Coronavirus (COVID-19) testing for hospices

This guidance sets out how hospices should access and use coronavirus (COVID-19) lateral flow device (LFD) testing for patient-facing staff presenting with symptoms of COVID-19, symptomatic patients where having COVID-19 will affect their clinical management and for outbreak testing.

What has changed

This guidance has been updated in line with changes to testing from 1 April 2023.

Most patients and non-patient-facing staff who have symptoms of a respiratory infection no longer need to take an LFD test for COVID-19.

Only patient-facing staff and eligible patients for COVID-19 treatments need to take a LFD test if they develop symptoms of a respiratory infection. Staff that carry out duties away from patients, such as back office staff, are ‘non-patient-facing members of staff’. Members of staff who provide direct care to patients are ‘patient-facing staff’.

Staff who test positive for COVID-19 should discuss with their line manager and follow locally agreed protocols before they return to work in direct care activities.

Rapid response testing for suspected outbreaks is no longer needed. Instead, the first 5 patients with symptoms of a respiratory infection should take an LFD test to identify if there is an outbreak and the pathogen involved. Any wider outbreak testing would only take place if advised by a health protection team where there are specific concerns

The use of PCR tests is no longer part of testing for admission into a hospice setting.

Admissions from hospital will be tested by LFD within 48 hours before discharge. Admissions from the community no longer need to test prior to admission.

Introduction

For most people, including in hospice settings, there is now a much lower risk of severe illness due to COVID-19 compared to earlier in the pandemic. This is due to high immunity, high vaccination coverage and increased access to COVID-19 treatments. There is a small cohort of people who remain at increased risk of serious illness from COVID-19.

Testing measures in this guidance are focused on the protection of hospice patients at a higher risk and eligible for COVID-19 treatments.

Separate arrangements are in place for hospices in Scotland, Wales and Northern Ireland. This guidance will be kept under review.

Hospices should continue to order tests in the same way and will be responsible for ordering kits for both ‘inpatient’ and ‘community based’ settings.

Staff with symptoms of a respiratory infection including COVID-19, or a positive LFD test result

Hospice staff who provide direct care to hospice patients

If a staff member who provides direct care to patients develops symptoms of a respiratory infection and has a high temperature or does not feel well enough to go to work, they should take an LFD test as soon as they feel unwell. If the result of this LFD test is negative, the staff member can attend work once they are well enough to do so and if they do not have a high temperature.

If the result of this LFD test is positive, they are advised not to attend work for at least 5 days. The staff member should only return if they feel well enough to work, and they do not have a high temperature. If they are still displaying respiratory symptoms when they return to work, they should speak to their line manager who should undertake a risk assessment.

The majority of COVID-19 transmission occurs within 5 days of symptom onset. A locally decided protocol, following risk assessment and direction from managers, may be used for staff who are returning to work 5 or more days after a positive test result where they are providing direct care to patients. This may include:

• redeployment to lower risk areas up to day 10 after symptom onset or first positive test result
• asking staff to wear a surgical face mask up to day 10 after symptom onset or the first positive test result
• negative results on LFD test prior to returning to work

The staff member must continue to comply rigorously with all relevant infection control precautions, including PPE use.

Hospice staff who do not provide direct clinical care

Staff who work within a hospice setting but who are not patient-facing, should follow local occupational health advice, together with guidance for people with symptoms of a respiratory infection.

If they have symptoms of a respiratory infection and have a high temperature or do not feel well enough to go to work, they are advised to stay at home and avoid contact with other people. These staff members no longer need to take an LFD test if they are symptomatic. They should stay at home until they no longer have a temperature or no longer feel unwell.

If these staff members receive a positive LFD test result for COVID-19, regardless of whether they have symptoms, they should follow guidance for the general public who have a positive test result.

Line managers should undertake a risk assessment before patient-facing healthcare staff return to work in line with normal return to work processes.

On returning to work, all staff members must continue to comply rigorously with all relevant infection control precautions including appropriate PPE use.

Patient testing

On admission

Patients with a scheduled date of admission to a hospice as an inpatient from the community or care setting are no longer advised to take a COVID-19 test before admission.

Patients being discharged from hospital into a hospice should be tested with an LFD test within 48 hours before planned discharge. This test should be provided and done by the hospital.

The result of the test should be shared with the individual, their key relatives or advocate; and the relevant care provided before the discharge takes place. Evidence of a negative LFD test result should be communicated by hospitals to the hospice in writing within the usual communications provided at the time of discharging a patient to a hospice.

Individuals who test positive for COVID-19 can be admitted to the hospice if the hospice is satisfied that they can be cared for safely. Individuals who are admitted with a positive test result should be isolated on arrival.

Symptomatic patients

Patients who are eligible for COVID-19 treatments and currently have symptoms of a respiratory infection should take an LFD test immediately and follow the guidance for people who are eligible for COVID-19 treatments. They should also stay away from others during this time if they either have a high temperature, or they feel unwell.

If the individual’s test results are all negative, they can return to their normal activities if they do not have a temperature and they feel well enough to do so.

If they receive a positive test result, they should also follow the guidance for people who have symptoms of a respiratory infection, including COVID- 19.

The test result should be reported in the first instance via GOV.UK or by dialling 119 in order to generate a referral to a COVID-19 Medicines Delivery Unity (CMDU), where an individual has been digitally identified as currently eligible for treatment.

Hospice settings will be able to order symptomatic test kits for patients when ordering symptomatic tests for staff. This process is explained in the ordering test kits section.

Hospice patients who are not eligible for COVID-19 treatment, and have symptoms of a respiratory infection and who have a high temperature or do not feel well enough to do their usual activities are advised to avoid contact with other people. They should be supported to stay away from others until they no longer have a high temperature or no longer feel unwell. These patients are not required to take an LFD test if they are symptomatic.

Outbreak testing

An outbreak consists of 2 or more positive or clinically suspected linked cases of COVID-19, within the same setting within a 14-day period. This means where the cases are linked to each other and transmission within the hospice setting is likely to have occurred. Linked asymptomatic cases are no longer counted as part of the definition of an outbreak.

As the majority of symptomatic COVID-19 testing has been removed, an outbreak may be suspected when there is an increase in the number of staff and/or service users displaying symptoms of COVID-19 at the same time and linked by personal contact.

If there is a suspected outbreak, the first 5 patients with symptoms of a respiratory infection should be tested using COVID-19 LFD tests. After this, new cases do not require testing unless they are eligible for COVID-19 treatments, as set out above in the symptomatic patient section.

There is no longer a need to test everyone in order to work out who has and has not acquired COVID-19. Instead, testing is now focused on determining the cause of an outbreak, and on preventing severe outcomes for individuals at high risk.

Ordering test kits

Unique organisation number (UON)

UKHSA assigns all participating hospices a single unique organisation number (UON). A UON is an 8-digit number that is exclusive to an individual hospice setting, and can be used to log in to all online elements of the testing process.

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.

Managers will need to use their UON for:

• ordering test kits
• contacting the national coronavirus contact centre for support (dial 119)

You will be able to order:

• LFD tests for any symptomatic patients eligible for COVID- 19 therapeutics or symptomatic patient-facing staff
• LFD tests in case of an outbreak

You will need:

• your UON
• the total number of patient-facing staff and patients eligible for testing

Enter the number of patient-facing staff and eligible patients who require testing.

Hospice settings will be able to order LFD test kits for symptomatic testing based on the number of symptomatic, patient-facing staff and eligible patients they have had over the past 42 days. Hospice settings will be able to make one symptomatic testing order every 42 days.

If the number of symptomatic staff increases within the 42-day period in a setting, a manual order of LFD test kits can be requested through the 119 service.

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 hospice address registered to the UON. It is the responsibility of the hospice manager to accept delivery of kits and arrange for dispatch or collection.

Recording important information before distributing rapid LFD test kits

It is important that you record the following details before distributing LFD test kits to staff.

• name, phone number and email address of each staff member receiving the box or boxes
• details of the lot or batch number of each LFD home test kit given to each staff member. The lot number is found on the side of each box and is 8 characters long: one letter followed by 7 numbers
• date of issue to user and number of test kits provided

Reporting LFD test results

Reporting your result

Every LFD test result should be reported online once completed.

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 report your first LFD test result 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 report a test result in the future.

Report your result as soon as the test result is determined. You need the ID number on the test strip to report the result.

Individuals or visitors can report a COVID-19 rapid lateral flow test result, with the option to sign in to an NHS account.

To report a test result:

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.

You can use the digital reader for reading LFD test results via the self-report journey. For detailed information consult the digital reader guide (PDF, 2.25 MB, 6 pages).

Support and resources

For the coronavirus testing contact centre, call 119. Lines are open:

• Monday to Friday (including bank holidays) 8am to 6pm
• Saturday and Sunday 9am to 1pm

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.