Letter to directors of adult services outlines winter discharge process for COVID-19 patients

The Department of Health and Social Care (DHSC) has sent a letter to directors of adult services in England outlining the requirement for designated care settings for people discharged from hospital who have COVID-19.

Entitled ‘Winter discharges: designated settings’, the letter was circulated to all local authority chief executives, CCG CEOs, acute trust CEOs and directors of public health on 21 October 2020.

The circulation of this letter follows the publication of the adult social care winter plan 2020-21, which outlines the UK Government’s ambitions for the sector and the challenges facing adult social care this winter, with a particular focus on COVID-19.

The plan also includes a commitment to deliver a designation scheme with the Care Quality Commission (CQC) of premises for people leaving hospital who have tested positive for COVID-19 and are transferring to a care home.

Now, the new letter – which is signed by Tom Surrey, Director for Adult Social Care Quality at DHSC – circulated to directors of adult services sets out an overview of the requirement for designated care settings for people discharged from hospital who have a COVID-19 positive status.

It also provides instructions for local authorities to commence identifying and notifying CQC of sufficient local designated accommodation and to work with CQC to assure their compliance with the infection prevention control (IPC) protocol.

The letter begins by thanking the social care sector for their outstanding work during the COVID-19.

“COVID-19 presents an unprecedented challenge for social care,” the letter reads. “There is an extraordinary amount of work underway up and down the country, with local authorities and care providers at the forefront of this vital response, working in partnership with the NHS. Thank you for all that you and your teams are doing to provide care and support for the many people who need it, and for helping to keep people safe during the pandemic.”

The new requirements

According to the letter, anyone who has tested positive for COVID-19 being discharged into, or back into, a registered care home setting must be discharged into an appropriate designated setting. This means a home which has the appropriate policies, procedures, equipment and training in place to maintain infection control and support the care needs of residents, where the patient will be looked after for the remainder of the required isolation period.

These designated accommodations will need to be inspected by CQC to meet the latest CQC infection prevention control standards.

“No one will be discharged into or back into a registered care home setting with a COVID-19 test result outstanding or without having been tested within the 48 hours preceding their discharge,” the letter states.

Everyone being discharged into a care home must have a reported COVID test result and this must be communicated to the care home prior to the person being discharged from hospital, DHSC instructs. The care home’s registered manager should continue to assure themselves that all its admissions or readmissions are consistent with this requirement.

This guidance builds on previous advice outlined by the government earlier this year, which states that if appropriate isolation or cohorted care is not available with a local care provider, the individual’s local authority will be required to secure alternative appropriate accommodation and care for the remainder of the required isolation period.

“Sufficient accommodation must be available to meet expected needs now and over the winter period. The costs of the designated facilities are expected to be met through the £588 million discharge funding,” the letter continues.

Residents who contract COVID-19 within the care home setting should be treated and managed in line with the admission of residents in a care home during COVID-19 policy. This guidance still requires all patients discharged from hospital, even with a negative test, to be isolated safely for 14 days to ensure any developing infections are managed appropriately.

Who this will affect

The designation scheme is intended for people who have tested positive for COVID-19 and who are being admitted to a care home. This applies to care homes who provide accommodation for people who need personal or nursing care. This includes registered residential care and nursing homes for older people, people with dementia, and people with learning disabilities, mental health and/or other disabilities and older people.

Importantly, the new government guidance does not apply to people who have contracted COVID-19 within a care home setting. DHSC reinforces that there is no need to transfer COVID-19 positive residents from a care home into designated accommodation, as long as safe isolation and care is being maintained.

In addition, the letter says that people living in their own home, including sheltered and extra care housing or living in supported living, do not need to be transferred from hospital into designated accommodation.

How the CQC assurance process will work

The CQC process would operate by providing assurance that each ‘designated accommodation’ has the policies, procedures, equipment, infection prevention control protocol and training in place to maintain infection control and support the care needs of residents. Once this assurance is received, premises would be able to receive COVID-19 positive people discharged from hospital, prior to their admission to a care home.

Action required

According to DHSC, CQC has the necessary capacity ahead of winter to deliver 500 assurances by the end of November.

“Local authorities should identify sufficient designated accommodation to meet current and future demand over winter in their local area and notify CQC of the details of these facilities as soon as possible and ideally by Friday 16,” the letter says. “Following notification of the facilities to CQC, local authorities will be asked to work with CQC to assure their compliance with CQC’s revised Infection Prevention Control (IPC) protocol.”

The government says that to help meet projected demand in England as quickly as possible, it aims for every local authority to have access to at least one CQC designated accommodation by the end of October.

Furthermore, the letter notes that local authorities will be able to identify more than one facility to be CQC assured, if needed to respond to geographical spread and size, such as those in tier 2 or tier 3 areas with higher levels of COVID-19 patients.