COVID-19: testing for hospices

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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 severely immunosuppressed hospice patients

If a staff member who provides direct care to severely immunosuppressed 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 careclinical to severely immunosuppressed hospice patientscare

Staff who work within a hospice setting but who doare not providepatient-facing direct care to severely immunosuppressed patients should follow local occupational health advice, together with guidance for for people with symptoms of a respiratory infection,.

If if they develophave symptoms of a respiratory infection and have a high temperature or do not feel well enough to go to work.

work, they are advised to stay at home and avoid contact with other people. These staff members dono notlonger need to take an LFD test if they are symptomatic. They areshould advised to stay at home and avoid contact with other people 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 doare notno needlonger advised to take a COVID-19 test before admission.

AsymptomaticPatients patients being discharged from hospital into a hospice areshould no longer advised to be routinely tested with a COVID-19 COVID-19 LFD test beforetest plannedwithin discharge.48 However,hours inbefore conjunctionplanned withdischarge. localThis hospicetest providers, acute health providers should havebe trustedprovided arrangementsand todone facilitateby safe discharges as set out in the hospital discharge and community support guidance.hospital.

TogetherThe withresult of the hospice,test hospitals should assessbe theshared riskwith in the periodindividual beforeand plannedtheir discharge,key seekingrelatives advice on proposed changes to testing arrangements from local authority public health teams or UKHSAadvocate. HPTs,The ifrelevant needed.care Followingshould discussionbe withprovided hospicewithin providersthe andhospital anybefore advicethe fromdischarge publictakes healthplace. teamsEvidence orof HPTs,the hospitals may decide to undertake an LFD test, for example if there is a local outbreak within the hospital setting. This test result should be providedcommunicated and done by thehospitals hospital. The hospice should speak to the hospital to raise any concerns about a planned discharge. Where a hospice isin providingwriting serviceswithin commissioned by the NHS,usual orcommunications aprovided localat authority,the andtime hasof concernsdischarging about a plannedpatient discharge that cannot be resolved with the acute hospital provider, they may wish to contacta the relevant commissioner.hospice.

IfIndividuals anwho individualtest is tested before discharge into a hospital and tests positive for COVID-19,COVID-19 they 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.

If there were signs of a new variant emerging or an increase in acute respiratory infection sufficient to impact on health and social care outcomes, UKHSA would manage any wider response through standard incident response structures. This would include the provision of public health advice to mitigate any risk, including the possible re-introduction of asymptomatic discharge testing if appropriate, alongside other infection prevention and control measures. 

UKHSA’s usual incident response procedures enable local authorities, NHS providers, and care providers to alert the relevant UKHSA Regional Response Centre, or HPT, of an incident that may require assessment and management. UKHSA regional teams will escalate nationally as required.

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 5-day14-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 anthere outbreak is suspected, contact your local HPT  who will conduct a risksuspected assessment.outbreak, The HPT will advise on the usefirst of multiplex PCR to test up to 5 linkedpatients cases with most recent onset of symptoms of a respiratory infection.infection Any patients who are eligible for COVID-19 treatments should also be tested asusing soonCOVID-19 asLFD possibletests. ifAfter theythis, developnew symptomscases ofdo annot acuterequire respiratorytesting infectionunless withthey COVID-19are LFDeligible tests obtained for thisCOVID-19 purpose,treatments, evenas ifset theyout areabove alsoin testedthe by PCR. See the symptomatic patients eligible for COVID-19 treatments section for further information..

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

Hospices

Unique haveorganisation beennumber provided(UON)

UKHSA assigns withall participating hospices a supplysingle ofunique LFDorganisation number (UON). testsA UON is an 8-digit number that is exclusive to an individual hospice setting, which can be used forto log in to all online elements of the testing symptomaticprocess.

Managers staffwill receive their UON via the registered email address – please make sure that the person who arereceives providingthese directemails careunderstands tothe severelyimportance immunosuppressedof patients.this Symptomaticmessage staffand knows who areto notcontact.

Managers providingwill careneed to severelyuse immunosuppressedtheir UON for:

• ordering patientstest shouldkits insteadfor followoutbreak and staff testing
• contacting the guidancenational COVID-19 contact centre for peoplesupport who(dial have119)

You symptomswill ofbe aable respiratoryto infection.order:

Reporting

• LFD tests for symptomatic patient-facing staff
• LFD test tests results

in case of an outbreak

UnderYou Regulationwill 4Aneed:

• your UON
• the oftotal Thenumber Healthof Protectionpatient-facing (Notification)staff Regulationsand 2010,patients hospiceswho arerequire stilltesting

Enter requiredthe tonumber reportof positive,patient-facing negativestaff and voidpatients who require testing.

Hospice settings are able to order LFD testtests resultsfor whereoutbreak theytesting haveevery assisted21 patientsdays toand takefor anstaff 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

ToYou supportwill hospicesreceive inan beingemail ablefrom organisation.coronavirus.testing@notifications.service.gov.uk who will confirm the estimated delivery date.

Test kits will be delivered to meetthe theirhospice Regulationaddress 4Aregistered duty,to the UKHSAUON. multipleIt registrationis spreadsheetthe willresponsibility remainof availablethe forhospice hospicesmanager to reportaccept COVID-19delivery of kits and arrange for dispatch or collection.

Recording important information before distributing LFD test results.kits

It Hospicesis areimportant stillthat ableyou torecord usethe thisfollowing routedetails before distributing LFD test kits to reportstaff:

• name, phone number and email address of each staff member receiving the resultbox or boxes
• details of the lot or batch number of each LFD home teststest thatkit havegiven notto beeneach providedstaff tomember. The lot number is found on the hospiceside directlyof each box and is 8 characters long: one letter followed by UKHSA7 numbers
• date of issue to user and number of test kits provided

Reporting LFD.

 test results

Reporting your result

ItFor isindividuals importantwho toare noteeligible thatfor theCOVID-19 registrationtreatments ofwho 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 leadhave 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 COVID-19test treatmentresult beingin prescribed.the Tofuture.

Report supportyour patientsresult as soon as the test result is determined. You need the ID number on the test strip to accessreport the result.

Individuals can report a COVID-19 treatments,rapid followLFD result, with the guidanceoption issuedto bysign thein to an NHS. account.