[Withdrawn] COVID-19 testing in adult social care

Question 1

1.  Introduction

Accepted Answer

This guidance is for adult social care providers and staff. It outlines the current testing regimes across adult social care that are informed by public health advice.

1.1 How to use this guidance

This guidance replaces all previous guidance for testing in adult social care and applies to:

care homes
homecare organisations
extra care and supported living services
adult day care centres
personal assistants
shared lives carers
social workers

Sections that are specific to a type of service will be clearly signposted.

This guidance uses the term ‘testing coordinator’ to describe the role that the person ordering and overseeing testing has in the process. The testing coordinator may be the service manager, or someone else who has responsibility for testing in the service.

The testing coordinator may be the service manager, or someone else who has responsibility for testing in the service. In some cases it may be the staff member ordering tests for their own use.

This guidance should be read in conjunction with the COVID-19 supplement to the infection prevention and control (IPC) resource for adult social care, which contains further details on measures in place to protect against COVID-19 in adult social care.

1.2 Eligibility for free testing in adult social care

Care homes are eligible for free testing if they are regulated by the Care Quality Commission (CQC). This guidance covers testing in care homes alongside guidance specific to small care homes.

A small care home is defined as 1 to 10 beds in this guidance. It is up to a service to determine and be prepared to evidence that small care home guidance applies to them if the size of the care home is above 10 beds. For example, if there are individual units or floors with completely separate staff and residents who do not mix with other staff and residents outside of this unit or floor.

Homecare organisations are eligible for free testing if they are regulated by the CQC.

Extra care and supported living settings are eligible if they meet at least one of the following criteria:

the setting is a closed community with substantial facilities shared between multiple people
it is a setting where the majority of residents (more than 50%) receive the kind of personal care that is CQC-regulated (rather than help with cooking, cleaning and shopping)

A setting is classified as a ‘high-risk extra care and supported living’ if it meets both criteria above. The guidance is clear where there is a distinction in testing for high-risk settings.

Day care centres are eligible for testing if they are run by paid care staff. Services must be for adults over 18 and must be provided within non-residential care settings that support the health and wellbeing of adults. This includes settings such as:

purpose-built day centres
day centres attached to or part of a care home or supported living setting
other buildings in communities specifically used for regular adult day care

Personal assistants are eligible if they are directly employed by an individual (or self-employed) to provide care and support to an adult to enable them to live as independently as possible. This care could include support in the home, or to go out into the community.

Shared Lives carers are eligible if they are working with a regulated Shared Lives scheme to provide care and support to an adult to enable them to live as independently as possible. This includes both carers who live with the person they support and those who live separately.

Social workers are eligible if they work with adults requiring support for their health, wellbeing and social care needs and are regulated by Social Work England.

Staff in an organisation eligible for testing include paid members of staff or volunteers who regularly attend a setting or other place where care is delivered including a person’s own home. This includes cleaners, catering, and support staff, but does not include office-based staff members who do not attend the locations where care is taking place. In the context of an individual’s own home, staff includes those who are paid to provide care or support to the individual.

Question 2

2.  Testing regimes for adult social care

Accepted Answer

2.1 Symptomatic testing for staff and residents

Symptomatic testing consist of 2 lateral flow device (LFD) tests taken 48 hours apart. This is available for:

all staff described in section 1.2
all residents in all care homes
all service users in extra care and supported living services which meet one or both of the criteria listed in section 1.2

Please see the COVID-19 supplement to the infection prevention and control (IPC) resource for adult social care for details of COVID-19 symptoms and when symptomatic testing is needed, as well as testing after a positive result.

Residents should be offered the choice to either self-administer the tests or to have the tests administered by a suitable member of staff.

2.2 Asymptomatic staff testing

Staff are not required to conduct regular asymptomatic staff testing at this time while prevalence of COVID-19 is relatively low. Some staff without COVID-19 symptoms may be asked to undertake testing as part of rapid response testing for care homes and high-risk extra care and supported living services (section 2.3), or as part of outbreak testing in care homes (section 2.4).

It is not recommended that staff should conduct any further asymptomatic testing beyond these situations at this time.

2.3 Rapid response testing in care homes and in high-risk extra care and supported living

2.3.1 Rapid response testing

Rapid response testing is triggered if one or more positive staff or resident cases are found in:

a care home
a high-risk extra care and supported living setting

Rapid response testing consists of daily LFD tests taken by staff on their working days for 5 consecutive days only. This is not undertaken by residents or service users.

The purpose of rapid response testing is to detect cases among staff to help determine whether an outbreak is occurring and to prevent further transmission.

This is distinct from outbreak testing which is only undertaken by care homes in the event that 2 or more positive or suspected linked cases of COVID-19 occur in the same setting within a 14-day period (this means where the cases are linked to each other and transmission in the care setting is likely). Please refer to section 2.4 for further details.

2.3.2 Rapid response testing in small care homes

This section outlines rapid response testing specific to small care homes. Please refer to section 1.2 to determine if the definition of a small care home applies.

High-risk extra care and supported living settings do not have access to outbreak testing, therefore regardless of their size they should continue to adhere to rapid response testing as outlined above in section 2.3.1.

If there is only 1 positive case in a small care home:

rapid response testing should be initiated

If there are 2 or more positive cases in a small care home:

a small care home should start outbreak testing as soon as possible – this is because there is a higher likelihood that these cases are linked due to the close networks in small settings
a small care home may decide to undertake rapid response and whole home outbreak testing at the same time or may only undertake outbreak testing in the event of 2 or more cases – rapid response testing should not delay outbreak testing in either case

Small care homes can therefore determine whether rapid response testing has value if there are 2 or more positive cases. For example:

rapid response testing of new staff would not be initiated if a high proportion of the staff are symptomatic or have tested positive, and new staff enter the home
rapid response testing has limited value in protecting residents if the majority of residents are symptomatic or have already tested positive; this may, however, still be beneficial to prevent further transmission among staff

This decision can be made by the provider, with further support available from the local health protection team (HPT), community infection prevention and control team, local authority, or integrated care board (ICB) in accordance with local protocols.

2.4 Outbreak testing in care homes

This section applies only to care homes. PCR tests issued from the government portal should not be used in homecare, extra care and supported living, or adult day care services.

An outbreak consists of 2 or more positive or suspected linked cases of COVID-19 that occur in the same setting within a 14-day period (this means where the cases are linked to each other and transmission in the care setting is likely). This applies to both staff and residents and includes PCR and LFD test results.

If the care home suspects that 2 or more confirmed or suspected cases are linked, the provider should conduct a risk assessment if they feel able to do so. This is to determine if an outbreak should be declared and to then determine what outbreak measures should be implemented.

The risk assessment can be undertaken directly by the care home provider with the expertise of relevant care home staff, and further support is also available from the local HPT (or other local partner such as community IPC team, local authority or ICB, according to local protocols) at the care home’s request.

The provider should inform the HPT or other local partner of a suspected outbreak, but they are not required to wait for advice from the HPT (or other relevant local partner) should they feel able to initiate a risk assessment independently.

2.4.1 Whole home outbreak testing in week 1 of an outbreak

This section outlines whole home outbreak testing in the first week of an outbreak and applies to all care homes, including small care homes.

If an outbreak is identified, the care home should implement whole home outbreak testing and consider further measures. More details can be found in the COVID-19 supplement to the infection prevention and control (IPC) resource for adult social care.

If the care home has initiated whole home outbreak testing, all staff and residents should conduct both an LFD test and a PCR test on day 1 of the outbreak and another LFD test and PCR test between days 4 and 7. The LFD test will allow the identification and isolation of the most infectious cases immediately while awaiting PCR test results, therefore reducing the risk of the virus spreading. This testing is in addition to rapid response testing conducted by staff if that is being undertaken as outlined in section 2.3.

It is highly likely that the individual has COVID-19 if either the LFD or PCR test is positive. Please refer to section 3.4.2 and to the COVID-19 supplement to the infection prevention and control (IPC) resource for adult social care for information on actions staff and residents need to take.

Care homes should follow further guidance below on recovery testing after conducting whole home outbreak testing, unless the setting meets the definition of a small care home. Small care homes should refer to section 2.4.2 for further details.

2.4.2 Outbreak recovery testing

This section and the sub-sections below do not apply to small care homes. Please refer to section 1.2 to determine if the definition of a small care home applies.

Outbreak recovery testing is undertaken to confirm that transmission of COVID-19 within the care home has ended so that outbreak measures can be lifted.

Outbreak recovery testing consists of a PCR test for all members of staff and residents, apart from those who have tested positive in the last 90 days.

Staff and residents should each take a PCR test at least 10 full days after the onset date of the latest symptomatic individual’s symptoms (where symptoms are confirmed as COVID-19 by testing), or from the last positive test if asymptomatic.

2.4.2.1 If there are only negative results from outbreak recovery testing

Outbreak measures can be lifted if there are only negative PCR results from outbreak recovery testing.

After an outbreak is declared over, if 2 or more positive or suspected linked cases of COVID-19 that occur in the same setting within a 14-day period are subsequently identified, this should be classed as a new suspected outbreak and the care home should inform the HPT again. This applies to both staff and residents and includes PCR and LFD test results. More details can be found in the COVID-19 supplement to the infection prevention and control (IPC) resource for adult social care.

2.4.2.2 If there are any positive results from outbreak recovery testing

Any further positive results could be linked to the original outbreak. Care home managers can risk-assess this themselves but if required may seek advice from their local HPT (or community IPC team, local authority, or ICB in accordance with local protocols), together with advice on when it might be reasonable to lift outbreak measures.

If the care home assesses that the further cases are likely to be part of the same outbreak, the care home should wait another 10 days with no positive results to conduct another round of outbreak recovery testing. The care home should not do any further rounds of whole home testing in this period.

2.4.2.3 Outbreak recovery testing and variants of concern

The local HPT will contact the care home if they have identified a particular variant of concern or variant under investigation which requires additional actions or measures. They will discuss whether additional measures need to be put in place to enable additional protection and how this impacts the testing required. This might include delaying the whole home outbreak recovery testing until 28 days from the latest case.

2.4.3 Small care homes outbreak testing

This section outlines rapid response testing specific to small care homes. Please refer to section 1.2 to determine if the definition of a small care home applies.

A small care home should start outbreak testing as soon as possible if 2 or more cases are identified. This is because there is a higher likelihood that these cases are linked due to the close networks in small settings.

Recovery testing does not need to be undertaken in small care homes. This is because transmission is likely to occur early in the outbreak with less potential for hidden chains of transmission in small populations. Instead, outbreaks can be considered to have ended once all resident self-isolation periods have been completed.

This does not alter when staff with COVID-19 should return to work, which is outlined in the COVID-19 supplement to the infection prevention and control (IPC) resource for adult social care.

After this point, if there are 2 or more positive or suspected linked cases of COVID-19 within the same setting within a 14-day period this would be considered a new COVID-19 outbreak.

Question 3

3.  Step by step testing process for adult social care

Accepted Answer

3.1 Ordering test kits

3.1.1 Accessing through a unique organisation number (UON) - applies to care homes, homecare, extra care and supported living and day care centres only

Personal assistants, Shared Lives carers and social workers should go straight to section 3.1.2 .

3.1.1.1 Unique organisation number

NHS Test and Trace assigns all participating organisations a single Unique Organisation Number (UON).

A UON is an 8-digit number that is exclusive to an individual organisation. This can be used to log in to all online elements of the testing process.

The UON will be needed for:

ordering test kits
registering test kits
contacting the national COVID-19 contact centre for support (dial 119)

Make sure the UON is correct when logging into the portal. If the UON entered is not valid, a new error message screen will appear. To find out the UON for a service, use the online UON look-up page, or call 119.

3.1.1.2 Onboarding for testing in extra care, supported living, and adult day care centres

Use the self-referral portal to request a testing account. To do this, the manager should complete the following steps:

On the portal, where asked to enter the ‘Referrer’s Unique Organisation Number’, enter 99874802 for extra care and supported living or 99915258 for adult day care centres. The code only needs to be used once and it cannot be used to order test kits.
Complete the eligibility questions.
Enter the information for the setting, including delivery address and contact details.
Submit referral.

Once the referral is submitted, the following happens:

the referral is sent to the local authority for approval
the local authority assesses if the service meets the eligibility criteria, and approves or denies the referral request
if eligible, the service is on-boarded onto the system and will be eligible to place an order for test kits
a confirmation email will be sent to the email address registered on the self-referral portal once the service has been onboarded – and will include a UON to order test kits

3.1.1.3 Ordering test kits with a UON – applies to care homes, homecare, extra care and supported living and day care centres only

Place an order for COVID-19 tests online. A setting should keep enough tests to ensure eligible staff, and residents can test in line with guidance. This should account for tests to be taken in the event of symptoms, tests to be taken following a positive test, and tests to be taken for any rapid response or outbreak testing where applicable. Care homes returning PCR tests through a courier can also order return boxes through the same portal. A service should only order more test kits when needed to replenish stocks. To apply, they will need:

their UON
total number of staff for testing

Once an order has been placed, the service will receive a confirmatory email from organisation.coronavirus.testing@notifications.service.gov.uk

The testing coordinator will receive an email from organisation.coronavirus.testing@notifications.service.gov.uk when their test kits have been dispatched, informing them of their delivery date.

Test kits will be delivered to the address registered to the UON.

Call 119 for any questions about an order. If a service is close to running out of stock and requires an urgent and emergency delivery, they should also call 119.

3.1.2 Ordering test kits without a UON – applies to personal assistants, Shared Lives carers, social workers and CQC inspectors only

Personal assistants (or their employers on their behalf), Shared Lives carers, social workers and CQC inspectors should order tests via the online government portal. They do not need a UON.

Employers of personal assistants ordering tests on their behalf should go through the ordering journey selecting options as if they are a personal assistant. Whilst tests can be ordered on behalf of others, tests should only be used for staff and not those who are receiving care and/or support.

Individuals who are already part of a regular testing regime at work should not access tests through this route.

Individuals should keep enough test kits in case they need to test because they become symptomatic, and they should only order more tests when needed to replenish stocks. When replenishing stocks for this purpose, they should select that they are symptomatic when going through the ordering portal.

An individual can choose which address their test kits are delivered to. Once they have placed an order, they will receive a confirmatory email.

For any issues with ordering test kits, please call the national COVID-19 contact centre on 119.

3.2 Receive test kits

Make sure that all test kits are stored according to the manufacturer’s instructions once received.

3.3 Registering and reporting testing

3.3.1 Register and return PCR tests – applies to care homes only

Every PCR test must be registered to receive a result. Where applicable, PCR tests should be registered using the organisation’s UON. Note the barcode number and time of each PCR test against the name of the person tested. Register the completed test online as close as possible to the time of the swab. PCR tests can be registered individually or using the multiple upload spreadsheet (see section 3.3.3).

PCR tests can be returned using priority post boxes – collection times of the post box should be checked prior to testing. Couriers are also available for returning 9 or more tests.

3.3.2 Report LFD test results – applies to all staff and services

Reporting the result of every LFD test is encouraged, even if it is negative or void. Staff members can register LFD tests individually, or managers can register them in bulk using the multiple upload spreadsheet (see section 3.3.3). Where organisations have a UON, staff should report results using that UON.

Providers do not need to retain records of proof of registrations.

Individuals in care homes, extra care and supported living services, adult day care centres, and homecare organisations can use the Digital Reader for reading LFD test results as part of the self-report journey. This tool allows users to take a photo of their LFD and uses artificial intelligence to determine the result of the test. Research has shown that users can correctly identify more positive results using this technology than without it. For detailed information, download the Digital Reader guidebook.

3.3.3 Multiple registration spreadsheet

Only use the multiple upload spreadsheet to register up to 100 tests (both PCR and LFD) at a time.

Services will need to use separate record keeping spreadsheets for staff and residents.

Once each PCR and LFD test has been successfully registered, a confirmation email will be received. When receiving the test result email, this may not include the name of the resident or staff member. Services should therefore retain a careful record of each test barcode and the name of the resident or staff member. Staff members should also retain a record of their own test barcode.

3.3.4 Registering and reporting on behalf of others

If staff or residents cannot report their own LFD test result online:

results can be reported on the individual’s behalf
the person reporting on behalf of the individual will need all test results and test strip ID numbers so that they can report results on their behalf
make sure that any forms containing the tested person’s personal details are deleted or destroyed as soon as you complete the online registration

If an individual cannot register their own PCR test, please follow the details in section 3.3.1 to do this individually or section 3.3.3 to do this for a group of people.

If any individual cannot complete the online form and someone can’t report the result on their behalf, they can call 119 and select option 1 to report their result.

3.4 Results

3.4.1 Individuals with a negative COVID-19 test result

Individuals with a negative COVID-19 result can continue with their normal routine unless:

they have symptoms of a respiratory infection and a high temperature
they have symptoms of a respiratory infection and do not feel well enough to continue their usual activities

Individuals who meet one of the above criteria should ensure they have received 2 negative COVID-19 results taken 48 hours apart before they consider continuing with their usual activities.

It should be noted that an individual with respiratory symptoms who tests negative for COVID-19, with 2 LFD tests taken 48 hours apart, may have another infectious illness like flu. Full criteria for individuals to consider before returning to their normal routine is set out in the COVID-19 supplement to the IPC resource for adult social care.

3.4.2 Individuals with a positive COVID-19 test result

3.4.2.1 If the individual is a member of staff

If the individual with a positive COVID-19 result is a member of staff, they should follow the advice regarding staying at home and avoiding contact with other people from the day they test positive or develop symptoms (day 0) to avoid passing on the virus.

Staff or visitors who test positive on-site should wear a face mask and leave the care service as soon as it is safe to do so.

Social care staff with COVID-19 should not attend work until they feel well, do not have a high temperature and have 2 consecutive negative LFD test results (taken at least 24 hours apart 5 days from when their symptoms started or from the date of the test if they did not have symptoms. Full guidance on returning to work is outlined in the COVID-19 supplement to the IPC resource for adult social care.

3.4.2.2 If the individual is a care home resident

If the individual with a positive COVID-19 test result lives in a care home, they should isolate in the care home for up to 10 days from when the symptoms started, or from the date of the test if they did not have symptoms. Tests should be used to end isolation earlier where possible, with full guidance outlined in the COVID-19 supplement to the IPC resource for adult social care.

If the individual lives in a residential setting that is similar to a care home, such as in an extra care and supported living service, providers may wish to follow all or some of the additional guidance for care home residents who are symptomatic or test positive in the COVID-19 supplement to the IPC resource for adult social care.

3.4.2.3 If the individual receives care and does not live in a care home

If the individual with a positive COVID-19 test result receives care and does not live in a care home, they should follow the advice for the general population to stay at home and avoid contact with others.

3.4.2.4 If the individual is in the highest risk group from COVID-19

Individuals with a positive COVID-19 test result who are in the highest risk group from COVID-19 should be supported to access COVID-19 therapeutics if they test positive by contacting 119 or a local GP as required. Please refer to section 3.4.5 below.

3.4.3 Individuals with an inconclusive test result

Individuals who receive an inconclusive test result should take another LFD test.

If the individual is symptomatic and does not have immediate access to another LFD test, they should not resume their normal routine while waiting to receive another LFD test to take. If the individual is a member of staff, they should therefore stay away from work before they can take another test.

If the individual took the test without any respiratory symptoms, they can continue their normal routine but should still take the repeat test.

The individual should follow the relevant guidance above upon receipt of the repeat test result.

3.4.4 Testing within 90 days of a positive result

3.4.4.1 Exemptions from PCR testing for individuals who have previously tested positive for COVID-19 within 90 days

Fragments of inactive virus can be detected by PCR tests in respiratory tract samples following infection for some time after a person has completed their isolation period and is no longer infectious. This can result in a positive COVID-19 PCR test in a person who is no longer infectious.

Asymptomatic staff and residents who do not have severe immunosuppression and who have previously tested positive for COVID-19 by LFD or PCR test are exempt from testing by PCR within 90 days from the initial illness onset or test date. This includes individuals who require testing within 48 hours prior to discharge to care homes. This exemption does not apply for anyone who develops new COVID-19 symptoms.

This exemption does not apply to LFD testing because LFD tests do not detect fragments of inactive virus. LFD tests can be conducted within 90 days of a positive COVID-19 test result. If staff or residents are tested with an LFD test within 90 days of a prior positive LFD or PCR test and the result is positive, residents should start a new period of self-isolation and staff should stay away from work (see COVID-19 supplement to the IPC resource for adult social care), unless a clinical or risk assessment suggests that a reinfection is unlikely.

Guidance on reinfection and performing clinical risk assessment is detailed in the Investigation and management of suspected SARS-CoV-2 reinfections: a guide for clinicians and infection specialists. This risk assessment should inform subsequent action including whether isolation is required.

3.4.4.2 Assessment of repeat PCR positive test results within 90 days of a prior positive test

If an individual is re-tested by PCR within 90 days of initial illness onset or prior positive

COVID-19 test and the PCR test result is positive, a clinical risk assessment should be used to decide whether a new infection (‘reinfection’) is a possibility and to inform subsequent action including whether isolation is required.

Guidance on reinfection and performing clinical risk assessment is detailed in the Investigation and management of suspected SARS-CoV-2 reinfections: a guide for clinicians and infection specialists.

The advice of an infection specialist should be sought to inform clinical risk assessment.

3.4.5 Accessing COVID-19 treatments for people in the highest risk group

Individuals who are in the highest risk group from COVID-19 can access new COVID-19 treatments directly.

Tests have been sent directly to these individuals to enable faster treatment of COVID-19 if they develop symptoms and more tests can be ordered from GOV.UK if required. In residential settings that conduct symptomatic testing, the existing stock of tests can also be used.

Eligible individuals should have received a ‘pre-notification’ letter or email (to the contact details specified in their GP record) to alert them that they have a condition, or are on a specific treatment, that may make them eligible should they test positive for COVID-19.

Service and care managers are requested to support people who are potentially eligible for treatment with where to store these tests so that they are available to be used if the individual experiences COVID-19 symptoms. Each test kit will have an information leaflet enclosed which details how these kits should be stored and provides full testing and reporting instructions.

Their test result must be reported via GOV.UK or 119 in order to generate a referral to a COVID-19 Medicines Delivery Unity (CMDU) where an individual has been digitally identified as eligible for treatment. When reporting their result, it is important to provide the individual’s NHS number and the postcode that is recorded with their GP, so that they can be identified as eligible for treatment. A phone number should also be provided so that they, or care staff, can be contacted.

If positive for COVID-19, the person or care home will be contacted by a CMDU clinician who will assess the person’s eligibility and decide whether treatment is appropriate and if so, which treatment might be most appropriate. A range of treatments are available, including intravenous and oral (tablet or capsule-based) treatment options. Most treatments have to be provided within 5 days of symptom onset, so timely reporting of test results is essential to identify and assess potentially eligible people within the treatment window.

If the person is not contacted within 24 hours of receiving the positive result, the service should contact their GP or call 111 who will refer them to a CMDU if they are potentially eligible.

Further information on treatments for COVID-19 is available on the NHS website.

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This guidance was withdrawn on 3 April 2023

Applies to England

1. Introduction