COVID-19: testing for hospices
Sets out COVID-19 testing for hospice patients and staff.
Applies to England
This guidance sets out how hospices should use COVID-19 lateral flow device (LFD) testing for patient-facing staff presenting with symptoms of COVID-19, how they should access testing for symptomatic patients where having COVID-19 will affect their clinical management, and polymerase chain reaction (PCR) testing during outbreaks of acute respiratory infection.
What has changed
This guidance has been updated in line with changes to the processes for accessing LFD tests for symptomatic staff. As of 1 April, only patient-facing staff who are providing direct care to severely immunosuppressed patients should take an LFD test if they develop symptoms of a respiratory infection. For this guidance, severely immunosuppressed refers to patients who are unlikely to mount an effective vaccine response, such as haemato-oncology and solid organ, stem cell or bone marrow transplant patients.
The definition of an outbreak of COVID-19 has changed to 2 or more epidemiologically linked cases with symptom onset within a 5-day period. As of 1 April, if there is a suspected outbreak of acute respiratory infection within the hospice setting, COVID-19 testing should be done by multiplex PCR tests accessed via the UKHSA health protection team (HPT) rather than LFD testing.
Routine COVID-19 LFD testing of asymptomatic individuals prior to discharge from hospital into hospices is no longer required. Testing may still be undertaken, based on local risk assessment by the hospital together with the hospice, for example during outbreaks.
Introduction
For most people, including in hospice settings, there is now a much lower risk of severe illness from COVID-19 compared to earlier in the pandemic. This is due to high immunity, high vaccination coverage and increased access to COVID-19 treatments. There is a small cohort of people who remain at increased risk of serious illness from COVID-19.
Testing measures in this guidance are focused on the protection of hospice patients at a higher risk and eligible for COVID-19 treatments.
Separate arrangements are in place for hospices in Scotland, Wales and Northern Ireland. This guidance will be kept under review.
Staff with symptoms of a respiratory infection including COVID-19, or a positive LFD test result
Hospice staff who provide direct care to severely immunosuppressed hospice patients
If a staff member who provides direct care to severely immunosuppressed patients develops symptoms of a respiratory infection and has a high temperature or does not feel well enough to go to work, they should take an LFD test as soon as they feel unwell. If the result of this LFD test is negative, the staff member can attend work once they are well enough to do so and if they do not have a high temperature.
If the result of this LFD test is positive, they are advised not to attend work for at least 5 days. The staff member should only return if they feel well enough to work, and they do not have a high temperature. If they are still displaying respiratory symptoms when they return to work, they should speak to their line manager who should undertake a risk assessment.
The majority of COVID-19 transmission occurs within 5 days of symptom onset. A locally decided protocol, following risk assessment and direction from managers, may be used for staff who are returning to work 5 or more days after a positive test result where they are providing direct care to patients. This may include:
- redeployment to lower risk areas up to day 10 after symptom onset or first positive test result
- asking staff to wear a surgical face mask up to day 10 after symptom onset or the first positive test result
- negative results on LFD test prior to returning to work
The staff member must continue to comply rigorously with all relevant infection control precautions, including PPE use.
Hospice staff who do not provide direct care to severely immunosuppressed hospice patients
Staff who work within a hospice setting but who do not provide direct care to severely immunosuppressed patients should follow local occupational health advice, together with guidance for people with symptoms of a respiratory infection, if they develop symptoms of a respiratory infection and have a high temperature or do not feel well enough to go to work.
These staff members do not need to take an LFD test if they are symptomatic. They are advised to stay at home and avoid contact with other people until they no longer have a temperature or no longer feel unwell.
If these staff members receive a positive LFD test result for COVID-19, regardless of whether they have symptoms, they should follow guidance for the general public who have a positive test result.
On returning to work, all staff members must continue to comply rigorously with all relevant infection control precautions including appropriate PPE use.
Patient testing
On admission
Patients with a scheduled date of admission to a hospice as an inpatient from the community or care setting do not need to take a COVID-19 test before admission.
Asymptomatic patients being discharged from hospital into a hospice are no longer advised to be routinely tested with a COVID-19 LFD test before planned discharge. However, in conjunction with local hospice providers, acute health providers should have trusted arrangements to facilitate safe discharges as set out in the hospital discharge and community support guidance.
Together with the hospice, hospitals should assess the risk in the period before planned discharge, seeking advice on proposed changes to testing arrangements from local authority public health teams or UKHSA HPTs, if needed. Following discussion with hospice providers and any advice from public health teams or HPTs, hospitals may decide to undertake an LFD test, for example if there is a local outbreak within the hospital setting. This test should be provided and done by the hospital. The hospice should speak to the hospital to raise any concerns about a planned discharge. Where a hospice is providing services commissioned by the NHS, or a local authority, and has concerns about a planned discharge that cannot be resolved with the acute hospital provider, they may wish to contact the relevant commissioner.
If an individual is tested before discharge into a hospital and tests positive for COVID-19, they can be admitted to the hospice if the hospice is satisfied that they can be cared for safely. Individuals who are admitted with a positive test result should be kept away from other patients on arrival.
The period individuals should stay away from others is from the day after the positive test and does not restart when the individual is admitted into the hospice. If the individual has already tested positive before the planned discharge, they do not need to test again if they continue to have symptoms of a respiratory infection and feel unwell or have a high temperature.
If there were signs of a new variant emerging or an increase in acute respiratory infection sufficient to impact on health and social care outcomes, UKHSA would manage any wider response through standard incident response structures. This would include the provision of public health advice to mitigate any risk, including the possible re-introduction of asymptomatic discharge testing if appropriate, alongside other infection prevention and control measures.
UKHSA’s usual incident response procedures enable local authorities, NHS providers, and care providers to alert the relevant UKHSA Regional Response Centre, or HPT, of an incident that may require assessment and management. UKHSA regional teams will escalate nationally as required.
Symptomatic patients who are eligible for COVID-19 treatments
People who are at higher risk of severe outcomes from COVID-19 may be eligible for COVID-19 treatments if they become unwell.
If someone who is eligible for COVID-19 treatments develops symptoms of a respiratory infection, they should be tested as soon as possible with an LFD test. Information on testing, reporting results and accessing COVID-19 treatments is available in the NHS guidance on COVID-19 treatments.
Treatments for COVID-19 are most effective if they are started early (ideally within 5 days of an individual first developing symptoms). It is therefore important that patients who are eligible for COVID-19 treatments take an LFD test as soon as possible if they develop symptoms so that they can access treatments early if needed.
If the patient tests positive for COVID-19, they should also follow the guidance for people who have symptoms of a respiratory infection, including COVID-19.
Staff providing care to people outside of residential care settings can help to support individuals who are eligible for COVID-19 treatments to access tests and treatments. More information is available on NHS.UK.
Symptomatic patients who are not eligible for COVID-19 treatments
Hospice patients who are not eligible for COVID-19 treatments are not required to take an LFD test if they are symptomatic.
If these patients have symptoms of a respiratory infection and have a high temperature or do not feel well enough to do their usual activities, they are advised to avoid contact with other people. They should be supported to stay away from others until they no longer have a high temperature or no longer feel unwell. They should follow the guidance for people with symptoms of a respiratory infection, including COVID-19.
Outbreak testing
An outbreak consists of 2 or more positive or clinically suspected linked cases of COVID-19, within the same setting within a 5-day period. This means where the cases are linked to each other and transmission within the hospice setting is likely to have occurred. Linked asymptomatic cases are no longer counted as part of the definition of an outbreak.
As the majority of symptomatic COVID-19 testing has been removed, an outbreak may be suspected when there is an increase in the number of staff and/or service users displaying symptoms of COVID-19 at the same time and linked by personal contact.
If an outbreak is suspected, contact your local HPT who will conduct a risk assessment. The HPT will advise on the use of multiplex PCR to test up to 5 linked cases with most recent onset of symptoms of a respiratory infection. Any patients who are eligible for COVID-19 treatments should also be tested as soon as possible if they develop symptoms of an acute respiratory infection with COVID-19 LFD tests obtained for this purpose, even if they are also tested by PCR. See the symptomatic patients eligible for COVID-19 treatments section for further information.
There is no longer a need to test everyone in order to work out who has and has not acquired COVID-19. Instead, testing is now focused on determining the cause of an outbreak, and on preventing severe outcomes for individuals at high risk.
How to access COVID-19 test kits
Accessing test kits for people eligible for COVID-19 treatments
Care providers can access LFD tests on behalf of service users who are eligible for COVID-19 treatments and therefore eligible for symptomatic testing.
Tests for this purpose are supplied by the NHS and should be accessed from a local pharmacy. Providers should speak to their local pharmacy to discuss access arrangements and whether the pharmacy is able to deliver tests in addition to collection options.
Pharmacies may ask questions about an individual’s medical history to confirm eligibility for free tests and update patient records for future test orders.
Providers should ensure that there are at least 3 tests available per eligible individual to enable them to test for 3 consecutive days if they develop symptoms of a respiratory infection.
More information is available on NHS.UK.
Accessing test kits for staff testing
Hospices have been provided with a supply of LFD tests which can be used for testing symptomatic staff who are providing direct care to severely immunosuppressed patients. Symptomatic staff who are not providing care to severely immunosuppressed patients should instead follow the guidance for people who have symptoms of a respiratory infection.
Reporting LFD test results
Under Regulation 4A of The Health Protection (Notification) Regulations 2010, hospices are still required to report positive, negative and void LFD test results where they have assisted patients to take an LFD.
To support hospices in being able to meet their Regulation 4A duty, the UKHSA multiple registration spreadsheet will remain available for hospices to report COVID-19 LFD test results. Hospices are still able to use this route to report the result of LFD tests that have not been provided to the hospice directly by UKHSA.
It is important to note that the registration of a positive COVID-19 LFD test result will not lead to a COVID-19 treatment being prescribed. To support patients to access COVID-19 treatments, follow the guidance issued by the NHS.
Last updated 25 March 2024 + show all updates
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Updated in line with changes to outbreak testing, symptomatic staff testing and testing upon discharge from hospitals into hospices from 1 April 2024. Updated the definition of an outbreak of COVID-19.
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Updated information on termination of testing services.
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Updated 119 hours.
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Updated information on the process for ordering LFD tests for those eligible for COVID-19 treatments.
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Removed digital reader information and guide as this is no longer part of the LFD reporting journey.
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Updated guidance.
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Removed information on testing for hospices in Wales and Scotland. Revised structure of the guidance.
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Updated in line with the pause to routine asymptomatic testing from 31 August.
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Updated 119 phone line opening hours.
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Removed Northern Ireland guidance.
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Updated in line with changes to testing in adult social care settings from 4 April.
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General updates and changes to policy, including self-isolation guidance for staff who test positive, testing within 90 days of a positive PCR result and removal of confirmatory PCR.
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Updated to reflect latest self-isolation guidance for fully vaccinated contacts.
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Updated to include information on testing for patient facing volunteers.
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Added information on changes to hospice visitor testing in Northern Ireland and updated the section on return box tracking.
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Updated to reflect changes that hospices are now eligible to bulk upload coronavirus test results.
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Updated to include information on return box tracking for PCR tests.
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NHS helpline for Scotland has changed to 119.
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Added new sections on the frequency of testing if you test positive, the information you need to capture before distributing rapid lateral flow test kits, and registering your result.
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First published.