Health and social care workers, including care homes self-isolation
The guidance on self-isolation for positive cases and contacts of positive cases, including household contacts changed on 6 January 2022.
A further update was sent to all stakeholders on 17 January which removed the requirement for fully-vaccinated health and social care staff to PCR test prior to returning to work.
The Self-isolation Framework Policy has been updated and provides full details of the guidance. The main points are summarised here.
Staff who have tested positive
All health and social care staff (this means anyone working within health or social care settings) who have tested positive for COVID-19 can return to work from day 7 of their self-isolation if they:
- are vaccinated or unvaccinated
- have two negative LFD tests - taken 24 hours apart - on day 6 and day 7
- have not had a fever over the 48 hour period (a temperature of 38 degrees or above) prior to returning to work
For clarity, if a staff member tests positive on day 6 but negative on day 7 and 8, they can return to work from day 8.
Fully vaccinated and identified as a contact
Fully vaccinated health and social care staff who are identified as contacts of a covid positive case can exit self-isolation and return to work, if they:
- have been double-vaccinated and received a booster vaccination at least 14 days before the last exposure to the case
- have a negative LFD test result each day before attending work. Staff should take a test each day for the 10 day period and from the 11th day continue with their routine workplace testing
- are not currently self-isolating as a COVID-19 case or under international travel regulations
- do not have COVID-19 symptoms
The 28 days starts on the first day of symptoms or positive test result (whichever comes first).
Where these conditions cannot be met, the staff member must not attend work and is expected to complete self-isolation for 10 days following exposure, returning to normal activities if well and no fever for 48 hours (without the use of anti-pyretic drugs).
The only exemption to this is when a staff member has been diagnosed as a Covid case in the 28 days prior to being identified as a contact of a positive Covid case. In this case, provided they do not have symptoms, they can exit self-isolation and attend work without taking a PCR or LFD test. If they have symptoms, they should isolate and take a PCR test.
If the member of staff develops symptoms during the 10 day period they should not attend work and should book another PCR test . If they have a positive LFD test, a PCR test is not needed and the LFD should be treated as confirmation of positive status. If the staff member tests positive through PCR or LFD during the 10 day period they should follow self- isolation guidance for staff who test positive.
In both scenarios (positive Covid case or contact of a positive case) where a staff member meets the conditions, but refuses to undertake daily LFD testing for the remainder of the 10 day period (unless they are exempt due to being covid positive within 28 days) they should not work in the care/clinical setting (including care home, hospital, person’s own home) but, where appropriate, may be asked to work from their own home.
Protecting those at high clinical risk
In both scenarios (positive Covid case or contact of a positive case) staff who can return should not work with individuals on the highest clinical risk list for the remainder of the 10 day period.
The highest clinical risk group includes patients on chemotherapy, immune-suppressants such as pre/immediately post-transplant, those who have profound immune-deficiency and other high clinical risk patients who are not vaccinated. This also includes those deemed at highest clinical risk in care homes and other social care settings. This list is not exhaustive and local line managers may determine other groups as fitting within the high clinical risk category. Staff can however be asked to return to work in roles to care for and support people who are not deemed at high clinical risk.
Not fully vaccinated and identified as a contact
If a health and social care worker is a contact of a positive covid case and is not fully vaccinated (meaning two doses and received booster more than 14 days prior) they should undertake a PCR test and self-isolate for 10 days.
The only exemption to this is when a staff member has been diagnosed as a Covid case in the 28 days prior to being identified as a contact of a positive Covid case. In this case, they can exit self-isolation and attend work without taking a PCR or LFD test.
The 28 days starts on the first day of symptoms or if asymptomatic, their positive test result.
Workplace testing – daily lateral flows
After the 10 day period, health and social care workers who were following testing and isolation guidance as Covid contacts should continue with their standard workplace testing regime, which is to undertake daily LFD tests prior to work on working days.
Staff who have been isolating as Covid positive cases and have returned to work after two negative LFD tests, should pause their workplace testing regimes. This is irrespective of vaccination status. The pause should be for 28 days for LFD testing and 90 days for PCR testing. The pause starts on the first day of symptoms or positive test (whichever comes first). For clarity staff should continue to take the 2 LFD tests required to exit self-isolation early, as per the guidance, but after they have received the 2 negative test results to return to work they do not need to take any further tests for the remained of the 28 day period.
How providers should support staff returning to work
If you are a care home or social care provider manager, you can support staff returning to work by:
- ensuring they understand that they must meet the conditions set out in the policy framework
- discussing the role that they will being returning to which will differ from their substantial role if the staff member declines daily LFD testing