Restricting workforce movement between care homes and other care settings

On 1 March 2021, guidance was published by the Department of Health and Social Care (DHSC) which restricts workforce movement between care homes and other care settings. The guidance follows on from the consultation launched on 13 November 2020 on proposals to use regulation to restrict staff movement. Although the Government did not decide to proceed with regulation, the guidance presents a raft of difficulties for care providers, which are yet to be adequately addressed. 

The overriding intention of the policy is to minimise the risk of infections and outbreaks of Covid-19 in care homes by restricting staff movement between care homes and other health and care settings. However, the policy does not take account of the host of unintended consequences arising across the adult social care sector. 

The crux of the policy follows that a staff member who typically works across two settings must be subjected to a 10-day interval between attending the two settings and require a negative test result prior to entering the setting. This should be followed in all but exceptional circumstances. Eligible adult social care providers are able to use the Government support funds, including the Infection Control Fund and the Workforce Capacity Fund, to support the implementation of the policy. 

The feedback Care England has received from members indicates that this requirement is simply unworkable and seems at odds with the general easing of restrictions, especially in light of the increase in testing and the continued success of the Covid-19 vaccine rollout. 

The workability of the policy rests upon the nuances of the policy being clarified and spelled out far more clearly. Care England has posed, and continues to pose, questions and issues to senior DHSC officials in relation to the policy. Such issues include the growing gap between what the Government support funds are intended to cover and what they are actually able to cover; what constitutes an ‘exceptional circumstance’; how the guidance relates to Extra Care and Supported Living settings; managing staff who work across NHS and adult social care settings; and the impact on staff and resident wellbeing. 

Without adequate clarity, adult social care providers are left to navigate challenging situations without any central direction or support. To use one of the issues presented above, some providers who employ staff working across NHS and social care settings have lost skilled staff to the NHS due to the difficulties associated with the policy. For specialist care providers, such as those providing care for individuals with a learning disability, this presents enormous difficulties. Specialist care services are able to deliver the high-quality care necessary to meet the needs of the individuals they support as a result of the high-quality staff they recruit. These staff members are integral in enabling a wide variety of individuals, with very challenging needs, to enjoy a rich and fulfilling life. Crucially, most residents work with a small and consistent group of staff, enabling trust and confidence to develop. However, many of these staff members work across multiple services and limiting their movement would have an enormously adverse effect on the individuals they support.

Perhaps, the most frustrating part of the policy for our members has been the lack of parity between the NHS and adult social care; NHS staff are not being subjected to the same requirements as adult social care staff. The difference in the treatment of the adult social care sector and the NHS seems to be disproportionate and unjustified, given the clinical evidence that there is a high risk of Covid-19 transmission amongst healthcare staff in healthcare settings[1] and the NHS also uses a high volume of agency staff.[2] 

Going forwards, Care England will continue to collate evidence from members in relation to the policy and continue to make representations to the DHSC around the need for greater clarity and recognition of the difficulties the policy presents. 

George Appleton
Senior Policy Advisor
gappleton@careengland.org.uk




[1] Houlihan, C. et al. (2020). Pandemic peak SARS-CoV-2 infection and seroconversion rates in London frontline health-care workers. The Lancet. 396: 6-7.

[2] UK Parliament (2020). Written questions, answers and statements. Hospitals: Staff. Question for Department of Health and Social Care. [online]. UK Parliament. Available at: https://questions-statements.parliament.uk/written-questions/detail/2020-07-08/71059