This guidance outlines a process of risk assessment and mitigation for patient/service user facing health and social care staff. This will provide additional safeguards and protections for people who may be more vulnerable to COVID 19. Staff who have not been fully vaccinated must continue to self-isolate when identified as a contact.
The majority of health and social care staff will be able to continue with their usual duties.
Those deemed to be working in close contact with those more vulnerable to adverse consequences of COVID 19, are likely to be staff who are currently eligible for regular asymptomatic testing.
We will keep this guidance under review to ensure additional measures:
- remain justified
- are proportionate to the current risk
We are currently considering the implications of not having to self-isolate when returning from amber list countries. Further guidance will follow.
When a patient/service user facing health and social care worker has been identified as a contact via TTP or the NHS COVID-19 app
Before the worker attends the workplace the employer should ensure:
- The staff member is asymptomatic. Symptomatic individuals must self-isolate in line with general guidance.
- The staff member has not received a positive COVID-19 PCR test result within the previous 90 days.
- The staff member does not reside with the person who has tested positive for COVID-19. If this is the case then individual must be redeployed into a role not involving contact with patients/service users or be required to not attend work where this is not possible.
- The staff member is fully vaccinated. This means they received their second vaccination (MHRA, EMA or FDA approved) at least 14 days before the point of exposure. Vaccination status should be verified via the Welsh Immunisation System (WIS) but local judgements may be made as to use of staff evidence of vaccination where necessary – unvaccinated staff must self-isolate in line with general guidance.
- If the staff member does not agree to the scheme of testing, they should either be redeployed to a non-patient/service user facing role or instructed not to attend work.
This guidance applies to staff working with the following two groups of patient/service users:
1. Workers in close contact with patients/service users
Where the staff member is providing care, support or treatment which means they are unable to maintain a social distance. This may include:
- the administration of medical treatment
- provision of personal care
- supporting the individual to promote their independence
- other interventions bringing staff into close contact with the patient/ service user.
Staff must agree to the specified testing process to continue to work with patients/service users. If they do not agree they should be redeployed or not attend work.
2. Workers in close contact with patients/service users who are immunosuppressed and/or clinically extremely vulnerable
For example patients in oncology or transplant services. Staff should not continue to work with these patients/service users. Staff should be redeployed to work with patients/service users who are not immunosuppressed and/or clinically extremely vulnerable. They will be asked to take the necessary tests or asked not to attend work.
If neither of the scenarios above apply, there are no specific requirements arising from this guidance on these workers.
Testing scheme requirements
To provide an additional level of safety to vulnerable patients and service users, the staff member must agree to take specific tests in place of the usual tests that person takes for their job role.
- Prior to attending work, the staff member will take a PCR test on the first day they are identified as a contact or as soon as possible thereafter. If the result is positive, the person must self-isolate.
- If a staff member has had a positive COVID-19 PCR test result within the previous 90 days, a local decision/risk assessment will be needed to determine the management of the staff member in terms of test monitoring or continuing to work.
- Following a negative PCR test, the staff member must take a LFD test each day before work until 10 days from the last contact with the confirmed case and receive a negative result. All results should be logged and reported appropriately: Report a COVID-19 rapid lateral flow test result - GOV.UK (www.gov.uk). If a LFD test is positive they must self-isolate and arrange a PCR test within 24 hours.
- If symptoms develop during the 10 days, staff must immediately self-isolate and follow the usual procedure.
Infection prevention and control
- To further mitigate the risks workers must continue to adhere to their employer’s guidance on infection prevention and control measures. This includes social distancing in the workplace when not delivering care or treatment and the use of PPE in line with the current Public Health Wales/UK COVID-19 IP&C guidance COVID-19: infection prevention and control (IPC (gov.uk).
- Within health boards and trusts, the medical and nursing leaders, the Board lead for IP&C and/or Director of Public Health will work with each organisation on this risk assessment process and use of the checklist with staff.
- In primary care the independent contractor should make decisions about this process in line with the criteria but must advise the health board about their approach.
- In regulated care services, the Responsible Individual is accountable for decision-making. Private sector employers may wish to liaise with health and social care commissioners.
- Managers in supported housing will make decisions and liaise with local authority commissioners as appropriate.
Annex A - Fact sheet for patient/service user facing health and social care workers following identification as a COVID 19 contact
In order for patient/service user facing staff to attend work, certain requirements which are summarised below must be met:
- The staff member is fully vaccinated at least 2 weeks prior to returning to work and are symptom free.
- Staff are not resident with the person who has tested positive for Covid-19.
- The staff member has a PCR test performed and has a negative result prior to returning to work.
- The staff member performs a daily LFD test, report results on the on-line portal and inform manager up to day 10 from initial exposure.
- Consideration is given to the patients/service user with whom the worker has regular contact. Please consult the guidance for further information.
What staff can expect from their employer
- That the employee checklist is completed in discussion with the staff member prior to staff member attending work. This should record vaccination status, PCR results, identifies that staff have no Covid-19 symptoms and records provision of LFD testing kits.
- That staff are supported to record LFD results.
- That consideration is given to the patients/service users the worker is usually in contact with.
- That if appropriate, suitable redeployment is considered.
What employers should expect from staff
- That they should have read this fact sheet to familiarise themselves with the policy and agree to the testing regime
- That they participate in completion of the employer checklist and discussion with manager prior to attending work.
- That they book a PCR test through agreed mechanisms and provide result to employer prior to returning to work.
- That they agree to perform LFD tests, inform employer of and record results for 10 days from initial exposure to the person who has tested positive to Covid-19.
- That they adhere to IPC procedures ensuring appropriate use of PPE at all times.
- That they refrain from work, inform manager and book a PCR test if symptoms develop or if a positive LFD result obtained.
Annex B – Checklist for employer to complete with staff member
This assessment to be used if a relevant health or social care worker has been identified as a contact of a positive case of COVID 19. This should be completed before the worker returns to the workplace and so should be discussed via phone or video call.
Does the staff member have COVID-19 symptoms?
Yes - should attend for PCR and self-isolate
No - move to Q 2
|2||Is the employee fully vaccinated (at least 14 days post 2nd vaccination and evidence provided)?||
No – staff member should self-isolate for 10 days.
Yes - move to Q 3
Does the staff member reside with the person who has tested positive for COVID-19?
Yes – they should not attend work until 10 days post initial exposure.
No – move to Q 4
|4||Is their PCR status known?||
Are they agreeing to follow the required testing process?
Yes - move to Q. 5
PCR positive - They self-isolate for 10 days.
Status unknown – Need to book PCR in order to return to work
|5||Does the staff member know where to access lateral flow devices and are able to use them appropriately?||
Yes – take a LFD test each day until the date 10 days after last contact with the positive case and receive a negative result before attending work and report result to their line manager and online Report a COVID-19 rapid lateral flow test result - GOV.UK (www.gov.uk). – move to Q 6No- Line manager should facilitate access to LFDs prior to return to work.– move to Q 6.
|6||Is the staff member working with patients/ service users in either of the two groups outlined in the guidance?||
No – there are no specific requirements on these workersYes – action should be taken as outlined in the guidance.