Coronavirus (COVID-19) testing for hospices
Sets out how hospices can access COVID-19 testing for staff and patients on-site, for staff visiting patients in their own homes, and for visitors to hospices.
Applies to England, Northern Ireland and Wales
Introduction
NHS Test and Trace is making weekly COVID-19 testing available to all hospices in England, Wales and Northern Ireland. Separate arrangements are in place for hospices in Scotland.
All registered hospices have been contacted with details of how to apply for test kits for their staff and patients. Hospices will be responsible for ordering test kits for both ‘inpatient’ and ‘community-based’ settings. Different testing routes apply depending on where the testing will be carried out, and these routes are described in detail in this document.
We will also cover rapid testing for visitors and visiting professionals for inpatient hospice settings.
Why testing is important
Testing:
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protects your patients, staff and visitors
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prevents and controls outbreaks by identifying cases early
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provides reassurance, allowing those who test negative to carry on working
Staff with symptoms should not be in work.
We need to carry on testing, and self-isolating if needed, regardless of the vaccine roll-out programme.
Webinars
For more information you can join our webinars, which are hosted on a regular basis.
These live webinars will talk you through the end-to-end process for hospice testing and will include a live question and answer session with the hospice testing team, who will be happy to answer your questions.
If there are no live webinars available, you’ll be able to sign up to access a recorded version.
Sign up to hospice testing webinars
1. Summary: testing for hospices
Types of COVID-19 test
Polymerase chain reaction (PCR) tests are over 99% effective and pick up positive results at early and late stages of the virus. Completed tests are sent to a lab for processing.
Rapid lateral flow tests are effective at detecting virus in those with high levels of coronavirus in their system. Results are given within 30 minutes and kits do not need to be sent to labs for processing.
About the service
The service covers 3 individual elements:
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inpatient hospice testing – where hospice staff look after patients on site
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community-based hospice testing – where hospice staff visit patients in their own homes
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visitor testing – for testing visitors, including visiting professionals such as faith leaders, before they come into contact with staff or patients in a hospice
Regular asymptomatic testing for hospices in England
Staff
All hospice staff should test with:
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1 polymerase chain reaction (PCR) test every week
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1 rapid lateral flow test on the same day as the PCR
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1 rapid lateral flow test midweek, 3 to 4 days after their PCR test
Staff must take a rapid lateral flow test before starting work if returning from leave or if they have worked somewhere else in between. If a staff member tests positive from a rapid lateral flow test, they must take a confirmatory PCR test and self-isolate until the result is available.
Patients
Patients should be tested with one PCR on admission (if appropriate), and ad hoc if required (if they are presenting symptoms).
Patient-facing volunteers
This guidance is only for patient-facing volunteers, who come into direct contact or carry out support work with hospice patients.
All patient-facing volunteers working at your hospice should test themselves with:
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1 polymerase chain reaction (PCR) test every week
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1 rapid lateral flow test on the same day as the PCR
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1 rapid lateral flow test midweek, 3 to 4 days after their PCR test
You can provide test kits for patient-facing volunteers using your current stock of test kits provided by NHS Test and Trace.
Please also ensure your patient-facing volunteers register their test kits the same way as staff, using the hospice’s Unique Organisation Number (UON).
If you need to order more test kits for patient-facing volunteers at your hospice, you can order them by adding the number of volunteers to the ‘number of staff’ in the ordering portal. Please double-check your stock levels before you order.
If you are going to need more test kits for patient-facing volunteers than you are able to order, please call 119 and ask for your staff numbers to be updated. You will need to give both the number of staff and the number of patient-facing volunteers. You should only order additional test kits for volunteers who are actively working with patients at your hospice.
Patient-facing volunteers who come into the hospice once a week or less should be tested as a visitor would, with a lateral flow test either on entry or on the day of their visit at home (with evidence of a negative result).
Other volunteers
In order to protect lab capacity and prioritise protecting the most vulnerable, non-patient-facing volunteers (such as shop, administration and maintenance volunteers) should order their own free packs of rapid lateral flow tests to be sent to their home via GOV.UK.
Rapid response testing for hospices in England
If a positive case is identified in a hospice setting (from a PCR or rapid lateral flow test), all staff should undertake daily rapid lateral flow test testing for 7 days.
If one of these is positive, a confirmatory PCR must be taken and then self-isolation until result is available.
In addition to this, if any positive cases found in a hospice (either PCR or rapid lateral flow test), the hospice manager should contact their local health protection team (HPT) immediately, and follow the advice given.
Regular asymptomatic testing for hospices in Wales, Scotland and Northern Ireland
Wales:
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all staff once a week using a PCR test
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patients upon admission (if appropriate)
Northern Ireland:
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all staff once a week using a PCR test
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patients upon admission (if appropriate)
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all visitors to hospices will be offered twice weekly self-testing (in the visitors’ own homes) using lateral flow devices
Scotland: testing is delivered locally through the local NHS.
Unique organisation number (UON)
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NHS Test and Trace assigns all participating organisations a single unique organisation number (UON)
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Managers will receive their UON via the registered email address. Please make sure that the person who receives these emails understands the importance of this message and knows who to contact
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A UON is an 8-digit number that is exclusive to an individual organisation – this can be used to login to all online elements of the testing process
Managers will need to use their UON for:
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contacting the national coronavirus contact centre for support (dial 119)
Staff will need to use their UON for:
- registering completed test kits to make sure they will receive their results
If you have any issues with this process, please call 119.
Frequency of testing if you test positive
If anyone tests positive with a PCR test they should not be tested again for 90 days, unless they develop new symptoms. If that happens, they should be tested immediately using a PCR.
The 90-day period is from the initial onset of symptoms or, if asymptomatic when tested, from the date of the positive test result.
During the 90-day period after a positive test it is more likely that a positive rapid lateral flow test would represent a false result. Testing in this 90-day period should not take place – the regular testing regime can resume once the 90 days have passed.
Self-isolation guidance for fully vaccinated contacts of a positive case
From Monday 16 August 2021, anyone in England who has been fully vaccinated, or is under the age of 18, is no longer required to self-isolate when they are a contact of someone who has tested positive for COVID-19. However, they will still need to take a PCR test and avoid people who are highly vulnerable to COVID-19.
Fully vaccinated means 14 days after receiving a full course of an MHRA approved NHS administered vaccine.
Hospice patients are generally highly vulnerable to COVID-19, therefore there are further risk mitigations in place for staff testing in hospices. Fully vaccinated health and care workers without symptoms who are identified as close contacts should attend work, subject to:
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Taking a PCR test and not attending work until they have had a negative result. Staff working in the sector would be expected to continue working following a negative PCR test.
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When returning to work following a negative PCR test, staff must test daily with a rapid lateral flow test for up to 10 days. It is recognised that despite hospice patients being highly vulnerable, workforce size and pressures may mean it is difficult to redeploy staff away from direct patient contact during this 10-day period without compromising service provision. Compromised services mean that fewer patients, all of whom have complex needs and most of whom are in the last weeks or days of their life, would not get the palliative care they need. Registered managers and senior medical staff should therefore carry out a risk assessment, on a case-by-case basis, to determine whether it is appropriate for that member of staff to work in direct contact with patients.
Contacts of a household case are more at risk of contracting COVID-19 than contacts of a non-household case. This should be considered when carrying out risk assessments on whether a staff member should return to work.
Decisions on whether staff should return to work following exposure to COVID-19 should be clinically based and weigh up the risks and benefits for each patient, their family and the functioning of the hospice.
Self-isolation is still required while awaiting PCR test results.
For patients and visitors to hospices, this change to self-isolation policy means:
- patients in hospices should be exempt from self-isolation following a negative PCR test and daily rapid lateral flow tests and can continue to receive visitors unless there is an outbreak
- visitors to hospices are advised against visiting if they are a contact unless necessary
Where visits do occur, visitors should have received a negative PCR result, and a negative rapid lateral flow test result on the day of their visit. However, in exceptional circumstances – where for example a patient is rapidly deteriorating towards end of life and there is insufficient time for the visitor to conduct a PCR test – a hospice should conduct an individual risk assessment and consider whether the visit can go ahead without a PCR result with additional precautions, including a negative rapid lateral flow test result.
Settings must continue to follow other precautions to minimise risk of infection including wearing the correct PPE appropriately in accordance with the current infection and prevention control (IPC) guidance.
For more information on the self-isolation policy, see COVID-19: management of staff and exposed patients and residents in health and social care settings .
This does not apply to staff, patients, and visitors who have tested positive for COVID-19. If someone has tested positive, they must self-isolate for 10 days where notified by NHS Test and Trace, or 14 days if they have been admitted to hospital, in line with the stay-at-home guidance. This applies even if they are fully vaccinated. Vaccination reduces, but does not eliminate, the risk of acquiring and transmitting infection.
2. PCR kits
Ordering test kits
You will need:
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your UON
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the total number of ‘staff’ and ‘patients’ for testing (‘staff’ only for community hospices)
Enter the number of staff who require testing, and the number of inpatient beds for the number of non-staff.
Hospices in England can also order rapid lateral flow tests. These will be provided in boxes of 7.
Once you have placed an order, you will receive a confirmatory email from organisation.coronavirus.testing@notifications.service.gov.uk.
Preparation
You will receive an email from organisation.coronavirus.testing@notifications.service.gov.uk who will confirm the estimated delivery date.
Test kits will be delivered to the registered address. It is their responsibility to accept delivery of kits and arrange for despatch or collection. Re-ordering should be done on a monthly basis.
Distributing test kits to staff who are testing remotely
Once kits have been delivered it is the manager’s responsibility to distribute to staff or arrange for collection. Staff can pick up kits at the same time as other materials (for example, personal protective equipment (PPE) or other medical supplies).
Each member of staff should receive 4 PCR kits and (if in England) 2 boxes of 7 rapid lateral flow test kits every 28 days so that weekly testing can continue without interruption.
Capturing important information before distributing rapid lateral flow test kits
It’s important that you capture the following details before distributing rapid lateral flow test kits to staff or visitors:
- name, phone number and email address of each staff member or visitor receiving the box or boxes
- details of lot or batch number of each rapid lateral flow home test kit given to each staff member or visitor. The lot number is found on the side of each box. It is 8 characters long: one letter followed by 7 numbers
- date of issue to user and number of test kits provided
Conducting PCR tests
Staff will conduct a combined throat and nose self-swab for the test.
Follow the instructional video on how to do a throat and nasal swab.
Always leave 7 days between tests where possible. Additionally, continue testing at home if on holiday (in the UK) or off work due to any illness which is not related to coronavirus.
Registering PCR tests
You must register every test kit online.
You will need:
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your UON
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the barcode number of the test kit you’re registering
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the email address and mobile phone number to which the test results should be sent
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the patient or staff member’s personal details
Registering multiple tests at once
From 1 July, you can use the new version of the record-keeping multiple registration spreadsheet. The updated spreadsheet will let you register both PCR test kits and rapid lateral flow tests at the same time.
Ensure you only use the most recent version of the multiple upload spreadsheet to register coronavirus tests for your organisation.
You can register up to 100 tests on the spreadsheet. You’ll need to complete separate spreadsheets for staff and non-staff.
Organisations can still upload their testing data using the self-registration route. This is an additional option and does not replace the self-reporting routes.
You will need to read the guidance and download the multiple registration spreadsheet to record the details of people you’ve tested for coronavirus on that day.
Return box tracking
Watch a video demonstration of return box tracking.
Please see a 2-page document which explains the
Benefits of using return box tracking:
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saves you time as you do not have to make up smaller boxes for returning individual test kits – test kits can be placed directly into the box in sample bags
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NHS Test and Trace can track your samples from when they are collected and leave your premises
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NHS Test and Trace can better manage test kit volumes across the network of laboratories
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reduces cardboard waste
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reduces the number of missing tests
Key changes:
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new outer return boxes with attached barcode, for packing up to 50 individual test kits
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no need to use individual test kit boxes – test kits can go directly into outer boxes
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write the number of test kits inside the box onto the outer return box
You can order outer return boxes from the same portal you order test kits from.
When registering your test kits please ensure you capture the outer return box barcode for every kit you pack into the box.
For single registration, complete the process as normal until you reach the screen “Do you have the outer return box barcode?”. Confirm if you have an outer return box and enter the barcode on the dark blue label on the box. You will need to complete this step for every person you are registering.
For multiple registration, make sure you record the outer return box barcode on the “Box Barcode” column of the multiple upload sheet.
Returning PCR test kits by courier
Return Box Tracking only applies if you return completed test kits by courier. Inpatient hospices returning more than 8 PCR kits should return them via courier using the outer return box.
The easiest way to ensure your package is safe is to use these outer return boxes labelled UN3373 and ensure the box is made up correctly and the test kits are securely packaged inside.
Booking your courier
You will need your UON and post code to book a courier. You must book for next day before 7pm.
You can specify pick-up slots when you book the courier online. Subject to availability you can choose from:
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9am to 1pm
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2pm to 6pm
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4pm to 9pm
If your courier does not arrive at the booked time, call 119. Do not contact the courier direct.
Returning PCR test kits by post
Staff testing remotely, or inpatient hospices returning fewer than 8 tests should return test kits via a Royal Mail priority box:
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Each test kit contains a pre-paid return label
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Attach the label to the outside of the delivery packaging next to the security seal
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If you do not have enough return labels, call 119
Only use a Royal Mail priority post box. It will be labelled with the priority box sign and one of the regional NHS logos.
Find your nearest priority post box and its collection times
Receiving PCR test results
The person tested will receive:
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an email
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a text message (if a mobile phone number was provided at registration)
The results will also include guidance on next steps for the person tested. Staff should inform their employer of a positive result immediately. After testing positive, you do not need to test again for 90 days unless you become symptomatic.
Find out what to do when you get your results
3. Rapid lateral flow test kits
Using the test kits for staff
Staff members will conduct a combined throat and nose self-swab for the test. Follow the instructional video on how to do a COVID-19 self test (rapid antigen test).
Reading your result
If a staff member receives a negative result with a rapid lateral flow test and remains without symptoms they can continue working. Staff members must continue following all infection prevention and control (IPC) measures such as wearing PPE, washing your hands and socially distancing where possible.
If any staff member tests positive, they will need to conduct a confirmatory PCR test and immediately self-isolate until they receive their PCR result. Following a confirmed (PCR) positive test, staff should stop regular rapid lateral flow tests and PCR testing for 90 days.
If a staff member develops new COVID-19 symptoms within the 90-day window, they should apply for a COVID-19 test through regular testing channels.
Registering your result
Every rapid lateral flow test must be registered online once completed.
Complete the registration as soon as the test result is determined. You need the ID number on the test strip to register the result.
When using the online form, there is the option to create a user account. When you create a user account, you link your email address to your personal details. After you register your first rapid lateral flow test using your user account, your personal details will be saved, and you will not have to re-enter them when you register in future.
Creating an account should take about 2 minutes and will save about 5 minutes each time you register a test in the future.
To register a test:
- Enter who you are reporting for.
- Select whether you would like to sign in or create an account or continue without an account.
- Follow the step-by-step instructions for creating an account (if required).
- Enter why you took the test (select testing for ‘a social care service’).
- Enter your role.
- Select ‘I work in an adult social care service’.
- Enter your UON.
- Select the appropriate country for where you live.
- Select the date of the test.
- Enter the test kit ID number (which can be found via the QR code).
- Add in the result of the test.
4. Visitor testing
Visitor testing is not mandatory, but is advisable to help protect visitors, staff and patients. Visitors should be tested on entry every time they visit the hospice, regardless of how recently the previous visit took place.
On-site testing (including for visitors and people living in the setting)
See Coronavirus (COVID-19) testing for adult social care settings for full details of how to conduct on-site testing.
Self-test (visitor testing at home)
Before you start testing
Conduct a rapid lateral flow test on the day of your visit to a care setting to help keep us safe, reduce the spread of coronavirus and prevent outbreaks.
Adult social care settings can provide you with a box of rapid lateral flow tests to take at home. Find out more about the different ways to access rapid coronavirus testing.
To ensure that your test is linked to the care setting you’re visiting, ensure all tests are reported to their UON. How to do this is detailed below.
You must be able to show staff the text (SMS) message or email from NHS Test and Trace as evidence of a negative test.
It is at the discretion of the setting manager whether they wish to accept visitors who have self-tested at home.
Registering visitor rapid lateral flow tests
Every rapid lateral flow test must be registered online once completed.
Complete the registration as soon as the test result is determined. You need the ID number on the test strip to register the result.
When using the online form, there is the option to create a user account. When you create a user account, you link your email address to your personal details. After you register your first rapid lateral flow test using your user account, your personal details will be saved, and you will not have to re-enter them when you register in future. Creating an account should take about 2 minutes and will save about 5 minutes each time you register a test in the future.
Registration step by step for visitors
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Select ‘Myself’ when asked who you are reporting a result for.
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You can choose to continue ‘without an account’ or ‘create an account’. Creating an account will save your details each time you report a test result. Creating an account only takes 2 minutes and you’ll save 5 minutes when reporting each test result.
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If continuing without an account, select, ‘A social care service’ when asked who the test was for.
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Select ‘I’m visiting someone who gets care or support’.
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Enter the UON of the care setting you are intending to visit. This should already have been provided to you by the setting manager.
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Check the details of the organisation are correct.
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Tell us when the test was taken. (This should always be ‘today’ as visitors to adult social care settings must show proof of a negative test conducted on the same day as their visit).
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Enter the ID number printed on the plastic test strip. You can also scan the QR code on the test strip if you are using a mobile device.
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Follow the remaining steps, entering your personal details to complete your report.
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You will receive a text message and email from NHS Test and Trace confirming your test result has been reported. You must take one of these with you to the setting you are visiting, as proof of a negative result.
Visitor test results
Negative
The visitor can continue with the visit if other IPC measures are adhered to. The visitor should only enter designated parts of the setting and must wear appropriate PPE including a face mask, gloves, apron and follow IPC measures in line with the national policy. IPC measures remain important because the test is not 100% sensitive.
Invalid or void
The visitor will need to re-test using a spare rapid lateral flow test kit to receive a conclusive result. If the re-test comes back as invalid, we recommend that you do not allow the visitor to complete the visit as planned, but this is at the discretion of the hospice manager.
Positive
If the visitor tests positive, whether the visit goes ahead is at the discretion of the hospice manager. A positive rapid lateral flow test result requires a confirmatory PCR test be taken and returned to the lab. If the additional PCR kits came with a Royal Mail label, the kit can be posted in a priority post box. If not, ring 119 to book a same-day courier. The visitor should immediately return home and isolate to wait for their PCR test result.
Support and resources
Coronavirus testing contact centre
Call 119 (England). Lines are open from 7am to 11pm daily.
After selecting your country, language requirements and data preferences, press ‘1’ for calling from an organisation who receives test kits directly from the national testing programme.
Consent form templates that can be used for staff and patients have been shared with local authorities.
Guidance on testing people who lack mental capacity
Learning disability-specific guidance:
Easy reads on coronavirus and testing:
Last updated
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Updated to reflect latest self-isolation guidance for fully vaccinated contacts.
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Updated to include information on testing for patient facing volunteers.
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Updated to reflect changes that hospices are now eligible to bulk upload coronavirus test results.
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Updated to include information on return box tracking for PCR tests.
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NHS helpline for Scotland has changed to 119.
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Added new sections on the frequency of testing if you test positive, the information you need to capture before distributing rapid lateral flow test kits, and registering your result.
Update history
2024-03-25 12:05
Updated in line with changes to outbreak testing, symptomatic staff testing and testing upon discharge from hospitals into hospices from 1 April 2024. Updated the definition of an outbreak of COVID-19.
2024-03-08 16:22
Updated information on termination of testing services.
2024-01-24 08:30
Updated 119 hours.
2023-11-14 14:40
Updated information on the process for ordering LFD tests for those eligible for COVID-19 treatments.
2023-04-25 12:12
Removed digital reader information and guide as this is no longer part of the LFD reporting journey.
2023-03-30 16:17
Updated guidance.
2022-09-28 12:34
Removed information on testing for hospices in Wales and Scotland. Revised structure of the guidance.
2022-08-24 16:53
Updated in line with the pause to routine asymptomatic testing from 31 August.
2022-05-30 00:15
Updated 119 phone line opening hours.
2022-05-19 17:23
Removed Northern Ireland guidance.
2022-05-05 13:43
Updated in line with changes to testing in adult social care settings from 4 April.
2022-01-20 16:02
2021-11-19 14:58
Updated to reflect latest self-isolation guidance for fully vaccinated contacts.
2021-09-22 15:09
Updated to include information on testing for patient facing volunteers.
2021-05-21 16:46
Updated to include information on return box tracking for PCR tests.
2021-05-20 12:00
NHS helpline for Scotland has changed to 119.