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19.9.20- Winter Plan

Letter from the Minister.

The full detail of the plan has been published here. Please read our Executive Director’s blog alongside the below. Four themes run through the plan:

  • preventing and controlling the spread of infection in care settings
  • collaboration across health and care services
  • supporting people who receive social care, the workforce, and carers
  • supporting the system

I have pulled out some key points below. We will continue our analysis over the coming days but at this stage we have some serious concerns over the measures to restrict visitors to care homes in ‘areas of intervention’.

National Support

This section details the steps central government will take.

  • As announced earlier this week, the plan states that over £500m will be made available to extend the Infection Control Fund until March 2021. The plan does not contain any more detail than this and we await further detail next week.
  • To appoint a Chief Nurse for Social Care
  • To work with CQC to create a designation scheme for premises that are safe for people leaving hospital who have tested positive for COVID-19 or are awaiting a test result. – See Vic’s blog for our opinion about this and other statements about discharge in the plan.
  • Commitment to ensure effective testing capacity
  • Improve the flow of testing data to all who need it
  • Free PPE to care home and domiciliary care providers via the PPE Portal until March 2021.
  • Free PPE to LRFs (if they choosen to continue in an area) or LA’s to distribute to social care providers ineligible for the PPE Portal until March 2021.
  • Make available for free the flu vaccine for health and care staff, PAs and unpaid carers

The sections on PPE don’t quite make it clear what the actual offer is. It refers to the portal which is at present offering a very small allocation of free PPE and would need a lot of ‘ramping up’ for it to work on the scale required. The arrangements are rather vague for those needing to access PPE through LRFs or LA’s.

Actions for LAs and NHS

  • LA’s are expected to put in place their own winter plans by 31 October and must have written to DHSC by this date to confirm it is in place.
  • LA’s are expected to distribute the Infection Control Fund money as quickly as possible in line with grant conditions (not yet published)
  • LA’s are expected to work with social care services to re-open safely day services or respite services. Where these can’t be accessed in a way that meets people’s needs, the LA must put an alternative arrangement in place.
  • There are a number of passages of text which imply there will be no discharge to care homes without test being carried out and a test result given but there are also other passages which are vaguer and imply the possibility of taking patients from hospital without a test. This has to be a red line.
  • LA’s and NHS organisations are expected to continue to provide appropriate primary and community care at home and in care homes.
  • CCGs are expected to work with LA’s to identify alternative accommodation where care homes cannot isolate safely. Care homes have a right to refuse admission to residents and should not accept admission if they cannot safely cohort or isolate them.
  • The NHS must also ensure that personalised care and support planning is at the hear of decision making. There should be no blanket decision making. This includes DNACPR orders, decisions on admission to hospital and decisions on the use of ambulances.
  • Directors of Public Health have been told to immediately stop visiting if an area becomes an ‘area of intervention’ – according to PHE, there are over 40 of these.

Actions for Providers

This section outlines the need for providers to do things such as updating business continuity plans and reviewing relevant guidance. Of note:

  • All eligible care providers can register for and use the new PPE portal. All providers must report PPE shortages through the Capacity Tracker, LRFs where applicable or any other relevant escalation or data collection route.
  • Providers ineligible for the portal should contact LRF or LA.
  • Care providers should develop a policy for limited visits in line with up-to-date guidance from their relevant Director of Public Health and based on dynamic risk assessments which consider the vulnerability of residents.
  • Isolate all residents discharged from hospital or interim care facilities for 14 days regardless of COVID-19 test result, unless they have already undergone isolation for a 14-day period in another setting, in line with the admissions to care home guidance.
  • Alert the LA if they have been requested to receive an individual from hospital with a confirmed COVID-19 positive test result

Social Care Taskforce Report

The taskforce report can be accessed here.

17.9.20 Social Care and the Rule of Six Guidance

DHSC has stated the following to our requests for clarification over how the rule of six impacts care, particularly day services and care homes:

“There is an exemption from the gathering limit for people working, this means that someone who is gathering with others where reasonably necessary for work purposes will not be subject to the 6 person limit. There is also an exemption from the gathering limit where the gathering is reasonably necessary to provide care or assistance to a vulnerable person, which would therefore exclude gatherings for the purposes of care from the limit. Residents would likely also be considered as being part of the same household unless for example they were living in separate buildings with distinct shared facilities, and so could gather with each other in groups larger than 6. Gatherings involving people visiting a care home would need to be limited to 6 including the resident(s).  We have also included an exemption for support groups. This means that the majority of support groups are not subject to the 6 person social gathering limit if they are organised by a business, a charitable, benevolent or philanthropic institution or a public body to provide mutual aid, therapy or any other form of support to its members or those who attend its meetings. This includes, but is not limited to, providing support to those with, or caring for persons with, any long-term illness, disability or terminal condition or who are vulnerable;”

11.9.20 – Coronavirus Cases Rising in Care Settings

PHE is reporting that the number of notifications of COVID-19 in care homes is increasing. This letter reiterates the importance of regular testing and the consistent use of PPE. It also states that they are aware of the issues with testing and results and are taking steps to resolve this.

In short, the letter is urging vigilance in the coming weeks and months

11.9.20 – Changes from Monday 14 September

From Monday 14 September, you must not meet with people from other households socially in groups of more than 6, indoors or outdoors. There are exemptions for COVID-19 Secure venues, such as places of worship, restaurants and hospitality venues. Education and work settings are unaffected. More information can be found here. The Secretary of State’s update to Parliament can be found here. See also the following pieces of guidance updated to reflect the changes:

We are seeking clarification about what this guidance means for the full range of care settings, as there isn’t anything explicit about social care. Our current reading is that the rule of 6 applies to social gatherings – not workplaces. So we’d assume that care settings, such as day services and day centres, should be treated as workplaces that need to be COVID secure and are therefore unaffected as long as the necessary rules on social distancing, hygiene and PPE are followed. As stated, we are seeking further clarification.

11.9.20 – Birmingham, Sandwell and Solihull local restrictions

Birmingham, Solihull and Sandwell are introducing tighter lockdown measures from Tuesday to prevent further rises in cases. If you live in the affected areas, you should not:

  • host people you do not live with in your home or garden, unless they’re in your support bubble
  • meet people you do not live with in their home or garden, whether inside or outside of the affected areas, unless they’re in your support bubble.

Do note that there are a list of exceptions which include ‘to provide care or assistance to a vulnerable person’.

These measures come into force on 15 September.

6.8.20 Supported Living Guidance

We finally have Supported Living guidance, nearly 3 months after it was withdrawn!

NCF’s initial reading is that it adopts quite a lot from existing guidance and links to it, such as the domiciliary PPE guidance, rather than anything new. It leaves a lot of the planning, responsibility and operationalisation of the guidance to care providers. In terms of testing, testing will only happen if symptoms are present. There are no mechanisms built-in for asymptomatic testing. We feel there are some odd gaps around what happens to someone in receipt of care if a staff member tests positive – we assume normal Test & Trace procedures would trigger. Please have a read and let us know what you think.

It sets out:

6.8.20 Expansion of PPE Portal (Clipper)

DHSC is rolling out registration on the PPE Portal to larger providers – both residential and home care – so that they are ready if they decide to make larger orders of PPE available. This decision has not been made yet. Providers should receive emails directly inviting them to register. Order limits will remain as they are for now – so only small amounts can be ordered. Larger providers will need to keep their BAU supply chain. PPE ordered via the portal is free.

30.7.20 Change of isolation rules

The self-isolation period has been extended to 10 days for those in the community who have COVID-19 symptoms or a positive test result.

30.7.20 Test & Trace: Business Plan

DHSC has released a document which sets out the next steps in the development of the NHS Test and Trace service over the next 3 to 6 months.

It contains plans to launch a new public health campaign to encourage more people to get testing and to expand testing capacity to 500,000 tests a day.

30.7.20 Self-Isolation on return to UK from high-risk countries for health and social care staff

We have an update on the rules for health and social care staff returning from abroad/travelling to the UK for the first time to work. A few of you raised concerns that members of staff were pointing to exemptions in the guidance to try and avoid self-isolation on their return from annual leave abroad.

From 31 July health and care professionals travelling to the UK from high risk countries will lawfully be required to self-isolate for 14 days. This brings the guidance into line with that for the wider public.

However, self-isolation does not apply for those travelling from countries with which the UK has an air corridor.

29.7.20 – Infection Control Fund Update

The Minister for Care has issued a letter about the Infection Control Fund. It states that the second tranche of funding was paid to Local Authorities on 24 July. More importantly it states that it is not anticipated that use of the clawback mechanisms of the fund will be necessary and that Local Authorities should not be doing this as a result. It gives further clarity as to the rationale for including those conditions in the grant circular.

24.7.20 – Expansion of Flue Vaccination Programme

The government has today announced an expanded flu vaccination programme to protect vulnerable people and support the NHS. The programme aims to vaccinate more than 30 million people this year. The free flu vaccination programme will be extended to:

  • people who are on the Shielded Patient List (SPL) and members of their households,
  • all school year groups up to Year 7
  • people aged over 65
  • pregnant women
  • and those with pre-existing conditions, including at-risk under 2s.
  • Later in the year, it will also be available for people aged 50 – 64

DHSC has also provided a link to order resources to support a staff facing promotional campaign for the take up of the flu vaccine – see here – the ‘I’ve had my flu jab’ order form:

22.7.20 Official Visiting Guidance

The DHSC has just issued its Update on policies for visiting arrangements in care homes

The guidance is structured as follows:

  1. the principles of a local approach and dynamic risk assessment
  2. advice for providers when establishing their visiting policy
  3. advice for providers when taking visiting decisions for particular residents or groups of residents
  4. infection-control precautions
  5. communicating with family and others about the visiting policy and visiting decisions

The guidance sets out very clearly that the first priority continues to be to reduce the risk of COVID 19 transmission in care homes and to prevent future outbreaks. This means that any visiting policy should still be restricted with alternatives sought wherever possible.

However, as the rate of community transmission has reduced, it sets out a framework for how care homes can now develop a policy for limited visits on the basis of a dynamic risk assessment which takes into account the significant vulnerability of residents in most care homes, the specific circumstances of the individual care homes and its local circumstances.

Further analysis can be found here.

17.7.20 – New Powers and framework to help contain COVID-19 locally

DHSC has published a new framework setting out how to manage COVID-19 outbreaks through the use of national and local expertise. It gives additional powers to local authorities.

16.7.20 – Issue with Randox Testing Kits

As you will no doubt have seen by now, DHSC is telling providers to stop using Randox Kits due to a safety issue they are investigating. The accuracy of testing results from these kits is unaffected. The request to stop using them only applies to unused Randox kits. Those already used can still be collected and analysed. DHSC has said providers will be supporting all testing settings to receive replacements kits as soon as possible.

The Secretary of State gave an update on the issue of the Randox tests this afternoon in the Commons – it would appear they are investigating the CE certification of the tests – we are awaiting more information.

16.7.20 – Face Coverings

Face coverings will now be required in shops from 24 July in England. Guidance has been issued in preparation for this and to explain the other settings where face coverings need to be worn.

16.7.20 – DHSC Stats on testing in care homes

DHSC has published statistics to 8 July about the testing in care homes.

It states that 741,021 tests (including those for family members) have been carried out for social care as a whole. 352,946 tests have been carried out for care home residents in Pillar 2 (swab testing through commercial partnerships). Note, that for both figures this isn’t the same as people being tested – an individual can receive more than one test.

Is estimated that an additional 100,900 residents of care homes have been tested via Pillar 1 testing (PHE labs and NHS hospitals). Pillar 1 testing counts the individuals being tested rather than the number of tests carried out.

15.7.20 – Cleaning of non-healthcare settings

PHE has issued guidance on cleaning non-healthcare settings outside the home. The guidance does not apply to settings where care is being delivered but will be relevant for office environments.

9.7.20 – Care Home Support: Council Transparency Data

To improve transparency, the government asked local authorities in England to publish on their websites the financial support they’ve offered to their local adult social care market.

The links in the document go to specific pages where you can read transparency data on each local authority’s website.

Updated 9.7.20 – Guidance for managing a funeral during the coronavirus pandemic

This advice is designed to assist people who are involved in managing or organising a funeral related to a death from any cause during the coronavirus (COVID-19) pandemic. It has been updated to reflect changes regarding overnight stays, instructions for testing and holding post-funeral rituals.

8.7.20 – Guidance for public health officers: potentially infectious persons

How public health officers apply Schedule 21 to the Coronavirus Act 2020 in response to the COVID-19 pandemic.

7.7.20 – Local Lockdowns

Government information on coronavirus includes a section on Local Lockdowns. This currently covers information on social distancing, education and childcare settings, travel, and specific information regarding Leicester.

3.7.20 Adult Social Care Testing Strategy

We’ve had some success! The government has finally listened to the argument NCF and others have put to them about the need for routine, regular testing for the social care sector.

Regular retesting rolled out for care homes + rapid testing for outbreaks

From Monday staff and residents in care homes for over-65s and those with dementia will receive regular, repeated testing. Staff will be tested weekly and residents every 28 days. In August this will be expanded to all care homes. You can now use the coronavirus whole home testing portal to apply for re-tests. Please start doing this ASAP.

A letter from the Director General of Adult Social Care, Rosamond Roughton details how the new testing strategy will work for both care homes with (from 13 July) and without outbreaks (from 6 July). See Annex B of the letter which explains the logistics of re-testing.

Note that bank, agency and visiting staff such as social workers and Allied Health Professionals working in care homes will be included in the weekly staff tests in care homes.

Testing for extra care, supported living

The letter from Rosamond Roughton also contains information about testing for other care settings – something NCF is calling for. However we have no timescales.

Extra care and supported living environments will soon see an expansion of testing to them. An initial round of testing for staff and residents will happen for those settings which meet certain risk-based criteria. The data from the initial round of testing in extra care and supported living will be used to shape how re-testing for these settings will work.

Testing for domiciliary care

The letter from Rosamond Roughton also contains information about testing for dom care settings. They are awaiting the results of a prevalence study from PHE before rolling out asymptomatic testing for domiciliary care. Again, we have no timescales on this.

3.7.20 Extension of VAT tax cut until October

HM Treasury has extended the temporary scrapping of VAT on PPE until the end of October.

3.7.20 Cardinal Facemask Recall – Update

Many of you will have received a recall notice for Cardinal facemasks over the last few days. DHSC has confirmed to us that where customers have purchased these masks from one of the DHSC supported wholesalers, the wholesalers will be in touch to organise a replacement product. The wholesalers which were supported by DHSC and which distributed this mask were:

  • Care Shop
  • Countrywide
  • Blueleaf
  • Deliver-net
  • Nexon
  • Gompels
  • Wightman & Parrish

3.7.20 Local Outbreaks Plans Explainer

The Association of Directors of Public Health have put together an explainer about Local Outbreak Plans to understand what they are and how they will work.

3.7.20 Helping day centres to ‘unlock lockdown’ – King’s College

King’s College London has released a document to help support day centres as they reopen. It covers infection control, communications, supporting staff and volunteers, and yourself, final things providers are likely to want to do before re-opening, and there is a practical scenario planning tool.  At the end are the source documents and further resources. There is also a second document which prompts social care providers to reflect on what has happened and what has to happen next.

2.7.20 Guidance for Taking Swab Samples

PHE has uploaded 2 new videos on how to swab for COVID-19 for social care staff.

2.7.20 Exceedances in Leicester

PHE has published a summary of the descriptive epidemiology of COVID-19 in Leicester. It concludes:

  1. The strongest evidence of an outbreak is given by the numbers of new infections identified in children and working age people, and rising proportion of positive tests also seen in these age groups, from late May onwards. These are trends not observed in other parts of the Midlands, or related travel areas.
  2. Evidence for the scale of the outbreak is limited and may, in part, be artefactually related to growth in availability of testing.
  3. If an outbreak is occurring, then care should be taken to ensure that the artificial geographical reporting boundaries do not obscure a problem that may cross the East Midlands and East of England border

19.6.20 Admission and Care of Residents in a Care Home During COVID-19 Guidance

The admission to care homes guidance has been updated. Please note that guidance about visiting has been removed from this guidance. Separate visiting guidance will be issued by DHSC.

Please note section 5 and Annex B of this updated guidance – they contain detailed care home specific test and trace guidance.

Thankfully this time PHE has included an overview of where changes have been made to the guidance pages 3-4. Key changes include:

  • Overall update in line with recent policy announcements such as the Care Home Support Package and latest symptoms advice
  • 14 day isolation for residents in care homes has been strengthened to align with other documents
  • The period for recovery from an outbreak is now 28 days.
  • PPE, testing, and track and trace sections have been updated to align with recent announcements. The PPE section includes updated advice on PPE distribution and utilisation and additional information on support available to the care sector, hand hygiene and respiratory and cough hygiene.
  • Information on visits has been removed. A separate piece of guidance will be published.

See NCF’s analysis here.

19.6.20 -CPA Visitors’ Protocol

Working with CPA, we have helped created a visitors’ protocol in absence of government guidance. This protocol aims to provide a set of principles and top tips to help people using care and support to have the opportunity to safely receive visitors during the COVID-19 pandemic, while minimising the risk of its introduction to, or spread within, the care setting. It is primarily aimed at care settings which cater for older people, including people with dementia, such as residential and nursing homes. However, it will be of help for other care settings supporting working age people. CPA will be producing further visitors’ protocols. We will also update this protocol when the Government issues further guidance on visitors. A PDF download can also be found on the CPA website linked above.

15.6.20 – Update to PPE Guidance

Guidance for PPE usage in care homes and home care has been updated.

12.6.20 – CPA Briefing note for care providers on reporting to local authorities

CPA has created a briefing note containing examples to support care providers’ reports to local authorities. We are suggesting that care providers should keep reporting to Local Authorities at a high level on the basis that getting into too much detail is an overhead to both the care providers and the LA’s in such reporting. The briefing contains a limited number of different areas at a top level against which care providers can easily allocate costs, whilst also giving a series of examples to prompt providers to think about how to consider their full range of costs.

11.6.20 – HSE Warning on KN95 masks

HSE has issued a safety alert about the poor quality of face masks claiming to be KN95. A substantial number have been found to be poor quality products accompanied by fake paperwork. HSE is stating that KN95 masks must not be used as PPE at work as their effectiveness cannot be assured.

Infection Control Grant FAQs

DHSC has published FAQs on the infection control fund.  It is a very short FAQ and we hope more will follow.

Section 1.1

Confirms that the grant cannot be used for expenditure already incurred but it can be used to pay for the continuation of IPC measures you may have already taken if in line with the grant conditions.

Please note the following sentence.

“The Infection Control Fund was announced on the 13th May and cannot be used retrospectively to cover cost incurred before then.”

It seems reasonable to interpret 13 May as the start date of the fund.

Section 1.2

Reconfirms that Local Authorities may not exclude care home providers because they don’t contract with them and that funding must be alloc on a per-bed basis (75% allocation). However, there is an unhelpful ‘limited circumstances’ clause in this section which states:

‘In some limited circumstances local authorities may need to take account of care home specific circumstances that mean there are a significant number of unoccupied beds not related to the outbreak of COVID-19, for example this could be due to a new and recently opened care home.  In these circumstances, local authorities may add this unallocated funding to the 25% allocation.’

It also states that the 25% of the grant which local authorities have discretion over, can be used for PPE costs if the Local Authority deems appropriate (not retrospectively).

5.6.20 The PPE Portal (Previously known as Clipper)

The government now has a page on its website dedicated to the parallel supply chain for social care. It is quite clear that the scope of this has changed- it is now described as a ’emergency top-up system’ rather than the robust supply chain which was implied to us 2 months ago. We are very disappointed but perhaps unsurprised.

They are prioritising small care providers at the moment and have limited the amount of PPE that can be ordered per week. You will receive an email when you can access the system.

26.5.20 Grant Conditions for Infection Prevention and Control Fund

This should have been circulated on Friday but it appears it was circulated to local authority leaders only. We have only had sight of the final version after it being flagged during the members’ call earlier. It is important to read both the Minister’s Letter and the Grant Circular (Annex C in particular).

22.5.20 – Guidance on the provision of home care

New general guidance has been published for the provision of home care. This does not replace the existing PPE guidance. It is complementary to it.

The new guidance covers:

  • Links to PPE guidance
  • Shielding and care groups
  • Hospital discharge and testing
  • Government support for social care
  • Information collection and governance

Please also see the letter from the Director-General of DHSC.

22.5.20 – FAQs on Care Homes and Care Home Support Plans

Local Authorities have been asked to draw up Care Home support plans. A very detailed FAQ has been created on what this means with some additional information about what commissioners in general need to do and what is being asked of care providers.

22.5.20 – Note about Capacity Tracker

The Better Care Support Team have issued a document explaining the rationale behind the new questions on the Capacity Tracker and the need to complete to receive funding from the new £600m fund.

22.5.20 – Antibody Tests

The government has uploaded more information about the antibody testing programme.

21.5.20 –  New Swab Tests

A new version of the existing swab test (those that tell you if you currently have COVID-19) is being trialed from today which can give a result in 20 minutes on site without having to be sent to a lab. The trial begins in Hampshire – if you have a care home in Hampshire and are part of the trial please let us know.

21.5.20 Infection Prevention and Control Guidance Update

The IPC and general PPE guidance has been updated.  Look at the change log on page 2. Please note the link to this evidence review regarding AGPs.

Updated 21.5.20- Revised PPE guidance and Infection Prevention and Control

The Government has updated the PPE guidance – see here. The main change is a new PDF compilation and a link to evidence review.

The previous change on 14.4.20: The key change was that the Government has updated the COVID transmission status to say that the whole of the UK is now defined as experiencing sustained transmission of COVID 19.

20.5.20 Guidance for stepdown of infection control precautions and discharging COVID-19 patients

The government has updated its IPC guidance for stepdown in hospital or discharge to home or residential settings.

18.5.20 – Expansion of Testing

The government has expanded its testing eligibility to everyone in the UK with symptoms. We’re very aware of the continued issues accessing testing for social care.

18.5.20 – Allocation table for the infection control fund as part of Care Home Support Plan

The allocation table for the £600m infection control fund has now been uploaded to the government website. The allocation formula is in the document. Do also note that each care home should receive an amount per CQC registered bed (not just locally commissioned) representing 75% of the funding. The remaining 25% must be used for infection control measures but local authorities are able to allocate based on need and therefore this may go to domiciliary care.

14.5.20 – Care Home Support Package

Please see the documents detailing the Care Home Support Package (this includes more details about the additional £600m). Please read them carefully and with what was circulated yesterday about testing in mind.

They state that the £600m will be used to reduce the rate of transmission in and between care homes and support wider workforce resilience. It will be ring-fenced and allocated to Local Authorities to distribute. It is in addition to the £3.2bn already allocated and it is expected by the government that Local Authorities will pass on the £3.2bn if they haven’t done already. Local Authorities are being asked to evidence how they have used the £3.2bn.

The Care Home Support Package (referred to as Annex A in the Minister’s letter) contains the following:

  1. Infection prevention and control and PPE: Particularly, training in infection control by CCG infection control nurses, a restatement of the efforts being undertaken to source PPE for LRFs and the establishment of the Clipper system, a statement that workforce movement between care homes should be minimised as far as possible, local authorities are being asked to ensure there are quarantining facilities which can be used before returning a resident to a care home if needed. SAGE have established a sub-group to look at care homes.
  2. Stepping up NHS Clinical Support – including timely access to named clinical contacts, proactive support for people living in care homes, support for care home residents with suspected or confirmed COVID-19 from multi-disciplinary teams where possible and sensitive and collaborative decisions around hospital admissions.
  3. A commitment to comprehensive testing for all residents and staff – it repeats much of the information I shared with you yesterday.
  4. A commitment to oversight and compliance – all local authorities are being asked to review or put in place a care home support plan, informed by the views of care providers. These need to be submitted by 29 May to DHSC.
  5. A commitment to expanding the workforce by 20,000 people in the next three months. This section mentions the new care campaign, CARE badge and app, as well as measures to fast track DBS.
  6. Funding – it reiterates that the £600m is in addition to previous tranches of money given to Local Authorities for social care among other areas. ADASS is currently surveying its members to understand whether the £3.2bn has actually been passed to social care providers – this needs to be completed by 15th May. Local Authorities are being directed to publish on their websites their rate uplifts and other extra funding they may have given to care providers – deadline for this is 29 May. This section also states that £1.3bn was also given to the NHS to support safe and timely discharge from hospitals into care.
  7. There is an Annex which describes in further detail ‘restricting workforce movement and minimising workforce transmission’

Annex B of the letter is the guidance for local authorities and system partners about the Care Home Support Plan. It details what Local Authorities must now do – including evidencing it to DHSC.

Annex C of the letter details emergency support arrangements and states that providers should escalate all issues to their Local Authorities.

Annex D provides an evidence review and international comparisons about deaths and outbreaks in care homes. It contains examples of ‘what good looks like.’

Annex E is a list of relevant guidance for care homes.

13.5.20 – Testing routes and Prioritisation

We have had a series of new information from the government to try and clarify the testing process and how it will be prioritised.

Please note the following from the above documents:

  • Homes referred by PHE and Local Authorities will be prioritised for testing. The prioritisation criteria are in the letter and factsheet.
  • 30,000 test kits have been allocated per day.
  • DHSC is planning to expand the care home portal to include other types of adult social care over the next few weeks – including those catering for adults with learning disabilities
  • Training and advice can be sought from local CCG Director of Nursing about carrying out tests.
  • Tests results should be emailed directly to the registered manager or directly to staff within 72 hours of the test arriving at the laboratory.
  • The matrix details the different routes to testing for different residents/staff and situations.

12.5.20 – Map of Testing Locations

We finally got a map from DHSC detailing the locations of test sites. We will circulate new versions as we receive them.

11.5.20 – Dedicated Testing Portal for Care Homes

The government has created a new dedicated portal for care home staff and residents to access testing, regardless of symptoms. Please let us know if you find any problems with this new system.

11.5.20 – Face Coverings

The plan to lift the lockdown now advises people to wear face coverings (not face masks!) when in enclosed spaces where social distancing is not possible, such as public transport or in the workplace. As such, they have released guidance on making your own face-coverings.

7.5.20 – New Testing System for Care Homes

A letter from the Minister for Care details plans to launch a new digital portal designed to give care homes priority to testing. It implies that testing will be offered to every staff and resident in care homes regardless of symptoms. The system will allow tests to be ordered for care home staff and residents. Local Directors of Public Health, DASS, local NHS providers and PHE are being directed to prioritise social care.

DHSC will work with local bodies to determine where mobile testing units and homes tests should be sent:

These local bodies should:

  • Identify all eligible care homes in a specific LA area
  • Refer homes for testing via the portal (or supporting the care home referring themselves)
  • Provide local contacts and support information for each home

We will keep you posted with information as it appears. We will be interested to see whether this starts to solve some of your issues accessing testing. We don’t have any timescales yet.

6.5.20 – Answers to PPE Questions from PHE

We have had a few answers to questions you asked us to pose to PHE. Some answers will require follow-up, but take a look a the answers to questions 5 and 6 in particular about the changing of masks when moving between residents with symptoms and those without.

30.4.20 – No VAT on PPE

From tomorrow (1 May 2020), PPE purchased by care homes, businesses, charities and individuals to protect against Covid-19 will be free from VAT for a three-month period.

Updated 30.4.20 – How to Work Safely in Domiciliary Care Settings

PHE has finally published its guidance for those working in domiciliary care. It is applicable to visiting homecare, extra care housing, and live-in homecare. Please see NCF’s summary analysis.

30.4.20 – Testing for Social Care

There has been a further expansion of testing. Testing now includes:

  • Everyone in England aged 65 and over with coronavirus symptoms can now get tested, along with symptomatic members of their households
  • Symptomatic workers who are unable to work from home also eligible for testing
  • Testing of all asymptomatic NHS and social care staff and care home residents also being rolled out
  • New expansion of testing made possible due to rapidly increasing testing capacity

More information on getting tested can be found on the .gov website. To access priority testing see below.

“In order to obtain a login, employers of essential workers should email [email protected] with:

  • organisation name
  • nature of the organisation’s business
  • region
  • names (where possible) and email addresses of the 2 users who will load essential worker contact details

Once employer details have been verified, 2 login credentials will be issued for the employer referral portal.”

You can find more information about the self-referral route on the .gov website linked above.

There are three testing routes:


This system is overwhelmed because individual members of staff are in competition with all other key employees from all relevant sectors. At the very least, encourage all staff to access this route if you still can’t access the employer portal.

Employer Referral

This system enables you, as the employer, to provide a list of all staff who require testing and will give you priority, alongside NHS employees. This route does not appear to be working for a significant number of members. However, please continue to try and access. We are escalating from our end.

Resident testing

The testing of residents is being handled by a different system run by PHE and CQC. For testing of care home residents, care homes should contact the local PHE Health Protection Team who will organise swabbing and testing for residents. You can find the contact details for your local health protection team here

We believe that PHE and CQC are also running a number of pilots to test all residents and staff in individual care homes. These involve testing swab kits being sent to care home by courier. They should contact you on your CQC registered email address if they invite you to the pilot.  This entire system relies on an accurate email address being held by CQC. If this is out of date we would suggest that you place forwards from that address to a current one whilst you apply to CQC to make the necessary changes.

Swab Testing

Advice on taking swabs is available at

27.4.20 – Resuscitation

The infection prevention and control guidance has been updated to add a statement following NERVTAG review of cardiopulmonary resuscitation. It does not regard chest compressions as an aerosol generating procedure. See page 40 of the pdf version of the guidance.

27.4.20 – How to Work Safely in Care Homes

The guidance on ‘How to work safely in care homes’ has been updated again. Please see this NCF summary of changes made.

The flowchart has been removed and the key message is now that facemasks are required in all the scenarios outlined in the guidance – so all staff, all the time, in all care settings regardless of symptoms.

17.4.20 – PPE Guidance Update – Table 4 Supersedes Table 2

We have now been told that the published guidance on the use of PPE for care homes and home care provision has been superseded, as well as Tables 1, 2 and 3 in the infection control guidance. All of the superseded guidance is still live on the .gov website so ensure you are looking at table 4. Table 4 is now the relevant guidance you are being advised to follow.

This means that usage of PPE will inevitably increase.

On 17.4.20 we formally asked DHSC to commission PHE to provide guidance to the social care sector on a risk-assessment methodology to be used when such PPE is not available. We have been advising PHE of the importance of this since 2nd April. NCF and the CPA have pushing the government and PHE to ensure that any updated PPE guidance is supported by a practical risk-assessment methodology in light of the current severe PPE shortages.

We are awaiting further information from PHE. **Update** ‘How to work safely in Care Homes was published late on 17.4.20

17.4.20 – CQC Update on Testing

CQC has given us an update on their testing roll-out. By the end of this week they will have contacted all 30,000 adult social care providers. The invite to test email is being sent to registered managers and they are asked to refer staff members who are self-isolating to access a test at the nearest site. The list of locations is currently as follows and more are being added:

  • Birmingham
  • Chessington
  • Gateshead
  • Gatwick Airport
  • Greenwich
  • Leeds
  • Manchester
  • Smethwick, Birmingham
  • Nottingham
  • Plymouth
  • Preston
  • Sheffield
  • Stansted Airport
  • Twickenham
  • Warrington
  • Wembley
  • Worcester

CQC is now working on a pilot of home testing which will start in the adult social care sector. This is aimed at those who cannot travel by car to the above locations.

A privacy notice for testing can be found on the .gov website and contains information about home testing kits and how that process will work.

17.4.20 – Extension of testing to other frontline workers

The government has announced it is expanding testing to more frontline workers beyond Social Care workers and NHS staff. Included among those now eligible for testing are: police, fire service, frontline benefits workers and those working with vulnerable children and adults.

16.4.20 – PPE Exchange

We have been made aware of a website resource launched this week which puts PPE suppliers and care providers in touch with one another to help try and source PPE. It provides updates of PPE in real time as to what is needed and what is available from suppliers. It was developed by a UK software house and is not connected to the government. It is free to use.

16.4.20 Expanded testing to social care

The government has finally agreed to offer testing ‘for all who need’ it in social care settings. Guidance on accessing testing can be found here. This should be read alongside the new Social Care Action Plan ( updated 16.4.20). The testing will include:

  • All symptomatic care residents
  • All patients discharged from hospitals before going into care homes
  • All social care staff who need a test will now have access to one with CQC to contact all 30,000 care providers in coming days

While welcome news, this comes way too late in the day. NCF has been asking for this testing since day one of the pandemic. It seems that the mantra ‘what gets measured matters’ has been applied to the lives of people in care homes, and without the vital test to tell us that many were suffering, ministers and officials were unable to see the impact of the pandemic outside of the hospital environment. This needs to stop now and NCF will be continuing to apply pressure to the government to see social care as an essential service. To win this ‘war’, the government needs to rapidly equip its whole army of health and social care with the equipment and the resources to fight the fight on every front.

1.4.20 – Parallel Supply Chain & Other Suppliers

DHSC is developing a Parallel Supply Chain to support the normal supply chain with a focus on delivering core PPE products for COVID-19. Until the new solution is fully operational, they are:

  1. Working to provide stock of PPE to wholesalers and distribuors for pharmacies, GPs, dentists, adult social care providers (such as care homes), and the third sector (such as hospices).
  2. Providers who have an urgent requirement for PPE, which they are unable to secure through their business as usual channels, should contact the National Supply Disruption Response (NSDR) via the 24/7 helpline: 0800 915 9964.


The seven wholesalers are: