Coronavirus (COVID-19) testing for hospices

Introduction

From 4 April 2022, the government will continue to fund targeted testing, prioritising groups most at risk of infection, whilst reducing testing requirements where possible to ease the additional burden.

UKHSA is continuing to make twice weekly COVID-19 testing available to all hospice staff in England and Wales during periods of high prevalence. 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.

Webinars

For more information you can watch our recorded webinars.

1. Summary: testing for hospices

1.1 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 infection. 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.

1.2 About the service

From 4 April 2022, this service now covers testing for:

• asymptomatic testing for hospice staff, both inpatient and community
• inpatient testing for patients who show COVID-19 symptoms
• rapid response testing, in the instance of an outbreak
• limited testing for visitors who provide personal care for patients

1.3 Staff Testing

1.3.1 Asymptomatic

From 4 April 2022, all hospice staff should test with:

• 1 rapid lateral flow device (LFD) test at the beginning of every working week
• 1 LFD test midweek, 3 to 4 days after their initial LFD test

This includes all staff and individuals who have previously been included in the staff numbers, for example patient-facing volunteers who were included in staff testing numbers.

Staff returning from leave must ensure that they restart weekly testing.

1.3.2 Symptomatic

Anyone who has symptoms of a respiratory infection and a high temperature, or symptoms of a respiratory infection and does not feel well enough to work, is advised to stay at home and avoid contact with other people.

Hospice staff who are concerned they may be experiencing symptoms of COVID-19 are able to access LFD tests (free tests are provided for symptomatic testing and staff should ensure they have some at home for this purpose). Hospice staff who have symptoms of a respiratory infection and who have a high temperature, or staff who have symptoms of a respiratory infection and do not feel well enough to work, should stay away from work and conduct an LFD test on the day they start to feel unwell (day 0).

If this test result is negative, they should take another test 48 hours later, continuing to stay away from work during this 48-hour period. If the second test is also negative, they can return to work if well enough to do so.

If either of the test results are positive, then they should follow the guidance for staff who test positive.

Further information on the symptoms of a respiratory infection and what to do if a staff member is concerned they may be experiencing symptoms of COVID-19 can be found in the COVID-19 supplement to the infection prevention and control resource for adult social care.

Further information on reading LFD results can be found in section 4 of this document.

1.4 Patient Testing

1.4.1 On admission

Patients with a scheduled date of admission to a hospice as an inpatient from the community or a care setting will be eligible for a PCR test 72 hours before admission (if appropriate) and an LFD test on the day of admission.

If inpatients cannot be tested with a PCR test (for example, unplanned or urgent admissions, or if they have tested positive in the last 90 days) then an LFD test on admission is sufficient.

Patients admitted to a hospice setting from an NHS hospital will be given a PCR test by the NHS hospital on discharge.

1.4.2 Symptomatic

Patients showing symptoms of a respiratory infection and a high temperature, or symptoms of a respiratory infection and do not feel well enough to take part in usual activities should be tested with one LFD test on the day the symptoms show (day 0).

For guidance on how to manage patients who may be displaying symptoms of COVID-19, and how to manage those that test positive, follow the advice given in the COVID-19 supplement to the infection prevention and control resource for adult social care.

1.5 Visitor testing

From 4 April 2022, visitors to hospices are no longer required to test. We ask that visitors take the necessary precautions to keep themselves and loved ones safe, in line with guidance for the general population.

There will be a small allocation of LFD tests available for visitors who provide close, personal care to patients. These tests will be allocated at the hospice manager’s discretion, dependent on the kind of care that is being provided. More information on visitor testing can be found in section 4 of this guidance. Testing is available for Care Quality Commission (CQC) Inspectors, social workers, Personal Assistants, and Shared Lives carers which can be ordered individually from gov.uk.

Visits to those at the very end of life, that is, in the last few days or hours of life should continue to be supported in all circumstances.

1.6 Rapid response testing for hospices in England

If one or more positive cases (staff or patient) are identified in a hospice, the hospice will be able to access rapid response LFD tests for all staff. Hospice staff working in the setting over the rapid response period should conduct daily rapid LFD testing every day they are working for 5 days from the day the positive case is identified. Staff not working during this period do not need to test.

Any staff member who tests positive should stay at home and try and avoid contact with other people. Staff should not return to work until they have had two consecutive negative test results.

In addition to this, if any positive case is found in a hospice (either staff or patient), the hospice manager should contact their local health protection team (HPT) immediately, and follow the advice given.

Hospice settings will be able to order ‘outbreak kits’ as an option on the test kit ordering portal.

1.7 Regular asymptomatic testing for hospices in Wales and Scotland

Wales:

• all staff once a week using a PCR test
• patients upon admission (if appropriate)

Scotland: testing is delivered locally through the local NHS.

1.8 Guidance for staff who test positive

For staff who have tested positive, hospices are advised to follow the guidance for people with symptoms of a respiratory infection including COVID-19. In addition to this, staff should not attend work until they have had two consecutive negative LFD test results, they feel well, and do not have a high temperature.

The first LFD test should be taken 5 days after day 0 (the day symptoms started and or/when they tested positive), the second test should be taken 24 hours after the first. If both LFD test results are negative, they may return to work immediately after the second negative LFD test result (if symptoms have resolved).

If a staff member’s LFD test result remains positive after 10 days, they should continue to take daily LFD tests. They can return to work after a single negative LFD test result.

The likelihood of a positive LFD test after 14 days is considerably lower. If the staff member’s LFD test is still positive on day 14, they can stop daily testing and return to work on day 15. A risk assessment should be carried out and consideration given to redeployment.

For staff who test positive between days 10 and 14 and who do not have a high temperature or feel unwell, managers can undertake a risk assessment with the view to them returning to work.

1.9 Testing within 90 days of a positive result

Staff who have tested positive within the last 90 days should continue to undertake regular asymptomatic rapid lateral flow tests during this time.

Advice on testing patients on admission who have tested positive with a PCR test in the last 90 days can be found in the patient testing section of this document.

2. Ordering test kits

2.1 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

Managers will need to use their UON for:

• ordering test kits
• 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.

Hospice managers can order test kits online.

You will be able to order:

• LFD tests, for regular asymptomatic testing of staff and for any symptomatic patients or staff
• outbreak LFD tests, if Directors of Public Health have recommended that you participate in rapid response testing
• PCR testing for admissions, for the purpose of testing a new patient admitted from the community. You can order a maximum of 10 PCR tests at a time

You will need:

• your UON
• 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.

2.2 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 dispatch or collection. Re-ordering should be done on a monthly basis.

Each hospice will receive enough LFD tests for each staff member to conduct 2 tests per week. You will also be sent enough LFD tests to conduct symptomatic testing on staff and patients.

2.3 Capturing important information before distributing rapid lateral flow test kits

It’s important that you capture the following details before distributing LFD 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 the lot or batch number of each LFD 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

3. PCR Test Kits

3.1 Conducting PCR tests

PCR tests should be reserved for new patients admitted from the community. Patients should conduct a combined throat and nose self-swab for the test.

Follow the instructional video on how to do a throat and nasal swab.

3.2 Registering PCR tests

You will need:

• your UON
• 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’s personal details

3.3 Returning PCR test kits by post

Each PCR test should be returned to the laboratory via a Royal Mail priority box.

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.

3.4 Receiving PCR test results

The patient tested will receive:

• an email
• a text message (if a mobile phone number was provided at registration)

The results will also include guidance on next steps for the patient tested.

4. LFD test kits

4.1 Reading your result

If a staff member receives a negative result with an LFD 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 their hands, and socially distancing where possible.

If any staff member tests positive, they should follow the guidance above in this document for staff who test positive.

4.2 Registering your result

Every LFD 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.

Register your result here: Report a COVID-19 rapid lateral flow test 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.

Individuals or visitors reporting rapid lateral flow test results can sign in to an NHS account to report tests quicker and also use the digital read service.

To register a test:

1. Enter who you are reporting for.
2. Select whether you would like to sign in or create an account or continue without an account.
3. Follow the step-by-step instructions for creating an account (if required).
4. Enter why you took the test (select testing for ‘a social care service’).
5. Enter your role.
6. Select ‘I work in an adult social care service’.
7. Enter your UON.
8. Select the appropriate country for where you live.
9. Select the date of the test.
10. Enter the test kit ID number (which can be found via the QR code).
11. Add in the result of the test.

4.3 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).

5. Visitor testing

Individuals who have been identified as providing personal care and therefore have access to testing must conduct an LFD test on arrival to the hospice on the day of the planned visit and show proof of this to the hospice before the visit goes ahead.

5.1 On-site testing (including for visitors and people living in the setting)

See COVID-19 testing for adult social care services for full details of how to conduct on-site testing.

5.2 Visitor test results

5.2.1 Negative

Visitors who are providing personal care should have a negative COVID-19 lateral flow test result from a lateral flow device before entering and should wear appropriate PPE for the task, unless medically exempt. The visitor should be encouraged to wear a face mask in any communal areas and comply with other IPC measures as advised by the setting during their visit.

Individuals who are symptomatic and/or feeling unwell should not visit even if they test negative for COVID-19, are fully vaccinated and have received their booster. Transmissible viruses such as flu, respiratory syncytial virus (RSV) and norovirus can be just as dangerous to hospice patients as COVID-19. If visitors have any symptoms that suggest other transmissible viruses and infections, such as cough, high temperature, diarrhoea or vomiting, they should avoid visiting if possible, until at least 5 days after they feel better.

Visits at the very end of life, that is, the last few days or hours of life should continue to be supported in all circumstances. Additional IPC measures, for example providing PPE and allowing visitors to go directly to the patient’s room without accessing any communal areas, will help reduce transmission.

5.2.2 Invalid or void

If a visitor is unable to produce evidence of a negative test, they may be asked to reschedule. This is at the discretion of the hospice manager. As above, individuals who are symptomatic or feeling unwell should not visit the setting.

5.2.3 Positive

It is advised that visitors who test positive follow the guidance for people with symptoms of a respiratory infection including COVID-19.

Visits at the very end of life, that is, the last few days or hours of life should continue to be supported in all circumstances.

Support and resources

Coronavirus testing contact centre

Call 119. Lines are open Monday to Friday from 7am8am to 11pm6pm daily.and 9am to 1pm on weekends.

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.

Easy reads on coronavirus and testing:

• COVID-19 PCR home test kit instructions