Find out how we are working together to support visits to care homes and other settings during coronavirus.
Making sure that residents in care settings across the county and their families can keep in touch during coronavirus is vital for physical and mental wellbeing. Following the latest guidance from the government, all care homes should allow every resident to have two named people who can come for a regular indoor visit.
Dear residents, families, friends and care providers,
Visiting for people who live in care homes, supported living, and extra care housing from 12 April 2021
Following the announcement on 5 April by the government, the next step of the roadmap out of lockdown will commence on the 12 April 2021. We wanted to update everyone on what that will mean for people in care to keep in touch with loved ones.
On 6 April, the government provided updated care home visiting guidance.
We have heard many wonderful stories over the last few weeks following the re-introduction of face to face close contact visiting. We hope that by now all care providers in North Yorkshire have reviewed their whole home risk assessments and have been able to establish their visiting policy and that this has been communicated to the people they support and families and friends.
From 12 April, residents will now be able to nominate two people to visit them for regular indoor visits. If the resident lacks the capacity to decide who they want their named visitors to be, the care home will speak with their family and friends so they can decide what to do between them. There will be no age restrictions on these nominated visitors and they do not need to be from the same household.
The named visitors will need to take a rapid (lateral flow) test and return a negative result every time they visit. If either of the visitors test positive they must both immediately leave the premises go home and self-isolate, avoiding public transport wherever possible. They must follow government guidance for households with possible or confirmed coronavirus (COVID-19) infection and immediately self-isolate and complete a confirmatory polymerase chain reaction (PCR) test that should be provided to them by the care home.
Visitors will need to wear PPE for the duration of these visits (gloves, apron and surgical mask) as well as observing any other infection prevention and control measures required by the care home. Indoor visits wherever possible, should take place in a designated, well-ventilated room, which avoids or minimises visitors having to walk through a home and reduces the likelihood of contact with other residents. Visitors should keep physical contact to a minimum. Visitors and residents may wish to hold hands, but should bear in mind that any contact increases the risk of transmission. There should not be any other close physical contact such as hugging because of the risk of infection.
This increase in the number of potential visitors will bring with it some additional risks and added pressures for care providers to manage. It is important that everyone co-operates to ensure this change in visiting arrangements is successful. All visits will need to be planned and residents and families/friends are asked to be mindful that everyone will want their ‘fair turn’ for visits. This may initially limit the numbers of visits that are possible. Providers are asked to give residents and loved ones enough time for meaningful visits, with at least 30 minutes a week (ideally more) of direct face-to-face time together – with additional time on top for residents to make their way to and from the visiting area and for cleaning of the area between visits.
Where practical, care homes should continue with the range of other visiting arrangement measures that they have put in place including separate visiting pods, use of window visits and virtual visits using technology.
The role of the ‘essential care giver’ continues and this is not counted within the two other nominated visitors. This may be appropriate for someone who may have a care or support need that cannot easily be provided by care home staff, or not without causing distress. These visitors will be able to visit more often in order to provide this essential care. They will have the same testing and PPE arrangements as care home staff.
On 7 April, the government provided updated guidance for visits out of care homes.
As the tone and content of this guidance could be viewed by some people as being overly restrictive, we want to ensure that we are providing the right advice to residents, people and care providers. The balance needs to be made between the rights of individuals and the risks to the wider care community (residents and staff). We have therefore escalated this issue to Department of Health and Social Care for clarification and additional guidance. We will provide further details once this clarification has been received. Our local position for the last few months has been to support trips out for fresh air and exercise, so long as these comply with national restrictions and maximise the safety, protection and wellbeing of individuals.
We continue to see a decline in the number of cases in the county, as well as of outbreaks in care homes. The ongoing restrictions as well as the vaccination roll-out are all playing their part in this. However, vaccination will not entirely prevent virus transmission so people who have been vaccinated are still required to abide by all government guidance on social distancing, face coverings and hand hygiene. We know from experience that the easing of restrictions can also lead to an increase in cases. We are still under national restrictions and so we must remain cautious as we consider how we increase visiting.
From 1 April, the guidance change for residents who are classed as “extremely clinically vulnerable” means they are no longer being advised to shield. This should not prevent people from having visits however should be considered within the individualised risk assessment and the advice is for people to continue to take extra precautions to protect themselves.
Visiting will cease in the care home during an outbreak except for ‘essential care givers’ and those visiting individuals who are, sadly, nearing the end of their life.
This update should be read in conjunction with the previous advice issued since November 2020.
We appreciate your continued support and acknowledge all the hard work that is happening during this very difficult time. By continuing to work together, we hope that we can take this next step out of restrictions safely together and support more people to see loved ones.
Richard Webb - Corporate Director, Health and Adult Services
Louise Wallace - Director of Public Health
The latest update should be read in conjunction with the previous letters that have been sent out.
Dear residents, families, friends and care providers,
Visiting for people who live in care homes, supported living, and extra care housing from 8 March 2021
Keeping in touch with friends and family is an important part of our sense of wellbeing. We believe it is important that everyone who lives in a care setting should be able to see their loved ones and to take trips out into the community if they want to.
As you know, we have tried in the last few months to do as much as possible to support people in care to keep in touch with loved ones during the pandemic. In the autumn, we set out our advice for safe visiting and trips out for people who live in care homes, supported living and extra care housing. Since then we have updated at each point when there has been a change in regional and national restrictions and guidance.
On 22 February, the Prime Minister set out his 4 stage Road-map for moving gradually out of restrictions. As part of this Road-map, the government said that it would re-introduce face to face indoor visits to care homes and that residents would be able to nominate a single named visitor, and it would offer further clarity on the role of a ‘trusted person’ to support with personal care tasks. There will also be additional testing provided to facilitate safer visits for residents in high-risk supported living and extra care settings.
On 4th March, the government provided updated care home visiting guidance. We are writing to say what this updated guidance might mean for visiting in North Yorkshire.
Since the peak in January, cases have been declining across the county. Previous lockdown restrictions have also led to a reduction in the number of people infected and that appears to be the case now. However, past experience also shows that the easing of restrictions can also lead to an increase in cases. We are still under national restrictions and so we must remain cautious as we consider how we increase visiting.
The national Covid-19 vaccination roll-out is another reason for optimism and the number of people who have received a vaccine so far is very encouraging. Still, it is important to remember the vaccine’s main purpose is to prevent or reduce risk of death and serious illness. People who have been vaccinated can still catch or transmit Covid-19. New variants of Covid-19 may also be resistant to the vaccine and present new risks so we need to remain careful and vigilant.
As before the lockdown, any arrangements for visits and trips must be consistent with national and local Covid-19 rules so that people are as safe as possible. We are asking care providers to review their visiting schemes to ensure that they reflect both our advice from November 2020 onwards and the Government’s new guidance on indoor visiting. Supported living and extra care may wish to use the care home guidance to support their visiting arrangements whilst we await the specific revised guidance.
Every care home is different and the needs and requirements of every resident and their families are individual to them. We also know that the infection rates and risks of contracting Covid-19 vary across the County. It is important that care homes use discretion based on their own circumstances; and that visiting arrangements are informed by individualised risk assessments, working with residents and families to identify and manage risks.
All care homes need to allow every resident to name one person who can come for a regular indoor visit. If the resident lacks the capacity to decide who they want their named visitor to be, the care home will speak with their family and friends so they can decide what to do between them. The named visitor will need to take a rapid (lateral flow) test and return a negative result every time they visit. If the visitor tests positive they must immediately leave the premises go home and self-isolate, avoiding public transport wherever possible. They must follow government guidance for households with possible or confirmed coronavirus (COVID-19) infection and immediately self-isolate and complete a confirmatory polymerase chain reaction (PCR) test which should be provided to them by the care home.
Visitors will need to wear PPE for the duration of these visits (gloves, apron and surgical mask) as well as observing any other infection prevention and control measures required by the care home. Indoor visits should wherever possible take place in a designated, well ventilated room which avoids or minimises visitors having to walk through a home and reduces the likelihood of contact with other residents. Visitors should keep physical contact to a minimum. Visitors and residents may wish to hold hands, but should bear in mind that any contact increases the risk of transmission. There should not be any other close physical contact such as hugging because of the risk of infection.
Everyone will need to co-operate to make indoor visiting a success bringing the enormous benefits that it undoubtedly will but without also bringing added risks. All visits will need to be planned and residents and families/friends are asked to be mindful that everyone will want their ‘fair turn’ for visits. This may initially limit the numbers of visits that are possible. Providers are asked to give residents and loved one enough time for meaningful visits, with at least 30 minutes a week (ideally more) of direct face to face time together – with additional time on top for residents to make their way to and from the visiting area and for cleaning of the area between visits.
Where practical, care homes should continue with the range of other visiting arrangements measures that they have put in place including separate visiting pods, use of window visits and virtual visits using technology.
The new guidance notes that some residents, for example people with significant dementia or a complex disability, may have a care or support need that cannot easily be provided by care home staff, or not without causing distress. This might include help with washing and dressing or where the resident is refusing to eat. The guidance recognises that a family member or friend can provide support to calm a person more easily than care home staff. In these circumstances, care homes should offer the ‘essential care giver’ scheme for these types of situations. These visitors will be able to visit more often in order to provide this essential care. They will have the same testing and PPE arrangements as care home staff.
Visits like these should be based on an individualised risk assessment for the resident which should include the risks and benefits of an essential care giver and this should be discussed and agreed with the resident’s family (or other interested parties as the case may be). The assumption is that there will only be one essential care-giver for one resident, although exceptions may be agreed subject to an assessment of the individual resident’s circumstances. This would likely be the same person as the single named visitor or could (with the agreement of the care home) be an additional person.
Trips out for fresh air and exercise should be supported, in line with our previous advice and taking into account the national restrictions advice in place at the time and bearing in mind the duty of care to keep people safe and well.
Visiting will cease in the care home during an outbreak except for ‘essential care givers’ and those visiting individuals who are, sadly, nearing the end of their life.
It is worth noting that the Government’s Roadmap indicates the hope that the number of visitors can be increased if the criteria for further reductions in restrictions are met. The first review will be in April 2021. Any updates and all previous advice on visiting will continue to be posted on our dedicated webpage here: www.northyorks.gov.uk/visiting.
Thank you for your patience whilst care homes get to grips with these changes, from next week.
We appreciate this is a very difficult time for everyone but by continuing to work together, we hope that more people can see loved ones and that we begin to see some light at the end of a very long tunnel.
Richard Webb - Corporate Director, Health and Adult Services
Louise Wallace - Director of Public Health
Dear Care Providers,
New Year’s Update
On New Year’s Eve, BBC Radio York was asking listeners to sum up 2020 and look ahead to 2021 in three words. When they interviewed me on the same show, I said “tough, kind and hopeful”. Tough, because it has been a tough year for all of us and also, because everyone has shown tremendous resilience, amidst all the highs and lows that we have all felt. Kind, because there have been amazing acts of kindness and a word that had somehow gone out of fashion is now back at the front of our minds. And, finally, hopeful, because although it’s hard right now and we are all tired, the vaccines have arrived and in the coming weeks and months, more and more people will have much greater protection against Covid-19.
During December and ever since, teams across agencies and communities in North Yorkshire have continued to focus on tackling the rising community infection rates and outbreaks (including the impact of the new strain of the virus); providing timely responses and clarity for changes to tiers and restrictions; and supporting colleagues with vaccination plans and capacity issues both within community services and our local hospitals. And from conversations with the Independent Care Group and the NHS, as well as our regular Wednesday night 5pm open call with all care providers, I thought it would be helpful to send out a New Year update.
Infection rates in the County are now very high. The county average is 436/100k as of today, with a rate of 525 in Selby and 284 in Ryedale. The peak infection rates are amongst the working age population – but they are increasing sharply amongst the over 60 age groups - and we all need to do all that we can to stop this increase spreading to people who use care services. Worryingly, 71 of our 235 care settings now have one or more Covid-19 cases amongst residents or staff and home care and day services are also impacted.
The latest, detailed advice on testing, vaccinations, visiting, daytime activities and respite services
The letter which Louise Wallace (Director of Public Health) and I sent out on 22 December 2020 provides detailed advice for all care providers, not just about Christmas but also about other key matters. This and this webpage should remain your main reference point for further updates.
However, today’s letter is intended to respond to some of the issues which you have raised with us since Christmas, as well as to update on the latest lockdown.
We have already set out our advice on the current and changing testing regimes that are now in place for providers. We are aware that some providers are feeling overwhelmed with the quantity and frequency of testing requirements.
We will continue to work with you, through training webinars and other advice, to make the most of the testing arrangements that are available for staff and people who use services.
We are also expecting to see further developments in national testing programmes in the coming weeks, including the likely roll-out of home testing for some of the population.
Meanwhile, if you do nothing else, please remember three key points about testing:
- PCR (full swab) tests are still the most effective means of testing for coronavirus and regular testing using PCR should be your testing priority for both people using your services and for your staff – lateral flow tests are a useful tool for identifying Covid-19 in people without symptoms, and you should start using them, if you can, but regular PCR testing is paramount and the best indicator of potential outbreaks at the moment. To put it simply: PCR is best for people who are symptomatic and/or who live and work in potentially high risk or vulnerable settings. LFD is useful for people who are asymptomatic and less high risk.
- North Yorkshire has extensive availability of fixed site and mobile testing if required and you can find your local facility on our covid testing pages.
- You should continue to have stringent infection control measures, including appropriate PPE and hand hygiene, and risk assessments in place to protect your staff, people using your service and your business. Social distancing for staff whilst at work and outside of work remains the most effective way of preventing the spread of Covid-19 and failure to comply with this has been identified as the main source of several outbreaks.
Visiting and trips out from care homes and supported living
From feedback so far, I understand that most people were careful and sensible about visiting arrangements to care services and/or visits out/family stays from care homes and supported living. Thank you for facilitating contact between families and friends and for handling difficult conversations and last-minute changes to plans where you needed to do so.
We continue to support and encourage regular, safe, planned visiting and trips out, except where there are outbreaks, subject to risk assessments and, ultimately, a decision taken by each Registered Manager. Please follow the advice that we issued on 22 December and in our previous letter from 30 October 2020 (see below).
Crucially, please follow the latest Regulations and Government Guidance, issued in response to the Prime Minister’s announcement of 4 January 2021.
The National Lockdown: Stay at Home guidance states that:
Visits to care homes can take place with arrangements such as substantial screens, visiting pods, or behind windows. Close-contact indoor visits are not allowed. No visits will be permitted in the event of an outbreak. You should check the guidance on visiting care homes during COVID-19 to find out how visits should be conducted. Residents cannot meet people indoors on a visit out (for example, to visit their relatives in the family home). There is separate guidance for those in supported living
Bearing in mind the national lockdown in England, residents, relatives and care providers need to be cognisant that we are all being asked to stay at home as much as possible, except where the person has a reasonable excuse to leave their home as set out in Government guidance and updated regulations. Separate rules have been set out for households forming a support bubble or linked households as they are now referred to (and home care and extra care providers will be aware of these requirements) but, in terms of visits to people living in care, then my advice is that local means local. Visits should take place from designated visitors within a reasonable radius (not defined in Government guidance but needs to be reasonable within the context of staying local and limiting travel) and trips out for fresh air and exercise should be very local to the resident’s home. Registered Managers continue to be responsible for visiting policies and must do so on the basis of a dynamic risk assessment.
I know that there is a strong national push to use lateral flow testing to support and extend visiting. Likewise, there are some queries as to whether visiting rules can be relaxed once people start getting vaccinated. Our strong advice to you is as follows: please continue to be cautious! Lateral flow testing is not a substitute for robust infection control. You should continue to operate a designated visitor scheme (as set out in our 30 October 2020 letter), with planned visits, on a regular basis, as set out previously, with safe visiting areas and procedures that meet strict infection control requirements. Likewise, good risk assessment should underpin your whole approach to visiting and day trips. Good hygiene, social distancing and proportionate risk assessment are the best ways in which we can keep everyone safe.
Whilst this advice may change in due course, I would urge caution at the present time, until lateral flow testing is demonstrated to have proven benefits and many more people have been vaccinated.
Day services and respite services
The National Lockdown: Stay at Home guidance states that you can leave home to provide care for disabled or vulnerable people, to provide emergency assistance, to attend a support group, or for respite care where that care is being provided to a vulnerable person or a person with a disability. Support groups that have to be delivered in person can continue with up to 15 participants but they must take place at a premises other than a private home. In light of this guidance, day services providers that have worked with our Service Development team and have completed appropriate risk assessments and demonstrated their ability to maintain a Covid-safe environment are able to continue, with appropriate ongoing risk assessment.
Individuals that attend day services may make their own decisions on whether it is suitable for them to attend during lockdown. Individuals who are clinically extremely vulnerable are advised to continue following shielding advice.
Respite services may also continue to be accessed, again with appropriate risk assessments and Covid safe practices.
This situation will continue to be reviewed as additional Government guidance is issued.
Where day services have not yet opened, please follow the process contained within the Covid-19 Resource Park for Day Services (pdf / 2 MB).
Re-opening of services is on an individual provider basis. Providers are responsible for ensuring their own service(s) meet the criteria set out within the National Guidance, and for undertaking their own Risk Assessments to demonstrate Covid secure status. A Self Assessment Checklist and Declaration Form has been developed to support this. Providers are asked to submit their documents to the Service Development Team for review prior to re-opening. Review is undertaken by a multi-disciplinary team, including Public Health. Where necessary, we can arrange for support from specialist teams, such as Infection Prevention & Control and/or Health & Safety. Providers are asked not to re-open until received formal communication is received following the multi-disciplinary meeting.
The Service Development Team will continue to work closely and collaboratively with providers to fully understand the measures being put in place to ensure the service is Covid secure on re-opening. Once all measures are in place, the Locality Service Development Team and the Locality Care and Support Teams work with providers on implementing safe re-opening plans, including prioritisation of individuals returning and transport.
Once re-open, providers are asked to engage with us on the ongoing monitoring of safe delivery of services, through the completion of the daily online survey. The survey should be completed every day the service is open to service users, and enables us to target support where needed.
It is great news that the Pfizer, Astra Zeneca and Moderna vaccines are now approved by the medicines regulator and that people across North Yorkshire are already being vaccinated.
My main message today is please be patient: the vaccination will be made available to people using your services and to your staff and this will happen in the coming weeks as more doses of the different vaccines become available. It is better that the vaccination programme is implemented in a safe way, than rushed.
Local NHS colleagues are working around the clock and, as soon as the national distribution system delivers new vaccine batches to North Yorkshire, they will be contacting people to vaccinate them. In most cases, GPs and their teams will be contacting you. However, in some cases, your local hospital may also offer vaccinations to staff and to people using services.
The UK’s four Chief Medical Officers agree with the Joint Committee on Vaccination and Immunisation (JCVI) advice that, at this stage of the pandemic, the priority should be to deliver first vaccine doses to as many people on the JCVI phase 1 priority list in the shortest possible timeframe. This will allow the administration of second doses to be completed over the longer timeframes in line with conditions set out by the independent medicines regulator, the MHRA, and advice from the JCVI. The evidence shows one dose of either vaccine provides a high level of protection from Covid-19.
It is expected that the NHS across the UK will prioritise giving the first dose of the vaccine to those in the most high-risk groups, with the second dose due to be administered within 12 weeks after the first. The second dose completes the course and is important for longer-term protection.
The JCVI’s independent advice is that this approach will maximise the benefits of both vaccines allowing the NHS to help the greatest number of people in the shortest possible time. It will ensure that more at-risk people are able to get meaningful protection from a vaccine in the coming weeks and months, reducing deaths and starting to ease pressure on our NHS.
With the exception of those who have appointments for their second dose booked this week (week commencing 28 December), the NHS will contact those who have already received their first dose to reschedule their appointment in line with this new advice.
Key points to remember:
- The NHS will contact you when the vaccines have arrived for your service, so please avoid ringing or emailing them asking when the vaccines will arrive
- Please prepare now for everything you need so that people using your service and your staff can be vaccinated – please refer back to our letter of 22 December 2020 (see below) for what you need to do; please use and complete the vaccination tracker (which I am enclosing again); and plan ahead for Best Interest decisions
- NHS services are facing significant pressures at the moment, both in terms of a rise in Covid-19 cases and other urgent Winter illnesses, as well as the large-scale vaccination programme which is now underway. Please make sure, as always, that the NHS is used appropriately – and that includes making contact with the NHS when someone does need medical or nursing intervention!
- If you have any major queries, ask your named GP practice lead/contact when they contact you for a routine call or visit. Likewise, you can contact the County Council with any major concerns and we will do our best to help – our contact details are at the end of this letter
We are aware that some staff may refuse to be vaccinated. We would strongly advise and encourage everyone to take up a vaccination but we understand that there are some valid reasons for staff refusing the offer of a vaccination, namely certain allergies, pregnancy and some matters related to religious beliefs.
Additional funding for care services
The County Council and its partners will continue to operate hardship and other funding schemes for care providers and to keep other local arrangements under review as the situation evolves. We will also ensure that nationally-designated funding is invested in the care sector.
Just before Christmas, the Department of Health and Social Care announced a national funding allocation of £149 million to support testing in care homes.
The grant will cover the infrastructure costs of the expanded testing programme including setting up testing areas and resource costs including gaining consent for tests, supervising the use of PPE and swab tests and then processing and logging the results.
The new grant allocation will be distributed to Local Authorities and notifications of allocations will be made early in January 2020. We will update you as soon as more details are available.
Further advice, help and support
I hope that this letter is helpful. The County Council, the Independent Care Group and the NHS can all offer support and practical advice and help. We continue to hold two Care Settings Gold and Silver meetings every weekday and have County Council cover in place at weekends, too. The County Council will continue to make regular contact, by telephone or online, with all residential and nursing homes and with other care providers.
The generic email address for the County Council’s care settings response team is
The Independent Care Group can be contacted as follows:
Phone: 07949 971 010
Phone: 07971 111 062
NHS 111 should be contacted when you have an urgent medical problem and are unsure what to do. Calls to 999 are for emergency medical care only.
There is also a weekly webinar call for all care providers in the county and everyone is welcome to join in, 5pm, every Wednesday:
New to GoToMeeting? Get the app now and be ready when your first meeting starts.
Once again, many thanks to you and your teams for all your hard work.
Corporate Director, Health and Adult Services
Dear care providers, residents, families and friends,
Update on visiting for people who live in care settings
Further to my recent letter about visiting arrangements for people who live in care, I am writing to update the advice that North Yorkshire County Council is now sharing with all care providers, residents and their families and friends, with effect from 1 November 2020.
We have heard from and spoken with residents, family members and care providers about this issue this month and I know how difficult the past few weeks have been for many people.
As you know, we advised all care providers to stop visits in person in September. This was done out of concern for the rising infection numbers in the community. We simply could not risk a repeat of what happened earlier in the year when so many lives of people in care settings were lost due to Covid-19. I then asked that the advice be extended to 31 October, with a commitment to review the decision by the end of this month.
Since then our Public Health and adult social care teams have been working closely with care providers and NHS colleagues to understand the risks of this second wave, and how we can make sure that people are safe now, and throughout the winter. This work has included daily contact with care homes across the county, a weekly meeting for all care providers to share experiences and ideas, and additional support to individual providers.
It is important to say that the community infection rates are deeply concerning. Although North Yorkshire is currently at, or just under, the national average, we have continued to see infection rates increase overall. This past week we have seen a rise in cases of Covid-19 in North Yorkshire care homes. We cannot ignore the very real risk of more people dying or becoming very ill. It is clear that social distancing helps stop the virus passing to others. Because of this, the advice from the Director of Public Health is to continue to minimise physical contact with others. In terms of being able to see loved ones, this means using window visits, socially distanced outdoor catch-ups, phone calls and video chats as much as possible.
However, it is also clear that these arrangements do not work for many people. Not being able to have visits is causing distress for many residents and their families and friends. There are also very real concerns about the long-term mental and physical wellbeing of loved ones. We need a plan that allows people to stay safe and which also makes sure people are keeping in touch.
Consequently, following discussion with the Director of Public Health and taking into account changes to the UK Government advice on visiting, I feel able to update our advice to care providers.
Starting 1 November, in-person indoor visits to people living in care settings can re-start, providing that each service can demonstrate that visiting arrangements meet the current guidelines on visits as set out in the government’s update on policies for visiting arrangements in care homes. This includes visitors wearing PPE, following rules about hand washing, and maintaining social distance during the visit. This would be based on each resident having one agreed designated visitor. If that person is not available, care providers can work with families to allow a substitute visitor, as long as a risk assessment of the care setting’s ability to support visiting takes place.
Where a care home has an outbreak (two or more residents or staff with Covid), then sadly in-person visits will need to be suspended. Contact will be restricted to virtual contacts, phone calls and outdoor window visits, except for people nearing the end of their lives or for visits by health and social care professionals.
A small number of care providers in North Yorkshire are now supporting people who are Covid-positive to be discharged from hospital into a bed in a care setting when they are unable to return home. These beds are in separate parts of the care setting, have a dedicated staff of carers working there and have been inspected by the Care Quality Commission (CQC) as being Covid secure. People in these beds will not be able to have visitors as they will still be in the isolation period. Other residents in those homes will be able to have visitors as long as the home does not have an outbreak in its non-Covid accommodation.
Expectations around indoor visits
In setting out this advice, I am asking all care providers to ensure that every resident (except where there is an outbreak) has the opportunity to have at least 30 minutes face-to-face, in person, time with their designated visitor each week. This means a minimum of 30 minutes of time together. Time needed to clean and sanitise meeting spaces should be planned in addition to people’s face-to-face time. I would hope that many care providers will be able to find ways of offering longer meeting times than this minimum.
Meeting up outdoors
We have also been asked about people being able to meet loved ones outdoors. This might mean meeting up for a walk in the park, the countryside or along a beach. My advice is that if people limit the contact to a maximum of two people, avoid crowded spaces, keep physically distanced and take precautions such as wearing face coverings, then outdoor meetings are a good way of keeping in touch.
I hope that this news brings some relief to those people who have not been able to see their families and friends. However, as winter approaches, I am aware that we will need to be creative and to find new and different ways for people to keep in touch.
To help with this work, I asked our team to bring together a task group of people who live in care, family member/friend representatives and care providers. The group included disabled people, younger and older people in care, parents and children of people in care, dementia advocates and service managers. Over three meetings in October, they shared how the restrictions on visiting are affecting them, and made suggestions about how people can stay in touch safely. This included stories about some very creative solutions by families and care providers to support Covid-safe visits over recent months.
The group has written up some recommendations and ideas for the county council to consider as part of work on a broader ‘Keeping in Touch’ plan. These are attached, and are available on the care visits during covid page of our website. They set out a broad range of practical actions for the county council, the care sector and the wider community so that we can all play a part in making sure people have contact with loved ones.
Having read your correspondence over recent weeks, I know that the points raised by the group will chime with many people. In particular, we are aware that people are concerned about what will happen for upcoming religious festivals, including Christmas. Although we cannot predict the rate of transmission for Covid in the months ahead, we will make sure that everyone has clear information about how to plan ahead.
I would like to thank the group for their commitment and hard work and their practical and helpful recommendations. I have shared these with the North Yorkshire County Council Management Board and our two Executive Members, who have asked us to work through all of the recommendations in the coming days and weeks. We will also keep supporting the task group to meet so we can be transparent and listen to people directly impacted by these issues. Updates will be posted to the care setting visits page on the North Yorkshire County Council website.
North Yorkshire MPs have also represented your views strongly in their conversations with the county council and are keen to see people protected and able to keep in touch with their families and friends. They have already joined me, the wider county council, the Independent Care Group and others to ask the government to support people living in care to keep in contact with their loved ones and to see if routine care home testing can be extended to designated visitors.
It is important to note that we are very dependent on the national picture, too. Since my last letter, the government has introduced the three-level structure for managing Covid restrictions in local areas. Although North Yorkshire is currently still in Level 1, if part, or all, of North Yorkshire, moves into a higher level of restrictions at any point then decisions about visiting may be taken out of our control. However, I have already alerted Public Health England that we would like to see a more flexible approach to care home keeping in touch arrangements than the current Level 2 and Level 3 restrictions allow.
Whilst North Yorkshire is currently in Level 1, I would encourage us all as a community to do all we can to keep the transmission rate down – in so doing, we make a big personal contribution to enabling care home residents and their families and friends to keep in touch in person. This includes hand washing, wearing face coverings, maintaining social distancing over two metres and reducing day-to-day contact with others. All of this will help keep us all safe and reduce the need to make any restrictions in the future.
Thank you all again for your understanding at this time around these difficult issues.
Corporate Director Health and Adult Services
Dear residents, families, friends and care providers,
Following the Prime Minister’s announcements on 19 December, we are writing to provide updated advice about visiting for people who live in care settings. This letter also provides information on the tier restrictions, testing and the roll-out of the vaccination programme.
Firstly, we want to thank everyone for all you have done since the start of the lockdown to reduce the risk of transmission. There have been huge sacrifices by individuals and communities. Unfortunately, infection rates across North Yorkshire are still five times higher than they were over the summer months. The virus is still out there and increasing significantly in some parts of the county. We are facing the possibility of a spike going into Christmas, and almost certainly, in the New Year. There is also a new Coronavirus strain which spreads more rapidly although it is not believed to lead to more severe symptoms.
Consequently, our main message is this: be extremely careful and cautious. In the words of the Prime Minister and the Chief Medical Officer, assume that many people are likely to be infectious! We must minimise our social contacts further, and we must all stay vigilant with facemasks, hand washing and social distancing.
This news is all the harder, coming at a time when we would normally be meeting up and celebrating with friends and family. However, as our Hindu, Jewish and Muslim communities know from recent experience, Covid-19 will mean that this Christmas will be very different to other years. All of us feel the sadness and heart-break that comes with this situation and many of us will worry about not being able to see loved ones face to face.
There are added complications for people living in care given the disproportionate impact on older and disabled people. We know that people are anxious to understand what the changes mean for being able to see loved ones in care and will address each of them in this letter.
Detailed advice on the restrictions tiers, testing, and vaccination programme are below. The main points are:
- We should minimise all travel, staying local where possible
- We need to limit Christmas contact:
- ‘Christmas Bubbles’ can continue for people living in/from Tier 1/2/3 areas but must not include anyone from a Tier 4 area
- The initial advice on ‘Christmas Bubbles’ has changed and is now limited to up to three households on 25 December only. Overnight stays are not permitted.
- We strongly advise against household mixing between people who live in care and family members and friends. If this does take place, we would urge that you:
- limit the numbers of people mixing (to less than in the national rules),
- limit the time spent together
- take sensible precautions about the number of people in one room at any time, keeping rooms ventilated and wearing face masks if that gives greater confidence and security
- Anyone who leaves their care settings for any overnight visit to family or friends, however short, will need to self-isolate on their return for 14 days. People and families should consider this carefully when planning visits
- We continue to recognise the importance of people being able to have visits in care settings. However, we ask care providers, residents and relatives, to ensure that visiting takes place on a planned and extremely cautious basis, with stringent infection control measures in place, as set out in our advice at the end of October. This includes using new rapid testing where available (see below for more detail)
- Where a resident does not have mental capacity to make decisions about visits, then an assessment of their Best Interests needs to take place
- Care providers and their Registered Managers have the final say in undertaking risk assessments and making decisions about visiting within care settings, so long as they are mindful of our advice, the latest Government guidance and the relevant human rights implications of their decisions (both in terms of Covid-19 safety and family and friendship connections)
- The Covid-19 vaccination programme is now underway. However, we would ask everyone to be patient until it can be rolled-out in a safe way, especially as supplies are limited at the moment.
Going to a family member or friend’s home for Christmas
The Government’s 19 December announcement about ‘bubbles’ with other households includes information for people living in care homes. Specifically, it states that, for people who are over 65, care homes should only support outward visits in exceptional circumstances, such as to visit a friend or relative who is at the end of their life. This means the majority of people who are over 65 and live in care homes should ideally remain in their care home over the Christmas holiday period. The government guidance is based on the known risks for older people in care homes and the need to minimise the risk of an introduction of infection into a care home.
For residents under 65 years, the advice also states they “may be able to leave their care home to form a bubble, in agreement with the home and subject to individual risk assessments. A care home resident may form a bubble with one other household, and should not form a three-household Christmas bubble at any point.”
The advice says that residents must be tested when they leave and return and must self-isolate on returning to the care home after forming a bubble with another household.
The Government’s Visits Out of Care Homes advice says the household where the resident is visiting needs to limit contacts with other people for 2 weeks prior to the visit and also be tested for Covid-19 using the new Lateral Flow Device testing if available. These are new quick turnaround testing kits (see attached information for more detail).
Where Lateral Flow Device tests are not available, risk assessments will need to consider how to mitigate risks for people who want to go home. Even where testing is used and is negative, it is essential social distancing and good hygiene practices are maintained. This is to reduce the risk of transmission in case the test returns a ‘false negative’ result.
Residents and families should discuss with care providers to decide if the requirement to isolate for 14 days on return is in a person’s best interests, especially where residents do not have the capacity to decide for themselves. Where a person is not able or willing to self-isolate on return, the risk assessment must consider whether it is appropriate for them to leave the care home for Christmas.
Supported Living settings will not have access to Lateral Flow Device tests. However, we strongly recommend individual risk assessments are completed and all other protection measures are considered as they are for residents of care homes. We will continue to work with the Government and care providers to clarify emerging issues.
There is government guidance you can read for more information on:
Visiting Care Homes
The Government updated its guidance for visiting in care homes on 19 December 2020. Previously, visiting was restricted to protect the residents, staff and visitors from the risk of Covid-19 infection and spreading the virus to others. For many residents, family and friends this has meant that having a meaningful visit has been a challenge. The latest guidance is about allowing visiting that minimises the risk of passing the virus to someone else.
This new guidance introduces Lateral Flow Device tests as another measure that care providers can use to keep people safe. The advice states that no direct contact face-to-face indoor visiting can take place without a Lateral Flow Device test.
These tests can be administered at the care homes and have a 30 minute result time, picking up on asymptomatic transmission. The full testing process takes between 45 minutes and one hour to complete. More detail on this testing is attached.
Although this new testing will reduce the risk of virus transmission, our advice is that it should not replace the already established visiting practices in care homes including:
- Pre-booked time slots for visits
- Thorough cleaning between visits
- Open air visits wherever possible
- Visitor and resident to remain at least 2 meters apart at all times
- Visits can take place at a window
- Appropriate PPE being used if a visit takes place in care home grounds / garden.
- Temporary outdoor structures – sometimes referred to as ‘visiting pods’
- Use of a dedicated room, such as a conservatory or a room that can be entered directly from outside, that is fully partitioned from the main area of the home. This needs to have a full barrier between visitors and care home residents in order to not be classed as indoor visiting.
- Ensuring good ventilation for any spaces used - for example, keeping doors and windows open where safe to do so, and using ventilation systems at high rates but only where these circulate fresh air.
Meeting indoors in other care settings
Lateral Flow Device tests are not currently available to Supported Living and Extra Care settings. In Supported Living settings and Extra Care housing where visits cannot be conducted outside, communal spaces should not be used for visiting and contact should be avoided with other people. Face coverings should be worn and appropriate safe distances maintained. Visits to residents of a shared accommodation should be conducted in the person’s own room to reduce contact with others.
Meeting up outdoors
North Yorkshire being a Tier 2 area means a return to the ‘rule of six’ where we can see friends and family outdoors in a group of no more than six people. However in light of the increasing community transmission we advise limiting any catch ups to smaller groups, preferably from no more than two households.
For catching up with loved ones, this means people can still go for a walk outside, for example in the park, the countryside or along a beach or seafront. We still strongly advise people should avoid crowded spaces, keep physically distanced and take precautions such as wearing face coverings to minimise the risk of infection.
Depending on the individual visiting policy of the care home, it may be possible to host up to 2 people in the grounds of a care home, which includes the garden. These still need to be arranged in advance to allow the staff in the care home to support the residents with their visiting arrangements and to ensure safe numbers of visitors at any one time.
The advice for supported living settings again stresses the need to maintain a safe distance, to wear a face covering and to plan any garden visits to allow visits for other tenants to be staggered.
Travelling from outside North Yorkshire
We know that many residents have relatives and friends who live outside of North Yorkshire and who may be in a higher tier. People in every tier are being advised not to travel beyond their immediate local area. Restrictions are more severe for those in Tier 4 and by and large, travel from, or into, Tier 4 areas is banned.
There are exceptions including for the purpose of caring for another person. Designated visitors are considered to be providing part of residents’ support and should be able to continue to undertake visits. If you are visiting from outside of North Yorkshire, or from a different tier area, this should be by exception and solely for one of the listed exemption reasons, such as providing care. You should limit the duration and frequency of your visits, and take necessary infection control measures if visiting shared accommodation such as a care setting. Visitors from Tier 3 areas must continue to follow tier 3 rules, even when outside of your own Tier 3 area.
Suspension of visits during an outbreak
If a care setting experiences a Covid-19 outbreak, care providers will suspend all but essential visits, for example visits to residents who are, sadly, at the end of their lives. If an outbreak occurs, in-person visits are restricted until the outbreak is under control and the care home is in recovery. Other types of visiting such as external window visits, video and telephone calls should continue.
Many of you will have seen pictures in the media of the first Covid-19 vaccinations taking place. We welcome the news that vaccinations are starting to become available, albeit in very small amounts, for people aged over 80 and for residents and staff of care homes.
Although residents of care homes are a priority, there are logistical issues with managing the Pfizer vaccine which cannot be moved once it has been delivered to the designated local NHS site. As a result, vaccines are currently being provided on an appointment basis to over 80s who are living in the community and who can access their local designated site.
Where there are local hospital Covid vaccination hubs, for example South Tees and Bradford, staff may be invited to attend for a vaccination. NHS Clinical Commissioning Groups are working closely with primary care colleagues and the local authority to support the roll out of vaccinations. NHS colleagues have advised people not to contact GP surgeries to ask when vaccinations will be available as the additional calls are preventing practice staff from being able to prioritise their planning. You will be contacted when arrangements can be made for the vaccinations.
Vaccinations of care home residents and staff will commence as soon as it is practicable when more supplies are available. This is a huge undertaking so will take time to roll out.
Although care home residents and staff are not all in the initial round of vaccinations, there are steps that care providers can be taking to prepare. This includes consideration of who will be able to consent to receiving a vaccination and those who will need a mental capacity assessment and best interest decision record. The consent and best interest decision will need to be made immediately ahead of the vaccination but having conversations with people and their families now will help prepare for this to be done.
There will be a need to maintain a record of staff and resident consent / best interest decision, allergies, dates of vaccinations etc. The Care Setting Support Team have developed a spreadsheet template that may be of assistance to you. There is no requirement to use this version, but we just wanted to provide a tool that may be useful.
We appreciate that there are many things changing at this moment in time and we will ensure that we keep in regular contact and provide further updates in due course. We are working to update all of our guidelines about visiting for people in care settings. We also continue to work with the Keeping in Touch Task Group, which includes residents from care settings, family members, advocacy organisations and care providers. They are helping us create information and resources that will make visiting processes easier for all.
As this most challenging of years draws to a close we would like to thank each and every one of you for the personal sacrifices you have all made to help fight this virus. All of us have been touched in some way. We would like to extend our sympathies to those who have lost loved ones, or had other personal experience of Covid. This includes everyone who has not been able to have contact with friends and family as you would have liked.
We would also like to thank the individuals, community organisations and businesses who have stepped up to support the community at this difficult time. To all care staff, managers and other professionals, our sincere thanks for the incredible dedication and flexibility you have shown day after day, month after month. There are still hard days ahead but we know that we are equal to the challenge. One day we will look back with pride on what we have achieved together as a community and that we will be able to see each other again.
Thank you all again for your understanding at this time around these difficult decisions.
Richard Webb, Corporate Director - Health and Adult Services
Louise Wallace, Director of Public Health
Lateral Flow Device tests
On 8 December the Government released advice about using lateral flow testing for visitors in care homes. This information explains what lateral flow testing is and how it will be used as an additional measure to help people safe from Covid.
What is lateral flow testing?
Lateral flow antigen testing involves processing a throat and nasal swab sample with an extraction fluid and a lateral flow device or ‘LFD’. The device looks a bit like a traditional pregnancy kit. The LFD can detect an antigen produced when a person is infectious with Covid-19. If the antigen is present, a coloured strip will appear, indicating a positive result.
Lateral Flow Device Tests and visiting
The government guidance says that family members and friends wanting indoor, in person visits must take a lateral flow test. The introduction of Lateral Flow Device tests offers the potential for increasing in-person contact between families, friends and residents, without the need for physical barriers such as Perspex screens. By testing visitors, it reduces the risk that people will bring Covid-19 into homes, especially if they have no symptoms.
Visitors will still need to wear PPE, follow social distancing and hand hygiene. Close physical contact, such as kissing and hugging, must still be avoided. This is to reduce the risk of transmission of the Covid-19 virus in case a visitor has a ‘false negative’ test result. This is where the test has not detected a visitor has Covid-19 and incorrectly returned a false result.
Administration of tests
The Lateral Flow Device tests can be administered at the care homes and have a 30 minute result time. The full testing process takes between 45 minutes and one hour to complete. During the test visitors must provide signed consent for the test and the sharing of information, wear PPE and be registered on the NHS Track and Trace website. Following the test, the visitor must then either wait outside the care home, or in a room provided for the purpose until they get the result.
Care Homes in North Yorkshire are working hard to prepare their teams and their premises to introduce Lateral Flow Device tests to visitors, but they must be able to do this safely whilst still providing safe and effective care to their residents. This will mean that the speed of implementing the tests will depend on the situation in each care home, including the staffing, layout and the needs of their residents.
What happens if I get a positive test result?
Visitors who test positive will be immediately required to leave the premises, and follow up with a more accurate PCR test. As per government guidance they must isolate alongside the rest of their household and support bubble, with the results of the test being passed to NHS Test and Track for follow up.
Reliability of Lateral Flow Testing
Whilst lateral flow tests are becoming more available, they are still not as accurate as the more common PCR swab tests which are processed in a laboratory. We know that Lateral Flow Device tests, if self-administered, only have an accuracy rate of approximately 58%. This testing is therefore are not a guarantee of protection from Covid-19.
Test results giving a positive result (indicating a person has Covid-19) appear to be reliable. However this is not always the case for negative test results. Although there is a low risk of a false positive, research shows there is a risk of people who have Covid-19 testing negative with an LFD when they may have tested positive with a PCR test.
Maintaining social distancing and wearing PPE will help reduce the risk of transmission where Lateral Flow Device tests have provided a false negative result.
Use of lateral flow testing in North Yorkshire
The Government guidance is for care homes to offer tests to up to two visitors, twice per week, per resident. Reliability and accuracy concerns about the tests for visiting is causing concern amongst care home providers. Because of this, some care home providers and Registered Managers may choose not to use these tests. It is important we continue to support the hard work of our care providers in ensuring Covid-secure environments within care settings. Our advice to care providers is to start slowly and carefully with the introduction of the LFD testing in order to build up confidence in its use and administration.
The guidance is clear that, for all types of visiting, where possible there should be a maximum of two consistent visitors; this means the same family members or friends visiting each time. By limiting the overall number of visitors to the care home and/or to the individual, we help reduce the risk of the virus being passed on. To help manage the situation, care homes should keep families and friends informed of the progress made on implementing the guidance, and with visiting in general.
Where visitors test negative, other infection prevention, and control measures such as personal protective equipment (PPE) and social distancing should continue. However, if a care home decides they are not able to support the Lateral Flow Device testing, existing keeping in touch arrangements should continue.
As the tests are relatively new, we are still working through the details of how this new testing approach will be carried out by care homes. We are doing this in partnership with our care home provider colleagues. We are also developing easy to use guides for people and families with our Keeping in Touch Task Group, which includes residents and families of people living in care. Guidance will be made available as soon as it is available.
This letter is also available in an easy read format.
The latest information, in the letter above, should be read in conjunction with our previous update from 30 October, much of which is still relevant.
Visiting task group
In September we also set up a task group to see what could be done to support people who live in care to stay in touch with loved ones in a Covid-secure way. Members of the group include residents of care settings, family and care provider managers as well as our Health and Adult Services staff. Read about the first meeting of the task group.
In October the task group presented its recommendations to the county council. Read the task group report and recommendations or an easy read version of the report and recommendations.
One of the recommendations was to develop a keeping in touch plan that people and care providers can use to support visiting, the template for this is attached here (docx / 26 KB).
You can read more about the changes, as well as the story of one of the members of the task group on our keeping in touch with people in care page.
Additional comments on the recommendations can be sent to HASCovidComms@northyorks.gov.uk.
We'll continue to work closely with care providers across the county and keep everyone up to date as the situation changes.