COVID-19: testing for hospices

This guidance sets out how hospices should access and use 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 the processes for ordering LFD tests and reporting results for patients who develop symptoms of respiratory infection and who are eligible for COVID-19 treatments. As of 6 November, LFD tests taken by individuals eligible for COVID-19 treatments should be ordered via NHS routes.

Introduction

For most people, including in hospice settings, there is now a much lower risk of severe illness from 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.

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.

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 a COVID-19 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 and their key relatives or advocate. The relevant care should be provided within the hospital before the discharge takes place. Evidence of the 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 kept away from other patients on arrival.

The period individuals should stay away from others is from the day after the positive test and does not restart when the individual is admitted into the hospice. If the individual has already tested positive before the planned discharge, they do not need to test again if they continue to have symptoms of a respiratory infection and feel unwell or have a high temperature.

Symptomatic patients who are eligible for COVID-19 treatments

People who are at higher risk of severe outcomes from COVID-19 may be eligible for COVID-19 treatments if they become unwell.

If someone who is eligible for COVID-19 treatments develops symptoms of a respiratory infection, they should be tested as soon as possible with an LFD test. Information on testing, reporting results and accessing COVID-19 treatments is available in the NHS guidance on COVID-19 treatments.

Treatments for COVID-19 are most effective if they are started early (ideally within 5 days of an individual first developing symptoms). It is therefore important that patients who are eligible for COVID-19 treatments take an LFD test as soon as possible if they develop symptoms so that they can access treatments early if needed. 

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

Staff providing care to people outside of residential care settings can help to support individuals who are eligible for COVID-19 treatments to access tests and treatments. More information is available on NHS.UK.

Symptomatic patients who are not eligible for COVID-19 treatments

Hospice patients who are not eligible for COVID-19 treatments are not required to take an LFD test if they are symptomatic.

If these patients have symptoms of a respiratory infection and have a high temperature or do not feel well enough to do their usual activities, they 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. They should follow the guidance for people with symptoms of a respiratory infection, including COVID-19.

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 patients eligible for COVID-19 treatments 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.

How to access COVID-19 test kits

Accessing test kits for people eligible for COVID-19 treatments

Care providers can access LFD tests on behalf of service users who are eligible for COVID-19 treatments and therefore eligible for symptomatic testing.

Tests for this purpose are supplied by the NHS and should be accessed from a local pharmacy. Providers should speak to their local pharmacy to discuss access arrangements and whether the pharmacy is able to deliver tests in addition to collection options.

Pharmacies may ask questions about an individual’s medical history to confirm eligibility for free tests and update patient records for future test orders.

Providers should ensure that there are at least 3 tests available per eligible individual to enable them to test for 3 consecutive days if they develop symptoms of a respiratory infection. 

More information is available on NHS.UK.

Accessing test kits for outbreak and staff testing

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, which 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 for outbreak and staff testing
• contacting the national COVID-19 contact centre for support (dial 119)

You will be able to order:

• LFD tests for 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 who require testing

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

Hospice settings are able to order LFD tests for outbreak testing every 21 days and for staff testing 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 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

For individuals who are eligible for COVID-19 treatments who have a positive COVID-19 LFD test result, follow the information in the NHS guidance for COVID-19 treatments.

Every result of an LFD test taken by symptomatic staff or as part of outbreak testing 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 can report a COVID-19 rapid LFD 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.

Support and resources

For the COVID-19 testing contact centre, call 119.

Lines are open:

• 9am to 5.30pm Monday to Friday

• Closed on weekends and Bank Holidays

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.