Consultation outcome

Proposal to regulate to stop movement of staff between care settings

Updated 29 June 2021

Applies to England

Summary

Stopping staff movement between different care settings and between health and care settings is critical to minimise the risk of infection of COVID-19. In our adult social care winter plan we committed to new regulations to enforce limitations on staff movement between care homes, and between care homes and other health and care settings, focused on care home providers.

The policy objectives of this consultation are to consult the adult social care sector on the proposal to stop staff movement.

Background to the policy

The findings of a study on the impact of coronavirus in care homes in England indicated one of the common factors in care homes with higher levels of infection among staff was the extent to which those homes employed staff who worked across multiple sites.

In its adult social care winter plan the government made clear that stopping staff movement between care settings is critical to minimise the risk of infection of COVID-19 and other viral illnesses, including flu. The winter plan also set out steps that government, local authorities and care home providers should take to limit all staff movement between settings unless absolutely necessary.

To ensure movement between care homes and other health and social care settings is stopped in all but limited circumstances, it is the government's intention to regulate care home providers. The Infection Control Fund (ICF), which has been extended until March 2021 with an extra £546 million of funding, is in place to support adult social care providers to reduce the rate of COVID-19 transmission within and between care settings, in particular by helping to reduce the need for staff movement between sites.

The policy intention

We’re proposing to make regulations that create a requirement on residential and nursing care home providers in England to restrict the movement of staff providing personal care or nursing care in their services. We also intend to amend the code of practice on the prevention and control of infections to explain the requirement. This is intended to contribute to the control of infection by preventing situations where staff are working in more than one setting.

The requirement would apply to Care Quality Commission (CQC) registered residential and nursing care home providers in England. These providers would be required not to use staff to provide nursing or personal care who are carrying on, or who have carried on within the previous 14 days, a regulated activity in another setting and/or for another health or social care provider subject to certain exceptions.

The requirement would apply to the use of all staff including bank or agency staff, excluding registered managers, or individuals deployed to undertake tasks other than the delivery of care, such as cleaning. The requirement would not include primary or community health care staff who are not employed or engaged by the home provider (for example district and community nurses, GPs or other visiting healthcare professionals).

It is not the intention of the policy to prohibit the employment of an individual who holds a relevant second job with another provider, providing they are not attending that setting for the period the requirement is in place. Providers could continue to use agency or other temporary staff provided those individuals are not attending another health or social care setting. If staff move settings there should be a 2-week period in between.

Where deploying agency staff, to support this, providers could consider the use of exclusivity contracts with agencies or block-book agency workers on a temporary or minimum hours contract. Providers would be expected to ensure temporary workers have access to a test before they begin their placement, as well as routine testing during their placement.

The ICF is to support adult social care providers to reduce the rate of COVID-19 transmission within and between care settings, in particular by helping to reduce the need for staff movement between sites. Examples of how the funding can be spent to support measures to restrict staff movement can be found in the ICF guidance.

Providers would be expected to take reasonable steps to identify those workers who hold additional jobs. Where an individual holds more than one relevant job, we propose it would be at the discretion of the individual worker which role they intend to continue. Providers would need to engage in discussions with such workers about their decision.

We propose a limited exception to the requirement in order that care home providers can continue to ensure enough staff are available to care for service users safely. This would allow providers to use people who are also being deployed in another health or social care setting, or who have been within the previous 14 days, but only for a reasonable period of time to allow the provider to make other arrangements to enable them to comply with the requirement. This may apply where, for example, a provider has taken all available action but is still unable to engage enough staff to cover specific shifts or perform specific duties. Likewise, there may be unplanned absences due to a significant proportion of staff self-isolating as a result of COVID-19 requirements, or another unforeseen circumstance that prevents staff from attending work (for example a school closure).

For the exception to apply, the provider would need to be able to demonstrate that it has adequately planned its staffing requirements in accordance with existing CQC fundamental standards and is actively taking steps to address any resourcing needs, but is still unable to ensure sufficient staff are available to care for service users. Providers would also be expected to demonstrate that, in so far as reasonably practicable, all staff used in this situation have had a test for COVID-19 in the previous 7 days and received a negative result. The provider must be satisfied the individual has had training in infection prevention and control and have a risk assessment in place.

In these circumstances, providers can use agency or other temporary staff (for example bank or pool), provided they meet the requirements set out in the exception above. Providers should seek to engage agency staff on a block-booking or placement basis and take all reasonable steps to ensure those staff are not attending other settings.

Where a provider makes use of the exception and deploys staff who are also attending another care home setting, or who have been within the previous 14 days, the second provider (usually where the individual staff member has chosen as their primary place of work) would not be in breach of the requirement.

The requirement will not apply to those staff who have been attending another health or social care setting in the 14 days prior to the proposed regulations coming in to force.

Following consultation, to support providers to comply with the regulation and maintain safe staffing levels we will issue more detailed guidance for providers.

Code of practice

In order to support the new regulation, the code of practice is proposed to give clear guidance to providers on how to fulfil the new requirement. We recommend respondents view the full proposed code of practice before responding to the consultation questions.

Consultation questions

Respond online

The scope of the proposal

Question: To what extent will the new requirement being proposed incentivise providers to further limit the movement of care workers into/between care homes and other health and care settings?

• It will help reduce staff movement
• It may help reduce movement, but with changes to the proposals
• It will not help reduce staff movement
• It will make reducing movement more difficult
• I don’t know / not applicable
• (please provide information to support your answer)

The proposed requirement currently excludes some job roles within care homes.

Question: Do you feel the proposed requirement should be extended to registered managers within care homes?

• It should apply
• It should not apply
• I don’t know

Question: Do you feel the proposed requirement should be extended to staff who are not carrying out a direct care role (for example cleaning staff) within care homes?

• It should apply
• It should not apply
• I don’t know

Question: Please state if you feel any other types of role should be excluded.

• (open text box for respondents to give detail to support their answer)

The proposed requirement will require care home providers to restrict movement between their care home and other health and social care settings.

Question: Do you consider any type of residential or nursing care home should be excluded from the requirement?

• (open text box for respondents to give detail to support their answer)

Question: Are there any other health and social care settings that should be excluded from the requirement, meaning that care home providers could continue to deploy care home workers who were also actively working in those settings?

• (open text box for respondents to give detail to support their answer)

Question: Are there employment settings other than health and social care settings that should be included in the requirement, meaning that providers could not deploy care home workers who were also actively working in those jobs? Please list any you feel should be added to the new requirement.

• (open text box for respondents to give detail to support their answer)

Implementing the proposal

Question: How easy do you believe it will be for care home providers to implement changes to meet the proposed requirement?

• Very easy
• Quite Easy
• Quite difficult
• Very difficult
• I don’t know / not applicable
• (please provide information to support your answer)

Question: How often do you believe care home providers will need to use the exemptions to the proposed requirement in order to maintain safe staffing levels?

• Daily
• Weekly
• Fortnightly
• Monthly
• Less frequently
• I don’t know / not applicable
• (please provide information to support your answer)

How individuals and businesses are affected

Protected characteristics are age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex and sexual orientation.

Question: Are there particular groups of people, particularly with reference to those with protected characteristics, that might be negatively affected by a new requirement which limits staff movement between care homes and other relevant health and care settings? This includes impacts on both those who work in adult social care or those who access adult social care services.

• Yes ‒ in full
• Yes ‒ in part
• No
• I don't know
• (please provide details to support your answer)

Question: How could we make sure these groups or individuals are supported or not affected negatively?

• (open text box for respondents to give detail to support their answer)

Question: Are there any businesses that might be negatively or disproportionately affected by this new requirement to stop staff movement?

• Yes
• No
• I don't know
• (please provide details to support your answer)

Question: How could we make sure these businesses are supported or not affected negatively?

• (open text box for respondents to give detail to support their answer)

Ensuring continuity of care

Question: Do you have any concerns about the impact of the proposed requirement on the ability of care home providers to maintain a safe service?

• Yes
• No
• I don't know / not applicable
• (please provide details to support your answer)

Question: Do you consider it will be possible for care home providers to offer workers additional hours to mitigate hours they may lose from their other roles?

• Yes ‒ in most cases
• Yes ‒ in some cases
• No
• I don't know / not applicable
• (please provide details to support your answer)

Question: Will the proposed requirement cause any conflicts with other existing statutory requirements for adult social care providers?

• Yes
• No
• I don't know / not applicable
• (open text box for respondents to give detail to support their answer)

Question: Do you anticipate that you will have sufficient access to the support provided through the Infection Control Fund (ICF) to cover any additional costs resulting from implementing this new requirement?

• Yes ‒ in full
• No
• I don't know / not applicable
• (please provide details to support your answer)

Views regarding provision of care to you / your family and loved ones

The following questions are seeking your views about how the proposed new requirement will help support effective care and infection control in the care home that you, or your family, friends or loved ones, are resident in.

Question: Do you have any concerns about the current situation, whereby care providers are advised to stop staff moving between settings but this is not a requirement in law?

• Yes

• No

• I don't know / not applicable

• (please provide details to support your answer)

Question: Do you have any concerns regarding the impact of the proposed requirement on the ability of care home providers to maintain a safe service?

• Yes
• No
• I don't know / not applicable
• (please provide details to support your answer)

Question: Do you have any concerns about the flexibility in the proposals which enable providers to continue to use staff who work in other locations to maintain safe staffing numbers?

• Yes

• No

• I don't know / not applicable

• (please provide details to support your answer)

Question: Please use this space to give us any additional feedback you may have regarding this proposal.

• (open text box for respondents to give detail to support their answer)