Official Statistics

Adult social care monthly statistics, England: April 2023

Published 6 April 2023

Applies to England

Main points

Coronavirus (COVID-19) testing in care homes

In the week ending 19 March 2023:

• there were 2,170 positive lateral flow test results among care home staff. This number has broadly increased since the week ending 22 January 2023, when 1,020 positive tests were recorded
• there were 734 positive lateral flow test results among care home residents

The total number of lateral flow tests conducted among care home staff and residents has broadly increased since the end of January 2023.

COVID-19 and flu vaccination in social care settings

As of week ending 19 March 2023, the proportions who had received their flu vaccination for the 2022 to 2023 season were:

• 75.6% of total residents and 16.5% of total staff of older adult care homes
• 63.5% of total residents of younger adult care homes
• 15.1% of total staff of younger adult care homes and 15.6% of total domiciliary care staff

Visiting in care homes

In the week ending 14 March 2023, 98.7% of care homes in England were able to accommodate residents receiving visitors. This figure has been stable since September 2022.

Staff absences due to COVID-19

In the week ending 14 March 2023, 0.6% of care homes staff and 0.6% of domiciliary care staff were absent due to COVID-19 related reasons. This proportion increased slightly for both care home and domiciliary care staff in the last month, compared to the week ending 14 February 2023 when 0.5% of care home staff and 0.5% of domiciliary care staff were absent due to COVID-19 related reasons.

Introduction

This is a monthly publication by the Department of Health and Social Care (DHSC) of official statistics on adult social care in England. This statistical bulletin provides an overview on a range of information on social care settings, with a focus on the impact of COVID-19.

This report provides information on:

• uptake of full primary course of COVID-19 vaccinations and flu vaccinations for the 2022 to 2023 season in adult social care settings at national, regional and local authority level
• visiting in care homes at national, regional and local authority level
• staff absence rates due to COVID-19 in care home and domiciliary care at national, regional and local authority level
• testing for COVID-19 in care homes at national, regional and local authority level

Data used in this publication is taken from Capacity Tracker and the NHS Test and Trace service. Capacity Tracker is a web-based digital insight tool originally developed by NHS England and the Better Care Fund to enable the system to better manage hospital discharges by identifying available capacity in care homes. It enables care homes to share their vacancies in real-time, meaning hospital discharge teams and other health professionals can rapidly search availability throughout England. Since spring 2020 the tool has also been used by DHSC to gather COVID-19 related data to help monitor the sector’s response to the pandemic.

For more information on data sources, on the data previously published as part of this report and on other published sources of adult social care data, see the background quality and methodology note.

Publication updates

Updates on this report

From 22 February 2023, the collection of data on COVID-19 autumn booster vaccinations in social care settings was ceased. The full timeseries up to 19 February 2023 is published this month and can be found in the ‘COVID-19 and flu vaccination statistics, April 2023 data tables’ on the Adult social care in England, monthly statistics: April 2023 page.

Updates on future reports

The next publication will be released on 4 May 2023. Dates for future publications will be pre-announced on the GOV.UK publication release calendar.

As the seasonal flu vaccination campaign comes to an end, the collection of data on flu vaccination will be temporarily ceased. The timeseries for flu vaccination will end on 29 March 2023 and the data tables will feature in the May 2023 publication, but not in subsequent publications until data is collected again next winter.

From 29 March 2023, providers will be asked to record spring booster vaccinations among care home residents in Capacity Tracker. Previously, data on boosters has been published in this report. We are reviewing future publication plans for vaccination data and will provide an update in next month’s report.

Due to an incoming change in the way Test and Trace data will be accessed and made available, we are considering the possibility of ceasing the publication of the testing data in future releases. If you are a regular or occasional user of this data and would be negatively affected by this change, please contact asc.statistics@dhsc.gov.uk.

COVID-19 and flu vaccination in adult social care settings

How the data can be used

This data can be used for:

• comparing vaccination rates across local authorities and regions in England as self-reported by care providers for:
  • the full primary course of the COVID-19 vaccine
  • flu vaccinations for the 2022 to 2023 season
• monitoring vaccination rates over time for:
  • the full primary course of the COVID-19 vaccine
  • flu vaccinations for the 2022 to 2023 season
• estimating the size of the adult social care workforce at a given time, using the total staff headcount provided in the accompanying tables, while carefully considering the caveats presented in the background quality and methodology note

This data cannot be used for:

• estimating the number of social care staff or residents who have not been vaccinated
• comparing with vaccination rates in other countries of the UK
• directly comparing vaccination take up rates between different types of care home staff (directly employed and agency staff)
• estimating the number of vaccinations delivered each day
• monitoring adult social care workforce size trends over time using the total staff headcount provided in the accompanying tables without carefully considering the caveats presented in the background quality and methodology note

The total number of staff and residents for each social care setting as well as the number reported to be vaccinated for COVID-19 and flu are self-reported by the care provider and local authorities. As a result, the rates in this publication refer to the percentage of staff and residents reported to be vaccinated by care providers. This means that the number of individuals who have not received a vaccine cannot be directly derived from the data published in these statistics as the vaccination status of some individuals may be unknown to the care provider.

The dates in this section refer to the dates on which vaccinations were reported by care providers rather than the dates on which vaccinations were administered.

Some care providers have reported the total number of staff or residents but not the numbers vaccinated. As a result of this, vaccination rates are affected by response rates and may be underestimated.

Among care home staff, there is a substantial difference in reported vaccination rates for COVID-19 vaccinations between staff directly employed by care homes and staff employed by agencies operating within care homes. This could be due to, for example but not exclusively, different uptake rates, vaccination status not being known to the care provider, or the nature of employment and information available to the care homes.

From 31 July 2022, providers were mandated to complete Capacity Tracker on a monthly basis. Providers are required to update Capacity Tracker with the required data within a designated 7-day reporting window. This window will open at the start of the 8th day of each month and run until the end of the 14th day of each month, or the next working day where the 14th day falls on a weekend or public holiday.

This means that response rates are likely to be higher during the mandation window and may be lower in other weeks of the month. Therefore, weeks which coincide with the mandation window may see a bigger increase in vaccination rates, due to higher response rates in those weeks. These data points are flagged in the accompanying ‘COVID-19 and flu vaccination statistics, April 2023: data tables’ on the Adult social care in England, monthly statistics: April 2023 page.

From 9 October 2022, the weekly data points for COVID-19 and flu vaccination refer to weeks ending on a Sunday rather than weeks ending on a Tuesday. This change means that the data point for the week ending 9 October only covers 5 days rather than 7, so there are a lower number of additional vaccinations reported for that data point due to the shorter time period.

For more information, see the background quality and methodology note.

In the accompanying COVID-19 and flu vaccination statistics data tables, the total staff count is provided as the denominator used to calculate the staff vaccination rate. There has been a growing interest in using these statistics to monitor trends in staff headcount over time.

We have investigated the data in more detail to better understand its quality and the underlying drivers of change in staff headcount over time. Our investigation showed that staff headcount trends, as presented in these tables, are driven by multiple factors, including changes in Capacity Tracker response rates over time. This makes it difficult to distinguish between changes in response rates and genuine changes in staff headcounts. As such, we do not recommend that the vaccination rate denominator is used to monitor or estimate changes in staff headcount over time. We will continue to monitor the quality of this data and will provide more information here if anything changes.

These caveats do not affect the resident and staff vaccination rates which are published in the accompanying COVID-19 and flu vaccination statistics data tables. These statistics are internally consistent and can be used to monitor vaccination trends over time.

COVID-19 vaccinations

The NHS started administering vaccinations for COVID-19 in England on 8 December 2020. Social care staff and residents of care homes were prioritised for the vaccine according to the Joint Committee on Vaccination and Immunisation (JCVI) recommendation. For more information see Priority groups for coronavirus (COVID-19) vaccination: advice from the JCVI.

On 15 August 2022, the JCVI issued advice and formally launched the latest COVID-19 booster vaccination campaign, for autumn 2022, for the following individuals:

• residents in a care home for older adults and staff working in care homes for older adults
• frontline health and social care workers
• all adults aged 50 years and over
• persons aged 5 to 49 years in a clinical risk group, who are household contacts of people with immunosuppression, or who are carers

NHS vaccination teams started visiting care homes to administer the vaccine on 5 September 2022, a week before the formal launch of the campaign.

From 1 September 2022, providers are mandated to submit data on the numbers of residents and staff who have received a full primary course and are no longer asked about first and second doses separately. A full primary course does not include COVID-19 boosters. For most people, a full primary course is defined as 2 doses of COVID-19 vaccination. For a small number of people, however, including people who were vaccinated abroad, people who have received a single-dose vaccination such as Janssen, or people who are severely immunosuppressed, a full primary course may mean a different number of doses.

From 1 September 2022, providers were also encouraged to submit data on individuals who have received their autumn 2022 COVID-19 booster vaccine. An autumn booster is defined as any booster delivered under the autumn booster campaign which started on 5 September 2022. Data on autumn 2022 boosters is available from week ending 13 September 2022. It became mandatory for providers to submit data on autumn booster vaccinations from the October reporting window. The full timeseries for first and second doses and first and second booster doses of COVID-19 vaccination up to 31 August 2022 (including vaccination in other care settings) can be found in the accompanying ‘COVID-19 vaccination statistics, up to 31 August 2022: data tables’ on the Adult social care in England, monthly statistics: October 2022 page.

On 21 December 2022, NHS England published additional operational management information (see Tracking autumn boosters for care home residents using operational data) to track the number of COVID-19 boosters administered to residents of all adult care homes in England during the 2022 autumn winter campaign. In the NHS England publication, Capacity Tracker is used as a primary data source to estimate the number of autumn boosters administered to residents, but for those care homes without Capacity Tracker data entries, the number of vaccines administered is either collected via a complementary survey or taken from the National Immunisation Management System (NIMS). The NHS England publication therefore presents 2 vaccination rates: one using Capacity Tracker data only and one using a combination of the 3 data sources.

The NHS England publication also presents the percentage of ‘eligible’ residents reported to be vaccinated with an autumn booster. This measure uses the number of residents who have received a full primary vaccination course as the denominator instead of the total number of residents, and is therefore not directly comparable to the vaccination rate presented in these DHSC adult social care in England monthly statistics.

From 22 February 2023, the collection of data on COVID-19 autumn booster vaccinations in social care settings was ceased. The full timeseries up to 19 February 2023 is published this month and can be found in the ‘COVID-19 and flu vaccination statistics, April 2023 data tables’ on the Adult social care in England, monthly statistics: April 2023 page.

COVID-19 vaccinations in older adult care homes

For full response rates, see the accompanying ‘COVID-19 and flu vaccination response rates, April 2023: data tables’ on the Adult social care in England, monthly statistics: April 2023 page.

Residents of older adult care homes

As of week ending 19 March 2023, in older adult care homes:

• 93.1% of residents have been reported to have received a full primary course

Staff of older adult care homes

As of week ending 19 March 2023, in older adult care homes:

• 89.6% of staff have been reported to have received a full primary course

COVID-19 vaccinations in younger adult care homes and domiciliary care settings

The following proportions of social care staff and residents have been reported to have received their COVID-19 vaccination doses.

Residents of younger adult care homes

For younger adult care home residents, as of week ending 19 March 2023:

• 87.6% of residents have been reported to have received the full primary course

Staff of younger adult care homes

For younger adult care home staff as of week ending 19 March 2023:

• 86.5% of staff have been reported to have received a full primary course

Domiciliary care staff

For domiciliary care staff as of week ending 19 March 2023:

• 83.8% of staff have been reported to have received a full primary course

As data is self-reported by care providers, COVID-19 vaccination rates are affected by response rates.

For full response rates, see the accompanying ‘COVID-19 and flu vaccination response rates, April 2023: data tables’ on the Adult social care in England, monthly statistics: April 2023 page.

Flu vaccination in adult social care settings

The national influenza (flu) immunisation programme aims to provide direct protection to those who are at higher risk of influenza associated morbidity and mortality. Groups eligible for NHS influenza vaccination, from 1 September 2022, are based on the advice of the JCVI. More details can be found in the national flu immunisation programme 2022 to 2023 letter.

This year, frontline social care workers, carers and everyone over the age of 50 is eligible for a flu vaccine. Social care workers who are in direct contact with people who receive care and support services should have the flu vaccine provided by their employer. However, there are circumstances where frontline staff, who are employed by specific social care providers without access to employer led occupational health schemes, can access the vaccine through the NHS free-of-charge.

This report covers cumulative flu vaccination rates for the 2022 to 2023 season in the below adult social care groups:

• residents in older adult care homes
• staff directly employed by older adult care homes
• agency staff working in older adult care homes
• residents of younger adult care homes
• staff directly employed by younger adult care homes
• agency staff working in younger adult care homes
• domiciliary care staff registered to independent CQC providers

Data is self-reported by care providers and local authorities, who may submit their resident and staff numbers but not the number receiving the flu vaccination, resulting in a lower reported percentage vaccinated. An overview of response rates for the numbers vaccinated is in the table below.

Data on flu vaccination rates for the 2022 to 2023 season is available from 13 September 2022.

For more information, please see the background quality and methodology note.

The proportions of providers that have provided data on the number of staff or residents who received a flu vaccination for the 2022 to 2023 season, as of 19 March 2023 were:

• 99.4% of older adult care home providers
• 98.6% of younger adult care home providers
• 95.5% of domiciliary care providers

For full response rates please see the accompanying ‘COVID-19 and flu vaccination response rates, April 2023: data tables’ on the Adult social care in England, monthly statistics: April 2023 page.

As of week ending 19 March 2023, the proportions of those who had received a flu vaccination in care settings were:

• 75.6% of residents in older adult care homes
• 16.5% of all staff in older adult care homes
• 63.5% of residents in younger adult care homes
• 15.1% of all staff in younger adult care homes
• 15.6% of staff who work in domiciliary care settings

There is regional variation in reported flu vaccination uptake among each of the adult social care groups. The variation is most pronounced among residents of younger adult care homes.

Figure 1: percentage of residents in older and younger adult care homes and who have received their 2022 to 2023 flu vaccine, England, as of 19 March 2023

Reported 2022 to 2023 flu vaccination rates have been steadily increasing among residents of older adult care homes and younger adult care homes since mid-September 2022.

Source: Capacity Tracker

This data can be found in tables 1 and 5 of the accompanying ‘COVID-19 and flu vaccination statistics, April 2023: data tables’ on the Adult social care in England, monthly statistics: April 2023 page, in addition to data by region and local authority.

Accommodating COVID-safe visitation in care homes

How the data can be used

This data can be used for:

• estimating the number and proportion of care homes that indicate they are accommodating COVID-safe visits within the care homes in line with government guidance
• monitoring trends over time
• comparisons across local authorities and regions in England

This data cannot be used for:

• estimating the number of visitors in care homes and their infection or vaccination status
• comparing with other countries of the UK
• estimating rates of compliance with the mandatory provision of certain data items as set out in the adult social care provider information provisions. Response rates for visiting questions during the reporting window as set out in the adult social care provider information provisions are not equivalent to compliance rates because there may be extenuating circumstances in which a provider has not responded for legitimate reasons

This data is self-reported and is therefore affected by response rates. From August 2022 onwards, any care home that has not submitted data within the mandation window is excluded from the relevant analysis for that month. Prior to August 2022, responses that were not submitted within the 7 days prior were also excluded each week.

Visiting guidance and data trends

There are currently no restrictions on visiting in care homes under normal circumstances. However, during periods of outbreak or when a resident is COVID-positive, visits may need to be limited to one visitor at a time for each resident. From 4 April 2022, visitors are no longer required to test before the visit, unless they are providing personal care. From 31 August 2022, testing for visitors providing personal care was suspended.

Until 31 March 2022, the Adult Social Care Infection Control and Testing Fund provided funding from local authorities to ensure that infection prevention control (IPC) measures were in place to curb the spread of COVID-19, including accommodating COVID-19 safe visitation in care homes in line with government guidance. To support the monitoring of the fund, data tracking the adult social care sector’s implementation of IPC measures was collected. The fund ended on 31 March 2022 and the majority of the IPC related questions were removed from the collection tool on 4 April 2022.

The question on COVID-safe visitation in care homes is still included in the data collection but was updated in early May 2022 to remove the reference to government guidance since restrictions on visiting in care homes have been removed. This wording change has had no substantial impact on reporting. In July 2022, the question changed from asking care homes whether residents had been allowed visits in the last 7 days to whether residents had been allowed visits in the last month.

Since 31 July 2022, this question is part of the subset of data which providers are mandated to submit on a monthly basis. For more information, see the background quality and methodology note.

The table below summarises the changes in guidance on allowing care home residents to have visitors since December 2020.

Table 1: changes in visiting guidance since December 2020

Date	Guidance
From 31 August 2022	Visitors providing personal care no longer need to test before a visit
From 4 April 2022 to 30 August 2022	No restrictions on visitation in care homes. Every care home resident should have one visitor who can visit in all circumstances (including during periods of isolation and outbreak) Visitors are not required to test before a visit, unless providing personal care Visitors providing personal care do not need to test more than twice a week
From 31 January 2022 to 3 April 2022	No limits on the number of named visitors, with testing and guidance to support safe visiting in place
From 15 December 2021 to 30 January 2022	Residents are permitted to have 3 named visitors for regular visits with testing in place
19 July 2021 to 14 December 2021	No limits on the number of named visitors, with testing and guidance to support safe visiting in place
17 May 2021 to 18 July 2021	Residents are permitted to have 5 named visitors for regular visits with testing in place
12 April 2021 to 16 May 2021	Residents are permitted to have 2 named visitors for regular visits with testing in place
8 March 2021 to 11 April 2021	Residents are permitted to have 1 named visitor for indoor visits with testing in place
6 January 2021 to 7 March 2021	No indoor visits permitted due to the national lockdown
1 December 2020 to 5 January 2021	Indoor visits permitted with testing in place (from 19 December 2020 - no indoor visits permitted in tier 4 areas)

Note: timelines for guidance are accurate as of 6 April 2023.

More information on the current visiting guidance can be found in the COVID-19 supplement, which accompanies the infection prevention and control in adult social care settings.

In the week ending 14 March 2023:

• 98.7% of care homes in England were able to accommodate visits in or out of the care home for residents in all circumstances during the last month. This proportion has broadly increased since the end of January 2022, but has shown little variation since September 2022
• a further 0.7% were able to accommodate visits in exceptional circumstances. This is a slight increase on February 2023, but this figure has broadly declined since April 2022 with the exception of another slight increase between September and October 2022. Exceptional circumstances are individually defined by each care home but are generally thought to be considered when residents are palliative

Regional variation has steadily decreased over the past year as more and more providers are able to accommodate visitation across all regions.

Figure 2: percentage of care homes accommodating or limiting visits for residents, England, 4 January 2022 to 14 March 2023

The proportion of care homes accommodating visiting for residents has broadly increased since mid-January 2022 with the exception of slight decreases in early January 2022, early April 2022 and early July 2022. This number has stabilised since September 2022.

Source: Capacity Tracker

Note: the dotted lines in this chart represent the implementation of the changes in care home visiting guidance or changes to the visiting question in Capacity Tracker:

• A: from 31 January 2022, no limits on the number of named visitors, with testing and guidance to support safe visiting in place
• B: from 4 April 2022, no restrictions on visitation in care homes. Every care home resident should have one visitor who can visit in all circumstances (including during periods of isolation and outbreak)
• C: from 4 July 2022, the visiting questions in Capacity Tracker changed so care homes were asked whether residents had been allowed visits in or out of the care home in the last month, instead of in the last 7 days
• D: from 31 July 2022, providers are mandated to submit data on visiting on a monthly basis. From August 2022 onwards the data points in this graph are monthly instead of weekly

This data can be found in table 1 of the accompanying ‘Visiting and workforce statistics, April 2023: data tables’ on the Adult social care in England, monthly statistics: April 2023 page, in addition to data by region and local authority.

Adult social care workforce

Staff absence rates

How the data can be used

This data can be used for:

• estimating the number and percentage of staff absent because of COVID-19-related reasons
• monitoring trends in COVID-19-related absence rates over time
• comparisons across local authorities and regions in England

This data cannot be used:

• as a sole indicator of all workforce pressures faced by the social care sector, since they only cover COVID-19-related absence
• to directly compare absence rates related to COVID-19 between domiciliary care and care home staff
• for comparing with other countries of the UK
• for linking COVID-19-related absence rates with test positivity rates
• for inferring trends about staff headcounts as these are partly driven by response rates

Absence rates related to COVID-19 are calculated using the reported number of staff employed and the reported number of staff out of work that day because of COVID-19 related reasons. Both the number of total staff employed, and the number of staff absent might be affected by provider response rates as only numbers reported by providers in the last 7 days (or during the mandatory reporting window where this is longer than 7 days) are included in the total counts.

Absence data started to be reported by care providers in Capacity Tracker from December 2020. However, low response rates in the first few months of collection mean that the workforce data is incomplete, which affects the accuracy of the absence data during that period.

Providers who are the least likely to respond are likely to be those experiencing the most pressures on delivery due to high levels of staff absence. For this reason, data from December 2020 to the start of February 2021 for care homes, and from December 2020 to the start of March 2021 for domiciliary care providers, are not presented in this publication.

COVID-19-related absences cannot be directly linked to staff test positivity rates. This is because absences related to COVID-19 can cover a wide range of reasons, including but not restricted to staff:

• testing positive to COVID-19
• self-isolating
• caring for someone who has tested positive to COVID-19
• suffering from illness related to COVID-19

For more information, see the background quality and methodology note.

Absence rate statistics presented in this section were added for the first time in February 2022, following growing general interest in workforce pressures from various sources.

From 31 July 2022, workforce absence data is part of the subset of data which providers are mandated to submit on a monthly basis. Only data submitted during the monthly mandation window are included in these statistics.

COVID-19-related absence rate statistics alone are not sufficient to give a full picture of workforce pressures faced by the sector - however, they may provide some insight on some of the challenges. Additional statistics, such as general absences, retention or recruitment could provide a more complete picture.

In care homes

Data on care home staff absences related to COVID-19 is available from 9 February 2021.

Absence rates in care homes increased slightly over the last month. In the week ending 14 March 2023, 0.6% of care home staff were absent due to COVID-19 related reasons, compared with 0.5% in the week ending 14 February 2023.

Care home staff absence related to COVID-19 reached a peak of 2.9% in the week ending 11 January 2022 and has remained below 1.0% since August 2022.

In the week ending 14 March 2023, there was some regional variation, with COVID-19 related staff absence rates ranging between 0.3% and 0.7% across all regions. Over the last month, absence rates increased in the East Midlands and the South East.

Data on absences and response rates can be found in tables 2 and 5, respectively, of the accompanying ‘Visiting and workforce statistics, April 2023: data tables’ on the Adult social care in England, monthly statistics: April 2023 page.

In domiciliary care

Data on domiciliary care staff COVID-19 related absences is available from 2 March 2021. Absence rates in domiciliary care settings are not directly comparable with those in residential care homes.

In the week ending 14 March 2023, 0.6% of domiciliary care staff were absent because of COVID-19 related reasons, which is slightly higher than the week ending 14 February 2023, when 0.5% of domiciliary care staff were absent.

In the week ending 14 March 2023, there was some regional variation, with regions reporting absence rates between 0.5% and 0.7%. Over the last month, absence rates increased in the East Midlands, North West, South East, South West, West Midlands and Yorkshire and the Humber.

Data on absences and response rates can be found in tables 3 and 6 of the accompanying ‘Visiting and workforce statistics April 2023: data tables’ on the Adult social care in England, monthly statistics: April 2023 page.

Figure 3: percentage of staff absent due to COVID-19 related reasons, England, 4 January 2022 to 14 March 2023

Since the peak of 2.9% in January 2022, there have been 2 further spikes in care home staff absence rates, in late March 2022 and mid July 2022. For domiciliary care absence, following a peak of 4.8% in January 2022, there have been a further 3 spikes, in late March 2022, mid July 2022 and mid October 2022. Since November 2022, absence rates due to COVID-19 related reasons have remained broadly stable in both care homes and domiciliary care settings.

Source: Capacity Tracker

Notes:

• the proportion of staff absent due to COVID-19-related reasons is not comparable across care settings
• the dotted lines in this chart represent the move to monthly reporting after the start of the mandatory data provision implemented on 31 July 2022. From August 2022 onwards the data points in this graph are monthly instead of weekly

This data can be found in tables 2 and 3 of the accompanying ‘Visiting and workforce statistics, April 2023: data tables’ on the Adult social care in England, monthly statistics: April 2023 page, in addition to data by region and local authority.

COVID-19 testing in adult care homes

How the data can be used

This data can be used for:

• estimating the number of PCR and rapid lateral flow tests taken and positive results returned in care homes, and comparing across local authorities and regions in England
• estimating trends in prevalence and positivity rates for COVID-19 in care homes based on trends in positive tests

This data cannot be used for:

• calculating positivity rates for COVID-19 in care homes due to routine and repeat testing of individuals
• linking positivity rates in care homes to lower vaccination rates in care homes
• estimating the number of people tested and positive cases in care homes as people can take more than one test

Data is collected from management information generated during the operation of the NHS Test and Trace service. This publication will only include tests which were registered through the National Testing Programme digital infrastructure. Data from approximately 2 months before the cut-off date is updated each month.

For more information on:

• the rollout of the testing programme in care homes, see the background quality and methodology note
• testing kits used, see the ‘Terminology’ section below

Testing guidance

Since early September 2022, the number of tests conducted per week is substantially lower following the release of the new testing guidance, which announced the temporary suspension of asymptomatic testing in care settings from 31 August 2022. The number of tests conducted has remained well below levels reported in August 2022.

As of the week ending 19 March 2023, which is the latest data point included in this publication, the regular testing regime in place was as follows.

Care home staff testing:

• no asymptomatic testing
• if symptomatic, 2 rapid lateral flow tests taken 48 hours apart

Care home residents testing:

• no asymptomatic testing
• if symptomatic, 2 rapid lateral flow tests taken 48 hours apart
• as soon as they join a care home, if they are new, with a PCR test

Care home visitors and visiting professionals testing:

• no testing is required

The Infection prevention and control in adult social care: COVID-19 supplement has been updated to reflect the latest changes in testing guidance.

Different testing regimes apply when there is an outbreak of COVID-19 in a care home. See the COVID-19 supplement for more details.

Changes to testing guidance have affected the trends in the number of PCR and rapid lateral flow tests conducted among staff and residents. An overview of the changes to the testing guidance in care homes since June 2020 is presented in table 2 below.

Table 2: changes in testing guidance in care homes since June 2020, as of 19 March 2023

Date	Changes in guidance
From 31 August 2022	No asymptomatic testing for staff, residents or visitors If symptomatic 2 rapid lateral flow tests taken 48 hours apart, for staff and residents
From 4 April 2022 to 30 August 2022	Staff - 2 rapid lateral flow tests per week If symptomatic 2 rapid lateral flow tests taken 48 hours apart Residents - no asymptomatic testing If symptomatic 2 rapid lateral flow tests taken 48 hours apart Visitors - no testing unless providing personal care
From 16 February 2022 to 3 April 2022	Staff - pre shift rapid lateral flow tests
From 11 January 2022	Staff and residents - removal of confirmatory PCR test following a positive rapid lateral flow test
15 December 2021 to 15 February 2022	Staff - weekly PCR and 3 rapid lateral flow tests per week
7 June 2020 to 14 December 2021	Staff - weekly PCR and 2 rapid lateral flow tests per week Residents - monthly PCR PCR tests for staff and residents if symptomatic Visitors - required to take a rapid lateral flow test before each visit (tests are free)

To see the latest testing regime guidance for care homes, see the COVID-19 supplement and infection prevention and control in adult social care settings guidance.

Care home staff

Rapid lateral flow tests

The total number of rapid lateral flow tests (which includes positive, negative and void tests) conducted among staff was 34,920 in the week ending 19 March 2023. This number has increased since the week ending 5 March 2023 when 33,286 tests were conducted. This follows a period of decrease between the week ending 19 February 2023 and the week ending 5 March 2023.

Following the pause in asymptomatic testing for care home staff from 31 August 2022, the number of tests conducted has broadly declined since early September 2022.

In the week ending 19 March 2023, 2,170 positive lateral flow tests were conducted among staff. This number has broadly increased since the week ending 22 January 2023, when 1,020 positive tests were recorded, with the exception of slight decreases in mid-February and early March 2023.

PCR tests

The overall number of PCR tests conducted (including positive, negative and void tests) in care home staff broadly increased from late-January 2023 until early March 2023. In the week ending 19 March 2023, there were 19,215 PCR tests conducted among care home staff, compared to 12,712 in the week ending 29 January 2023. This number has decreased since the week ending 12 March 2023, when 20,035 tests were conducted.

Due to changes in testing guidance for care home staff at the start of April 2022 requiring symptomatic staff to take a rapid lateral flow test instead of a PCR test, PCR test results are now less relevant than rapid lateral flow test results in measuring COVID-19 prevalence in care homes.

Care home residents

Rapid lateral flow tests

In the week ending 19 March 2023, there were 734 positive tests returned from lateral flow tests in care home residents. This figure has broadly increased since the week ending 22 January 2023, when 313 positive tests were recorded.

The overall number of rapid lateral flow tests conducted in care home residents (which includes positive, negative and void tests) has broadly increased since late-January, with the exception of slight decreases in early and mid-February and another in early March. In the week ending 19 March 2023, there were 4,770 rapid lateral flow tests conducted among care home residents, compared to 2,890 in the week ending 29 January 2023.

PCR tests

The number of PCR tests conducted in care home residents increased from late-January 2023 until early March 2023. There were 23,542 tests conducted in the week ending 19 March 2023, compared to 16,049 in the week ending 29 January 2023. This number has decreased since the week ending 12 March 2023, when 24,082 tests were conducted.

Figure 4: number of tests conducted in care home staff and residents, England, September 2022 to March 2023

Between September 2022 and March 2023, there were 2 spikes in the number of tests conducted among care home staff and residents, one in October 2022 and a lower one in early January 2023.

Source: NHS Test and Trace

Note: in order to show the overall trend, all data points in this chart contain data for the past 7 days. This means that the data point for 9 October 2022 is higher than it is in the data tables because it represents data for a 7-day window rather than a 5-day window as in the data tables.

See table 2 (above) for a breakdown of prior changes to testing guidance.

This data can be found in tables 1 and 2 of the accompanying ‘COVID-19 testing statistics, April 2023: data tables’ on the Adult social care in England, monthly statistics: April 2023 page, in addition to data by region and local authority.

Figure 5: number of positive test results in care home staff and residents, England, September 2022 to March 2023

Between September 2022 and March 2023, there have been 2 spikes in the number of positive tests results among care home staff and residents, one in October 2022 and another in early January 2023. There was a smaller increase in the number of positive tests between late January and mid-February 2023. Since early March 2023, the number of positive PCR tests has started to decrease, while the number of positive lateral flow tests has started to increase.

Source: NHS Test and Trace

Note: in order to show the overall trend, all data points in this chart contain data for the past 7 days. This means that the data point for 9 October 2022 is higher than it is in the data tables because it represents data for a 7-day window rather than a 5-day window as in the data tables.

See table 2 (above) for a breakdown of the specific changes.

This data can be found in tables 1 and 2 of the accompanying ‘COVID-19 testing statistics, April 2023: data tables’ on the Adult social care in England, monthly statistics: April 2023 page, in addition to data by region and local authority.

Staff and residents have different testing regimes as outlined in the background quality and methodology note. As a result, the number of positive test results returned are expected to be of a different scale between staff and residents.

Terminology

Care home

Facilities providing residential care. The data in this bulletin refers to Care Quality Commission (CQC)-registered care homes.

Older adult care homes

Care homes serving any older people (aged 65 and over) as identified from the latest CQC data on care homes in the ‘older people service’ user band. A small number of residents within care homes serving older people may be aged under 65.

Younger adult care homes

Care homes not serving any older people (aged 65 and over) as identified from the latest CQC data on care homes in the ‘older people service’ user band.

Domiciliary care

Services providing personal care for people living in their own homes. The data in this bulletin refers to domiciliary staff employed by independent CQC-registered providers.

Staff

Unless specified, staff can refer to staff directly employed by a provider and/or through an agency.

PCR (polymerase chain reaction) tests

PCR tests check for the genetic material of the coronavirus in the sample, which is taken using a swab and is processed in a lab via a polymerase chain reaction (PCR). These are predominantly used in care homes for people who experience symptoms, and for routine asymptomatic testing for staff and residents.

Rapid lateral flow tests

Often referred to as ‘rapid tests’ or lateral flow device tests, these test for the presence of proteins called ‘antigens’ which are produced by the virus. They are swab tests that give results in 30 minutes or less, without the need for processing in a laboratory. These tests are primarily used in care homes for routine asymptomatic testing for staff, residents and visitors.

About this data

These statistics are being published as a part of a wider landscape of statistics on adult social care. The Government Statistical Service (GSS) compiles a UK adult social care database of official statistics on adult social care across the 4 nations of the UK. This is updated on a monthly basis.

The UK Statistics Authority (UKSA) conducted a review of adult social care statistics in England which called for:

• better leadership and collaboration across different organisations publishing official statistics. This publication has been produced in collaboration with other statistics providers of COVID-19 adult social care data and DHSC will endeavour to work with various stakeholders as more data is published through this publication

• addressing of gaps in available data, particularly in privately funded care. This bulletin aims to plug some of that gap by including data on residents privately funding their care in addition to those funded by local authorities

• improving existing official statistics. These statistics are badged as official statistics and more data will be added iteratively based on user needs

Data sources

Data on visiting in care homes, staff absence and vaccinations is taken from self-reported data submitted by care providers in England through a data collection and insight tool called Capacity Tracker. From 31 July 2022, this data is part of the subset of data which providers are mandated to submit on a monthly basis.

Data on testing in care settings is collected from management information generated during the operation of the NHS Test and Trace service.

More detailed information about data sources can be found in the Adult social care monthly statistics, England: background quality and methodology. This document also includes detailed information on:

• data coverage
• data quality
• relevance
• accuracy and reliability
• timeliness and punctuality
• comparability and coherence
• accessibility and clarity
• cost and burden

Revisions

Any revisions to past publications will be in line with DHSC’s revision policy and highlighted in future publications accordingly.

Feedback

For feedback and any further questions, contact asc.statistics@dhsc.gov.uk.