New Government guidance: COVID-19 testing in adult social care

Published 12 abril 2022

On 31^st March 2022, the Government issued updated guidance for adult social care providers and staff (“the Updated Guidance”). The guidance replaces all previous guidance for testing in adult social care settings and applies to:

• Care homes;
• Homecare organisations;
• Extra care and supported living services;
• Adult day care centres;
• Personal assistants;
• Shared lives carers; and
• Social workers.

The key points arising from the Updated Guidance are:

• Care homes and homecare organisations are eligible for free testing if they are regulated by the Care Quality Commission.
• Asymptomatic staff testing continues and staff should conduct two lateral flow tests a week, taking them before they begin work and spaced three to four days apart.
• Staff with symptoms should take a lateral flow test as soon as they develop symptoms and take another test 48 hours after the first test.  Symptomatic staff should stay away from work and conduct a lateral flow test at home. Staff can come into work if both lateral flow test results are negative and medically fit to do so.
• Staff who have a positive test should return home, ideally using private transport, if they are on site, and follow the guidance for people with symptoms of a respiratory infection including COVID-19 here https://www.gov.uk/guidance/people-with-symptoms-of-a-respiratory-infection-including-covid-19 . The key points are:
  • to stay at home and avoid contact with other people for five days after they take the test, and until they feel well enough to resume normal activities and no longer have a temperature;
  • to work from home if they can, and if they can’t to talk to their employer about other options; and
  • avoid meeting people at higher risk of becoming seriously unwell from COVID-19, especially those whose immune system means that they are at higher risk of serious illness from COVID-19, despite vaccination, for 10 days after the day they took their test.

However, as many social care providers are likely to be working alongside or in partnership with NHS providers and/or commissioners, regard should also be had to the new guidance for managing healthcare staff in the NHS and NHS commissioned services with symptoms of a respiratory infection or a positive COVID-19 test which is set out here . The key points are:

• Routine twice-weekly asymptomatic testing of patient facing healthcare staff.
• Staff who have symptoms of a respiratory infection and have a high temperature or do not feel well enough to go to work are advised to stay at home, avoid contact with other people, and follow the guidance here.
• Patient-facing healthcare staff who have symptoms of a respiratory infection, and who have a high temperature or do not feel well enough to attend work, should take a lateral flow test as soon as they feel unwell. They should follow the guidance below if the test is positive.
• If the lateral flow  test result is negative, they can attend work if they are clinically well enough to do so and they do not have a high temperature unless they work with patients whose immune system means that they are at higher risk of serious illness despite vaccination. In that case, they should discuss this with their line manager who should undertake a risk assessment.
• If the staff member is still displaying respiratory symptoms when they return to work, they should also speak to their line manager who should undertake a risk assessment.
• All patient-facing healthcare staff should resume routine asymptomatic lateral flow  testing when they return to work, taking the first of these tests 48 hours after the lateral flow test that was positive.
• Staff must continue to comply rigorously with all relevant infection control precautions and PPE must be worn properly throughout the day.
• Staff who have a positive COVID-19 test result, regardless of whether they have symptoms, are advised not to attend work for 5 days.
• Patient-facing healthcare staff can return to work after a positive COVID-19 test when they have had two consecutive negative LFD test results (taken at least 24 hours apart). The first lateral flow test should only be taken 5 days after the day symptoms started. They may return to work immediately after the second negative lateral flow test result provided they meet the following criteria:
  • they feel well enough to work, and they do not have a high temperature
  • if they work with patients whose immune system means that they are at higher risk of serious illness despite vaccination, a risk assessment should be undertaken, and consideration should be given to redeployment until 10 days after their symptoms started (or the day their first positive test was taken if they did not have symptoms)
  • they must continue to comply rigorously with all relevant infection control precautions and PPE must be worn properly throughout the day.
  • If the staff member’s lateral flow test result is positive on the 10th day, they should discuss this with their line manager who may undertake a risk assessment.
  • Healthcare staff who are contacts of a confirmed case of COVID-19 should continue twice weekly asymptomatic lateral flow testing. Where they are a household or overnight contact of someone who has had a positive test they should discuss ways to  minimise risk of onwards transmission with their line manager.
  • While they are attending work, staff must continue to comply rigorously with all relevant infection control precautions.
  • If staff develop any symptoms within a 10 day period of being a close contact they should follow the advice above for staff members with symptoms.

WHAT DOES THIS MEAN FOR EMPLOYERS?

Managing staff absence levels due to COVID-19 and the impact this has on service delivery remains a significant challenge for healthcare providers.  The new Guidance endeavours to address the particular challenges of COVID-19 in the health and social care environment.

We knew from the Government’s Living with COVID-19 strategy that, at this stage of the pandemic, the onus would move onto employers and individuals to manage the risk of COVID-19 transmission rather than requiring compliance with emergency legislation brought into deal with the pandemic.  1^st April was the backstop date for this shift, and organisations now need to ensure their managers and staff are complying with the current guidance. Moreover, independent sector organisations will also need to be cognisant of the NHS-specific guidance which NHS partner/commissioning bodies may expect to be followed in other adult health and social care settings.

For the time being at least, testing continues to play a central role in both the health and social care sectors, along with the rigorous application of infection control measures in the workplace.  The Government’s updated guidance for all employers (Reducing the spread of respiratory infections, including COVID-19, in the workplace) confirms that employers are no longer required to explicitly consider COVID-19 in their statutory health and safety risk assessments.

However, our view is that it remains important to ensure statutory health and safety risk assessments are reviewed and refreshed given the general duty to provide employees with a reasonably safe place of work.  Employers will also need to carry out individual risk assessments in the circumstances detailed above, as well as for those employees who are immune-suppressed.  The pre-pandemic requirement for pregnant employees to have a specific risk assessment also remains in place.