Capacity Tracker that significant numbers of residents that have not yet been offered a first dose vaccination.  We have 55 homes reporting that they have over 10 staff not yet been offered first dose vaccination.  It is absolutely critical that we have accurate reporting so we can support homes who may have issues with resident or staff vaccinations and we can only do this if the data being provided is truly reflective of the position on the ground.  We do very much appreciate how busy you all are, but it is important to note that the data from the capacity Tracker is being used nationally and is incumbent on all of us to try and ensure this is correct.

Vaccination for 17 year old carers.

We are aware that there are a small number of carers who are aged 17yrs and therefore only able to receive Pfizer vaccine.  We are working to provide opportunities for these individuals through the two hospital hubs who hold Pfizer towards the end of this month.

If you have any staff that are 17yrs and able to receive vaccine please can you collate details and forward them to us via asccovid19@somerset.gov.uk we will look to use them for short notice cancellations and as such we will need, name, date of birth, mobile contact number and email address.

Help with getting to vaccination appointments

If you have not yet had your vaccination, it might be worth preparing in advance how you will get there. If you are not able to drive yourself, but you have a family member or friend who might be able to support you – it’s always worth having that conversation now.

While many older and more vulnerable people will be able to attend a location close to their home, some will be relying on public transport.

Somerset County Council is working with bus operators and community transport providers to help vulnerable residents to get to their COVID-19 vaccination appointments.

• A free Somerset County Council Taunton town centre shuttle service has been launched to get people straight to their vital vaccination slot. The Covid vaccination shuttle bus service runs every 30 minutes from Castle Way in Taunton town centre to Taunton Racecourse. The seven-day a week service uses one of the Council’s fleet of minibuses and will help to support those who don’t drive and will link easily with other operators coming into the town centre. The shuttle service is set to run every day throughout March and April except for the following dates when the vaccination centre is closed for race days: 4, 15 and 23 March; 8 and 21 April.
• The new Taunton service starts at 8.20am each day, and will also serve bus stops along South Road and Shoreditch Road on route to the Racecourse. The last bus each day is 6.05pm from the Racecourse. There will be capacity for a maximum of four passengers on each journey due to the need for social distancing. The service is reserved for those who have a pre-booked vaccination appointment at the Racecourse and this will be verified before passengers board the bus. It’s recommended those using the service catch a bus to arrive approximately 10 minutes before their vaccination slot. You can view the timetable here
• First West of England provides a bus service every 30 minutes from Wells Bus Station stopping at Shepton Mallet. The bus service terminates at the Bath and West Showground and operates seven days a week. The service provides connections to and from other bus services at both Wells Bus Station and Shepton Mallet Cenotaph. This service is free for bus pass holders. If you plan to use this bus service, please make sure that you take your appointment letter with you and try to use the timetabled journey which arrives at the Bath and West Showground as close to your appointment time as possible. This will avoid waiting time on site. You can view their vaccination centre travel guide here
• Current concessionary bus pass rules have been suspended so that bus passes can be used on all public services before 9.30am. This came into effect from February 1.
• Somerset County Council is working with Community Transport and Slinky Demand Responsive Services across Somerset to allow free travel for bus pass holders when attending vaccination appointments. You can find information and contact details for Community Transport Services on Travel Somerset

If you are concerned about getting to an appointment, or need other help or support during the pandemic, please phone the Coronavirus helpline on 0300 790 6275. Lines are open from 8am to 6pm, seven days a week.

Astra-Zeneca Vaccine

As we are sure you will be aware, there has recently been significant media coverage regarding the Astra Zeneca vaccine and an associated potential risk of the development of blood clots within the brain.  It is therefore important that we work with you and our staff to ensure that the correct information is provided and that any potential disruption to vaccine uptake is managed appropriately.

What is important is to stress that whilst a potential link between the Astra Zeneca vaccine and a very rare adverse event has been identified, we need to consider this in its entirety.  In a high exposure risk environment such as the Care Sector, as can be seen from the graphic below even in the highest risk group (20-29yrs) the relevant risk from the vaccine at 1.1 is significantly below the relevant risk from the vaccine at 6.9.  The vaccine remains very safe and staff within this group who have yet to accept first dose will have an option of an alternative vaccine

.

Second Dose

What is clear from the evidence provided is that all cases so far identified have followed first dose vaccination and generally all cases had identified symptoms within the first few days post vaccination and all within 21 days.  Therefore if you have had first dose vaccination with Astra Zeneca and have had no significant adverse effect, then there is very little risk from the second dose, your body has in many respects shown its tolerance of the vaccine through first dose and as such the risk reduces even further.

We are therefore very keen to support staff in continuing to accept second dose vaccination, we know that the link between Covid and deaths is being broken through vaccination, and it is vital if we are to continue to protect those we care for that we continue to follow clinical guidance and roll out second dose vaccination.

Further Information:

• COVID-19 vaccination and blood clotting (Public Health England, updated 07/05/2021)
• COVID-19 vaccination and blood clotting (Summary) (Public Health England, 07/04/2021)
• Communicating the potential benefits and harms of the Astra Zeneca COVID 19 vaccine (University of Cambridge, 07/04/2021)

Further information:

• Public Health Somerset has produced a ‘myth-buster’ sheet about some of the vaccine myths that we are aware of for you to share with your staff.
• Please don’t contact your GP surgery to ask about vaccinations, they will contact you, unnecessary calls are jamming GP switchboards and as such are stopping people who need urgent appointments from getting through.
• You cannot choose which vaccine you want, they are very safe and very effective.
• The previous advice that anyone who carries an EpiPen or has a significant history of an anaphylactic-type reaction should not receive a vaccination has now been updated and now only contraindicates based on a specific allergy to one of the ingredients contained within the vaccine (see below).  This new guidance has been developed following the vaccinations carried out in the UK so far and the ever growing evidence base this generates.

Vaccine contra indications

It is important that we look to vaccinate as many staff as possible, we do appreciate some are nervous, but these vaccines ate incredibly safe.  Although it is true that they were completed in record time, we had a head start, Covid-19 is a Coronavirus and we have been working on Coronavirus vaccines for many years.  Vaccines are normally worked on by small groups of scientists with limited funding and infra-structure; this has been an international programme with unlimited resource, worked on by hundreds of scientists 24/7.

No staff who are currently symptomatic or isolating should attend for vaccination until such time as their isolation period ends.  Staff should attend individually and not share transport to the hospital.  Staff will need to wear a face covering when being vaccinated.  All staff will need to be registered with a GP and have an NHS Number (if staff can’t access their NHS Number it can be looked up on the day).

It is important that staff have access to and read the patient advice leaflets for further details of indications and contra-indications

General information about COVID-19 vaccines

• COVID-19 vaccination: women of childbearing age, currently pregnant or breastfeeding (Public Health England, 12/05/2021)
• The COVID-19 vaccination programme (Public Health England, updated 11/05/2021)
• Coronavirus (COVID-19) vaccine (updated 29/04/2021)
• COVID-19 vaccination: a guide for social care staff (Public Health England, 01/03/2021)
• COVID-19 vaccination: guide for healthcare workers (Public Health England, 01/03/2021) 
• Covid-19 Immunisation – Consent Guidance
• Public Health England: Immunisation (updated 15/01/2021)

Leaflets:

• Easy read answers to questions about the coronavirus vaccine
• What to expect after your COVID-19 vaccination (Public Health England)
• COVID-19 vaccination:  A guide for adults (Public Health England
• Easy read information about the Covid-19 vaccine (Mencap)

Videos:

• British Sign Language (BSL) videos on COVID-19 vaccination (Public Health England, 05/05/2021)
• Public Health England have produced a series of videos in English and other languages to combat vaccine disinformation.  View them here (public Health England, updated 13/04/2021).
• NHS England has produced a series of animated videos, aimed at anyone who has received their COVID-19 vaccination, to explain why it remains important to follow current infection prevention guidelines after vaccination.
• Information about vaccines: For people with a learning disability and autistic people (NHS England and NHS Improvement)

Vaccination Frequently Asked Questions (FAQs)

People aged 70 and over, including care home residents, identified by the new QCOVID risk assessment model will have received this letter advising them to shield. Please see information supplied by Government below regarding the QCovid model and the reasons for including more people at this time. You should continue to follow guidance on shielding and protecting people defined on medical grounds as extremely vulnerable (Public Health England and Department of Health and Social Care, updated 30/04/2021)already in place and if you have any concerns or queries please contact us via ASCCOVID19@somerset.gov.uk.

QCOVID

Summary

• QCOVID is a new predictive risk model to help clinicians identify adults with multiple risk factors that make them more vulnerable to COVID-19.
• Research was developed by subgroup of NERVTAG, led by the University of Oxford and funded by National Institute for Health Research.
• Individuals identified through the COVID-19 population risk assessment, using the QCovid® model, have been added to the Shielding Patient List (SPL) on a precautionary basis.
• Individuals aged 19-69 within this group started being added to the SPL last week, enabling them to be prioritised for a vaccination.
• This week, individuals who are 70 and over, as well as residents of care homes, have been added to the SPL. Please note, this does not change any guidance already in place for care homes and their residents.

Development of QCOVID

• We are continually learning more about COVID-19 and the factors that lead to poor outcomes including death and hospitalisation.
• An expert subgroup of NERVTAG was commissioned by the Chief Medical Officer to develop a predictive risk model, to enable a more sophisticated approach to clinical risk based on multiple risk factors.
• The new risk assessment model came out of research funded by the NIHR (National Institute for Health Research) and was published in the British Medical Journal (BMJ) on 20 October.
• This model combines a number of characteristics to estimate the risk of catching and then being hospitalised or dying from COVID-19. These include age, sex registered at birth, ethnicity, body mass index (BMI), and specific health conditions and treatments.
• Refining the model and working through how we might apply it as accurately as possible, has been complex and challenging. This world leading approach has been developed at unprecedented pace over some months, whilst simultaneously aiming to meet the highest standards of evidence, clinical safety and technical assurance.

Application

• The model has been applied to medical records of NHS patients in England.
• This has recently enabled us to help identify people who may be at high risk of becoming seriously unwell from coronavirus because of a combination of their individual characteristics and their underlying health conditions.
• We want to provide vaccination more quickly to them and also offer further advice and support. The easiest way for us to ensure early vaccination for this group is to include them within the list of those who are clinically extremely vulnerable (also known as the Shielded Patient List).
• People may feel that at this stage of the pandemic, when rates of infection overall are declining, the advice is not relevant. However, we think it is important that this group are aware of their risk status and of the support available to them, both now and for any future changes in the pandemic so they can make an informed choice themselves. Their GP will also be notified.
• The COVID-19 Population Risk Assessment, powered by the QCovid® model, uses data held centrally by the NHS from a number of sources including general practice.
• People who may be high risk who are not registered with a GP practice are included and will be communicated with and added to the SPL in the same way.
• Recognising the current pressures on the health system, there is no action required of clinicians for these additions to the SPL to take effect. As now, GPs have the option to add or remove patients from the SPL, based on their clinical judgement.

Assurance

• The new predictive risk model has been developed through research funded by the National Institute for Health Research (NIHR).
• The findings from the development of the QCovid® model were published in the BMJ. The Office for National Statistics (ONS) independently validated the performance of the QCovid® model. The ONS has shown that the model performs in the ‘excellent’ range, and accurately identifies patients at high risk from COVID-19. This means we are fully confident that the model is robust and meets the highest standards of evidence.
• NHS Digital have developed the COVID-19 Population Risk Assessment using the QCovid® model. It has been through a functional assurance process which aims to ensure that the QCovid® model has been used correctly, works as expected and produces accurate outputs.
• The model has been approved for use as a Class 1 medical device with the Medicines and Healthcare products Regulatory Agency.

• Department of Health and Social Care:
  • COVID-19: supporting adults with learning disabilities and autistic adults (updated, 10/05/2021)
  • Supported living services during coronavirus (COVID-19) (22/04/2021)
  • COVID-19: guidance for commissioners and providers of services for people who use drugs or alcohol (updated 07/04/2021)
  • Temporary approval to suspend the need for signatures on prescriptions, dental and ophthalmic forms until 30/06/2021 (31/03/2021)
  • Supporting people living with dementia through safeguarding processes (updated, 31/03/2021)
  • Home delivery of medicines and appliances during the COVID-19 outbreak (16/02/2021)
  • COVID-19 testing in general practice (04/03/2021)
  • Vitamin D and care homes guidance (24/02/2021)

• NHS England and NHS Improvement:
  • Mental health, learning disabilities and autism guidance (15/03/2021)
  • Primary Care standard operating procedure (updated 03/03/2021)
  • Urgent dental care guidance and standard operating procedure (updated 05/02/2021)
  • Dementia wellbeing in the COVID-19 pandemic (26/01/2021)
  • Standard operating procedure – Community Pharmacy (updated 27/10/2020)
  • Third phase of NHS response to COVID-19 (updated 13/10/2020)
  • South West Care Home Winter Readiness Pack (updated 14/09/2020)
  • Guidance for healthcare teams on the release of adult patients from the secure and detained estate during coronavirus (19/05/2020)
  • Workforce guidance for mental health, learning disabilities and autism, and specialised commissioning services during the coronavirus pandemic (08/04/2020)
  • A letter clarifying the use of the Clinical Frailty Scale (CFS) and the use of do not attempt cardiopulmonary resuscitation (DNACPR) with younger patients, those with a stable long term physical need, learning disability or autism (03/04/2020)

• National Institute for Health and Care Excellence (NICE):
  • COVID-19 rapid guideline: managing COVID-19 (updated 08/04/2021)
  • COVID-19 rapid guideline: rheumatological autoimmune, inflammatory and metabolic bone disorders (updated 31/03/2021)
  • Safeguarding adults in care homes (26/02/2021)
  • Creating a safeguarding culture:  A quick guide for registered managers of care homes (2021)
  • Developing and implementing guidance for staff delegating clinical tasks to informal carers and relatives during the COVID-19 pandemic (September 2020)
  • COVID-19 rapid guideline: dialysis service delivery (updated 11/09/2020)
  • COVID-19 rapid guideline: interstitial lung disease (15/05/2020)
  • COVID-19 rapid guideline: chronic kidney disease (15/05/2020)

•  Association of Directors of Adult Social Services (ADASS)
  • Cohorting, Zoning and Isolation Practice – Commissioning for Resilient Care Home Provision – Sept 2020 (15/09/2020)

• Social Care Institute for Excellence (SCIE)
  • Delivering safe, face-to-face adult day care (updated 30/04/2021)

• Office of the Public Guardian
  
  • Being a deputy or attorney during the coronavirus outbreak (updated 23/04/2021)
  • Coronavirus (COVID-19): Office of the Public Guardian response (updated 12/05/2021)
  • Making and registering an LPA during the coronavirus outbreak (updated 12/05/2021)
  • How to register an EPA during the coronavirus outbreak (updated 23/04/2021)

• Medicines and Healthcare products Regulatory Agency
  • Medical devices given exceptional use authorisations during the COVID-19 pandemic (updated 13/05/2021)

• British Geriatrics Society:
  • Guide on Managing the COVID-19 pandemic in care homes (updated 18/11/2020)
  • Coronavirus and older people resource series
  • Identifying older people most vulnerable to COVID-19 (07/09/2020)
  • Atypical Covid-19 presentations in older people – the need for continued vigilance (updated 14/04/2020)
  • Managing a fall that may require an ambulance during the COVID-19 pandemic (May 2020)

• National Institute for Health Research (NIHR):  Patients living with dementia who ‘walk with purpose or intent’ in the COVID-19 crisis (22/04/2020)
• Video (8 min): Meeting the Needs of People with Dementia Living in Care Homes during Covid-19
• The British Psychological Society: Supporting older people and people living with dementia during self-isolation (08/04/2020)
• Real Talk: COVID-19: Evidence-based advice for difficult conversations (23/03/2020)
• VitalTalk:  COVID communication guide
• Digital Social Care: Covid-19 Guidance

Guidance for Coronavirus (COVID-19): looking after people who lack mental capacity (Department of Health and Social care, updated 27/04/2021) for health and social care staff who are caring for or treating a person who lacks mental capacity during the pandemic was updated  on 27/04/2021.

The ability of our Local Authority DoLS team to carry out assessments and provide authorisations is severely impaired by understandable access restrictions imposed by care homes and hospitals.

The following approach has been adopted (from 18 March 2020) as Somerset County Council policy for the immediate future:

• The DoLS team will make case-by-case decisions about whether any particular DoLS assessments must be completed, and will negotiate this accordingly.
• This is only likely to be required in cases where to leave a person without authorisation would put them at some significant risk of harm. There are likely to be safeguarding cases.
• Other part-completed assessments or those awaiting allocation will be put on hold and monitored until the current situation improves.
• The DoLS team will look for alternative methods for conducting assessments where face-to-face contact is not considered appropriate. Discussions are underway about how to conduct some DoLS assessments by phone, but we are also mindful of the need to avoid placing any unnecessary additional pressures upon the time of staff in care settings

We have received guidance that support groups that have to be delivered in person can continue with up to 15 participants where these are formally organised groups to provide mutual aid, therapy or any other form of support, where it is necessary for these to take place in person. 

Day services are covered by the term ‘support group’, and are therefore can remain operating, and consequently day care providers are encouraged to continue to operate providing that the meet all the national government guidelines including:

• A maximum of 15 people are supported in one building at any one time.  This cannot be a private dwelling. 
• Social distancing is maintained and that the building remains Covid secure
• Test and Trace information is recorded and confirmed
• Providers liaise with people who use their service and their families to ensure that they do not fall in the over 60,  clinically vulnerable or extremely clinical vulnerable categories, and as a consequence may not want to attend their day care service during the lockdown period. If someone does not wish to attend their day care then providers should contact JCawley@somerset.gov.uk.

Should you require any further advice regarding the steps you should be taking to reduce the transmission risk, please email us at ASCCovid19@somerset.gov.uk.

The Social Care Institute for Excellence (SCIE) has released guidance (updated 30/04/2021) commissioned by the Department for Health and Social Care to support day services for vulnerable adults to re-open or continue to operate in a safe manner. Somerset County Council asks that all day service providers follow this guidance released by SCIE, drawing attention to the request for transparency with service users, families, the Local Authority and other providers regarding risk assessments both business wide and for individuals. We have also produced a summary guide which we hope will be of use to affected services which covers aspects including funding, PPE and transport.

All Local Authorities were asked by the Department of Health and Social Care to submit and make public a letter setting out a short overview of its current care setting support activity and forward plans by 29 May 2020. The letter should be accompanied by a short capacity tracker template confirming the current level of provider access to the support offer (self-reported by local regulated care homes), as well as details of issues and support needs.

View the letter and template here

• Webinar with Mel Lock on 05/06/2020

In this webinar Mel Lock (Somerset County Council’s Director of Adult Social Care) was joined by Tim Baverstock (Assistant Director of Adult Social Care) to discuss grant funding.  Alison Bell (Strategic Manager for Public Health) will also be joining to provide an update of Care Home Testing, and Dave Partlow (Strategic Manager for Adult Social Care) will provide an update on PPE.

• • View the webinar 
  • View Alison Bell’s presentation
  • Responses to questions that were followed-up after the webinar had finished:
    • Q:  Could we use the funding for staff who are shielding.  It states that staff who self-isolate can be claimed but does that cover shielding staff wages also?
      • A:  Shielding staff members can be allocated to the staff cost under the category of isolation and protection of staff and residents from infection/vulnerability – the Director of ASC has agreed this can be signed off against the grant determination.
    • Q:  Can you confirm when the Infection Control Grant Applies from
      • A:  Start date is on signing and return of the grant agreement and the condition states that it cannot be used for expenditure already incurred.
    • Q:  With regards to the grant, is there any further guidance regarding specifics of what you can/can’t spent the grant on?  e.g. Is capital expenditure allowed?  For example with regards to transport for staff.
      • A:  Capital spend is not excluded (provided it meets one of the categories). Please check if you are unsure.
  • The Department of Health and Social Care have also released an Infection Control Fund Question and Answer document 

• Webinar with Mel Lock on 16/06/2020

In this webinar Mel Lock (Somerset County Council’s Director of Adult Social Care) was joined by Tim Baverstock (Assistant Director of Adult Social Care) to discuss the remaining 25% of Infection Control Grant monies. This webinar was primarily for:

• • Domiciliary care providers
  • LD supported living providers
  • Extra Care housing providers
    • View the webinar

• Webinar with Mel Lock on 01/07/2020

In this webinar Mel Lock (Somerset County Council’s Director of Adult Social Care) was joined by Tim Baverstock (Assistant Director of Adult Social Care) and Dave Partlow (Strategic Manager, Adult Social Care COVID19 Response Team) to give an update on how we have progressed with exploring ways to help providers source PPE and use the bulk buying power of the council to do this at a favourable cost, and explained how providers will be able to purchase PPE going forward.

• • • View the webinar

• Webinar with Mel Lock on 25/09/2020

In this webinar Mel Lock (Somerset County Council’s Director of Adult Social Care) was joined by Tim Baverstock (Assistant Director of Adult Social Care), Alison Bell (Consultant in Public Health) and Dave Partlow (Strategic Manager, Adult Social Care COVID19 Response Team) to give an update on testing, the Adult Social Care Winter Plan that was published on 18/09/2020 and PPE.

• • • View the webinar

• Webinar with Mel Lock on 16/11/2020

In this webinar Mel Lock (Somerset County Council’s Director of Adult Social Care) was joined by Tim Baverstock (Assistant Director of Adult Social Care), Alison Bell (Consultant in Public Health), Dave Partlow (Strategic Manager, Adult Social Care COVID19 Response Team), Jo Howarth (NHS England and NHS Improvement) and Conner Dicks (NHS England and NHS Improvement) to give an update on the Covid-19 Vaccination programme, care home visits, the current public health position in Somerset and IPC Grant monies.

• • • View the webinar

• Webinar with Mel Lock on 18/12/2020

In this webinar Mel Lock (Somerset County Council’s Director of Adult Social Care) was joined by Tim Baverstock (Assistant Director of Adult Social Care), Alison Bell (Consultant in Public Health), Dave Partlow (Strategic Manager, Adult Social Care COVID19 Response Team) to give an update from Public Health  and on vaccinations, Lateral Flow Device Tests (LFTs), Care Home Visits, Business Continuity and out break planning, finance and grants and Christmas messages including #ConnectACareHome

• • • View the webinar

• Webinar with Mel Lock on 28/01/2021

In this webinar Mel Lock (Somerset County Council’s Director of Adult Social Care) was joined by Tim Baverstock (Assistant Director of Adult Social Care), Alison Bell (Consultant in Public Health), Dave Partlow (Strategic Manager, Adult Social Care COVID19 Response Team) to give an update from Public Health, and on outbreak management (planning for an outbreak, learning from recent experiences), Lateral Flow  Device Tests (LFTs, ) and testing, vaccinations, grant funding – Infection Control Grant 2 (ICF2) and testing funding support, proud to Care Somerset case study request and the Millbrook equipment return campaign and self-assessment portal.

• • • View the webinar

• Webinar with Mel Lock on 24/02/2021

In this webinar Mel Lock (Somerset County Council’s Director of Adult Social Care) was joined by Councillor David Fothergill (Leader of Somerset County Council), Tim Baverstock (Assistant Director of Adult Social Care), Alison Bell (Consultant in Public Health), Liz Green (Health Protection Practitioner) and Dave Partlow (Strategic Manager, Adult Social Care COVID19 Response Team), The agenda included:

• • Thank you from Cllr David Fothergill
  • Infection prevention and control – ventilation, cleaning etc.
  • Covid-positive discharges
  • Care home visiting guidance
  • Workforce capacity fund
  • Vaccinations
  • Flagging different vaccine brands
  • EU settlement
  • Any other business

• • • View the webinar

• Webinar with Mel Lock on 26/03/2021

In this webinar Mel Lock (Somerset County Council’s Director of Adult Social Care) was joined by Alison Bell (Consultant in Public Health), and Dave Partlow (Strategic Manager, Adult Social Care COVID19 Response Team), The agenda included:

• • Current situation, and need to remain vigilant
  • Testing in outbreaks
  • Vaccination update
  • Visiting in care settings
  • Funding
  • World Autism Awareness Week
  • Any other business

• • • View the webinar
    • View Alison Bell’s presentation

• Webinar with Mel Lock on 20/04/2021

In this webinar Mel Lock (Somerset County Council’s Director of Adult Social Care) was joined by Alison Bell (Consultant in Public Health), and Dave Partlow (Strategic Manager, Adult Social Care COVID19 Response Team), The agenda included:

• • Testing
  • Vaccination stats and consultation
  • PPE usage and guidance
  • Grant funding and Capacity Tracker
  • Preparation for reopening of community services/respite
  • Any other business

• • • View the webinar

The Government announced that it has moved to institute a policy of testing all residents prior to admission to care homes, starting with those being discharged from hospital with the NHS having the responsibility for testing these specific patients in advance of timely discharge, and has published Hospital discharge service guidance (02/02/2021) including leaflets for patients, the admission and care of people in care homes (updated 01/04/2021) and stepdown of infection control precautions within hospitals and discharging COVID-19 patients from hospital to home settings (22/03/2021).  On 01/04/2021 the national guidance was updated on Discharge into care homes: designated settings for people leaving hospital who have tested positive for COVID-19 and are transferring to a care home (this includes working age adults who reside in a care home).

Somerset NHS Foundation Trust has confirmed that this process has been implemented for all  patients that are admitted (for more than 24 hours).  If they are simply seen on AMU or within the Emergency Department they will not be tested ahead of discharge back to care homes.  Following testing, timing of discharge will be with the agreement of the care home in question regarding if the individual can be accepted to an isolated area within the care home pending test result.  The same process is applicable for community hospitals as well. The Somerset NHS Foundation Trust process is detailed in this flowchart (updated 21/04/2020)

We are seeking further information from Yeovil District Hospital and will add further detail on the arrangements once it becomes available.

The Somerset COVID-19 Local Outbreak Management Plan Dashboard is updated daily with the latest information about infection rates in Somerset.  To view the dashboard follow this link.

Visits in to care homes

Welcoming people into care homes from the community inevitably brings infection risk, but this is a risk that care homes can mitigate with appropriate control measures, tailored to each individual site. It is a risk that should always be balanced against the importance of visiting and the benefits it brings to care home residents and their families. 

Visiting should be supported and enabled wherever it is possible to do so safely, in line with this guidance and within a care home environment that takes proportionate steps to manage risks.  All visitors also have an important role to play – helping to keep their loved ones safe by carefully following the policies described in government guidance, and the practical arrangements that care homes put in place. 

In each care home, the registered manager is responsible for setting the visiting policy in that home, and they should do so on the basis of a dynamic risk assessment taking into consideration the needs of individuals within their home and with regard to the advice of the local Director of Public Health (DPH) and Director of Adult Social Services (DASS).

The Government has updated the guidance on care home visits (Department of Health and Social Care, updated 04/05/2021) to incorporate the new visitor scheme for care homes which has been put in place from 12/04/2021, the availability of self-testing for visitors and changes to PPE advice.  This includes summary of guidance for visitors (Department of Health and Social Care, updated 04/05/2021).  In summary, the details of these changes are:

• Indoor visiting by up to 2 ‘named visitors’ for each resident. These visitors will need to take a rapid lateral flow test, and test negative before every visit (while visitors can now self-test at home the guidance states that a test taken onsite at the care home is preferable for assurance purposes). They should minimise physical contact with residents. They must observe social distancing and PPE use, and follow all necessary infection control measures.  An essential care giver (see below) may also take part in these visits.
• The resident can meet with both of their 2 named visitors at the same time (for example, during the same visit as long as the care home is able to accommodate this) or can meet with them separately if that is what they prefer.
• Visits including babies and very young children may also take place with the agreement of the care home manager. These children do not need to be counted as an additional visitor. Care home managers and families can agree to exercise some discretion here – but in general a child under the age of 2 need not be counted.
• Additionally, residents with higher care needs can also choose to nominate an ‘essential care giver’ who can provide close contact personal care where it is critical for the resident’s immediate health and wellbeing. These ‘essential care givers’ will be supported to follow the same testing arrangements, and the same PPE and infection control arrangements, as care home staff.  The situation described for essential care givers is considered an exceptional circumstance, and the guidance stated that they should therefore continue in the event of an outbreak unless there are specific reasons not to do so.  The essential care giver does not need to be the same person as one of the named visitors.
• Opportunities for every resident to see more people than just their named visitors, by enabling outdoor visiting or ‘screened’ visits incorporating appropriate screening to reduce the risk of infection .

As with the previous guidance:

• Visits should take place in a well-ventilated room, for example with windows and doors open where it is safe to do so. Providers should consider the use of designated visiting rooms, which are only used by one resident and their visitors at a time and are subject to regular enhanced cleaning and ventilation between visits. Any areas used by visitors should be decontaminated several times throughout the day and providers should avoid clutter to aid cleaning.
• Visitors should wear appropriate PPE as laid out in the guidance on how to work safely in care homes in England (Public Health England, updated 16/04/2021). This guidance sets out the appropriate levels of PPE for a range of scenarios, such as being in physical contact with a resident, or being within 2 metres of a resident but not touching.
• Visitors should keep physical contact to a minimum. Visitors and residents may wish to hold hands, but should bear in mind that any contact increases the risk of transmission. There should not be close physical contact such as hugging
• Visitors should also be careful to ensure they observe strict social distancing from other residents, visitors and staff at all times.
• In the event of an outbreak in a care home, the home should immediately stop visiting (except in exceptional circumstances such as end of life) to protect vulnerable residents, staff and visitors. Essential care givers can continue to visit unless there are specific reasons not to do so.
• Vaccination is not mandatory and is not a condition of visiting, although it is strongly recommended that all visitors and residents take up the opportunity to be vaccinated when they are invited to do so through the national programme.
• The frequency and duration of the visits are at the care home’s discretion, and it is recommended that it is recommended that the care home has a simple booking or appointments system to enable visits

In all cases it is essential that visiting happens within a wider care home environment of robust infection prevention and control (IPC) measures, including ensuring that visitors follow (and are supported to follow) good practice with social distancing, hand hygiene and PPE use.

Where residents have particular needs (for example, those who are unable to leave their rooms, those living with dementia or those who may lack relevant mental capacity) which may make it challenging to follow some of the detailed advice in the guidance on the conduct of visits, the the provider should work with the resident, their family, friends and any volunteers to develop a tailored visiting policy within the principles outlined in the guidance.

The government has also published the following tips to prepare for visits:

• Communicate expectations to families and visitors
• Ensure you have appropriate PPE on site for visitors
• Begin to schedule visits, the frequency and duration of visits are at the care home discretion
• Prepare staff for visitation
• Have devices available if visitors require assistance registering their result

Each care home is unique in its physical layout, surrounding environment and facilities and that residents vary in their needs, health and current wellbeing.  The guidance therefore recognises that care home managers are best placed to decide how their care home can best enable visiting in line with this guidance, and in a way that meets the needs of their residents both individually and collectively, and we will continue to support care home managers in making the right decision for their home.

It is important that the named visitors remain the same people as far as possible. This is important in reducing the risk of transmission, by limiting the number of different people coming into the care home from the community. However, we recognise that there will be situations in which a named visitor cannot continue to visit (for example because of illness).  The guidance advises that care homes and families take a pragmatic approach, with the aim of minimising change wherever possible.

The individual resident, their views, their needs and wellbeing should be taken into account when decisions about visiting are made, recognising that the care home will need to consider the wellbeing of other residents as well.  These decisions should involve the resident, their family and friends and the provider and other relevant professionals such as social workers or clinicians where appropriate. Throughout the guidance the phrase ‘family and friends’ is used, and this is intended to be a wide-ranging and inclusive term to describe the network of people around the resident who may wish to visit, or whom the resident may wish to meet.

All decisions should be taken in light of general legal obligations, such as those under the Equality Act 2010 and Human Rights Act 1998, as applicable. Providers must also have regard to the Department of Health and Social Care (DHSC) ethical framework for adult social care (Department of Health and Social Care, 28/04/2021).  The Care Quality Commission (CQC) has regulatory powers that can be used where they have concerns regarding visiting.

We recognise how important visiting is as residents approach the end of their lives, and this should not just mean at the very end of one’s life.  Families and residents should be supported to plan end-of-life visits, with the assumption that visiting will be enabled to happen not just towards the very end of life, and that discussion with the family should happen in good time. As has been the case throughout the pandemic response, visits in exceptional circumstances such as end of life should continue in all circumstances (including in the event of an outbreak).

Visiting is just as important for people living in supported living and extra care settings. This guidance does not directly apply to those settings – the diversity of the settings and the needs of those who live in them means it will not be suitable in all cases. However, supported living and extra care managers may wish to use the guidance to help them support safe visiting in these settings.

All visitors should be screened for symptoms of acute respiratory infection before entering. No one who is currently experiencing, or first experienced, coronavirus symptoms in the last 10 days, should be allowed to enter the premises, nor anyone who is a household contact of a case or who has been advised to self-isolate by NHS Test and Trace, or who is in a relevant quarantine period following return from travel.

Any potential visitor who tests positive should immediately leave the premises and self-isolate. They should be offered a confirmatory PCR test by the care home and their household contacts may also be required to self-isolate in line with current guidance. Screening questions that care homes may wish to ask visitors on arrival are:

• Have you been feeling unwell recently?
• Have you had recent onset of a new continuous cough?
• Do you have a high temperature? A care home may consider providing a temperature check for all visitors to provide confidence to visitors and to staff.
• Have you noticed a loss of, or change in, normal sense of taste or smell?
• Have you had recent contact (in the last 14 days) with anyone with COVID-19 symptoms or someone with confirmed COVID-19. If yes, should you be self-isolating as a family member or as a contact advised to do so by NHS Test and Trace?
• Have you returned from an overseas visit recently and are you still in the quarantine period?

Staff should discuss with visitors any items they wish to bring with them on their visit, such as a gift. It will need to be something that can be easily cleaned by the care home to prevent cross contamination. For example, a box of chocolates that could be sanitised with wipes.

Care homes should support NHS Test and Trace by keeping a temporary record (including address and phone number) of current and previous residents, staff and visitors (including the person/people they interact with – for example if a person visits their loved one who is also visited by a chaplain in the course of the visit), as well as keeping track of visitor numbers and staff.

Covid-19 has not yet been beaten, a single course of vaccinations does not mean that we can relax and risk further outbreaks, it remains our priority to work with providers to keep our vulnerable population safe and we continue to be very supportive of the measures that each provider has in place to control risk within each residential setting.

Visits out of care homes

Following the recent reduction in transmission rates and a gradual reduction in restrictions, national guidance on visits out of care homes (Department of Health and Social Care, 01/05/2021) has been updated to include visits out of care homes: supplementary guidance (Department of Health and Social Care, 01/05/2021) to support external visits and wider social contact with families that often forms an intrinsic part of the care package surrounding individuals.

Guidance from 12/04/2021

As such it is important that we consider social group contacts that are vital to the support for individuals in residential settings, including Supported Living, and that we enable individual risk assessments to be undertaken to support the balance between continued isolation and transmission risks associated with wider social contact.

This risk assessment should be clearly documented and would need to include information on such considerations as:

• Two negative LFD tests in the preceding week on both family and individual visiting
• LFD testing prior to return
• Whether all parties have received their first dose of covid19 vaccination
• Correct use/supply of PPE for the duration of the visit
• An agreed cleaning schedule for any vehicle or home environment
• An agreed isolation plan in the event of a positive case during or returning from the visit
• That there is no active outbreak in the care setting at the time of the planned visit
• That the individual is not travelling into or out of an area of high transmission or where there is a known variant of concern
• That there is no increased risk of transmission introduced through transport, ideally parents to collect
• Consideration of increased risk of transmission through increased social interaction (parties, large gatherings, foreign travel etc).

Supplemental guidance from 04/05/2021

From 4 May 2021, residents should be enabled to leave their care home to spend time outdoors, without subsequent isolation for 14 days, in the following circumstances:

• residents may be accompanied by:
  • a member of care home staff
  • one or both of their nominated visitors
  • their essential care provider (where applicable)
• care homes should discuss arrangements with residents’ nominated visitors, or essential care provider, in advance
• visits should take place solely outdoors, except for the use of toilet facilities
• there should be no visits to indoor spaces (public or private)
• visits should not involve the use of public transport
• Where a care home is situated in a local community with high, or rapidly rising, levels of infection, and/or where there is evidence of variants of concern (VOCs), care home managers should seek additional local advice from directors of public health.

National Guidance:

• Visiting arrangements in care homes (Department of Health and Social Care, updated 04/05/2021)
• Summary of guidance for visitors (Department of Health and Social Care, updated 04/05/2021)
• Visits out of care homes: supplementary guidance (Department of Health and Social Care, 01/05/2021)
• Visits out of care homes (Department of Health and Social Care, 01/05/2021)
• Deputy Chief Medical Officer Blog:  Dr Jenny Harries OBE, Deputy Chief Medical Officer, explains more about the approach to easing care home visiting restrictions in a blog (11/03/2021).

Partners in Care resources

To support the easing of restrictions on care home visits, the National Care Forum has led the creation of a new set of resources called Partners in Care. They’ve been produced in collaboration with Rights for Residents, Relatives and Residents, John’s Campaign and Age UK and backed by many others in the sector.

These resources can be used and adapted by care homes. They include a visiting charter setting out shared rights and responsibilities and a visiting pledge, covering commitments all parties can sign up to.

Some care home residents have received a letter advising them they have been added to the shielded patients list (because they are clinically extremely vulnerable). The Department of Health and Social Care has made an addition to the guidance to make clear being on the list does not prevent care home residents from receiving visitors in the same way as others

The Gold Standards Framework Centre CIC (GSF Centre CIC) which provides training for generalist frontline staff in health and social care, to enable the provision of ‘gold standard’ care for all people nearing the end of life, has published The Gold Signposting and guidance on the Coronavirus Epidemic.

Local Guidance

• Poster giving contact information for if you need support or have questions about palliative or end of life care for your residents
• Essential COVID-19 symptomatic advice and care resources for healthcare professionals and care providers is available through St Margaret’s Hospice. 
• NHS Somerset Clinical Commissioning Group COVID19 End of Life Support Guidance (April 2020)
• Use of oral/buccal medication for symptom control  and a list of oral/buccal medication
• Carer administration of rectal suppositories
• Carer administration of scopoderm patch
• Carer administration of sublingual lorazepam

Join the Somerset Care Homes Palliative Care ECHO network

variety of participants can share best practice and learning – all staff from signed up teams are welcome.

Signed up professionals and care homes will have access to:

• Ten facilitated ECHO sessions per year
• Share knowledge and network with other professionals and care homes in Somerset
• Access to a variety of specialists in palliative care
• Certificate of attendance (following completion of feedback)
• Opportunity to achieve a Champion Care Home award from St Margaret’s Hospice Care where minimum standards are met

The sessions are FREE, held remotely and coordinated by the Hub (St Margaret’s Hospice Care). All you need is a device that you can access the internet and emails on, with a camera, microphone and speaker. No special software is needed – a link will be sent in an email that allows you to join the session directly.  

The network will work slightly different for care homes and health and social care professionals and we have therefore added further information provided by St Margaret’s Hospice below: 

• Information for care homes
• Information for health and social care professionals

Easy Read Palliative Care Resources:

• Getting ready to die
• Choosing where to die
• Changes that can happen at the end of life
• The end of life – the last few days

In response to COVID-19, the Home Office and the Disclosure and Barring Service (DBS) have put temporary arrangements in place to provide DBS checks and fast-track emergency checks of the adults’ and children’s barred lists free-of-charge to healthcare and social care workers being recruited in connection with the care and treatment of COVID 19 in England and Wales.

These arrangements will provide employers with the option to appoint new recruits into regulated activity with adults and/or children, as long as the individuals are not barred, and appropriate measures are put in place to manage the individual until the full DBS check is received.

Guidance has been developed for organisations who need to do these checks, setting out how who can have them and how to complete the applications so these can be easily identified and the right level of information provided as quickly as possible.

These checks will be free of charge to reduce the burden on services at this time of need.

The guidance can be found here (updated 22/10/2020) and all other DBS guidance relating to COVID-19 can be found here (updated 16/07/2020) .

Most EU citizens living in the UK (as well as those from the EEA and Switzerland) need to apply to the EU Settlement Scheme to gain Settled Status so they can continue to live and work in the UK after 30 June 2021.  This includes both employees and care home residents.  The pandemic is having an impact on application times to the EU Settlement Scheme, so it’s vital that people apply as soon as possible.

You can apply for settled status at https://www.gov.uk/settled-status-eu-citizens-families

You should consider the impact on your organisation or business if staff do not have Settled Status, as they will not be able to work after June 2021. You can also play an important role by sign posting your service users to the scheme, as some people in our community may not be aware of the need to apply or may need help.

Local charity Diversity Voice, in partnership with Somerset County Council, are working with the Home Office to provide help from regulated advisors for those who need it, including vulnerable people and employers.  They can provide posters, hand-outs for service users and 1:1 help for applicants in any language.  There’s no charge for this service.

Contact euss@diversityvoice.org.uk or 0300 075 0105.

• Red, amber and green list rules for entering England (Department for Transport, updated 12/05/2021)
• How to quarantine when you arrive in England (Department of Health and Social Care, updated 11/05/2021)
• Travel abroad and coronavirus (COVID-19) (Foreign & Commonwealth Office and Foreign, Commonwealth & Development Office, updated 07/05/2021)
• Coronavirus (COVID-19): safer travel guidance for passengers (Department for Transport, updated 19/04/2021)

• COVID-19: guidance for arranging or attending a funeral during the coronavirus pandemic (Public Health England and Department of Health and Social Care, updated 12/05/2021)
• What parents and carers need to know about early years providers, schools and colleges during the coronavirus (COVID-19) outbreak (Department for Education, updated 12/05/2021)
• Maintaining records of staff, customers and visitors to support NHS Test and Trace (Department of Health and Social Care, 11/05/2021)
• Working safely during coronavirus (COVID-19) (Department for Business, Energy & Industrial Strategy, updated 11/05/2021)
• Actions for schools during the coronavirus outbreak (Department for Education, updated 10/05/2021)
• Coronavirus (COVID-19): guidance for local government (Ministry of Housing, Communities & Local Government, updated 05/05/2021)
• COVID-19: guidance for households with possible coronavirus infection (Public Health England, updated 30/04/2021)
• Guidance for contacts of people with confirmed coronavirus (COVID-19) infection who do not live with the person (Public Health England, 26/04/2021)
• How to stop the spread of coronavirus (COVID-19) (Cabinet Office, 23/04/2021)
• Face coverings: when to wear one, exemptions, and how to make your own (Department of Health and Social Care and Cabinet Office, updated 22/04/2021)
• Making a childcare bubble with another household (Department of Health and Social Care, 15/04/2021)
• Coronavirus (COVID-19): advice on accessing green spaces safely (Department for Environment, Food & Rural Affairs, updated 12/04/2021)
• COVID-19: Guidance for the safe use of multi-purpose community facilities (Ministry of Housing, Communities & Local Government, updated 12/04/2021)
• Making a support bubble with another household (Department of Health and Social Care, updated 29/03/2021)
• Somerset Local Outbreak Management Plan (Somerset County Council, 24/03/2020)
• Coronavirus: How to help safely (Department for Digital, Culture, Media & Sport, updated 05/03/2021)
• COVID-19: guidance for hostel services for people experiencing homelessness and rough sleeping (Public Health England and Ministry of Housing, Communities & Local Government, 06/01/2021) 
• SAGE advice on reducing the risk of coronavirus (COVID-19) transmission in the home (Cabinet Office, 07/12/2020)
• COVID-19 Winter Plan (Cabinet Office 02/12/2020)
• The Cold Weather Plan for England: Somerset Delivery Framework (30/10/2020)
• Local COVID-19 outbreaks: lessons learnt and good practice (Ministry of Housing, Communities & Local Government, 14/09/2020)
• Care Act easements: guidance for local authorities (updated 01/09/2020)
• COVID-19 (coronavirus) absence: A quick guide for parents and carers (Public Health Somerset, September 2020)
• Coronavirus (COVID-19): local death management (Ministry of Housing, Communities & Local Government, 14/05/2020)