Correspondence

Designated settings requirements: FAQs

Updated 13 November 2020

Applies to England

Letter to directors of adult social services.

Copied to:

• local authority chief executives
• CCG CEOs
• acute trust CEOs
• directors of public health
• ASC providers

Dear colleagues,

We would like to thank you for your phenomenal efforts to date in operationalising the designated settings scheme. With thanks to your help, settings across England have now been designated for this purpose, with the aim to help protect residents, staff and visitors from COVID-19 over winter.

We recognise there are some questions and further points of clarification, and we are keen to support you in ensuring the policy is fully operational as soon as possible, with full coverage of designated settings across England.

With this in mind, we provide additional information and clarification below, building on the information already set out in the winter discharges: designated settings letter. The FAQ below covers key questions to support operationalisation of the scheme, and we will address any further questions in a full GOV.UK guidance that is currently being developed in consultation with stakeholders.

Yours sincerely,

Tom Surrey, Director for Adult Social Care Quality, DHSC

What is the process to activate designated settings?

The local authority should identify a setting, in collaboration with the proposed provider, to be put forward for CQC assurance (see the winter discharges: designated settings letter for more details).

CQC will then:

• inspect the premises against the IPC protocol
• notify the result to the DASS in the local authority on whether the facility meets assurance. A full report will be provided through the normal CQC process

DASS should then:

• communicate the result to the relevant provider (including if the setting has not passed the assurance, and/or requires changes in order to pass assurance)
• if the setting has passed assurance, notify the local CCG, and agree between the CCG and provider on when the discharge pathway is to be ‘switched on’ and when the designated setting is therefore ready to be used. (We expect local partners who have not already done so, to ‘switch on’ the scheme as soon as possible this month.)

DASS/CCGs should then notify hospital/multidisciplinary discharge teams and DsPH that the newly designated setting is available for discharge. The new discharge pathway will then be ‘switched on’.

When will the scheme be ‘switched on’?

As above, the scheme should be ‘switched on’ in a local area as soon as local partners agree to do so. In practice, this will be once the CCG and/or DASS notify the hospital/multidisciplinary discharge teams that the newly designated setting is available for discharge.

We expect local partners who have not already done so to ‘switch on’ the scheme as soon as possible this month.

Current discharge arrangements for COVID-19-positive individuals, as set out in the existing discharge guidance and admissions to care home guidance, should continue to apply until new arrangements are ‘switched on’ in the local area. This includes the requirement to provide a test result prior to discharge, notify the person’s COVID-19 status to care providers and ensure 14-day isolation within a care home following admission. No patient should be discharged to a care home without a test result.

Discharge arrangements for people with negative COVID-19 results prior to discharge are unaffected by this scheme, and existing discharge guidance and admissions to care home guidance should continue to be followed by all care homes that are not CQC designated settings.

As is currently the case, under the new discharge arrangements, health and social care systems should continue to work together to prioritise the ‘Discharge to Assess’ (D2A), HomeFirst model and follow current discharge guidance in the first instance.

How is the designation scheme funded?

Local partners will already be working together to ensure sufficient accommodation is available to meet expected needs now and over the winter period. The costs of the designated settings will be met through the £588 million discharge funding until the end of March. CCGs should not reduce commitments for discharge to assess.

The time spent by an individual within an isolation facility contributes towards the up-to-6 weeks’ funded care provided on discharge from hospital for new or additional care needs.

The current discharge guidance provides further detail on financial support and funding flows.

What requirements must a setting have to be designated?

The setting:

• must meet the CQC infection prevention tool
• must meet CQC registration requirements and not be in breach of regulation
• should provide a service that is rated ‘good’ or ‘outstanding’. If the service is rated as ‘requires improvement’ with no breach of regulation, CQC will assess this on a case-by-case basis

Care home providers should also ensure they have sufficient insurance cover to provide the services. Providers who find they are unable to get sufficient cover should notify their local LA and/or CQC contacts. This intelligence will be passed on to colleagues in DHSC.

In addition, the following expectations should be met regarding infection prevention control and clinical support:

• there should be adequate separation of the designated setting
• the setting must accommodate each individual in the setting in their own room
• it is strongly advised that individuals should isolate in their own room. It is recognised this is a particular challenge for people living with dementia, or who walk with purpose. Please refer to SCIE guidance and the admissions to care homes guidance for further support on supporting those with dementia in care homes
• where possible, providers should also ensure that each person has access to their own bathroom. If this is not possible, then the provider should ensure that bathrooms in the facility should be designated for particular set of individuals in the setting
• the setting must be supported by sufficient clinical treatment and oversight ‒ CCGs will be asked to ensure that the necessary clinical support is in place, drawing on support through the EHCH programme plus any additional monitoring required given the cohort of people being cared for. This will require agreement between local acute trusts, community health providers, GPs and the providers of the designated settings
• sufficient arrangements should put in place for staff isolation or non-movement
• sufficient arrangements should also be guaranteed for staff to have repeat testing, PPE and sickness pay, including if they need to isolate, and support for their wellbeing

Local authorities may agree with local NHS partners to make use of NHS settings to fulfil the role of a designated premises. In this instance, it will not be necessary for that NHS setting to be inspected by CQC specifically for the purpose of this arrangement.

What does this mean if you are a discharge manager?

Health and social care systems should continue to implement and embed Discharge to Assess (D2A) arrangements to support timely discharge. This should embody Home First principles and include early discharge planning and proactive COVID-19 tests to prevent discharge delays.

When planning for discharge, discharge managers should be mindful of potential risks to individuals of multiple transfers.

NHS provider organisations must ensure that COVID-19 test results for all persons being discharged into a care home are received and shared with the person concerned and their key relatives/representatives and the relevant care home provider prior to discharge taking place. This is regardless of whether a designated setting is operational in the locality.

NHS provider organisations must ensure that people have full information and advice about the temporary arrangements and ensure they fully comply with DoLS requirements.

NHS provider organisations must ensure all persons being discharged into care homes have received a COVID-19 test within the preceding 48 hours of the discharge date. For persons whose hospital stay has been less than 48 hours, the COVID-19 test undertaken at the point of admission will still be valid to enable discharge to a care home. This is regardless of whether a designated setting is operational in the locality.

Once the scheme has been ‘switched on’ (see when will the scheme be ‘switched on’?), you can start discharging to the designated settings.

The care home’s registered manager is legally responsible to ensure that the service can meet the needs of people admitted. The decision to accept or decline an admission lies with a registered manager of the care service.