Policy Updates 29th November 2021
The following policy updates have been curated from the week commencing 29th November 2021.
New Covid-19 Omicron variant
Care England posed a raft of questions to the Department of Health and Social Care (DHSC) in relation to what the new Omicron variant means for the policy which underpins the adult social care sector, including:
Will rules around staff isolation change?
Will visiting rules change?
Any changes to IPC?
Any changes to the testing regime?
Parity with the NHS in terms of staff isolation, PPE, etc?
Rules around hospital discharges?
Will there need to be more designated sites?
Will blue light to care home be instigated in order to bypass hospitals?
Will rules around admissions from the community change eg isolation periods?
Staffing level management - how will this be monitored?
Outbreak guidance to be amended?
PPE guidance to be amended?
How will VCOD be affected across care homes, the NHS and the wider social care sector - will timeframes change, will boosters be added etc.?
In response, the Department stated that they are not expecting imminently to announce any changes other than those already announced at the weekend (red countries, PCR tests for arrivals from abroad, masks in retail and on public transport, isolation for omicron contacts). They are currently considering communications to the sector and the best way to reflect those announcements in guidance, where necessary. Everything else is contingency planning; we currently know little about the transmissibility and severity of the new variant, or how it is affected by the vaccine.
Care England will be involved in forthcoming stakeholder engagement sessions.
UPDATED POLICY
To confirm that the following guidance has been published this week:
Guidance on care home visiting - GOV.UK (www.gov.uk)
COVID-19: guidance for supported living - GOV.UK (www.gov.uk)
Guidance for those who provide unpaid care to friends or family - GOV.UK (www.gov.uk)
What do we know about Omicron?
The government has moved much faster against this variant of concern than previous ones due to the number of mutations present on the spike protein which may result in less effective vaccine and antivirals. It is worth stressing that we don't yet know conclusively what the actual impact of the variant's mutations are in real life. The World Health Organisation issued a statement last night designating it a Variant of Concern due to:
Potential increased transmissibility but this needs to be confirmed by studies. The number of cases in South Africa have risen rapidly but it is still not clear whether this is due to Omicron itself or some other environmental factors
It is not yet clear whether infection with Omicron causes more severe disease compared to other variants. Preliminary data suggests that there are increasing rates of hospitlisation in South Africa but this may be down to the increased numbers of people becoming infected (see above) rather than the variant itself.
Preliminary evidence suggests there may be an increased risk of reinfection with Omicron compared with other variants of concern.
It is still not clear what the impact will be on the efficacy of vaccines but they should still offer some protection against severe disease and death
PCR testing is able to identify the new variant. Tests are underway to ensure rapid testing (such as LFD tests) are not impacted.
Studies are under way to understand the known unknowns. The variant is currently present in Scotland and England and is probably now in community transmission. UK Medical Officers have stated today that they expect the numbers of this variant to increase rapidly in the next few days and weeks.
JCVI Advice on COVID-19 Booster Vaccines & Second Doses for 12 to 15 year olds
JCVI has advised and the government has agreed to roll out booster vaccines to everyone over 18-years of age and reduce the gap between a second (or third dose if immunosuppressed) and a booster dose from 6-months to 3-months. We expect this to work in reverse age order as with the initial roll-out. JCVI advised:
Booster vaccination eligibility should be expanded to include all adults aged 18 years to 39 years
Booster vaccination should now be offered in order of descending age groups, with priority given to the vaccination of older adults and those in a COVID-19 at-risk group. Booster vaccination should not be given within 3 months of completion of the primary course.
Severely immunosuppressed individuals who have completed their primary course (3 doses) should be offered a booster dose with a minimum of 3 months between the third primary and booster dose. Those who have not yet received their third dose may be given the third dose now to avoid further delay. A further booster dose can be given in 3 months, in line with the clinical advice on optimal timing.
Both the Moderna (50 microgram) and Pfizer-BioNTech (30microgram) vaccines should be used with equal preference in the COVID-19 booster programme. Both vaccines have been shown to substantially increase antibody levels when offered as a booster dose.
In addition, all children and young people aged 12 to 15 years should now be offered a second dose of the Pfizer-BioNTech vaccine at a minimum of 12 weeks from the first dose.
We anticipate that the National Booking Service will be updated this week to allow more age groups to book. While boosters are not currently part of the VCOD regulations in care homes or the draft ones for wider social care settings, please encourage staff to get a booster vaccine as soon as they are able - remember that there is technically nothing to stop DHSC adding them to the draft expanded regulations to be voted on in January.
Please see these relevant bits of guidance:
Coronavirus: how to stay safe and help prevent the spread - updated to reflect Omicron
Face Coverings and Testing Requirements
From 4am tomorrow (30.11.21) morning:
Face coverings will be compulsory in shops and settings such as banks, post offices and hairdressers as well as on public transport unless an individual is exempt from doing so.
All travellers arriving into the country from 4am tomorrow will be required to take a PCR test on or before day 2 and self-isolate until they have received a negative test result. These PCR tests must be purchased from private providers.
All close contacts of anyone who has tested positive for the Omicron variant are required to isolate for 10 days regardless of whether they have been vaccinated. We are of course exploring what this means for social care - and in particular guidance around outbreaks. The current visiting and outbreak guidance is not entirely clear on how long an outbreak lasts if a variant of concern such as Omicron is found.
These restrictions will be voted on retrospectively by MPs during a debate tomorrow and reviewed in three weeks (w/c 20 December). If it turns out that Omicron isn't a threat, the government has committed to dropping all the additional restrictions it is imposing.
We anticipate updated admissions and designated settings guidance being published in coming weeks.
NCF Update to guidance on restricting workforce movement between care homes and other care settings
The guidance for care home providers on restricting staff movement has been updated. The guidance recognises that movement continues to be a concern for transmission of infection between settings. It therefore continues to advise care home providers to limit routine staff movement between care homes and other health and care settings.
However, the guidance now also details the circumstances in which care home providers may now allow some movement of staff between settings, and advice about how they can mitigate the risks associated. Instead of restricting all but exceptional staff movement, the updated guidance gives advice to care home providers on how they can cautiously permit staff movement subject to certain conditions. These conditions are defined in the guidance.
The guidance also defines when we would recommend any permitted staff movement should stop except in exceptional circumstances. Examples include high local infection rates, outbreaks in the provider’s setting, and where advised by local health protection agencies (for example the Director of Public Health).
Health and Care Bill
The Health and Care Bill has now passed the House of Commons after two days of debate and will move onto the House of Lords. The government rejected and voted against nearly all the non-government amendments to the Bill – including those we managed to influence. This includes amendments in relation to workforce planning for social care, NHS and Public Health (Jeremy Hunt and Labour’s amendments) and the removal of assessments prior to discharge as part of discharge to assess (one Labour amendment to add safeguards and another to remove the clause entirely). Debates around the membership of Integrated Care Boards and Integrated Care Partnerships unfortunately got stuck on the issue of private sector involvement due to a number of Labour MPs trying to unhelpfully cast the Bill as an ‘NHS Privatisation Bill’.
The most controversial element of the debate was the amendment to exclude means-tested support from counting towards the new capped cost model for social care. A sign of how contentious this is can be seen in the fact that 19 Conservative MPs voted against the amendment with many more abstaining – the amendment impacts Northern and Midland Conservatives in particular due to the lower average house prices. The amendment passed 272 to 245. Last week we created a briefing on what this means. We will be updating our parliamentary briefing for the House of Lords to reflect the above and will include our concerns about the changes to the cap on care costs and the suggested Daily Living Costs as part of that. We will also be calling on parliamentarians to widen the debate beyond this rather narrow definition of social care.
The first reading of the Bill in the House of Lords is today(!) and the second reading on 7 December.
Leadership review into health and social care
The terms of reference for the leadership review in health and social care, to be led by former Vice Chief of the Defence Staff General Sir Gordon Messenger and supported by Dame Linda Pollard, Chair of Leeds Teaching Hospital Trust, has been published alongside a letter from Sir Gordon and Dame Linda.
Updates to Discharge Guidance Leaflets
A series of leaflets have been updated relating to discharge:
Update to supported living services
This guidance was updated earlier this week in line with the latest advice from UKHSA. The summary of changes note at the top of the page outlines what has changed. Changes include advice on staff moving between care settings, visiting and discharge from hospital. On that last point, the guidance now states that supported living settings that 'are comparable to care homes should refer to the admissions guidance for advice on self-isolation following an unplanned admission'.
Update to providing unpaid care guidance
This guidance has been updated and the change note at the top of it outlines what has changed in line with UKHSA advice. Of note are new sections on booster vaccination, accessing testing as well as changes to PPE table. See also this newly published guidance on PPE recommended for unpaid carers.
Infection Prevention and Control Good Practice Guide
Skills for Care has published a guide outlining good practice examples for care home and home care workers, and for infection control teams. It has a preamble from Professor Deborah Sturdy.
Vaccinations and Capacity Tracker
It is now a requirement for all care home staff to have received both their vaccinations. There is now also a requirement making vaccination a condition of employment in the health and the wider social care sector. These regulations will require workers who have direct, face to face contact with service users to provide evidence that they have been vaccinated, subject to limited exceptions. This will apply across Care Quality Commission (CQC) regulated health and social care services. Staff will be required to have their first vaccination dose by the 1st February 2022 to meet the deadline that will come in to force on the 1stApril 2022.
Vaccinations can be accessed via www.grabajab.net which has a list of walk in clinics staff can access.
This email is also a reminder that you need to regularly update all areas of the National Capacity Tracker – at a minimum this should be every 48 hours.
Central Government continues to use this data on a daily basis to identify issues or raise concerns with Local Authorities to investigate further. Therefore, it is really important that the system is kept up to date, particularly vaccination uptake for staff, and residents where you are a care home provider.
The tracker is also a Government requirement and its regular use forms the basis for distributing additional funding support to providers, eg Infection Control Fund.
We appreciate that at times the system experiences data errors so if you notice this then please continue to raise your queries directly with the Capacity Tracker Support Team (tel: 0191 691 3729, email: necsu.capacitytracker@nhs.net and insert ‘Capacity Tracker’ into the subject line.
Wider Stakeholder News
DHSC Research: NHS-Funded Nursing Care 2021 Survey
The Department of Health and Social Care is conducting research on NHS-Funded Nursing Care (FNC): if your nursing home has residents who are eligible for FNC, you should have received an email from the DHSC asking for your feedback. Any information you give will provide valuable insights to inform the 2022-23 FNC rate and assess the impact of COVID-19 on FNC and associated costs in 2021-22.
Face coverings: when to wear one, exemptions, and how to make one
This page explains when to wear a face covering, exemptions from wearing one, and how to make your own face covering
29 November 2021: Updated to reflect that the public and staff in public facing areas will be required to wear face coverings in some settings from 4am on 30 November:
30 November 2021: Updated to add transport hubs to the list of settings where face masks are required.
Found at: GOV.UK
Fighting against micro-aggressions for minority ethnic nurses
"Minority ethnic students and staff frequently face demeaning and offensive comments about their bodies, cultural traditions and professional competency."
Found at: GOV.UK
Beyond 2021: the future of local COVID-19 outbreak management
As we approach a challenging Winter and with the new UK Health Security Agency fully operational, this Government-funded webinar will explore the current COVID-19 response, what to expect in the Spring and planning for living with COVID-19 in the long term. We will discuss the latest epidemiology, what the data is telling us and the future vision for Local Outbreak Management. Tuesday 7 December, 13:00-14:30.
Found at: LGA