Policy Updates 18th December 2022
Monthly update from Bristol, North Somerset and South Gloucestershire.
This week, we would like to let you know more about:
1. New guidance for adult social care - COVID-19 supplement
2. Quick guides to managing COVID-19 and Influenza in care settings
3. Risk assessment checklist for requesting an urgent admission to a care setting at the weekends and bank holidays
4. Sirona care & health updates information for care homes
5. New telephone number for Sirona care & health Adult Learning Disability Health Service
6. New telephone number for Sirona care & health’s Diabetes and Nutrition Service
7. Discharge from hospital to care settings
8. Useful information and guidance
We hope that this information is helpful. Thank you for your continuing commitment to supporting and protecting our vulnerable population.
NCF Members' Briefing 15.12.22
Update to the Infection Prevention and Control and Outbreak Guidance
The COVID-19 supplement and testing for adult social care services guidance have been updated to reflect changes to mask and outbreak guidance. Please see the attached letter and my summary below. Providers can move to implement the guidance straight away if they wish but services do not need to move to the changes until 22 December 2022. The key changes:
Universal masking will cease and be replaced by a risk-based approach.Care homes will have greater autonomy to assess and manage COVID-19 outbreaks. There is now a distinction between 'small care homes' and other care homes when it comes to outbreaks.
Changes to Mask Guidance
Care workers and visitors no longer need to routinely wear a face mask at all times in care settings or when providing care in people's own homes. There are still some scenarios where it is recommended to wear a mask to minimise risk of transmission of COVID-19:
if the person being care for is known or suspected to have COVID-19 (Type IIR fluid-repellent surgical mask recommended)if the member of staff is a household or overnight contact of someone who has had a positive test result for COVID-19if the care setting is in outbreak
You may also want to consider wearing a mask if it is the preference of the person you care caring for. Type IIR masks should always be worn if there is risk of splashing of blood or body fluids.
Sessional use of masks only applies when working in a communal setting where you are caring for a cohort of clients who are all suspected or confirmed to have COVID-19, or if 'universal masking' is in place due to an outbreak. In this scenario- "after 4 hours, or after leaving the room, (or cohorted areas) of someone with suspected or confirmed COVID-19 (whichever is sooner) masks should be disposed of and hand hygiene performed before putting on a new mask (if required)."
AGPs also require masks.
See the COVID-19 supplement for more detail, and in particular PPE tables 1 to 3.
Note that the letter confirms that free PPE will remain available until March 2023.
Changes to Outbreak Guidance
The outbreak management portion of both bits of guidance has also been updated to give the provider greater autonomy. The COVID-19 supplement contains more information about what a risk assessment needs to consider while the COVID-19 testing for adult social care services guidance has the more detailed outline of the testing process, so you will need to look at both.
There is now a distinction in guidance made for 'small care homes' which are defined as a setting with 1 to 10 beds. The guidance also states that it "is up to a service to determine and be prepared to evidence that small care home guidance applies to them if the size of the care home is above 10 beds. For example, if there are individual units or floors with completely separate staff and residents who do not mix with other staff and residents outside of this unit or floor".
Rapid response testing (daily LFD tests taken by staff on their working days for 5 consecutive days) is triggered if one or more positive staff or resident cases are found in both care homes and high-risk extra care and supported living settings. For small care homes the process from this point is slightly different:
If there is only 1 positive case in a small care home, rapid response testing should be initiatedIf there are 2 or more positive cases in a small care home then outbreak testing should start as soon as possible because it is highly likely they are linked. The guidance states that "a small care home may decide to undertake rapid response and whole home outbreak testing at the same time or may only undertake outbreak testing in the event of 2 or more cases – rapid response testing should not delay outbreak testing in either case". In short, the rapid testing might be redundant in small care homes if it is already clear that there are multiple positive cases.
Section 2.4 of the testing guidance outlines outbreak testing in care homes generally while 2.4.3 outlines what this looks like in small care homes - note that recovery testing does not need to be undertaken in small care homes, instead outbreaks can be considered to have ended once all resident self-isolation periods have been completed.
More generally, if an outbreak is suspected, the care home should undertake a risk assessment to determine if the situation can be considered an outbreak. They should inform HPT but the provider no longer has to wait for advice from HPT before they carry out this assessment. The COVID-19 supplement outlines what this risk assessment should cover to determine if cases are linked. Any measures put in place must ensure visiting continues and resident wellbeing is prioritised.
In the event an outbreak is identified, the care home should implement whole home outbreak testing in week 1 of an outbreak and consider what other measures are needed. You do not need to wait for HPT to tell you to do so. All staff and residents should conduct both an LFD and PCR test on day 1 and again between days 4 and 7. This testing is in addition to rapid response testing conducted by staff if that is being undertaken.
Unless it is a small care home, the care home should then proceed to outbreak recovery testing. Staff and residents (except those who have tested positive with a PCR test in the last 90 days) should each take a PCR test at least 10 full days after the onset date of the latest symptomatic individual's symptoms (confirmed by test) or from the last positive test if asymptomatic. Outbreak measures can be lifted if there are only negative PCR results from outbreak recovery testing. If the care home assesses that any further cases are likely to be part of the same outbreak during this period, the care home should wait another 10 days with no positive results to conduct another round of outbreak recovery testing. The care home should not do any further rounds of whole home testing in this period.
Update to Health and Social Care Act 2008: code of practice on the prevention and control of infections
Earlier this week, this guidance was updated for the first time since 2015 to reflect changes to the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, and the role of infection prevention and control (IPC) (including cleanliness) in optimising antimicrobial use and reducing antimicrobial resistance. The new document takes account of changes to the IPC landscape and nomenclature that have occurred since the COVID-19 pandemic.
Social Housing Rent Increases
Following the social housing rents consultation, the secretary of state has issued a new Direction on the rent standard. The Direction on the rent standard 2023 requires the regulator to set a rent standard for registered providers of social housing.
From 1 April 2023 to 31 March 2024:
The CPI+1% limit on annual rent increases is subject to a 7% ceiling. This ceiling applies to both social rent and affordable rentThere is an exception on the ceiling for supported housingThis 7% ceiling does not apply to the initial rent that may be charged when social rent or affordable rent properties are first let or re-let.
The Direction on the rent standard 2023 sits alongside the existing direction from 2019.
COVID-19 On-site Vaccinations
Homeless Link has circulated an offer from NHSE to support housing and homelessness services to get vaccinations to the people using those services. While not aimed directly at social care providers, we suspect there will be a number of services amongst our members who may benefit from this. You need to register by the end of tomorrow: https://www.tfaforms.com/5032453.
CQC Fees Scheme for 2023/2024
See this message from CQC:
"The CQC fees scheme for providers, which covers our costs of provider regulation, including registration, monitoring and inspection will not change next year – in 2023/24. This means that, for many providers, their fees will have remained the same for the last four years, unless you have changed your registration – for example, by adding locations or service types. As in previous years, NHS trusts, NHS GPs and community social care providers may also see a change to their fees from April 2023 (up or down), as we update the variables (turnover, list size, number of people using the service) used to calculate their fees. Since there is no change to our fees scheme, we will not be consulting on fees for provider regulation this year.
NCF Impact Report 2021-22
Finally, we have launched this year's NCF Impact Report. This outlines the achievements of the NCF team, our Board and our members during April 2021-November 2022.