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From midnight on Monday 4 January Portsmouth, along with the rest of England, moved into national lockdown, due to the rate that the virus was increasing across the country and the pressures on our local health and care services. With the new variant SARS-CoV-2 identified in London and the South East spreading more quickly we expect to see a further increase in infection rates during January and February and continued pressures on the system.

The Government has temporarily updated the care home visiting advice with visits to care homes only taking place with arrangements such as substantial screens, visiting pods, or behind windows. Close-contact indoor visits supported by testing, are not allowed during lockdown. No visits will be permitted in the event of an outbreak. Read more about what is allowed during lockdown. Close-contact indoor care home visits cannot currently be supported unless in exceptional circumstances such as end of life.

It is essential that any exceptional visits still happen within a wider care home environment of robust Infection Prevention and Control (IPC) measures, including ensuring that visitors follow good practice with hand hygiene and the use of Personal Protective Equipment (PPE).

As the infection rate continues to increase we ask everyone to maintain heightened awareness and follow the national guidance to reduce the risk to the most vulnerable members of our city.

What to do following exposure or outbreak in social care setting – December 2020 update

We are seeing increased exposures and outbreaks in social care settings in the city.

This outbreak flowchart lists the actions you should take, including when to inform the Hampshire and Isle of Wight health protection team (HPT).

Please report to the HPT in the following circumstances:

  • single case of suspected or confirmed COVID-19, ILI or flu in a resident (we can arrange testing and will give IPC advice)
  • suspected outbreak of COVID-19 or flu in the care home (we can arrange testing and will give IPC and outbreak management advice)
  • more than one staff member off sick with symptoms of COVID-19 or ILI OR 1 staff member laboratory confirmed with COVID-19 or flu
  • any concerns about the management of cases/outbreaks of COVID-19 or flu

To contact the HPT, please call 0344 225 3861 (0844 967 0082 out of hours), choose the COVID-19 option and ask for the local health protection team.
Please note this number will put you through to Public Health England, who can provide general advice on health protection matters but will put you through to the local team if local action or risk assessment is required.

Information for care homes

There is a lot of information available to support care homes. It’s being updated regularly, so we’ll be saving updates and signposting to the latest guidance from this portal:

National Capacity Tracker for Care Homes

All homes should be signed up to the National Capacity Tracker and entering data on at least a daily basis.

The Coronavirus support for care homes support package sets out the support that is available to your care home during the COVID-19 pandemic that helps to protect your residents and staff.

This support is being provided through access to effective infection control training/support, clinical support and testing for asymptomatic residents and staff. Local authorities are being asked to ensure that this support reaches you directly and to ensure this happens. To do that, we’re asking you to complete a template confirming the actions you are taking.

To implement this, and to avoid multiple requests for information, the capacity tracker is now collecting information on:

  • infection prevention and control measures
  • testing
  • Personal protective equipment (PPE) and clinical equipment
  • workforce support
  • clinical support.Please can you ensure you are completing all sections daily, or more often when any response changes.

Your answers will help:

  • the NHS to understand if you have been able to implement the guidance and access the support available.
  • local authorities to direct support to care homes to manage COVID-19
  • local authorities, local resilience forums and CCGs to see where support is required and what is needed.

Home managers are now also asked to enter data on new laboratory confirmed or clinically suspected cases of COVID-19 infection in either residents or staff on the Capacity Tracker every day.

Covid 19 positive resident numbers need to be removed from the capacity tracker once the home has passed 28 days from the date of the last suspected / confirmed case. At this point the home is considered ‘recovered’.

Once past the 28 day marker this will trigger the home back into the Covid 19 retesting regime and it is expected the home will undertake whole home testing for those who have tested negative previously and then weekly testing of staff.

This data will be used by Local Authority Directors of Public Health and Directors of Adult Social Services and their partners, local Health Protection Teams, Clinical Commissioning Groups, and care homes themselves to understand how effectively any identified outbreaks are being controlled and what further help and support may be needed.

NHSmail accounts

NHSmail has been set up for social care providers, to enable the secure exchange of patient or sensitive information with other health and social care organisations.

With the active use of NHSmail we wanted to provide you with some support to manage the account and help with any frequently asked questions (FAQs) you may have.

NHSmail FAQs

What to do if you are joining a social care provider and require an NHSmail account?

  • If you do not have an NHSmail account you will need to inform the shared mailbox owner for your new provider. This is likely to be the organisation’s manager or administrator. This can be setup by another individual at the specific home who has an account already. Most homes when setting up have 2 individuals designated as connected to the homes shared mailbox.
  • You will need to provide them with your personal mobile phone number, as your password will be sent to you via a text message. The existing NHS mail account holder will need to login to their own account and open up the shared mailbox.
    From that shared mailbox account they need to send an email to careadmin@nhs.net and ask for a new account to be setup for that particular home with the following details:
  •      First name and surname of the person needing the new account
  •      The job role of the new person (so for your specific enquiry new registered manager)
  •      An email address for the incoming person (can be personal email but this is where the setup stuff is sent)
  •      A mobile phone number for the incoming person (as the unlocking password is sent to this by text message)
  •      NHS Digital will do all the setup work on the new account and email & text the details to the new person usually within 24 hours.

What do I need to do if I’m moving to another provider or leaving social care altogether?

If your account is administered by the national administration service team:

  • If you are leaving your organisation you will need to notify the national helpdesk via careadmin@nhs.net . They will mark your NHSmail account as a ‘leaver’ and ensure that you are removed from any shared mailboxes you no longer need access to.
  • If you are moving to another health or social care organisation you will also need to inform the national helpdesk. This is so that they can mark your NHSmail account as a ‘joiner’ and ensure that you are added to the shared mailbox of your new organisation, if needed.
  • If you are leaving the social care profession and no longer require an NHSmail account, your account will be permanently deleted 30 days after being marked as a ‘leaver’. You should ensure any data required by your team is saved locally, for them to access at a later date.
  • If you are a shared mailbox owner, you will need to ensure a new owner is identified and the national helpdesk are informed.
  • Update: Changes to shared mailbox names

Telemedicine service

Telemedicine service

Immedicare provides the Telemedicine Service which was first introduced in Portsmouth in December 2019. Since the first introduction to a small number of homes, additional homes across the City are now benefiting from accessing the great service.

During this time, almost 300 calls have been made. Following a telemedicine consultation 90% residents were able to remain in their home (with just 9% requiring an ambulance call out).

We would like to raise awareness and encourage you to use the service whenever you need any additional reassurance, advice, or that bit of extra help and support for your residents and staff team.

When should I use the Telemedicine service?

You can phone and speak to a member of the team if you need reassurance, help or support. You can phone any time you feel that something “isn’t quite right” with your resident, you know them best.

Some examples are below:

  • Falls, slips, trips
  • Suspected UTI’s/ Chest infections
  • Wound care
  • Breathing difficulties
  • Pain management
  • Skin complaints; localised infection or swelling
  • Assist in verifying an expected death of a resident

Please remember the Telemedicine service is not an emergency service. If you have an emergency you should still call 999.

Please be assured that no question is a ‘silly’ or ‘small’ question. The Telemedicine Service is here to enhance the care that you deliver.

What are the benefits of calling the Telemedicine Service?

There are a number of benefits to you, your team and the residents when you use the Telemedicine Service.

The Telemedicine Service aims to:

  • Support care homes to make joint decisions, resulting in residents (if possible) remaining in their own home and being cared for by someone they know.
  • Provide ongoing support and reassurance for staff and the resident when required.
  • Coordinate care and any referrals with the other health care professionals.
  • Reduce avoidable GP call outs, 111 calls, and ambulance or A+E attendances

What are people saying about the Telemedicine Service?

Positive feedback has been collected over the last few weeks which shows the benefits of the service.

GP Partner Trafalgar Medical Group Practice and Director Portsmouth Primary Care Alliance Ltd, Dr Howard Smith says:
“Feedback from our existing telehealth users has been very positive – staff in our Care Homes have video access 7 days a week, 24 hours a day to Specialist nurses and Doctors who have full access to residents medical records. The service provides timely clinical assessments meaning residents can receive the right care at the in the right place and unnecessary delays and conveyances to hospital can be avoided”

Caroline Berry, Registered Manager, Russets Respite and Residential Services says:
“We found it (Telemedicine service) very helpful and easy to use. There has been great support to the team at Russets on how and when to use it. It’s also good to know that it is available for us to have face to face consultations and seek advice when we need that extra support.”

If you would like any more information about the Telemedicine Service, please contact Paula Grundy (Immedicare – Telemedicine Service). Paula is your local Relationship Manager for SE Hampshire.
You can contact her Monday through to Thursday by:

Telemedicine- Support for ambulance crews attending care homes

Across Portsmouth and South East Hampshire, South Central Ambulance Service (SCAS) and the Telemedicine Service Provider for Care Homes (Immedicare) have developed a formal pathway to provide ambulance clinicians with multi-disciplinary support when attending residents in Care Homes. Please see the attached information.

Families and visitors

Visits to care homes

The Government has released guidance on enabling visitors to residents in care homes:

It is currently understood that the majority of care home transmission is caused by asymptomatic staff rather than visitors and that the risk of transmission from visitors must be balanced alongside the positive impact of visits to residents from their loved ones.

The Director of Public Health is responsible for providing regular updates on local rates of infection, and will update care homes if the position around visiting changes. Visits to residents will need to stop in the case of a confirmed outbreak in a home. The exception to this is when a resident is at the end of their life, in which case visits should be permitted in all circumstances.

The Council and Portsmouth CCG have issued tools to support you to carry out whole home and resident risk assessments for enabling visits to residents. There is a template policy which can be adapted and shared with residents, staff and visitors. To request a copy, please contact pccg.qualityimprovementteam@nhs.net

The Relatives & Residents Association and the National Care Forum has set out shared expectations and good practice relating to the importance of clear, open, transparent and regular communications during the COVID-19 crisis between care providers and the families of their residents.

This has been endorsed in a joint statement on communication expectations by the Care Provider Alliance, the Care Quality Commission and Skills for Care and should be considered by all providers throughout their response to the pandemic.

We have developed a risk assessment tool to help keep workers visiting people in their homes safe. Download the risk assessment. Large-print version also available.

Testing

Latest updates

Domiciliary and supported living providers can now access regular weekly testing for staff.

Lateral Flow Device (LFD) tests are available for staff and visitors.

Care home staff can now carry out LFD testing at home.

90 days testing policy

The government has published a note explaining the policy relating to the 14 – 90 day period after a positive test result. It provides clarity on section 4.3 of the existing guidance – there is no new policy but it aims clarify the process to acute staff and care homes with a step-by-step process to determine whether it is appropriate for a person to be discharged into an ordinary care home setting without entering and isolated in a designated care setting. See a PDF version of the note here.

Testing contact centre
When calling 119 the options you will be asked have changed. This is to make it easier and quicker for care homes to reach the specialist care home team.

When calling 119, follow these steps to reduce your wait time:

  • select whether you’re calling from England, Scotland, Wales or Northern Ireland
  • select your language
  • choose if data is captured
  • select 1 in response to question “if you are calling because you have an upcoming hospital procedure, or from an organisation who receives test kits directly from the national testing programme, press 1.”

Call 119 (7am – 11pm) for questions about:

  • testing,
  • delayed results,
  • issues with couriers or
  • if you need additional test kits before you’re able to place your next order.

This number is for England, Wales and Northern Ireland. Please note this number has replaced the mailbox, covidcarehometesting@dhsc.gov.uk, which is now closed.

Routine whole home testing

  • Accessed via digital portal
  • All staff (including bank, agency and visiting staff (e.g. social workers, allied health professionals) – weekly
  • All residents – monthly

Ordering routine tests

  • All tests need to be ordered from the digital portal
  • The portal is currently open for around 9,000 homes for the over 65’s and those with dementia. Extra Care and Supported Living will be added from September 7th
  • You will receive enough testing kits to carry out 4x staff testing and 1x resident testing (i.e. 28 days’ supply of test kits)

Outbreak testing:

  • Accessed via HIOW Health Protection Team (HPT) at Public Health England
  • In hours: 0344 225 3861 – (choose COVID option and request to speak to the local Hampshire and Isle of Wight health protection team (HPT)
  • Out of hours: 0844 967 0082
  • HPT can authorise whole home testing (staff and residents) via the Community Testing Service (CTS will drop off and collect swabs – homes will need to complete their own testing)
  • Repeat testing at 4-7 days of all staff and residents who screened negative via the Community Testing Service (CTS will drop off and collect swabs – homes will need to complete their own testing)
  • Repeat whole home testing at 28 days to confirm end of outbreak via the digital portal
  • It is important that the different tests you have in stock are not used for testing routes than the one they were supplied for to avoid delays and errors in processing.
  • Care Home staff who are self-isolating, because a member of their household has symptoms, should continue to use the self-referral website to book a home test or an appointment at a test site.

How to complete the Care Home Capacity Tracker

COVID-19 positive resident numbers need to be removed from the capacity tracker once the home has passed 28 days (not 14 as previously stated) from the date of the last suspected / confirmed case. At this point the home is considered ‘recovered’.

Once past the 28 day marker this will trigger the home back into the retesting regime and it is expected the home will undertake whole home testing for those who have tested negative previously and then weekly testing of staff.

How to apply the MCA to whole home testing

Homes carrying out COVID-19 testing need to ensure that they abide by relevant legislation and standards for consent and the Mental Capacity Act. The government has developed guidance to support this.

Consent means a resident must give permission before they receive any type of medical treatment, test or examination. For consent to be valid, it must be voluntary and informed, and the resident consenting must have the capacity to make the decision.

The meanings of these terms are:

  • voluntary – the decision to either consent or not to consent to testing must be made by the resident, and must not be influenced by pressure from staff, friends or family
  • informed – the resident must be given all of the information about what the test involves, including the benefits and risks, alternatives, and what will happen if test does not go ahead
  • capacity – the resident must be capable of giving consent, which means they understand the information given to them and can use it to make an informed decision.

If a resident has the capacity to make a voluntary and informed decision to consent to or refuse the test, their decision must be respected.

  • Consent can be given verbally or in writing. A resident could also give non-verbal consent, as long as they understand what is about to take place – for example, by allowing a throat/nose swab to be taken
  • As a minimum, homes should record in their records that a resident with capacity gave verbal consent for COVID-19 testing. Homes may wish to record this on a consent form and ask the resident to sign it

If a resident does not have the capacity to make a decision about testing and they have not appointed a lasting power of attorney (LPA), care home staff should act in their best interests. Staff must take reasonable steps to discuss the situation with the resident’s friends or relatives before making these decisions.

Key principles:

  • Homes should record a Mental Capacity Act assessment for the resident – the assessment should be time and decision specific around whether the resident wishes to have a COVID-19 test. The Hampshire MCA toolkit can support staff to make this assessment
  • No-one else can consent on behalf of the resident, including GP’s. However, others can inform and contribute to a best interests decision
  • The best interests decision should weigh the positive benefits to the resident of having a COVID-19 swab (for example, no longer having to be isolated, excluding COVID-19 as a diagnosis if they are unwell) versus the negative effects (for example, distress and discomfort, risk of harm if the resident bites the swab)
  • The MCA assessment and Best Interests Decision must be clearly documented in the care records for future reference
  • Every decision must be an individual assessment for each resident and episode of testing as situations and circumstances may change

Homes should not feel under pressure to swab residents who lack capacity to make a decision on testing if they conclude that it is not in their best interests.

Test and Trace

It is critical that all providers follow the guidance contained in How to Work Safely in Care Homes and How to work safely in domiciliary care to reduce the risk to residents from the spread of COVID-19 and also avoid unnecessary staff isolation.

It is vitally important that all staff continue to follow social distancing guidance. This includes socially distancing from each other as well as residents and not taking breaks together or sharing offices in close proximity without wearing face-coverings.

It also includes not sharing cars to work where possible and wearing face masks whilst working in all areas of the home.

Antibody testing

Antibody testing is now available to care homes in Portsmouth. This will be extended to other social care providers. Home manager must complete a referral form and arrange for a mobile testing unit to visit the home.

The Antibody test is part of a regional study programme led by NHS England. Results will provide more detailed knowledge about how widely the infection has spread across the country. It is important to stress that this is voluntary and not a requirement or compulsory.

The Antibody test for COVID-19 is accurate in determining if there is evidence of past infection in your blood. When antibodies are detected it almost certainly means you have been infected with the virus. However, there is not currently enough evidence to confirm whether having antibodies against COVID-19 will protect you against the infection in the future. Therefore, it is vital that everyone continues to follow infection prevention and control and social distancing.

Referrals for staff and any enquiries about Antibody testing should be directed to hampshire.antibody-testing@nhs.net

Testing - Frequently Asked Questions

  • Staff and residents

What should I do if staff or resident tests positive but is already suspected to have had COVID-19 (not confirmed by a previous test)?

It is not possible to distinguish between current asymptomatic infection and a false positive test due to a previous infection (where the previous infection was not confirmed using a COVID-19 test). Therefore in this situation staff or residents must be managed as though they have active COVID-19 and self-isolate for the required period of time.

Do I need to swab staff or residents who have previously had a confirmed COVID-19 positive test result as part of the whole home testing?

Swabbing a member of staff or resident who has had COVID-19 (confirmed) in the last six weeks is likely to produce a positive test result. This is because the current swab test looks for fragments of COVID-19 virus but does not distinguish between virus that is live (viable) or dead (inactive). Fragments of dead COVID-19 virus (inactive) can be recovered from a person’s nose for around 5-6 weeks following infection. Where the person is well, this does not mean your staff member or resident still has COVID-19 or is an infection risk to others.

Updated government guidance indicates that staff who have previously tested positive for SARS-CoV-2 by PCR should be exempt from being retested within a period of 90 days from their initial illness onset, unless they develop new possible COVID-19 symptoms. This is because fragments of inactive virus can be persistently detected by PCR in respiratory tract samples for some time following infection. If a staff member is found to be positive for SARS-CoV-2 by PCR within 90 days from their initial illness onset, depending on their symptoms and advice from an infection specialist, they may need to self-isolate again. Additional consideration should be given to staff who are immunocompromised regarding retesting for SARS-CoV-2 by PCR.

If staff are tested for SARS-CoV-2 by PCR after 90 days from their initial illness onset and are found to be positive, this should be considered as a possible new infection. If they have developed new possible COVID symptoms, they would need to self-isolate again and their contacts should be traced. If, however, they are asymptomatic, further management should be discussed with an infection specialist (e.g. Microbiology, Virology, Infectious diseases) before a decision is made regarding another self-isolation period.

  • Residents

Should I get a clearance screen for COVID-19 for a person who has been previously positive?

No. There is no requirement to get a clearance screen for COVID-19, unless the person is very severely immunocompromised. You can discuss these cases with the HIOW IPC service if you need guidance.

Trying to get a negative screen following COVID-19 may put your resident at risk. The current swab test looks for fragments of COVID-19 virus but it does not distinguish between virus that is live (viable) or dead (inactive). Fragments of dead COVID-19 virus (inactive) can be recovered from a person’s nose for around 5-6 weeks following infection. This does not mean your resident still has COVID-19 or is an infection risk to others. Trying to get a clearance swab may mean that the resident swabs positive for five to six weeks, meaning they stay in isolation unnecessarily, miss vital appointments, or cannot go home to the community. Once the person has been isolated for 14 days and no longer has acute symptoms of COVID-19 (cough and loss of smell/taste may continue longer) they can come out of isolation.

Should homes test all residents who have previously tested positive before transfer to another placement?

If the resident is asymptomatic, displaying no symptoms other than a cough, and it has been 14 days since the first onset of symptoms or date of positive test then they do not need to be re-tested.

‘Asymptomatic’ requires that they don’t need medication to control their temperature.

If the resident remains symptomatic, again they do not require re-testing as their status is known. A clinical decision would be needed to risk assess the residents fitness for transfer, the level of risk posed to others as part of the transfer, risks for the receiving placement and its residents along with the receiving placements ability to provide a single room for continued isolation, management and treatment as per the government guidance.

How do I get a COVID-19 test for a person in the community awaiting admission to my care home?

The government has issued guidance. See annex K in Coronavirus Covid-19 admission and care of people in care homes including urgent admissions.

Home managers should make sure the individual has not had close contact with anyone with COVID- 19 symptoms. If they have not had a test within two days of admission the manager must arrange for a test.

If the individual lives in Hampshire, Southampton or Portsmouth, testing before admission can be arranged in their own home by contacting hiow.c19ipc@nhs.net.

If they live outside this area homes are advised to contact the CCG where the person lives to access the Community Testing Service who can screen them.

Even if the test result is negative it is recommended that the resident is isolated for 14 days.

Can I shorten the period of isolation post discharge from hospital if I screen the resident for COVID-19 and they are negative?

No. The test is not predictive of whether the resident will go on to develop COVID-19. The test will only tell you that they do not have active disease at that moment in time. Even if (for example) you screen the resident on day five post hospital admission and they are negative, they could be incubating COVID-19 and develop active disease between days 6-14. As the incubation period for COVID-19 is up to 14 days, all residents must be isolated on discharge from hospital (inpatient) for 14 days.

Do I need to isolate a resident for 14 days if they attend an outpatient appointment at the hospital or another setting?

You need to risk assess this. You may decide that the risk of them being exposed to COVID-19 is low and 14 days of isolation is not required if:

  • the resident has been transported to the appointment without sharing transport with others
  • the resident has been able to maintain social distancing
  • the resident has gone to a site with no COVID-19 (cold site)
  • The resident has taken other precautions like wearing a mask

 

  • Staff

How will the new screening programme impact on test and trace?

Routine testing is likely to identify a number of COVID-19 positive staff members and residents and these cases will be subject to test and trace.

It is critical that all staff follow the guidance contained in How to Work Safely in Care Homes  and How to work safely in domiciliary care to reduce the risk to residents from the spread of COVID-19 and avoid unnecessary staff isolation.

When can we get antibody testing for care staff?

Antibody testing is being rolled out to local social care workers, beginning with care homes. As antibody tests require a whole blood sample, they are more difficult to do.

The antibody test only tells you that a person has had COVID-19 in the past. It does not tell you that they are immune to future COVID-19, or that they would be unable to pass it on to others if they came into contact with COVID-19 again in the future. Due to this, antibody tests are also of no use in clinical management and will not change the way you can use or deploy staff.

Staff must continue to wear full PPE and observe hand hygiene and all other precautions, including social distancing, regardless of their antibody status.

How do I manage staff who refuse to be tested for COVID-19?

Staff do not have to agree to be tested for COVID-19 and no member of staff should or can be compelled to have a test.

However, all staff have a duty of care to their residents and ethically should take reasonable steps to protect the people they care for. Recent studies indicate that staff (and particularly regular use of agency staff and those working across sites):

  • are likely to be a major risk factor driving transmission within care home settings
  • 1.2% of staff without symptoms of COVID-19 tested positive during the last round of testing.

Homes should work with staff to ensure they understand the reasons for weekly testing and ensure that staff who are required to isolate receive their full salary.

If staff go on leave should they be tested before being allowed back into the work place?

Unless they are displaying symptoms they are OK to come back to work. They should follow the national guidance and self-isolate for 14 days if:

  • they were to develop symptoms
  • they become aware they have been in close contact with a family member / friend who has developed symptoms or tested positive for Coronavirus

If they have been abroad, they will need to follow the government quarantine guidance and self-isolate for 14 days upon return from high risk areas.

Information for Supported Living Providers

 

This guidance is designed to update and build on the previous advice to supported living providers, which was withdrawn on 13 May 2020.

It sets out:

Guidance on infection prevention, control, supply and use of Personal Protective Equipment (PPE)

IPC guidance

CQC: infection, prevention and control in care homes

We previously introduced how we are looking at infection prevention and control (IPC) in care homes. We have now published our new IPC inspection tool on our website.

As we increase targeted and focused inspections of high risk services, this tool will be used to look at how well staff and people who live in the care home are protected by the prevention and control of infection (Key Line of Enquiry S5). Over time, we will look to improve and adapt the tool for other types of services.

The tool will help us to gather information about the strengths of a service and to understand if there are any gaps or concerns around IPC where we can signpost to resources which could help.

We all plan to manage any risk of a second wave of the coronavirus and the impact of winter pressures. This helpful tool is something you can use to prepare.

PPE in care homes

We currently remain in a period of sustained transmission. Requirements for PPE in care homes during sustained transmission are set out in: How to work safely in care homes.

The key general summary on PPE use is:

  • When providing direct care (contact) or when within 2 meters of a symptomatic resident – full PPE (apron, fluid repellent surgical face mask, gloves) is required with a risk assessment around eye protection
  • When within 2 meters of a resident who has no symptoms but not performing direct care (contact) or touching them, and there is no one within 2 metres who has a cough – fluid repellent surgical face mask

When working in communal areas where you may be within 2 meters of a resident on occasions – fluid repellent surgical face mask (note that all symptomatic residents should be isolated)

    When you’re 2 metres or more from a resident you should be wearing a Type I or Type II surgical mask. This includes staff not in a caring role e.g. cleaners, receptionists and when not in direct proximity to residents e.g. in staff only areas.

If you work alone in an office you will not be expected to wear a mask but when you leave the private work area to move through the care home building, e.g. on an errand, or for meal breaks, you should put on a surgical mask (Type I or II)

    • This is assuming care workers are not undertaking aerosol generating procedures, information on that is below.

PPE in domiciliary care settingsWe currently remain in a period of sustained transmission. Requirements for PPE in domiciliary care settings during sustained transmission are set out in: How to work safely in domiciliary care

The key general summary on wearing PPE is:

  • When providing personal care in direct contact with client – full PPE apron, fluid repellent surgical face mask, gloves) is required with a risk assessment around eye protection
  • Whenin the client’s property but not performing direct care- wear a surgical mask
  • Always risk assess the need to wear eye protection eg. When there is the potential for splash back.
  • Where there is more than one client in the household , gloves and aprons will need to be changed between each episode of care
  • Symptomatic patients could be asked to wear a surgical mask where tolerated.
  • When you are within 2 metres of anyone in the household who is coughing, even if not providing care to them- full PPE (apron, fluid repellent surgical face mask, gloves) is required with a risk assessment around eye protection
  • If you have been giving personal care to clients and you are changing your work duties e.g. going to your organisation’s office, then you need to remove your face mask, clean your hands and then put on a new Type l or Type ll face mask
  • If you share workspace/working environment (e.g. including the office, staff communal areas and dining rooms) with care workers who care for clients then everyone in that workspace including yourself will need to wear a Type I or Type II face mask. If you do not share workspace or working environment with care workers who care for clients (e.g. if care workers are in a different office or part of building with no shared communal areas) then you do not need to wear a face mask. If you do work in a separate (e.g. private) office but share communal areas (e.g. dining room) with care workers then you would need to wear a Type I or Type II face mask in those communal areas.

•    Sessional use refers to wearing masks and eye protection continuously until you take a break or the session ends (e.g. leaving one household)

•    Where you need to remove your mask (e.g. to take a drink or eat) then you need to dispose of it safely. Do not dangle your mask or eye protection around your neck. Do not re-use your mask

•    Where there is a shortage of FRSM FFP2 masks can be used; where there is an acute shortage of FRSM and FFP2 masks a non-fluid resistant mask can be worn with a full face visor.

This is assuming care workers are not undertaking aerosol generating procedures, information on that is below.

Aerosol Generating Procedures

Please be aware that that there are some aerosol generating medical procedures that might be in use in care homes and other community settings. These include CPAP and BiPAP machines, (sometimes used to treat the symptoms of sleep apnoea). There are additional PPE requirements that need to be considered in these circumstances where care is being provided to a person while they are using the equipment and up to an hour after it has been switched off.

These include the use of gowns and FFP3 masks. FFP3 masks must be fit tested to ensure an appropriate fit and training in the doffing and donning of PPE should be provided. If you are supporting someone who uses this type of equipment please contact the health care professional who is supporting the service user to discuss this further. If you have a service user using other equipment and you are not sure if this is aerosol generating again please contact the health care professional for clarification.

Public Health England provide a list of Aerosol Generating Procedures.

Update:

The current position of PHE is that suctioning of the oral cavity in front of the pharynx*, where you can still see the tip of the yankeur sucker or catheter does not constitute an AGP. If suction is past the pharynx, this could generate aerosols and although the risk is felt to be low it does constitute an AGP.

*The pharynx (plural: pharynges) is the part of the throat behind the mouth and nasal cavity, and above the oesophagus (food tube) and larynx. 

You will need to have staff in your team trained to fit test employees for the safe use of FFP3 masks. Contact the Quality Improvement team to arrange training for staff: pccg.qualityimprovementteam@nhs.net

Demonstration of donning and doffing PPE.

Skills for Care SE IPC WhatsApp Group and Weekly Webinar

The Infection Prevention and Control leads in the South East group aims to provide a forum where IPC leads can support each other, share resources and ask questions.

The network is open to:

  • All staff who take responsibility for infection, prevention and control for their organisation. Each week, if questions have not been answered by the group and support from
  • NHS/Improvement Team and Public Health England these are addressed at the weekly webinar.

If you would like to join the closed WhatsApp group and would like details for the Infection, Prevention and Control webinars please email your contact details, care organisation, mobile number to Debbie.boys@skillsforcare.org.uk Skills for Care Locality Manager, Southampton, Hampshire, IOW and Portsmouth. Your details will not be shared with third parties.

Information about PPE supply

Support systems have been put in place at national and local levels to ensure health and social care providers can access PPE when they need it.

Please order PPE via the following routes:

  • Non-covid related PPE to be ordered via your existing suppliers
  • Covid-related PPE to be ordered via the PPE portal at nhs-ppe.co.uk
  • Additional PPE can be made available via the council at ppe@portsmouthcc.gov.uk if you have a clinical need (e.g. spike in local cases) or temporary difficulties accessing PPE by other means including the PPE portal. Health and care providers not eligible to use the PPE portal can also contact this address to order covid PPE
  • If you cannot obtain PPE by any of these routes and have run out or will do imminently you should contact the National Supply Disruption Respond (NSDR) helpline on: 0800 915 9964

Please regularly update the NHS Capacity Tracker with your PPE status – this helps us know where we need to provide support.

National PPE portal – FAQs 

Who can use this service?

GPs, residential social care providers, domiciliary social care providers, pharmacies, dentists, orthodontists, optometrists, children’s care homes and secure homes, children’s residential special schools, community drug and alcohol services, residential drug and alcohol services.

How do I order?

Providers who are eligible to use this service will have received an email invite to register. The invite will have been sent to the email address registered with the Care Quality Commission (CQC), NHS Business Services Authority (BSA), NHS England, Medicines and Healthcare products Regulatory Agency (MHRA) or the Department for Education.

Register or login

If you have not received an email, would like to check your eligibility or have any other queries you can call the customer service team on: 0800 876 6802.

Orders are limited depending on the type and size of the provider.

GOV.UK: How to order emergency personal protective equipment

Note: FFP3 respirator masks and gowns for aerosol generating procedures are not currently available through this route and this has been escalated to the Department of Health and Social Care.

Portsmouth City Council PPE support

Who can use this service?

  • Providers delivering health and care support in Portsmouth – there is no requirement to register
  • Providers who are not eligible to use the National PPE Portal (including wider community services and personal assistants)
  • Providers who have not been able to obtain additional PPE either through their normal supply route or the National PPE Portal
  • Providers who have a clinical need (e.g. a demonstrable spike in local COVID-19 cases, enhanced PPE not available through any other route)

How do I order?

Email ppe@portsmouthcc.gov.uk using the order form.

The council carries as standard: Type IIR masks, nitrile gloves, aprons, face visors and hand sanitiser. If there is a clinical need for enhanced PPE then we can also supply FFP3 respirator masks and long sleeved disposable gowns.

You should receive a response within 24 hours (excluding weekends) and deliveries can be made to postcode areas PO1 to PO7.

If you have any queries about the service or stock availability then please email ppe@portsmouthcc.gov.uk

PPE Equipment Safety Information

Disposable gloves

Government guidance on PPE and gloves has been updated. Gloves protect from SARS-CoV-2 (the virus that causes COVID-19) in the environment. This includes contaminated surfaces, or directly from people infected.

Deciding whether to wear gloves may be based on a risk assessment of the task being carried out. You must wear disposable gloves (nitrile, neoprene or latex1 ) when providing personal care and when exposure to body fluids or blood is likely. Disposable gloves are single use and you must dispose of them immediately after finishing a procedure or task, and after each resident, and then clean your hands. You must take care not to touch your face, mouth or eyes when you are wearing gloves.

Vinyl gloves should not be worn if you anticipate there will be contact with bodily fluids or blood. They may be worn for routine cleaning, however if chemicals are being used as part of a decontamination schedule a COSHH assessment must be carried out and the correct PPE worn.

Disposal of used PPE

Used PPE should be stored securely within disposable rubbish bags, placed into another bag and kept separate from other waste. This should be put aside for at least 72 hours before being put in the usual disposal bin.

Pressure damage from wearing PPE

Guidance for staff has been published around the prevention of facial skin damage beneath personal protective equipment (PPE). Advice includes:

  • keeping your skin clean and well hydrated/moisturised
  • applying creams at least 30 minutes before applying PPE (Caution: skin protectants and emollients with white soft paraffin are flammable. You are advised not to smoke with them present on your skin)
  • Considering the use of a barrier skin wipe/skin protectant if you are likely to be wearing PPE for extended periods
  • Taking time to fit your mask before starting a shift/procedure. Ensure all folds in your mask have been used to optimise the correct fit for you and do not over-tighten
  • Regularly inspecting your skin for signs of redness/soreness
  • Taking regular breaks (we recommend every two hours) from wearing a mask to relieve the pressure and reduce moisture build-up
  • Staying well hydrated throughout the day.

Useful links

Access to Care and Health Information Exchange

Part of the local CCGs’ digital initiatives to support service providers

Care and Health Information Exchange (CHIE) is a shared care record which is simple to navigate and holds data for ALL patients registered to a Hampshire and Isle of Wight GP practices.

To access CHIE from within your care home setting, you will require a PC or a laptop with web browser software installed (e.g. Internet Explorer or Chrome) and a user account for each individual staff member who will be accessing the system.

Access to CHIE will enable you to see the following:

  • GP information including medical history, medications, diagnoses and allergies.
  • Discharge summaries from Hampshire Hospitals, University Hospitals Southampton and Portsmouth Hospitals Trusts.
  • Radiology and pathology reports from the above Trusts including (COVID-19 status)
  • Community and Mental Health Service Information from Southern Health NHS Foundation Trust, Solent NHS Trust
  • Adult Social Care information from Hampshire County Council, Southampton City CouncilNext steps

If you would like access to CHIE in your care home, please email Sally Manger:  sally.manger@nhs.net with the following information for each member of staff for whom you are requesting access:

  • Job title
  • Contact email for user account creation
  • Phone numberEach staff member will be contacted and supplied with a user name and password and details of how to reach the log on page and copies of user guides (including top tips).

CHIE is a read-only, web based system that is very easy to navigate and requires no 1:1 training.

Staff are asked to accept the T&Cs and acknowledge the following:

Acceptable user agreement

“I will ensure that where practical, as a care professional, I will ask the patient before accessing CHIE for patient care. If the patient is unconscious or not present but would benefit from my care, I may use my judgement about accessing the information and will record my reason for doing so.”

The registered manager (or nominated deputy) will also be asked to sign and return a Data Sharing Agreement.

Training and e-learning modules

New guidance on training from Skills for Care

Following Government advice on returning to work, Skills for Care have updated their face-to-face training and assessment guidance. The guidance is  available for employers, learning providers and in-house trainers during COVID-19.The guidance encourages digital solutions to deliver and access training. If digital solutions are not possible, then the guidance recommends and assists you to develop a thorough risk assessment. This will ensure any face to face training you assess as needed by staff can be carried out with minimal risk for all involved.

Visit the Skills for Care website to read the guidance in full.

Learning from events – Skills for Care new digital learning module

Skills for Care has launched a short digital learning module to support adult social care managers in carrying out holistic learning reviews following any incidents or near misses within their care setting, such as a COVID-19 outbreak.

The free, easy to use module commissioned by the Department of Health and Social Care covers:

  • what learning reviews are, why they’re needed and how they can help you
  • how managers can move from completing reviews at an individual level to involving the wider team
  • practical tips and templates for embedding learning reviews into your working environment.

Employers can claim £100 from the Workforce Development Fund for everyone who completes the module. You can find our more information and how to make a claim by visiting the Skills for Care website.

e-Learning for healthcare

Health Education England programme in partnership with the NHS and professional bodies has launched an e-learning module called Coronavirus (COVID 19):

Grey Matter Learning

A free e-Learning course has been launched – Coronavirus (COVID-19) Essentials:


Free Skills for Care webinars

If you’d like to join one of the webinars, please register using the links below. A limited number of places are available but the webinars will be recorded and hosted on Skills for Care website for viewing.

Each webinar will last 30 minutes. If you have any questions on the topic that you’d like to see raised, please email these to  events@skillsforcare.org.uk.

 

Business support

Businesses affected by coronavirus that would like some help and support on how to proceed in the current climate can now access Portsmouth City Council’s dedicated helpline. Please call 023 9284 1641 Monday to Friday, 7am – 7pm to speak to our economic growth team. They can help businesses navigate the wide range of support that is available.

Employee support

The government as well as many public and private organisation have some additional support, advice or offers in place, to support employees in adult social care professionals during these demanding times.

Mental health and wellbeing

There are some simple things you can do to look after your mental health and wellbeing at the current time. Looking after your mind and body will help you both at work and home.

  • Remember that it is OK to struggle at the present time. Everyone reacts differently and you may feel different emotions at different stages of the pandemic. However, it may cause you to feel worried, stressed, sad, scared or helpless – these are understandable feelings.
  • Take time to look after your physical wellbeing – this will have a big impact on how you feel emotionally. Taking breaks at work, maintaining a routine, eating well and exercising can help.
  • Think about what has helped you cope in the past to cope with stressful situations. Focus on what is in your control, try to pace yourself and remember that this will not last forever.
  • Extend the self-compassion and care you have for others for yourself.
  • Look after your emotional health. After difficult or stressful experiences at work, it is normal for memories or images of what has happened to come into your mind. Try to let these memories come and go rather than blocking them or trying not to think about them. Try not to stay focused on difficult thoughts and feelings – using some of the resources below can help.

Getting help and support

  • Reach out to colleagues, friends or family members for support
  • Text messaging support service by Shout. Text 85258 or find out more.
  • Health and wellbeing information for social care workers: advice, tips and tools on how to manage stress and wellbeing by LGA and NHS.
  • Mental health support for social care workers: Mental Health at Work offer round-the-clock, one-to-one support, along with a collection of resources, tips and ideas chosen to support the mental health of social care workers.
  • General health and wellbeing advice for residents, including Every Mind Matters.
  • Help for Heroes have developed a useful resource for health and care staff
  • Hospice UK run a bereavement and trauma support line – call 0300 303 4434 between 8am and 8pm, seven days a week to talk to a trained professional for support. They’re there for all adult social care workers that have experienced a bereavement, witnessed traumatic deaths at work or would like to talk to a trained professionals about any emotional distress experienced as a result of the coronavirus epidemic.
  • A practical guide by the Community Care Inform Team on developing emotional resilience and wellbeing. If you are pushed for time and want to jump straight to techniques and tools to try, go to the final section: What can I do to enhance my resilience? (page 17).
  • Make use of local resources such as chaplaincy services, professional membership organisations, unions, employee assistance programmes and others
  • Although it is normal to find what is happening emotionally difficult (for example, you may experience bad dreams or feel anxious), look out for signs of feeling emotionally exhausted, tearful, overwhelmed or low – these feelings are a cue to get support including telling your manager how you are feeling
  • Find an IAPT Service. Most people won’t need to access psychological therapies, but it is important to get help if you need it. If you have been exposed to highly stressful, traumatic or frightening experiences at work, you are more likely to develop post-traumatic stress disorder (PTSD). Symptoms include reliving what has happened through vivid dreams or flashbacks, feeling very anxious, angry, irritable and guilty. Some people will feel low in mood, have trouble sleeping and have physical symptoms. For many people, these symptoms will improve over time, but if they don’t improve after one month, you can be referred or self refer for psychological therapy. Services will also work with you if you are suffering from depression or anxiety.

Social care workers app

The Department of Health and Social Care has launched a social care workers App: The purpose of the app is to:

  • act as a one-stop-shop, providing the sector with all the latest guidance, wellbeing support and advice they need to protect themselves from COVID-19 and keep themselves well
  • provide access to learning resources on crucial areas such as infection control as well as practical advice and support for mental wellbeing
  • show how care workers can take advantage of offers available to NHS and social care staff, including free car parking and discounts through organisations and initiatives like Discounts for Carers and the Blue Light Card
  • signpost free access to apps like Silvercloud, Daylight and Sleepio, which can help boost users’ mental wellbeing through programmes covering sleep, stress and resilience

A video introducing the app can be found here.

Other support available for key workers