RCN position on the early return to work of nursing staff who are self-isolating under Test and Trace guidance (England)
Across the UK community transmission of the Delta variant of the SARS-COV-2 virus is rising rapidly with exponential growth in cases across the UK with an average of 40,000 cases reported per day and a prediction that this may reach 100,000 -200,000 cases per day by the end of August 2021 should current rates of infection continue.
People found to be positive to coronavirus infection are required to self-isolate. Self-isolation remains one of the key interventions to reduce the transmission of infection. Currently across the 4 countries of the UK there is a requirement to isolate for 10 days if an individual has been in contact with a positive COVID case.
Rising COVID-19 cases is challenging due to the number of health professionals required to self-isolate is providing workforce planning difficulties.
This is causing immense and immediate pressure on the health and social care system, specifically a shortage of staff to deliver services. Guidance was issued in England on 19 July (updated 22 July) for health and adult social care staff to manage this pressure on a case by case basis in extreme situations and maintain essential services. Guidance for Scotland is being developed and likely to be published soon, and other devolved nations are expected to review their policies in relation to this issue. Other essential workers (air traffic controllers etc.) are also being considered for such a scheme to maintain essential services.
For health and care workers the principles of eligibility for return from self-isolation in the English guidance is based on:
- Staff are double vaccinated
- Negative PCR test confirmed before returning and daily LFT testing is undertaken daily for 10 days and staff remain negative and asymptomatic during that period
- Staff only leave their home for the purposes of work.
The PHE guidance (England) is accompanied by a briefing note and NHS letter. Discrepancies between these documents were identified, along with a number of questions requiring clarity. Details of concerns have been sent to the National COVID Response Centre (NCRC) (20 July 2021). It is recognised in the accompanying briefing note that clusters and outbreaks of infection may occur as a result of the change in policy.
Current specific RCN concerns relate to:
- Whether/How data will be collected on the number of staff asked to return to work and not self-isolate and the proportion of these that return from self-isolation? This is of particular concern given the inadequacy of current HCW work related infection data (see RCN briefing on this).
- The need for a standardised template risk assessment tool
- The pressure on specific teams to undertake risk assessments (health protection teams, Infection Prevention & Control teams and occupational health teams)
- Transparency/duty of candour to patients/carers if cared for by staff who would otherwise be self-isolating
- Staff only released for the purposes of work. Following risk assessment and daily testing staff are either considered safe or not safe to mix with the public. Many health and social care workers move around community settings or places of work as part of their role.
- Employers expecting staff to return regardless of risk assessment with the policy adopted as business as usual not in extremis.
- How staff are expected to take breaks in areas not used by others – this risk staff not having access to adequate rest and hydration breaks.
The following represents an updated RCN position from the previous holding statement of 13 July.
The RCN acknowledges the risks associated to delivery of health and social care services as a result of large numbers of staff asked to self-isolate currently and over the next 4-6 weeks. The risks to patient safety as a result of staff shortages and the risk of infection need to be considered. Long elective waiting lists also carry harm and this reflects the original estimates of non-covid related excess mortality predicted in early 2020.
Position – the RCN recognises risks associated with acute staff shortages. The RCN is very concerned at some of the lack of detail in the published Public Health England guidance and other official communications.
The RCN expects the following to be clarified or put in place:
- The evidence used to inform this policy. We will follow the evidence/science in our decision making.
- Governance of this policy and where ultimate accountability lies within government at a time when the legal obligation to self-isolate remains.
- Accountability for any decision to implement this policy must be clear and does not sit with the individual nurse or healthcare worker.
- Data must be collected centrally across health and social care and reported transparently in real time on the number of staff assessed for eligibility to return to work and the number deemed safe to do so. Data must also be available on how many returning staff are redeployed or subsequently found to be positive to COVID-19 and any incidents of transmission associated in areas where staff return.
- Clarity on what extreme situations that require this policy to be in place are and data on the frequency of implementing this. This data must be publicly available.
- The RCN expects that re-mobilisation plans and elective services be limited as the first measure to increase capacity, as we have done at other critical parts of the pandemic – i.e. slow down/stop elective work
- Employers should make appropriate respiratory PPE, FFP3 masks, available to staff as necessary.
Until these concerns are addressed, evidence provided and assurances received the RCN remains unable to give support to this guidance. We will continue to press government bodies and the NHS system for information and clarity on behalf of members.