Safety recommendation
It is recommended that NHS England and NHS Improvement:
- supports additional capacity for testing for NHS patients and staff (Pillar 1 testing)
- facilitates the accessibility of rapid testing for NHS trusts, as soon as an increase in rapid testing supplies becomes available.
Response:
Nosocomial infections are a national priority for the NHS and a range of teams have been taking and continue to take actions to maintain patient safety.
The NHSE/I Infection Prevention and Control (IPC) team works alongside PHE to provide leadership to the NHS in England. NHS providers work to ensure that the latest Public Health England IPC guidance is implemented rigorously, best practice is shared and direct support is provided to trusts that require this.
The IPC team works alongside other teams to support local action to minimise nosocomial infections, particularly the testing, people and estates teams.
Since the start of the pandemic, the availability of testing for staff and patients has increased, which has supported the early identification of potential sources of nosocomial infections.
The impact of the hospital estate is a key consideration and constraint in IPC and trusts have taken this into account to support local implementation of measures to prevent hospital infections.
Finally, the effort that staff have made in working through this pandemic, particularly in terms of fatigue and distress, has been recognised and a wide range of national support has been provided to help NHS organisations support their staff.
Actions: Ensuring adequate testing capacity for NHS staff and patients has been a top priority throughout the pandemic in line with Government decisions about who is eligible for testing.
In terms of additional capacity for staff testing, the following actions have been taken by DHSC:
- From 12 April testing has been available to symptomatic staff and their household members across the NHS, including individuals working in the NHS outside of acute care.
- From 9 November plans were implemented to make asymptomatic testing available to all NHS patient facing staff. 34 trusts were early adopters of lateral flow antigen tests before a wider rollout to all trusts by the end of the month.
- Lateral flow antigen testing kits were provided to all NHS trusts by the end of November so that patient facing st+P226aff can test twice a week. Lateral flow technology is the main mechanism for staff testing and this can continue to be used alongside PCR and LAMP testing.
- In December, we confirmed that lateral flow antigen testing would be rolled out to the whole of primary care (around 40,000 organisations) for asymptomatic patient facing staff, including GP practices, pharmacies, opticians, community health services, and vaccinators. More than 16 million tests will be available for staff to test themselves twice a week. Positive tests will be followed up by a confirmatory PCR test.
In terms of extra capacity for testing patients, the following actions have been taken, following DHSC decision:
- Provision is in place so that all elective and emergency patients can be tested, and this includes people who are attending via emergency admission, whether or not they have symptoms.
- There are processes in place to retest patients at intervals whilst they are in hospital even if they do not show COVID symptoms; at days 3 and 5 - 7.
- All patients are tested 48 hours before they are discharged to other care settings, including care homes and hospices, in line with DHSC policy and requirements.
- In December we published guidance for trusts on supporting maternity patients. This included patients and their support person having access to lateral flow testing so they can attend scans and be present at birth.
In addition to this, we are currently facilitating rapid turnaround testing for patients where a fast result is needed, reducing risk for patients and staff.
Depending on the testing platform, rapid turnaround testing can be completed in anything from 15 to 120 minutes. However, there is no perfect test available currently which provides very rapid near patient testing alongside appropriate sensitivity and specificity levels for that use case, and which has sufficient available supplies for a national rollout. Access to rapid turnaround testing is being prioritised for emergency pathways.
Therefore, we are continuing to work with regional pathology and clinical networks on the clinical operational aspects of deploying the different rapid testing technologies in the most useful ways to frontline clinical teams to reduce the risk of nosocomial transmission.
These include the supply of reagent for the differing platforms, the license agreements and terms of use for the platforms and funding for any additional workforce requirements. We continue to work with DHSC’s Test and Trace teams to verify and validate new technologies and consider their appropriateness for NHS deployments as these become available.
Timeline:
Staff and patient testing – complete – sufficient capacity available to test as regularly as is recommended by CMO – evaluation is underway and will be reviewed on an ongoing basis.
Rapid testing – ongoing as new technologies become available.
Response received on 25 January 2021.