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 21/07/2021)
• Moving to step 4 of the roadmap (Cabinet Office, 19/07/2021)
• Guidance for local authorities and clinical commissioning groups in the delivery of direct payments and personal health budgets (Department of Health and Social Care, 19/07/2021)
• Using direct payments during the coronavirus outbreak: full guidance for people receiving direct payments and personal assistants (Department of Health and Social Care, updated 19/07/2021)
• Overview of adult social care guidance on coronavirus (COVID-19) (Department of Health and Social Care, updated 23/06/2021)
• Getting help with daily activities outside your home during coronavirus (Department of Health and Social Care, updated 21/05/2021)
• Coronavirus (COVID-19): providing home care (Department of Health and Social Care, updated 17/05/2021)
• COVID19: ethical framework for adult social care (28/04/2021)
• Guidance for care of the deceased with suspected or confirmed coronavirus (COVID-19) (22/04/2021)
• Coronavirus (COVID-19): support for care homes (updated 01/04/2021)
• 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 COVID-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

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 Vaxzevria (previously COVID-19 Vaccine AstraZeneca) (Medicines and Healthcare Products Regulatory Agency, 19/07/2021)
• Regulatory approval of Pfizer/BioNTech vaccine for COVID-19 (Medicines and Healthcare Products Regulatory Agency, updated 09/07/2021)
• Regulatory approval of COVID-19 Vaccine Moderna (Medicines and Healthcare Products Regulatory Agency, updated 25/06/2021)

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, and want to say a huge thanks to you all for making this possible. 

In order to pick up the remaining staff who have yet to be vaccinated these can be booked via the National Booking Service.  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

NHS Somerset CCG is also been providing walk in vaccination clinics at different venues throughout the County, please visit their website for details of dates and times. 

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.

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.

Vaccination for pregnant women

From 13/05/2021 the National Booking Service will enable pregnant women to book appointments at a site that offers the Pfizer-BioNTech or Moderna vaccine following a series of screening questions.  

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.

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

• 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.

Vaccination Buddy programme now live

In your day to day work you may come into contact with people who have questions and concerns about the Covid-19 vaccination.  Public Heath Somerset has launched a Vaccine Buddy programme in partnership with Spark Somerset.  This programme provides a trained a team of volunteer Vaccination Buddies who can offer 1-2-1 telephone support to people who are worried or unsure about having the vaccine.

The Buddies come from all walks of life and have the right skills to support people to make informed decisions about having the Covid-19 vaccination.

Individuals can be referred (or self-refer) to the scheme and a fully trained Vaccination Buddy will then contact them by phone to discuss their concerns and offer information and reassurance.

Please share or complete this form to make a referral.  If you have any questions or comments, please don’t hesitate to get in touch with Helen.Fielden@sparksomerset.org.uk at Spark Somerset.

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 14/06/2021)
• 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

• Coronavirus (COVID-19) vaccine (updated 22/07/2021)
• The COVID-19 vaccination programme (Public Health England, updated 14/07/2021)
• Public Health England Vaccine Communications Toolkit for Adult Social Care (updated 23/06/2021)
• COVID-19 vaccination: women of childbearing age, currently pregnant or breastfeeding (Public Health England, 14/06/2021)
• 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, 17/06/2021)
• Recorded webinar:  Webinar: Your Questions Answered on the COVID-19 vaccine (Department of Health and Social Care, 21/05/2021)
• 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 21/07/2021)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.

Further Information:

Coronavirus (COVID-19) risk assessment (NHS Digital, 25/03/2021)

• Department of Health and Social Care:
  • National strategy for autistic children, young people and adults: 2021 to 2026 (updated 22/07/2021)
  • Alcohol and drug misuse prevention and treatment guidance (updated 21/03/2021)
  • COVID-19: supporting adults with learning disabilities and autistic adults (updated 19/07/2021)
  • COVID-19: providing unpaid care to adults with learning disabilities and autistic adults (updated 19/07/2021)
  • Supported living services during coronavirus (COVID-19) (updated, 16/07/2021)
  • Bridging the gap: Transitional Safeguarding and the role of social work with adults (03/06/2021)
  • Supporting people living with dementia through safeguarding processes (updated, 31/03/2021)
  • COVID-19 testing in general practice (04/03/2021)
  • Restricting workforce movement between care homes and other care settings (updated 03/03/2021)
  • Vitamin D and care homes guidance (24/02/2021)

• NHS England and NHS Improvement (NHSE&E):
  • Updates to general practice regarding COVID-19 (updated 20/07/2021)
  • Updates to community pharmacy regarding COVID-19 (20/07/2021)
  • Dental standard operating procedure: Transition to recovery (updated 16/07/2021)
  • Dementia wellbeing in the COVID-19 pandemic (15/06/2021)
  • Mental Health needs in Care Homes, a presentation by Dr Amanda Thompsell, National specialty advisor in older adult’s mental health NHSE&I (added 21/05/2021)
  • Mental health, learning disabilities and autism guidance (15/03/2021)
  • Third phase of NHS response to COVID-19 (updated 13/10/2020)
  • 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 03/06/2021)
  • 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 18/05/2021)
  • Best interests decisions: A COVID-19 quick guide (updated 18/05/2021)
  • Best interests decisions: A COVID-19 quick guide (updated 18/05/2021)
  • Prevention in social care (May 2021)
  • COVID-19: Supporting autistic people and people with learning disabilities (updated July 2020)

• Office of the Public Guardian
  
  • Coronavirus (COVID-19): Office of the Public Guardian response (updated 19/07/2021)
  • Making and registering an LPA during the coronavirus outbreak (updated 19/07/2021)
  • Being a deputy or attorney during the coronavirus outbreak (updated 19/07/2021)
  • How to register an EPA during the coronavirus outbreak (updated 21/06/2021)
  • NHS and social care staff: check if a COVID-19 patient has an attorney or deputy (Updated 31/03/2021)

• Medicines and Healthcare products Regulatory Agency
  • Medical devices given exceptional use authorisations during the COVID-19 pandemic (updated 20/07/2021)

• 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)

• Health and Care Video Library:  How to use a pulse oximeter at home (added 28/05/2021)
• University College London have produced a decision guide to support practitioners and family carers of people with dementia during Covid-19 as part of the NHS England Dementia wellbeing in the COVID-19 pandemic guide (added 21/05/2021)
• 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 as Somerset County Council policy during the pandemic:

• 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

From 19/07/2021 all legal restrictions were removed the number of people who can gather both inside and outside.  However, all organisations still have a legal duty to manage risk as outlined in Coronavirus: how to stay safe and help prevent the spread (Cabinet Office, 22/07/2021)

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 published guidance (updated 18/05/2021) commissioned by the Department for Health and Social Care to support day services for vulnerable adults to operate in a safe manner, however it is yet to be updated to reflect the changes that came into effect on 19/07/2021. Somerset County Council asks that all day service providers follow the sections of this guidance that have not been superseded by the changes on 19/07/2021, 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. 

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

Very many thanks to all those who took the time to respond to our Care Provider Survey during June.

Your feedback and contributions have been enormously helpful to our wider health and care system and we are ensuring the results and themes emerging from it are being heard across the Somerset system, including the ICS People Board, County Council Recovery Board and our operational and strategic Care Sector groups.

We were keen to share with you the overarching themes and responses at our earliest convenience, which you can view here.

We were very pleased to hear that, overall, 88% of you have felt ‘well’ or ‘very well’ supported during the pandemic by health and care system colleagues in Somerset, but absolutely recognise amongst your feedback many of the concerns, asks, wants and needs you still have, particularly in relation to continued communication/engagement with us, help with recruitment and retention, concerns re financial sustainability, and the importance of mental health and wellbeing support.

We would like to remind you of the next Provider Webinar scheduled for Thursday 22 July 2021, 16:00 – 17:00.  We will be using this session to explore the survey results in more detail and update you on some of our plans to provide ongoing or improved support in some of these key areas, as well as ensuring time for more general Q&As you may have following national and local developments.  We hope you can join us later this month and, in the meantime, find this overarching analysis helpful.

• Webinar with Mel Lock on 22/07/2021

In this webinar Mel Lock (Somerset County Council’s Director of Adult Social Care) was joined by Niki Shaw (Strategic Manager: Quality & Performance ), Dave Partlow (Strategic Manager: Acutes, Safeguarding and Partnerships) and  Liz Green (Health Protection Practitioner, Public Heath Somerset).  The agenda included:

• • Welcome
  • Feedback & Next Steps: Somerset Care Provider Survey (June 2021) – Niki Shaw
  • Question & Answers – this was an opportunity for providers to raise any questions they had for Adult Social Care and Public Health colleagues
  • Any other business

• • • View the webinar
    • View Niki Shaw’s presentation

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 (Department of Health and Social Care, updated 02/02/2021) including leaflets for patients, the admission and care of people in care homes (Department of Health and Social Care, NHS England, Public Heath England and the Care Quality Commission, updated 16/07/2021) and stepdown of infection control precautions within hospitals and discharging COVID-19 patients from hospital to home settings (Public Health England, updated 22/03/2021).  On 17/05/2021 the national guidance was updated on Discharge into care homes: designated settings (Department of Health and Social Care, NHS England, Public Heath England and the Care Quality Commission, updated 17/05/2021) 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).

The Government has also published guidance on Hospital discharge and community support: policy and operating model (Department of Health and Social Care, updated 05/07/2021)

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 government 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, such as internal risk assessment and infection prevention and control protocols.

Each care home is unique in its physical environment and facilities, and the needs and wishes of their residents. As such, care home managers are best placed to develop their own policies (in consultation with residents and their relatives) to ensure that the visits described in government guidance are provided in the best way for individual residents, their loved ones, and care home staff.

If the provider or manager has any queries regarding visiting, a range of additional support is available. Providers may wish to seek advice from their local Director of Public Health (DPH) or Director of Adult Social Services (DASS), both of whom have an important role to play in supporting visiting, and in supporting the care home to deliver the visits described in this guidance. Additionally, care homes may wish to make use of the resources provided by Care England and Partners in Care, a coalition of providers, relatives and residents organisations facilitated by the National Care Forum.

The Government has published updated guidance on care home visiting (Department of Health and Social Care, 16/07/2021) which came in to effect from 19/09/2021.  This includes summary of guidance for visitors (Department of Health and Social Care, updated 16/07/2021).  In summary, the guidance states that all care homes, except in the event of an active outbreak, should seek to enable::

• every care home resident can have ‘named visitors’ who will be able to enter the care home for regular visits. There is 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.  These named visitors should remain unchanged, within reason and should comply with the arrangements for testing, PPE and limiting close contact laid out in the guidance on care home visiting (Department of Health and Social Care, 16/07/2021).
• 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).
• named visitors and residents are advised to keep physical contact to a minimum (excluding essential care givers). Physical contact like handholding is acceptable if hand washing protocols are followed. Close personal contact such as hugging presents higher risks but will be safer if it is between people who are double vaccinated, without face-to-face contact, and there is brief contact only.
• care homes can also continue to offer visits to friends or family members through arrangements such as outdoor visiting, rooms with substantial screens, visiting pods, or from behind windows.
• Visits in exceptional circumstances including end of life should always be enabled..

In terms of the arrangements for visits:

• The individual resident, their views, their mental capacity, 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 government 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.
• Care homes are best placed to decide how often and for how long it is possible for visitors to come into the home. This is likely to be determined by practical considerations such as the layout of the home, and the numbers of residents and families who wish to have visits. In practice this is likely to mean that the frequency of visits is limited by setting-specific constraints.
• It is recommended that the care home has a simple booking or appointments system to enable visits. Ad hoc or unannounced visits may not be possible.
• 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, 19/07/2021). This guidance sets out the appropriate levels of PPE for a range of scenarios.
• Visitors should limit contact with residents and staff, and maintain as much distance as possible.
• 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 before conducting visits.
• If there is a restriction to visitors in place, alternative ways of communicating between residents and their families and friends should be offered. The care home should also provide regular updates to residents’ loved ones on their mental and physical health, how they are coping and identify any additional ways they might be better supported, including any cultural or religious needs.

Providers are best placed to design individual visiting arrangements that take account of the needs of their residents and what is possible within the layout and facilities within the home. In this context, the provider must develop a dynamic risk assessment that assesses how the care home can best manage visits safely, and how this is delivered.

This dynamic risk assessment should consider relevant factors relating to the rights and wellbeing of the residents. Any risk assessment should follow the CQC regulatory framework around providing person centred care. It may also be appropriate or necessary for providers to apply different rules for different residents based on an assessment of risk of contracting COVID-19 in relation to such residents, as well as the potential benefits of visits to them. The risk assessment should consider the need to enable essential care giver visits.

Some residents will 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 this guidance on the conduct of visits. If so, providers should work with the resident, their family, friends and any volunteers to develop a tailored visiting policy within the principles outlined in government guidance.

In all cases it is essential that visiting happens within a wider care home environment of robust infection prevention and control (IPC) measures. The government has produced infographics which may be useful in supporting visitors to follow good practice with hand hygiene (hand washing or using hand sanitiser) and putting on and taking off PPE.

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 – and for essential care givers) to protect vulnerable residents, staff and visitors.

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.

Testing of Named Visitors

Testing of visitors onsite at the care home is preferable for assurance purposes. However, recognising that individuals now have access to testing through other routes and visitors may be travelling long distances to visit, care home managers can allow visitors to provide evidence of a recent negative test undertaken through other means, if the test has been taken that same day. Alternative routes may include:

• assisted testing at another lateral flow site such as an asymptomatic testing site (ATS)
• self-testing at home through test kits provided by the care home using packs of 7 test kits (which the MHRA has authorised for self-test use)
• self-testing at home using test kits provided by the government such through a school, workplace, the universal testing offer, or collected from a pharmacy

Wherever the test is conducted, it must be done on the day of the visit. Once the visitor has reported the test, they will receive confirmation of their result by text message (SMS) and email to show proof of result. Visitors should show proof of a negative test result before every visit, such as:

• an email or text from NHS Test and Trace
• a date-stamped photo of the test cartridge itself

If visitors are not able to produce a negative test, they may be asked to reschedule or be prepared to take the test on site.

Care homes do not need to retain records of proof. All tests done both at the care home and when self-testing at home should be reported to the unique organisation number (UON) of the care home and managers should ensure visitors are aware of their UON and the legal duty to report the result. 

Any potential visitor who tests positive should immediately leave the premises and self-isolate. They should complete a confirmatory Polymerase Chain Reaction (PCR) test which should be provided to them by the care home if testing on site, or ordered by the visitor from the get a free PCR test to check if you have coronavirus (COVID-19) or by calling 119. 

The role of an essential care giver and testing arrangements 

The essential care giver role is intended as a way of supporting residents to benefit from companionship and additional care and support being provided by someone with a unique personal relationship with the resident, perhaps formed over many years. Essential care givers should be allowed to continue to visit during periods of isolation or where there is an outbreak (unless the essential care giver or resident are COVID-positive).

The essential care giver arrangements are intended for circumstances where the visitor’s presence, or the care they provide, is central to the health and wellbeing of the resident, and their health or wellbeing could deteriorate without it. It is likely that the requirement for this support from the resident’s loved one will already be part of (and documented in) their care plan – although this should not be considered a condition of this type of visit. Managers should not assume that, in order to fulfil this role, an essential care giver must commit to visiting a specific number of times each day or week – the care and support provided may still be critical even if it is not provided every day.

Essential care givers  are a central part of delivering the appropriate care and support to the resident, and as such play a role alongside professional members of the care home staff. Additionally, because they will have closer physical contact with the resident, and may spend longer in and around the care home, including areas that other visitors do not enter – it is important that they take further steps to reduce the risks (to themselves to residents and staff members) of infection.

Therefore, these essential care givers will need to follow the following testing arrangements:

• take a minimum of 2 rapid lateral flow tests a week: one rapid lateral flow test on the same day as a PCR test, and one rapid lateral flow test 3 to 4 days later, except in the circumstances relating to testing following a prior positive PCR, outlined below. These rapid lateral flow tests can be done onsite, at an asymptomatic testing site (ATS) or at home with tests that come in packs of 7. These tests should be reported as ‘visitor’ using the care home UON
• take a weekly PCR test and share the result with the home. Care homes should use their existing PCR stocks to test these visitors and these should be registered as ‘staff’ tests using the care home UON and be returned via courier with other staff tests
• be subject to additional testing in line with care home staff should the care home be engaged in rapid response daily testing or outbreak testing. If this includes lateral flow tests, these can be done at home with tests from a pack of 7

This testing must be conducted in accordance with the guidance for care home staff (Department of Health and Social Care, 07/07/2021) on PCR testing, rapid lateral flow testing including rapid response testing, and outbreak testing.

Screening all visitors for symptoms of acute respiratory infection

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.  Screening questions that care homes may wish to ask visitors:

• 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 tested positive for COVID-19 in the past 10 days? (Note: if that positive test was from a rapid lateral flow test and was followed by a negative PCR test within 2 days, that would not preclude the visitor coming in)
• 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.

Visitors who have recently tested positive for COVID-19

Visitors who have recently tested positive for COVID-19 from a PCR test should not routinely be retested within 90 days unless they develop new symptoms or unless specific infection detection and response plans are in place for individuals or in the local area already. This means that some visitors will not need to be tested regularly because they will still fall into this 90-day window. These visitors should use the result of their positive PCR result to show that they are currently exempt from testing until the 90-day period is over following their period of self-isolation. Once the 90-day period is over, visitors should then continue to be tested. They should still continue to follow all other relevant IPC measures throughout these 90 days, including social distancing, maintaining good hand hygiene and wearing PPE.

Visits out of care homes

The national guidance on visits out of care homes (Department of Health and Social Care, 15/07/2021) has been updated to include changes that came in to effect from 19/07/2021.  

There are certain types of activity where the risks are inherently higher and the advice is that in these cases the resident should self-isolate on their return (to the care home). This is to ensure that, in the event they have unknowingly become infected while out of the home, they minimise the chances of passing that infection on to other residents and staff. These activities are::

• overnight stays in hospital
• visits assessed to be high-risk following an individual risk assessment

All other visits out of the care home that are not assessed as high risk should be supported, and not subject to advice to self-isolate on return to the care home, subject to an individual risk assessment (see section on individual risk assessments below). Where applicable, attention should also be given to any additional local guidance provided by the local director of public health (DPH) and director of adult social services (DASS).

All precautions relating to COVID-19 (including social distancing and those set out below) should be followed while out of the care home. Where residents are visiting a location with an existing testing regime – for example a workplace, day care centre or education setting – they should participate in the relevant testing regime for that organisation where possible.

Separate guidance is available on the admission and care of people in care homes (Department of Health and Social Care, NHS England, Public Heath England and the Care Quality Commission, updated 16/07/2021) for use when planning visits that residents may need to make to a hospital or other healthcare setting.

The following measures can support safe visits out of care homes and to minimise the risk of transmission of infection to care home residents and other people they live with in the care home, the following measures are advised and should be considered for all visits out of care homes:

• if appropriate, residents being accompanied by::
  • a member of care home staff
  • one or more of their named visitors, and/or
  • their essential care provider (where applicable)
• residents maintaining social distance from anyone who is not one of their named visitors, essential care providers, or care staff and, wherever possible, avoiding close physical contact with those who are supporting their visit to minimise the risk of infection
• residents avoiding crowded places
• residents avoiding using public transport where possible, especially at peak times; travelling in a family car or private taxi is an acceptable alternative

Where visits out are accompanied by a named visitor, the visitor should follow the relevant testing regime as referenced in the guidance on care home visiting and receive negative test results in the same way as if they were visiting in. Testing arrangements are outlined in more detail in the guidance on care home visiting.

Where possible, anyone else who the resident meets as part of an indoor visit should undertake a lateral flow device test and receive a negative result on the day of the visit. This can be confirmed by the named visitor. All tests should be reported to the Unique Organisation Number (UON) of the care home.

Where residents are visiting a location with an existing testing regime, for example a workplace, day care centre or education setting, they should participate in the relevant testing regime for that organisation where possible.

Others involved in the visit should take steps leading up to the visit to minimise the risk to the care home resident and others in the care home, recognising that introducing COVID-19 to a care home puts all those who live and work there at risk. This includes receiving a negative test and following good infection control practice including social distancing, hand hygiene, wearing face coverings and avoiding crowded places.

If the resident is being accompanied by a member of care home staff, a risk assessment should be carried out. This should assess the COVID-19 transmission risk to the care worker arising from any activities during the visit to ensure that the necessary precautions are in place. This may, for example, include if the care worker is likely to undertake direct personal care, as per the ‘How to work safely in care homes’ guidance, and therefore whether the care worker requires PPE (above the requirements for individuals in a public place). If necessary, the staff member should take the required additional PPE, as well as the means to safely store or dispose of it, along with a spare, replacement face covering with them when they leave the care home.

Individual risk assessments

No visit out of a care home during a pandemic is without risk, but there are steps we can take to reduce those risks. Care homes should discuss and agree arrangements with residents, residents’ named visitors, or their essential care provider in advance.

Decisions about an individual resident’s visits out of a care home should be taken with the resident’s assessed needs and circumstances considered. The care home should balance the benefits of visits out of the care home against a consideration of the risks to others in the home, where necessary.

It is important that the resident and their family are involved in discussions throughout this process. If undertaking a visit out is not possible because of the risk to the individual and other residents and staff, care providers should communicate the reasons for this decision clearly to the resident and their family.

Individual risk assessments should take into account:

• the vaccination status of residents, visitors and staff, including the extent of 2nd vaccinations
• any testing of those accompanying the resident or who they intend to meet on their visit out
• levels of infection in the community
• variants of concern in the community
• where the resident is going on a visit and what activities they will take part in while on the visit
• the mode of transport that residents intend to use

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 or variants under investigation, care home managers should seek additional local advice from their local authority DPH.

Regard should also be given to the ethical framework for adult social care, and the wellbeing duty in section 1 of the Care Act 2014, and 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 consider the rights of residents who may lack the relevant mental capacity needed to make a decision about visits out of care homes. These people are protected by the empowering framework of the Mental Capacity Act (MCA) 2005 and its safeguards. The government has published advice on the MCA and application of Deprivation of Liberty Safeguards (DoLS) (Department of health and Social Care, updated 27/04/2021) during the pandemic.

We remain very happy to support any provider who has concerns and wishes to discuss individual cases with us, please contact using the usual email ASCCovid19@somerset.gov.uk.

Visits in and out of supported living settings

The COVID-19: guidance for supported living (Department of Health and Social Care and Public Health England, updated 16/07/2021) has been updated to include guidance on visits in and out of supported living settings.  This guidance is intended for supported living settings, but many of the principles are applicable to extra care housing for older people. It may also be a useful resource for the wider supported housing sector, such as retirement or sheltered housing.

From 19/07/2021, there are no restrictions on the number of people individuals can meet. People living in supported living settings live in their own homes and visits should be supported and enabled wherever it is safe to do so.

However, a supported living setting may also be a staff workplace and include a range of communal areas and shared facilities. It is therefore important to consider the risks arising from visits, to those taking part, as well as the risks for others with whom they live, or may later come into contact.

In all cases, arrangements for visiting into and out of the setting should be supported by a dynamic risk assessment for the overall setting, as well as an individualised assessment of the benefits of visiting and the risks to particular people because of their care and support needs. The risk assessment should consider people’s rights and decisions should balance the resident’s assessed needs against the consideration of risk of infection. The risk assessment will also need to reflect whether the setting is a ‘high risk’ setting (as designated by the local Director of Public Health).

For visits taking place at the setting, the manager may also wish to consider:

• if a setting has a communal garden area which can be accessed without anyone going through a shared building, then using this space for visits should be encouraged
• if, in shared accommodation, visitors should limit close contact with other people who live there and staff
• visitors should be reminded and provided with facilities to wash their hands for 20 seconds or use hand sanitiser on entering and leaving the home, and to catch coughs and sneezes in tissues and clean their hands after disposal of the tissues

For visits taking place away from the setting, the manager should consider:

• testing visitors who are collecting residents and transporting them to or from the setting, and encouraging any others they may be meeting to conduct a test on the day
• offering support so people can find or go to outside spaces to see their relative in a safer environment
• factors to minimise the risk for staff and other individuals in the supported living setting (including the layout of the premises and the nature of the support provided)
• the nature and context of the visit – for example, whether the visit would include overnight stays in the family home or visits to a public place
• the support needs that the person may have during the visit, and whether they will need to be accompanied by a staff member, carer, family member or friend
• transport for the visit should avoid exposing the person to those outside the household they are visiting, for instance by travelling in a family car wherever possible
• increased communal risks that may arise in shared areas when people return from off-site visits (including shared spaces indoors and outdoors, on-site grouped services and social activities)
• the need for those returning from off-site visits to visits to self-isolate if they test positive for COVID-19, or have been notified by NHS Test and Trace that they have been in contact with someone who has tested positive for COVID-19. There is no expectation for someone to self-isolate for 14 days after a visit has happened if this is not the case

And in all cases, the manager should work with people being supported and their families to:

• make sure that no one with COVID-19 symptoms should participate in a visit and anyone with suspected symptoms should be tested
• make sure that no one visits when an individual is required to self-isolate as they have been a close contact of a COVID-19 case in the previous 10 days, and whether an individual needs to self-isolate if they have travelled to certain countries
• remind them to follow good infection control practice including avoiding close contact, hand hygiene and face coverings, and to consider whether their needs are likely to impact their ability to do so
• where possible, visitors can be given support on how to prepare for a visit and given tips on how to communicate if face coverings are required

Visitor testing is a tool to help mitigate the risks of visiting. Testing is not a requirement for visiting and managers should not refuse visits to visitors who have not taken a test unless they are symptomatic. Visitors must not visit if they are required to self-isolate (Public Health England, 19/07/2021) (for example, if they have been notified of a positive COVID-19 test, are a contact of someone who has tested positive or following travel). The government recommends that visitors participate in testing to reduce risk of introduction of infection through asymptomatically infected people, in particular for higher risk settings with shared living accommodation spaces which have a higher potential for outbreaks.

Testing onsite at the setting is preferable for assurance purposes. However, recognising that individuals now have access to testing through other routes and visitors may be travelling long distances to visit, managers can allow visitors to provide evidence of a negative test taken on the day of the visit through other means including:

• assisted testing at another lateral flow site such as an asymptomatic testing site (ATS)
• testing themselves at home through test kits provided by the care setting
• self-testing at home using test kits provided by the government such as at a school, workplace, the universal testing offer, or collected from a pharmacy

When considering the most appropriate testing route, managers should consider any additional risks that may arise from testing off-site, as well as the confidence and ability of visitors to carry out tests away from the care home. This may include factors such as:

• visitors inaccurately conducting or reporting lateral flow testing themselves
• the increased risk of visitors needing to take public transport to a testing site, particularly where it is far from the setting, or coming into contact with other people
• or where visitors may not have a mobile phone or email address to receive the result of their test
  Where visitors will be self-testing, managers may wish to supervise the first few tests on site and provide support to ensure visitors are confident conducting the tests at home and they are being completed and reported satisfactorily.

Wherever the test is conducted, it should be done on the day of the visit. Once the visitor has registered the test, they will receive a confirmation of their result by text message (SMS) and email to show proof of result. Proof of a negative result may include an email or text from NHS Test and Trace or a date- stamped photo of the test cartridge itself. Managers do not need to retain records of proof. All tests done at home should be registered to the UON of the supported living setting and managers should ensure visitors are aware of their UON and their responsibility to report the result. Being able to link visitors to a supported living setting enables public health teams to better support settings to reduce the transmission of COVID-19 and prevent outbreaks.

Any potential visitor who tests positive should immediately leave the premises and self-isolate. They should complete a confirmatory Polymerase Chain Reaction (PCR) test which should be provided to them by the care home if testing on site, or ordered by the visitor from the get a free PCR test to check if you have coronavirus (COVID-19) or by calling 119. 

Visitors who have recently tested positive for COVID-19 with a PCR test should not be retested within 90 days unless they develop new symptoms or unless specific infection detection and response plans are in place for individuals or in the local area already. This means that some visitors will not need to be tested regularly because they will fall into this 90-day window. These visitors should use the result of their positive PCR result to show that they are currently exempt from testing until the 90-day period is over following their period of self-isolation. Once the 90-day period is over, visitors can then continue to be tested. They should still continue to follow all other relevant IPC measures throughout these 90 days, including limiting close contact, maintaining good hand and respiratory hygiene and wearing PPE if appropriate.

It is not a condition of visiting that the visitor or the resident should have been vaccinated against COVID-19. However, it is strongly recommended that all visitors and residents take the opportunity to be vaccinated when they are invited to do so through the national programme.

National Guidance:

• Visiting arrangements in care homes (Department of Health and Social Care, updated 16/07/2021)
• Summary of guidance for visitors (Department of Health and Social Care, updated 16/07/2021)
• COVID-19: guidance for supported living (Department of Health and Social Care and Public Health England, updated 16/07/2021)
• Visits out of care homes (Department of Health and Social Care, updated 15/07/2021)

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) .

• Travel abroad and coronavirus (COVID-19) (Foreign & Commonwealth Office and Foreign, Commonwealth & Development Office, updated 19/07/2021)
• Red, amber and green list rules for entering England (Department for Transport, updated 19/07/2021)
• Quarantine and testing if you’ve been in an amber list country (Department of Health and Social Care, updated 19/07/2021)
• Coronavirus (COVID-19): safer travel guidance for passengers (Department for Transport, updated 19/07/2021)

• COVID-19: guidance for hostel services for people experiencing homelessness and rough sleeping (Public Health England and Ministry of Housing, Communities & Local Government, 21/07/2021) 
• Face coverings: when to wear one, exemptions, and how to make your own (Department of Health and Social Care and Cabinet Office, updated 20/07/2021)
• Maintaining records of staff, customers and visitors to support NHS Test and Trace (Department of Health and Social Care, 20/07/2021)
• Guidance for contacts of people with confirmed coronavirus (COVID-19) infection who do not live with the person (Public Health England, 19/07/2021)
• COVID-19: guidance for households with possible coronavirus infection (Public Health England, updated 19/07/2021)
• COVID-19 Response: Summer 2021 (Roadmap) (Cabinet Office, updated 19/07/2021)
• COVID-19: arranging or attending a funeral or commemorative event (Public Health England and Department of Health and Social Care, updated 19/07/2021)
• What parents and carers need to know about early years providers, schools and colleges during COVID-19 (Department for Education, updated 19/07/2021)
• Actions for schools during the coronavirus outbreak (Department for Education, updated 19/07/2021)
• Working safely during coronavirus (COVID-19) (Department for Business, Energy & Industrial Strategy, updated 14/07/2021)
• Coronavirus (COVID-19): guidance for local government (Ministry of Housing, Communities & Local Government, updated 13/07/2021)
• Coronavirus (COVID-19): local death management (Ministry of Housing, Communities & Local Government, 24/05/2021)
• COVID-19: Guidance for the safe use of multi-purpose community facilities (Ministry of Housing, Communities & Local Government, updated 17/05/2021)
• 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)
• SAGE advice on reducing the risk of coronavirus (COVID-19) transmission in the home (Cabinet Office, 07/12/2020)
• Local COVID-19 outbreaks: lessons learnt and good practice (Ministry of Housing, Communities & Local Government, 14/09/2020)
• COVID-19 (coronavirus) absence: A quick guide for parents and carers (Public Health Somerset, September 2020)
• Coronavirus (COVID-19): support for victims of modern slavery (Home Office, 06/04/2020)
• Coronavirus (COVID-19): working safely (Health and safety Executive)
• Working with migrants and refugees during the COVID-19 crisis (Chartered  Institute of  Housing)