Guidance

[Withdrawn] Restricting workforce movement between care homes and other care settings

Updated 23 November 2021

This guidance was withdrawn on 1 April 2022

The information in this guidance has been superseded by Infection prevention and control in adult social care: COVID-19 supplement.

Applies to England

Summary of changes in this version

This note outlines the changes to the ‘Restricting workforce movement between care homes and other care settings’ guidance as of 22 November 2021.

Number	Guidance section	Overview of changes
1	Introduction	Updated in line with the overall changes to this guidance. Notes that restricting staff movement remains an important measure to minimise the risk of infection of COVID-19. Links to other guidance and definition of health and care settings also added.
2	Restricting staff movement	Updated advice to provide more clarity regarding which staff whose routine movement care providers should restrict.
3	Allowing staff movement in limited circumstances	Previous guidance advised care home providers to only allow movement of staff in very limited exceptional circumstances. This update describes how providers and local authorities may allow staff movement to plan proactively for specific service requirements or capacity concerns, and to ensure continuity of care.
4	Restricting movement in case of outbreaks in a care home or high local infection rates	This section details how restriction of the movement of staff providing direct care will usually be recommended in response to an outbreak in a specific setting to avoid ‘seeding’ of outbreaks between different settings which may be caused by staff movement. Advice is provided regarding how care home providers can assess the local situation.

1. Introduction

We know that since the start of the pandemic most care home providers have been taking steps to minimise the risk of asymptomatic transmission of COVID-19. In March 2021, the UK government published updated guidance to care home providers on the need to restrict staff movement between care homes and other care settings, except in exceptional circumstances, recognising this as a critical infection prevention and control measure. While the COVID-19 vaccine roll-out has had a positive effect on clinical impact of infection and on rates of infection, challenges and uncertainties remain. There is therefore a continued need for infection prevention measures to further minimise these risks.

In line with the findings of research conducted in 2020, which demonstrated the role that movement of care staff between settings can play in outbreaks of COVID-19 in care homes, we continue to advise care home providers to limit routine staff movement between care homes and other health and care settings. Restricting staff movement therefore remains an important measure to minimise the risk of infection of COVID-19. However, in line with the positive impacts of the vaccine rollout this updated guidance for care home providers details the circumstances in which care home providers may now allow some movement of staff between settings, and advice about how they can mitigate the risks associated.

This guidance should be read in conjunction with all relevant guidance on IPC for care homes, including care home testing, vaccination as a condition of deployment, and self-isolation. It is also recommended that providers review the guidance for testing for professionals visiting care homes which covers testing for NHS professionals, Care Quality Commission (CQC) inspectors and other professionals visiting care homes in their professional capacity (as opposed to those staff care homes deploy directly).

Care homes do not need to limit the movement of staff who are not providing direct nursing or personal care. Examples include administrative staff, cooks, cleaners, or managerial staff, and registered managers (where they are not also providing direct care). Staff can also continue to be actively deployed if they hold additional roles in a non health or care setting. Examples include a member of staff who is also working in hospitality, retail or administrative roles as either their substantive or second job.

In this guidance a health or care ‘setting’ is defined as a single location under a single CQC registration, regardless of the number of regulated activities provided at or managed from the registered location. Where a single registered location has more than one building, even where delivering differing regulated activities, these are regarded as one setting for the purpose of this guidance and staff can move freely between them. However, where the regulated activities provided by the provider are registered as separate locations with the CQC (including, for example, multiple care homes run by the same provider but registered as separate locations or services) these would be regarded as separate settings.

2. Restricting routine staff movement

In addition to ensuring care staff and visiting professionals are fully vaccinated (unless they are exempt) we continue to recommend that, to reduce the risk of infections and outbreaks in care homes, providers do not routinely deploy staff to provide nursing or personal care if those individuals are also providing a regulated activity in another health or care setting at the same time. This includes:

• permanent and temporary staff deployed directly by the care home provider, including agency and bank staff
• staff who work across multiple settings for the same employer
• staff who work for more than one health and social care provider

The Infection Control and Testing Fund (ICTF), which has been extended until March 2022, is provided to support adult social care providers, including those who do not hold a contract with the local authority, to reduce the rate of COVID-19 transmission within and between care settings. This includes compensating staff whose normal hours are reduced due to restrictions on their movement. Further detail and guidance on how the ICTF can be used to support providers reduce staff movement can be found in the ICTF guidance.

3. Allowing staff movement in limited circumstances

In some circumstances, the movement of staff providing nursing or personal care may be needed to enable providers and local authorities to plan proactively for specific service requirements or capacity concerns, and to ensure continuity of care. Providers are able to facilitate the movement of staff in these circumstances, examples of which may include:

• managing periods of unplanned staff absence to ensure services have sufficient contingency in their staffing capacity
• where there are specific concerns regarding capacity that cannot be mitigated through the provider’s workforce planning measures
• ensuring the availability of any specialised staff the care home deploys. This includes specialist trainers and educators who ensure the continued quality, knowledge and skills within staff teams is maintained and staff with additional, specialist training to meet a person’s needs that could not be delivered by other staff. This may also include regulated professionals where these are employed directly by the care home provider and/or other staff groups that are difficult to recruit locally
• providing continuity of care staff where there is a specific risk to the resident’s well-being, for example, where a resident needs to be cared for by staff they recognise or have an established bond with

In these circumstances, providers can exercise a more flexible approach to facilitate staff movement to take place, subject to certain conditions:

• any staff facilitated to move between settings where needed must be fully vaccinated with at least 2 doses of COVID-19 vaccination in line with the Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) Regulations 2021, which make it a requirement for workers in care homes to be fully vaccinated against coronavirus (subject to limited exceptions)
• it is recommended that any staff moving between care homes and other health/care settings should also have had a COVID-19 booster vaccination and a recent flu vaccination unless they are exempt
• care home providers facilitating staff movement between settings should ensure all relevant staff are participating in the testing regime for their place of work and have a negative lateral flow test at the start of the working day before any movement occurs. Deployed agency staff should also be taking part in the care home’s testing regime
• before allowing any movement of staff between care homes and other health and care settings, providers should prepare a risk assessment. This should include sufficient detail to show the provider is assured of the service requirements for this movement, and the mitigations the care home has put in place, and the number of staff moving. The guidance below on restricting movement in the case of outbreaks or high local infection rates may inform providers on further considerations their assessment should cover.
• movement is only facilitated to ensure sufficient workforce is available to deliver services effectively

4. Restricting movement in the case of outbreaks in a care home or high local infection rates

Restriction of the movement of staff providing direct care will usually be recommended in response to an outbreak in a specific setting to avoid ‘seeding’ of outbreaks between different settings which may be caused by staff movement. Local health protection teams and/or directors of public health will usually provide advice in response to specific outbreaks to care home providers to guide action.

Providers are strongly recommended to ensure they review any communications or data available from local and national partners regarding other local circumstances such as high levels of community infection, concerns about specific variants, and/or other local intelligence on transmission patterns that may lead directors of public health and/or health protection teams to advise on time-bound restrictions on movement of staff providing direct care.

In these circumstances, or if they are advised to, providers should stop the movement of all staff providing direct care, except in exceptional circumstances. These exceptional circumstances are where, in order to ensure enough staff are available to provide care safely, care home providers may need to deploy people who are also working in another health or social care setting. These circumstances arise where a provider has planned its staffing requirements in accordance with CQC fundamental standards, and is actively taking steps to address any ongoing resourcing needs, but is still unable to ensure sufficient staff are available to deliver care safely.

Examples include situations where, when having taken all reasonable steps, a provider is unable to engage enough staff to cover specific shifts or perform specific duties and the need is urgent to avoid critical service delivery issues.

Providers deploying staff working in multiple locations in these exceptional circumstances should ensure this is for as limited a period of time as possible and should only be for as long as is needed for the provider to resolve any staffing issues.

Movement of staff providing direct care between care homes and other health and care settings should also be stopped if there has been an outbreak of COVID-19 in the previous 14 days in any setting the worker has been deployed in. Where agency staff are being deployed care home providers should take reasonable steps to understand other recent deployments individuals have undertaken.

The CQC continues to monitor whether providers are managing staff movement in line with current guidance and uses that information to help plan its regulatory activity.

Where a flu outbreak has been declared similar consideration should be given to restricting affected staff. Further guidance on flu is available online.