- 10 Jul 2020
This guidance is for managers, social workers and social care workers undertaking home visits and other face-to-face direct contact with service users and significant others in community settings.
During the Covid-19 pandemic, there will be many ways that social work and social care can continue to support people, without the need for face-to-face contact. It is essential to balance the need to protect, support and supervise, with the need to avoid causing harm by spread of infection.
Scotland’s Strategic Framework
From 2 November 2020 Scotland moved to a strategic approach to outbreak management. The Framework provides for flexibility in local and national response and sets out expectations within five levels of protection. These ‘tiers’ define what can and cannot be done in the areas in which you live, work and travel. Each area of Scotland is assigned to a COVID protection level, information about these can be found on local council websites.
The Strategic Framework also contains advice and guidance on shielding. This is linked to the protection levels, in order to ensure all interventions respond to the needs of the most clinically at-risk groups.
Additional measures of January 2021
Due to the rising number of infections and increased transmissibility risks apparent at the end of December 2020, the First Minister made an announcement on 4 January to further tighten restrictions in Level 4 areas. These came into effect on 5 January 2021. Please see Coronavirus (COVID-19): stay at home guidance for up to date information and for considerations and mitigations for your services. Some Islands in Scotland are in level three.
Infection control is dependent on everyone following FACTs measures and advice on the NHS inform website. To help stop the virus spreading you should:
- wear a face covering
- avoid crowded places
- clean hands and surfaces regularly
- stay 2m away from other people
- self-isolate and book a test if you have COVID-19 symptoms
Ongoing adjustments to measures
During lockdown phases, the primary reason for direct contact with individuals and their families is the management of risk of harm. As we move through different phases of the crisis, extension or restriction of direct contact with service users must reflect and respond to need, taking in to account the impact of the pandemic on individuals and families; changing local and national conditions; and the most current public health advice. Extensions and restrictions should take place as part of co-ordinated arrangements with local partners, wherever possible building on the relationships that are already in place.
Safe and ethical practice
Coronavirus (COVID-19): guidance on individual risk assessment for the workplace provides general advice. Staff who have concerns relating to their health about attending work should seek an Occupational Health referral, or discussion with their GP or clinical specialist for more advice.
The Chief Medical Officer wrote to everyone on the shielding list during the week beginning 4 January to set out advice. Any staff who are required to shield should work from home if they can. If they cannot work from home, they should not go to work. The letter they will receive from the Chief Medical Officer acts as a fit note for as long as lockdown restrictions are in place. This letter is called a shielding notification and replaces the need for a GP fit note. Scottish Government advice for those who have been shielding was updated on 4 January.
Staff must have appropriate training in relation to use of PPE and other infection control measures. Assessment of need and risk is needed for each proposed instance of direct contact. Full understanding of and compliance with mitigation measures and appropriate risk assessment including decisions about whether a home visit is essential or whether the contact could be made in other ways is the important factor here rather than default to a particular additional measure.
Staff who have been identified as a close contact either through Test & Protect or the NHS Scotland app (Test & Protect | Protect Scotland) must isolate for 10 days. Routine testing does not exempt staff from this isolation requirement.
All direct contact should be risk assessed and planned in advance, taking account of local guidance and the public health guidance.
Further information should be assessed at the commencement of the contact.
The risk assessment should take account of:
- the purpose of the visit or contact, as part of the child or adult’s plan
- how challenging this could be for the people involved, and what impact it might have on the safety of staff and others
- what information can be ascertained in advance from family and other sources
- what is known about the health status of all in the household or location where meeting will occur
- what is known about available space within the home or location where the meeting will occur
- whether anyone likely to be present at the home/location has symptoms or a diagnosis of COVID-19
- whether anyone is isolating as contacts of persons who have symptoms, whether in the household or not
- who will ensure the advance understanding of those involved about infection control/physical distancing and the purpose of the visit
- how the people to be visited, want the visit to be managed - if possible, discuss available choices with them, to maximise their sense of control and self-management
Essential visits to clients who are symptomatic, confirmed positive of COVID-19 or shielding
Where someone being visited may be symptomatic of COVID-19 or has a confirmed diagnosis, and the visit remains essential, those undertaking the visit should use appropriate PPE, according to current guidance and strictly adhere to other infection prevention measures, including good hand hygiene and maintaining 2m physical distancing, wherever possible.
Where there are concerns about the quality of information regarding the symptoms of people who are in a household, it would be appropriate to develop a visit plan based on the assumption that people are symptomatic.
Where anyone in the household meets the criteria for shielding, PPE must be worn for the protection of that person. Social work staff should: use fluid resistant face masks; ensure full compliance with mitigation measures for hand hygiene and 2m distancing; and use further PPE only if personal care is required. Risk assessment should support decisions about when and how to make appropriate use of additional PPE if required.
A direct contact or visit plan should:
- make clear the purpose of the visit
- take account of how the people to be visited want the visit to be managed
- take account of the need for hand hygiene
- adhere to current guidance on the use of face coverings or Fluid Resistant Surgical Masks (FRSM) appropriate to the setting being visited and current Scottish Government advice
- confirm PPE requirements for those involved, which may involve disposable gloves, disposable plastic aprons and face protection (in line with public health guidancei)
- consider contingency arrangements for access to PPE if it should become necessary
- where PPE may be required, ensure understanding of the section of the guidance: ‘Putting on and removing Personal Protective Equipment’
- include transport arrangements that minimise health risk
- consider optimal use of indoor and outdoor space
- anticipate possible outcomes and resourcing/safe management of outcomes
- have the agreement of the accountable line manager
- comply with lone working protocols, if applicable
- maintain records to support contact tracing in the event of symptoms arising
Infection control during home visit or contact
- check on arrival if there is any new information that suggests anyone has symptoms
- hands must be washed for at least 20 seconds prior to, at the commencement of, and immediately after the visit, using soap and water or hand sanitiser
- practitioners should avoid touching surfaces, avoid touching their own face, and keep two metres away from other people
- ensure adherence to any requirements for face coverings or face masks
Those who are being visited are likely to be more anxious than normal. A first and necessary step is to acknowledge their feelings and experience.
Staff should provide information and convey reassurance, care and respect, considering the support needs and understanding for all involved.
Where someone who is due to be visited refuses to allow this to take place in a safe way, appropriate options should be considered with supervisory managers.
Disposing of PPE
Where PPE has been worn during a visit to a household where someone may be symptomatic or has a confirmed diagnosis, the PPE should be double bagged and dated, and left in the household for 72 hours before being placed into the general waste.
If the service user is not symptomatic or thought to have contracted COVID-19, the PPE can be discarded into the normal bin at the household.
Access to PPE
Services may access PPE at the local Health & Social Care Partnership Hub. In addition, services registered with the Care Inspectorate can contact the triage centre at 0300 303 3020
- NHS Inform: Coronavirus (COVID-19) in Scotland | NHS inform. Latest coronavirus (COVID-19) guidance from NHS Scotland and the Scottish Government, including physical distancing measures and advice for infected households.
- Public Health Scotland (31/12/20) Information for social, community and residential care settings. v1.7. https://www.hps.scot.nhs.uk/web-resources-container/covid-19-information-and-guidance-for-social-community-and-residential-care-settings/
- Public Health Scotland (31/12/20) Information and Guidance for care home settings v 2.1.https://www.hps.scot.nhs.uk/web-resources-container/covid-19-information-and-guidance-for-care-home-settings/