Patients who are to undergo a pre-arranged hospital procedure or operation are required to take a coronavirus test before they are admitted. This will be done by the patient at home before their hospital admission. Patients must take the swab test exactly 3 days before admission. The test must be posted on the same day using the nearest Royal Mail priority postbox by midday, or no later than 1 hr before the last collection time. Where this is not possible patients should ring 119 to book a courier. The guidance takes you through all the steps, includes a few instructional videos and provides the 119 number if help is needed. It now includes supporting guidance on how and when to take each step in the home test kit journey.
All patients undergoing emergency admittance to hospital are tested for coronavirus. If you test negative, a second test will be undertaken 3 days after admission and a third test between 5-7 days following admission
Any inpatient that becomes symptomatic, who has not previously tested positive, should be immediately tested by the hospital Trust.
Patients are not moved until at least two negative test results are obtained, unless clinically justified.
All patients being discharged to a care home should be tested within the preceding 48 hours prior to their date of discharge (unless their hospital stay was less than 48 hrs, in which case their admission test still applies or if they have already completed 14 days isolation after previously testing positive). Anyone testing positive can only be discharged to a designated setting, which must be officially recognised as meeting specific CQC criteria, where they must undergo a 14-day period of isolation, after which they can transfer/return to the care home of their choice.
Each health and social care system is establishing designated settings for their area, which may be specific care homes or other locations. Hospitals, care homes and local authorities must work together to ensure the discharge system is understood by all, including patients and families, and operates safely.
There is also general guidance on the steps to be taken when patients are being discharged to their own home or to other home settings. All hospital patients with symptomatic COVID-19 should be isolated for 14 days from their first positive test, either within hospital or in self-isolation at home if they have been fit enough to be discharged from the hospital.
Individuals with a COVID-19 infection without symptoms, detected on admission to hospital for non-COVID reasons, should be advised on discharge to self-isolate for 10 days from their first positive test. If, during the 10 days isolation after discharge (i.e., at home), individuals develop COVID-19 symptoms, they must self-isolate for 10 days from the day they first develop symptoms.
A patient being discharged home who has not been in hospital for COVID-19 or who has previously tested negative whilst in hospital, may be tested 48 hours prior to discharge if they will require repeated hospital day care or if a member of their household is clinically extremely vulnerable.
Hospitals, mental health trusts, hospices and other healthcare inpatient settings must risk assess what visiting is possible in their circumstances. Some Trusts may be able to move towards more normal visiting. Trusts are encouraged to support limited, Covid secure visiting wherever possible, where infection rates do not prevent this from taking place. Before visiting, visitors should contact the ward department the inpatient is on to confirm visiting is permitted and should be informed about what to expect (i.e., social distancing, PPE and handwashing). The wearing of surgical face masks remains obligatory for all patients and visitors in all areas of all health settings, even after 19 July.
Where visiting remains restricted bedside visiting may be permitted in exceptional circumstances (end-of-life, maternity, and others - see guidance below and should be limited to one close family member or other important contact for the patient. Up to 4 visitors per day is allowed for people who are dying but all visitors must have an LFD test, provided and administered by the Trust. A positive test means the visitor must return home and self-isolate and advised to seek a confirmatory PCR test using the national testing portal.
Although NHS Trust staff are essential workers, they should use their own organisation’s testing processes. NHS Trusts will test patients in hospital, both on admittance and prior to discharge to other care settings, and staff working in the hospital. Re-tests will also be done where necessary.
NHS staff with symptoms (developed while at work) should inform their employer/line manager and return home and get a PCR test, either through their workplace testing arrangements or via the national testing portal, as soon as possible. If their PCR test is positive, they and their household should isolate for 10 days (this no longer applies to members of the household who are fully vaccinated or under the age of 18 years 6 months). They can then return to work, as long as they have been fever-free for 48 hrs. Some symptoms may remain, but this is normal.
Asymptomatic staff who test positive should follow the same rules, but if they develop symptoms, they must isolate for a further 10 days from when the symptoms began. Staff who have previously tested positive are exempt from taking a PCR test for a period of 90 days from their initial illness onset unless they develop new coronavirus symptoms.
Staff (clinical, non-clinical, students, contractors included) identified as a contact of someone with COVID-19 must isolate. However, fully vaccinated staff who have been identified as a close contact can continue working if they test negative (PCR) and continue to test negative using daily LFD tests for 10 days, do not get symptoms and follow IPC measures. Such staff should not work on clinically extremely vulnerable patients and must self-isolate if they test positive or develop symptoms of coronavirus.
Non-Trust NHS staff and healthcare workers or NHS Trust staff isolating at home follow the specific guidance on testing for essential workers on the Gov.UK. testing website. This testing portal allows staff to book a test by self-referral. Staff who need to self-refer should still notify their employer that they have symptoms of coronavirus and are booking a test.
The self-referral portal provides you with the option of being sent a home test kit or attending a drive-through or walk-through testing centre. You may also be offered a Mobile Testing Unit.
Some drive-through testing centres are for NHS and Social Care staff only and these will be identified when applying for a test.
Tests can also be offered to anyone living with NHS staff/healthcare workers who have symptoms.
If you have requested a home test kit this must now be registered
Patient-facing staff in all NHS Trusts (hospital, mental health/community and ambulance trusts) are strongly encouraged to undertake weekly tests for Covid-19. Lateral flow tests were introduced as the initial method of weekly asymptomatic testing and continue to be used across the Trusts in the region but have been replaced by saliva (LAMP) tests in large parts of several Trusts. Lateral flow testing is done twice a week using nasal and throat swabs and provides rapid results in half an hour. From 20 September 2021 saliva (LAMP) testing will also be done twice a week and results provided within 24 hours of being dropped-off. Both tests can be done at home before leaving for work.
A healthcare staff guide to using Lateral Flow Devices (LFDs) for asymptomatic testing of patient-facing staff in NHS Trusts and a lateral flow training video have been provided to NHS Trusts. These contain operating procedures for using LFDs and FAQs for staff. The test is voluntary but remains a vital tool in keeping staff, their loved ones, and the patients they care for safe, and reducing the spread of the virus. A positive result for an LFD test requires staff to self-isolate and to take a confirmatory PCR swab test using the Trusts own processes.
Asymptomatic lateral flow devices are also being used by patient-facing staff in all sectors in Primary Care (GPs, pharmacists, and dental practices). The staff guide for asymptomatic testing of primary care staff also contains a standard operating procedure, FAQs, and a supporting video.
The guidance on asymptomatic LFD testing for both NHS Trusts and Primary Care have been updated. From July 2021 staff are now required to order their own LFD tests online and will no longer receive these tests via their employer.
Saliva (LAMP) testing is gradually replacing lateral flow testing across the NHS Trusts in the region, although it is likely some lateral flow testing will remain after saliva testing has been rolled-out to all area. Saliva testing is less onerous for staff to undertake, provides rapid results and does not require a confirmatory PCR swab test. For more information on the saliva staff testing programme go to the saliva staff testing section of these webpages.
Staff who have previously tested positive are exempt from taking a PCR/swab retest for a period of 90 days from their initial illness onset unless they develop new coronavirus symptoms (40 days if this was a done using the saliva [LAMP] test).
It is really important that you continue to test yourself even after having the vaccine. Although vaccinated people will have more protection from COVID-19, not enough is known about the vaccine’s impact on a person’s ability to transmit the virus. Everyone who has received the vaccine should also continue to follow all infection prevention and control measures. Together, this will help manage infections in hospitals and help protect other staff, and patients, as well as your friends and family.
New guidance for testing professionals from NHS and other professions who visit care homes has been introduced. This requires all visiting professionals, including GPs, ambulance staff and community staff, to provide proof of a negative test within the last 72 hours (applicable to both LFD testing and saliva [LAMP] testing) or to have a negative lateral flow test taken at the care home, before being allowed to enter.
NHS professionals who are part of a regular testing regime should use this process to provide proof of a negative test. This can be done in a variety of ways, outlined in the guidance. If it has been more than 72 hours since the NHS professional was tested or the NHS professional is unable to provide proof, the care home should test the individual before entry to the care home. If for any reason this is not possible, it is the decision of the care home whether or not to admit the professional, taking into account the reason and urgency of the visit, unless the professional is required to enter by law.
Professionals who are not part of a regular testing regime will be given a rapid lateral flow test by the care home and must have a negative test result before gaining entry to the care home. If more than one care home is being visited on the same day, the test result from the first visit can be used as proof for any subsequent visits on that day.
This requirement does not apply in the case of an emergency or 999 visit to a care home, but all NHS professionals must follow their regular testing regime to reduce any risk from these visits.
This new testing regime is being introduced due to the substantial risks to care home residents if COVID-19 is introduced to the home. It is essential that professionals and all staff are tested regularly before visiting care homes to reduce the risk of transmission across different settings and to help keep residents and staff safe.
All staff at vaccination sites should be provided with access to LFD testing, including volunteers. All NHS staff already accessing LFD testing through their employer (primary care or secondary care) should continue to follow the routine testing already in place. NHS staff on temporary contracts at primary care network or community pharmacy-led vaccination centres should be given a box of 25 LFD tests and follow the primary care standard operating procedure for taking the tests. NHS staff on temporary contracts in hospital hub or large-scale vaccination centres should be given a box of 25 tests and follow the secondary care standard operation procedure for taking the tests.
Volunteers at any setting (PCN/pharmacy-led/hospital hub/large-scale site) should be tested on site at the beginning of their shift, either as an observed self-test or by trained vaccination centre staff. Reporting the results of tests is a statutory requirement and should be done immediately, using the NHS Digital online platform or, where access is available, via the host hospital trust's recording system. Positive tests require self-isolation and a confirmatory PCR test. Tests should be ordered through the relevant primary care or secondary care lead for the vaccination centre. The full operating procedures can be accessed here.
Hospice managers will receive their unique organisation number (UON) via their email address registered with CQC in order to participate in regular asymptomatic testing through NHS Test and Trace. This includes hospices that have inpatients and those that include or provide community services.
Hospice staff can now undertake weekly, asymptomatic PCR swab tests and twice-weekly lateral flow test (LFT), one of which should be on the same day as the PCR test. Staff must take an LFT before starting work after leave or if they have worked somewhere else. A positive LFT requires a confirmatory PCR test and self-isolation until results are known. A positive test within the hospice requires all staff to take daily LFT testing for 7 days and the hospice manager should contact their local health protection team. Patients may be tested upon admission and on an ad hoc basis if required.
Hospices must use their UON to order test kits on a 28-day cycle, receiving 4 PCR tests and 2 boxes of 7 LFT kits for each member of staff, which managers should distribute to all staff, including those that visit patients in the community. Hospices should use the courier service if returning 5 or more PCR tests or Royal Mail priority post boxes if less than 5 or if testing remotely and can attend the regular webinars on testing that include live Q&A sessions. This is for all staff who provide or support direct patient care, both in or out of hospices and includes volunteers and agency staff who have contact with patients.
Visitor testing is recommended and should be done every time a visit to the hospice is made on the day of the visit, either on-site or at the visitor’s home. If the latter the result of the test must be shown. If the test is positive a confirmatory PCR test is required and self-isolation, but hospice managers have the discretion to determine whether a visit is still possible. The guidance for coronavirus testing for hospices provides the information in full, with all relevant links to ordering, webinars, testing, results etc. Hospices can call 119 with any queries or concerns.
Government policy paper/business plan setting out the next steps for developing the NHS Test and Trace Service by breaking the chains of Covid-19 transmission to help people return to more normal lives can be viewed here.
Independent Health Providers in England can now order lateral flow testing kits (LFTs) directly from NHS Test and Trace to support the asymptomatic testing of patient-facing staff. Managers will use their unique organisation number (UON), which will be provided via email by NHS England and NHS Improvement, to order sufficient tests for 7 weeks of testing (to create a buffer of LFT tests) for all patient-facing staff, and re-order every 28 days. Managers are responsible for re-ordering and distribution of test kits to staff. Providers must keep detailed records of test distribution, dates etc. Staff should undertake twice-weekly testing and will need the UON to register test results. Positive tests require confirmatory PCR testing and self-isolation until results are known. The guidance below provides full details of the ordering and testing process, including links to live webinars and Q&A sessions.
Nurses arriving in England from overseas who have been recruited to take-up immediate employment in the NHS and who are from or have travelled through red-list countries (those countries to and from which travel is banned) are exempt from the travel ban and may stay in NHS Trust-arranged managed accommodation for the period of their quarantine (10 days). This is an alternative to the red-list hotel managed quarantine arrangements mandated by the government.
The guidance sets out the standards and conditions that any trust-arranged accommodation must meet in order to provide an alternative to the government’s hotel-managed quarantines. Trusts within a region may work together to provide suitable accommodation, but failure to comply with the standards required, at any time, would mean Trusts must use the government hotel-managed quarantine system until compliance is met.
Nurses recruited as a cohort and who travel from/through a red-list country may form a travel group, which means they will be able to quarantine together and share facilities. However, travel groups are limited to a maximum of 6 members for quarantine accommodation purposes.
Hospital-managed accommodation must be private or trust-owned and used exclusively for quarantine purposes and cannot be a commercial hotel.
Nurses must have a negative coronavirus test within 3 days of travelling to England and must take PCR tests on or before day 2 and on or after day 8 of their quarantine period, as arranged when they booked their travel. (Travel test packages must be booked by nurses as part of their travel booking). A positive test result requires a 10-day quarantine from the day of the test and requires the quarantine of any travel group members, where this applies.
Organisations registered with the National Testing Programme (NTP), such as GP practices and care homes, will be issued with a Unique Organisation Number (UON) which will allow better quality data to be produced. Organisations will need to use this number going forward to order new tests kits, book a courier and to register completed test kits for results. The NTP will issue the UON to organisations. See below the links to the UON guide and the spreadsheet that allows 50 tests to be registered at the same time.