Today’s ASC team within UKHSA is the descendant of the COVID-19 ASC Cell, set up by Public Health England in the early stages of the COVID-19 pandemic.
We support the delivery of the UKHSA’s responsibilities for ASC in partnership with other UKHSA teams and external partners. Our work is centred on understanding the variety of people, populations, settings and priorities relating to people drawing on and providing ASC.
High-quality advice and good decisions require understanding of the many different needs and characteristics of the people who draw on and provide care. We collect and use data, intelligence and evidence to support colleagues across UKHSA to provide a tailored health protection service across the sector.
Preparing for winter
Now is the time to start getting prepared for winter. There are several things that providers can do to prepare for and respond to winter-related issues. Fundamentally, providers should prepare for cold weather, which can put people at greater risk of ill health and even death. It increases the risk of falls and of complications from existing diseases. There are numerous actions care settings can take to prepare which are outlined here.
Secondly, providers should ensure best practice in Infection Prevention and Control (IPC) – preventing and reducing the spread of infection is key to the health and wellbeing of people drawing on and providing ASC. Standard Infection Prevention and Control precautions (SICPs) are basic measures that should be used at all times.
They include:
- Cleaning hands with soap and water or alcohol-based hand rub between tasks and between people drawing on ASC.
- Respiratory and cough hygiene (Catch it, bin it, kill it!).
- Regularly letting fresh air into rooms and shared areas (for more information on ventilation, see Government guidance on ventilation).
- Cleaning shared equipment, especially after use.
- Regular cleaning of the environment with particular attention to frequently touched surfaces and shared areas.
- Appropriate use of personal protective equipment (PPE).
- Correct handling and segregation of waste and infectious linen.
People drawing on ASC should also be supported to actively participate in these measures, especially handwashing and cough hygiene.
The role of vaccines
Vaccines are a crucial safeguard for the health and wellbeing of people drawing on and providing ASC. They reduce the risk of serious illness and outbreaks, which can be devastating in ASC environments (people drawing on ASC often have long-term health conditions and compromised immune systems, making them more susceptible to infectious diseases). Moreover, vaccinated carers are less likely to become ill themselves and transmit infections to vulnerable individuals.
Vaccines can also reduce the need for antibiotics, lessening the risk of Antimicrobial Resistance (AMR) developing. Many people drawing on ASC may not know which vaccines they received in childhood. This should be recorded on their GP records.
Three vaccinations are especially relevant for the care sector this winter. Firstly, from 1st September 2024, the Respiratory Syncytial Virus (RSV) older adult programme will start. People who turn 75 on or after 1st September 2024, as well as people already aged 75 to 79 (until the day they turn 80) will be eligible for a free vaccine to protect them from RSV. This is because older adults are more at risk of serious complications from RSV.
RSV infections can occur all year round, but cases peak every winter. RSV can spread through coughs and sneezes. To help prevent the spread of the virus, people drawing on residential care and support should be encouraged to cover their mouth and nose when coughing or sneezing (ideally with a tissue, or else into the bend of their elbow) and to wash their hands frequently. For further information, click here.
Secondly, from 1st October 2024, the following people will be offered the flu vaccine:
- People aged 65 years and over.
- People aged between 18 years and 65 years in clinical risk groups (as defined by the Green Book, Chapter 19: Influenza).
- People in long-stay residential care homes.
- Carers in receipt of carer’s allowance, or people who are the main carer of an older or disabled person.
- Close contacts of immunocompromised individuals.
- Frontline care workers without an employer-led occupational health scheme, including people working for a registered residential care or nursing home, registered domiciliary care provider, voluntary managed hospice provider or who are employed by people who receive Direct Payments (Personal Budgets) or Personal Health Budgets, such as Personal Assistants.
All frontline health workers, including both clinical and non-clinical staff who have contact with patients, should be offered the flu vaccine from 1st October 2024 as a vital part of their organisation’s policy for the prevention of the transmission of flu. This is in line with the national flu immunisation programme.
Thirdly, from 1st October 2024, adults aged 65 years and over, people living in a care home for older adults, people aged six months to 64 years who are in a clinical risk group (as defined in tables three and four of the Green Book, Chapter 14a – COVID-19 – SARS-CoV-2) and frontline health and care workers will be offered the COVID-19 vaccine.
 COVID-19 treatment eligibility
The NHS offers treatment to people drawing on residential care and support and people aged 70 years or over. Find the full list of eligible people here. NHS organisations are responsible for making COVID-19 treatments available.
The way providers can request and access the treatment for people in their care depends on where they live. Your local NHS integrated care board (ICB) will provide further information. The best way to protect people drawing on care and support from severe illness is to ensure they are offered the vaccine.
Changing guidance
Testing guidance has changed and now only Lateral Flow Devices (LFDs) should be used for testing symptomatic people who are eligible for COVID-19 treatments. Click here to find a local pharmacy where tests can be obtained.
Specific guidance on managing Acute Respiratory Infections (ARIs) such as RSV, flu and COVID-19, is available here and includes guidance on what to do if multiple care home residents develop ARI symptoms.
Any outbreaks of illness should be reported to your local Health Protection Team (HPT). It is common for vomiting bugs such as norovirus to circulate in care settings during winter. To find your local team, click here. Further IPC resource on ASC can be found here.
Supporting visiting
The guidance on visiting has been updated to reflect Regulation 9A, the new Care Quality Commission (CQC) fundamental standard on supporting the right to be visited and accompanied in health and care settings. This states that visits to care home residents must be facilitated, and that residents should not be discouraged from taking visits out of the care home.
The guidance explains how providers must respect the right of each person to receive visits, consider their needs and preferences and take account of relevant legislation. Providers must do what they can to ensure that visiting can occur safely, such as supporting visitors to practice good IPC.
In exceptional circumstances, HPTs may advise that, to reduce the risk of infection spread, the number of people entering and leaving a care home should reduce. This should only happen if facilitating a visit would pose a significant risk to the health or wellbeing of someone in the care home, which cannot be mitigated.
The UKHSA has published Supporting safer visiting in care homes during infectious illness outbreaks. This provides general operational principles for anyone involved in making decisions or providing advice to ASC homes. It describes a range of considerations for safely planning and protecting visiting during outbreaks of infectious illness.
Kelly Stoker is a Nurse Consultant for Adult Social Care at the UKHSA.
Email: [email protected]
X: @ukhsa
How will you ensure that best practice is implemented in your setting this winter? Visit www.caremanagementmatters.co.uk and comment on this feature or join the conversation to share your thoughts.