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.
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:
protects your patients, staff and visitors
prevents and controls outbreaks by identifying cases early
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.
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:
inpatient hospice testing – where hospice staff look after patients on site
community-based hospice testing – where hospice staff visit patients in their own homes
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:
1 polymerase chain reaction (PCR) test every week
1 rapid lateral flow test on the same day as the PCR
1 rapid lateral flow test midweek, 3 to 4 days after their PCR test
StaffStaff, whether working on an in-patient unit or in the community, 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 takeisolate ain confirmatoryline PCRwith testandself-isolateuntilthe resultstay-at-home isavailable.guidance.
Patients
PatientsInpatients admitted to a hospice 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:
1 polymerase chain reaction (PCR) test every week
1 rapid lateral flow test on the same day as the PCR
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).
Visitors must conduct a lateral flow test on arrival to the hospice or the day of the planned visit and show proof of this to the hospice before the visit goes ahead. Visitors should test on each day they visit the hospice, regardless of how recently the previous visit took place.
More information on visitor testing can be found in section 4 of this guidance.
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.
IfAny oneindividual ofwho thesetests ispositive positive,with a confirmatorylateral PCRflow musttest beduring takenthe andrapid thenresponse self-isolationtesting untilmust resultisolate isin available.line with the stay-at-home guidance.
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:
all staff once a week using a PCR test
patients upon admission (if appropriate)
Northern Ireland:
all staff once a week using a PCR test
patients upon admission (if appropriate)
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)
NHS Test and Trace assigns all participating organisations a single unique organisation number (UON)
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
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
Fully vaccinated means 14 days after receiving a full course of ana MHRAMedicines and Healthcare products Regulatory Agency (MHRA) approved NHS administered vaccine.
There continue to be additional requirements in place for health and social care staff who are identified as a close contact of someone with COVID-19. 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:
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. test, unless they become symptomatic.
When returning to work following a negative PCR test, staff must test daily with a rapid lateral flow test (and receive a negative result) for up to 10 days.days following their last contact with the case. This includes the days they are not at work.
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.
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.
If a staff member has tested positive for COVID-19 in the past 90 days, they should not have a PCR test and should only undertake daily lateral flow device antigen tests for this purpose.
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 (if daily tests are deemed appropriate) 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
It is recognised that even in times of outbreak or where someone wishing to visit has been identified as a close contact, there may be exceptional circumstances which mean that visits may still be facilitated, for example when a person is thought to be in the last few days of their life. In these cases, a risk assessment should be carried out by hospice staff and arrangements made to accommodate safe visiting if possible.
Where visits do occur, visitors should haveprovide receivedproof of 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.
This does not apply to staff, patients, and visitors who have tested positive for COVID-19. If someone has tested positive, they must self-isolateself-isolate where notified forby 10NHS days where notifiedTest and Trace byin NHSline Test and Trace,with orthe stay-at-home guidance14in dayssection if5, they haveIf beenyou admittedhave toCOVID-19 hospital,symptoms inor linea withpositive the stay-at-home guidance. ThisLFD or PCR test result. This applies even if they are fully vaccinated. Vaccination reduces, but does not eliminate, the risk of acquiring and transmitting infection.
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.
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.
the barcode number of the test kit you’re registering
the email address and mobile phone number to which the test results should be sent
the patient or staff member’s personal details
Registering multiple tests at once
From 1 July,July 2021, 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.
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
NHS Test and Trace can track your samples from when they are collected and leave your premises
NHS Test and Trace can better manage test kit volumes across the network of laboratories
reduces cardboard waste
reduces the number of missing tests
Key changes:
new outer return boxes with attached barcode, for packing up to 50 individual test kits
no need to use individual test kit boxes – test kits can go directly into outer boxes
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.
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.
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 with a PCR for 90 days unless you become symptomatic.symptomatic; however, you can continue to test with rapid flow tests. For further information see the management of exposed staff and patients guidance.
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 conductself-isolate aconfirmatoryPCRtestandimmediately self-isolatein untilline theywith receivethe theirstay-at-home PCRresult.Followingaconfirmed(PCR)positivetest,staffshouldstopregularrapidlateralflowtestsandPCRtestingfor90days.guidance.
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.
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.
Digital reader
You are able to use the digital reader for reading lateral flow test results via the self-report journey. For detailed information, please visit the Digital reader guide (PDF, 2.25 MB, 6 pages).
4. Visitor testing
VisitorVisitors testingmust isconduct nota mandatory,lateral butflow istest advisableon arrival to helpthe protecthospice visitors,or staffthe day of the planned visit and patients.show proof of this to the hospice before the visit goes ahead. Visitors should betest testedon entryeach everyday timethey visit the hospice, regardless of how recently the previous visit took place.
When you order, sufficient quantities of lateral flow tests will be provided to test 10 visitors or visiting professionals per patient per week (suggested split 8 visitors and 2 visiting professionals).
On-site testing (including for visitors and people living in the setting)
Conduct a rapid lateral flow test on the day of your visit to a carehospice settingto help keep usothers safe, reduce the spread of coronavirus and prevent outbreaks.
To ensure that your test is linked to the carehospice settingyou’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.
Select ‘Myself’ when asked who you are reporting a result for.
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.
If continuing without an account, select, ‘A social care service’ when asked who the test was for.
Select ‘I’m visiting someone who gets care or support’.
Enter the UON of the care setting you are intending to visit. This should already have been provided to you by the setting manager.
Check the details of the organisation are correct.
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).
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.
Follow the remaining steps, entering your personal details to complete your report.
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
Ifthevisitortestspositive,whetherthevisitgoesaheadisatthediscretionofthehospicemanager.A positive rapid lateral flow test result requires aself-isolation confirmatoryin PCRline testbetakenandreturnedtothelab.IftheadditionalPCRkitscamewith aRoyalMaillabel,the kitstay-at-home canbepostedinaprioritypostbox.Ifnot,ring119tobookasame-daycourier.ThevisitorshouldimmediatelyreturnhomeandisolatetowaitfortheirPCRtestresult.guidance.
Support and resources
Coronavirus testing contact centre
Call 119119. (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.
Published 29 April 2021
Last updated 1920 NovemberJanuary 20212022
+ show all updates
19 November 2021
Updated to reflect latest self-isolation guidance for fully vaccinated contacts.
22 September 2021
Updated to include information on testing for patient facing volunteers.
27 July 2021
Added information on changes to hospice visitor testing in Northern Ireland and updated the section on return box tracking.
1 July 2021
Updated to reflect changes that hospices are now eligible to bulk upload coronavirus test results.
21 May 2021
Updated to include information on return box tracking for PCR tests.
20 May 2021
NHS helpline for Scotland has changed to 119.
11 May 2021
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.