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3 April 2020

Latest updates on covid-19 from DHSC

Every week we meet with Jonathan VanTam, Deputy Chief Medical Officer at the Department of Health and Social Care. This is an opportunity for us, along with other health charities, to seek clarification on the questions you ask us about epilepsy and covid-19. 

Below is a summary of questions and answers from this week's briefing. Often, the most frequently questions are the same across many different health conditions. For example why are certain conditions - in our case, epilepsy - not included in the high-risk category. In these instances, Jonathan Van Tam has provided general, rather than specific answers.

Shielding guidance

Why isn’t a patient with [xx] condition included on the list of extremely vulnerable people?

The list was created by a number of specialist clinicians before being signed off by the Chief Medical Officer, Professor Chris Whitty.

The guidance for the general public has moved on in recent days – you shouldn’t leave the house apart from to get groceries and other essential items, for one form of exercise, or to go to work if working from home is not possible. Therefore, the only difference in guidance is now that those included in the shielding guidance should not leave the house even for these reasons. However, we are aware that many people with underlying health conditions may choose to shield, even if they are not specifically listed as extremely vulnerable.

Is there additional guidance for key workers who live with a vulnerable or extremely vulnerable person?

Key workers should follow the government’s advice on living with a vulnerable person with extra care.

If you live with someone who is shielding, you can help that person by stringently following the guidance on social distancing and, doing all you can to minimise your contact with people outside the home. Within your household, you should also reduce contact as much as possible with the individual who is shielding.

Minimise as much as possible the time you spend near the person who is shielding and keep shared spaces well ventilated.
Aim to keep 2 metres (3 steps) away from the shielded person as much as you can and if don’t share a bed or a bedroom with them.
Make sure you use separate towels from the person who is shielding both for drying after bathing or showering and for hand-hygiene purposes.

Contacting extremely vulnerable people

How will extremely vulnerable people be contacted?

People falling into this extremely vulnerable group include:

People who’ve had organ transplants
People with specific cancers

People with cancer who are undergoing active chemotherapy or radical radiotherapy for lung cancer
People with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage of treatment
People having immunotherapy or other continuing antibody treatments for cancer
People having other targeted cancer treatments which can affect the immune system, such as protein kinase inhibitors or PARP inhibitors.
People who have had bone marrow or stem cell transplants in the last 6 months, or who are still taking immunosuppression drugs.

People with severe respiratory conditions including all cystic fibrosis, severe asthma and severe COPD
People with rare diseases and inborn errors of metabolism that significantly increase the risk of infections (such as SCID, homozygous sickle cell disease)
People on immunosuppression therapies sufficient to significantly increase risk of infection
People who are pregnant and who also have significant heart disease, congenital or acquired

People in these categories will receive an NHS text message, using the number patients have provided to their registered GP Practice. Texts will be sent to the mobile number and followed up on Monday with a letter, which will repeat the info for those who have the texts and ensure that the other 20% don’t miss out by not having identified a phone number. Recipients can opt-out of the text messages as all text messages end with “To opt-out reply STOP”

If you are classed as an extremely vulnerable person you will receive a letter from NHS England setting out next steps, you should stay at home from the point you receive the letter or are notified by your GP. This advice will be in place for at least twelve weeks.

Have any accessible materials been produced?

An easy read version of the letter is available here.

The letter will be made available in alternative languages. These are currently in development and should be available no later than 30 March 2020. These will also be uploaded online.  

The Public Health England Guidance, which the letter is based on, will be available online in different languages and accessible formats.

Will the letters acknowledge people with multiple conditions?

As the purpose of the letter is to inform the patient that they are classified as an extremely vulnerable person and offer guidance on what to do next, the letters do not go into detail on the patient’s specific condition. The patient’s medical history, which will have been used to make the decision, will contain all conditions the patient has and will have therefore informed the decision.

Supporting the extremely vulnerable

Who should/can register for support?

It is important to speak to friends, family and neighbours (by phone) and ask them to help you to make arrangements for the delivery of food, medicines and essential services and supplies, and look after your physical and mental health and wellbeing.

If this is not possible, then councils, businesses, charities, and the general public are gearing up to help those advised to stay at home. If you do not have contacts who can help support you, you can register for support here.

What about people not in the ‘extremely vulnerable’ category that are vulnerable, but who’s employers are insisting they come to work?

This is an issue recognised by DWP and is being looked at in further detail. In the meantime, the below information might prove useful.

The Government and the Advisory, Conciliation and Arbitration Service (ACAS advise) that businesses encourage their employees to work at home, wherever possible. If the employee does not wish to attend work, and is not in one of the groups advised to self-isolate, the employer must listen to the concerns of the employee.

If there are genuine concerns, the employer must try to resolve them to protect the health and safety of their staff. ACAS suggest that the employer could consider offering flexible working or agree with the employee to take time off as holiday or unpaid leave. However, there is no obligation on an employer to agree.

An employee who has 26 weeks’ continuous service has a statutory right to request flexible working. An employer can refuse a request on a number of statutory business grounds. It is also important to be aware that any change to the contract is permanent unless the employer agrees it is for a temporary period.

Flexible working may not be possible for a large number of workers, particularly frontline workers. It is not hard to imagine a situation where employees say they are unwilling to attend work because one or more work colleagues are not following hygiene rules and they fear they are being placed at increased risk. In such situations, the employer will need to consider the employee’s concerns very carefully before deciding how to respond. In addition, in some cases the anxiety caused by the outbreak of COVID-19 may itself render the employee unfit to work and entitled to sick pay.

As the Government has advised that certain people who are at higher risk to take additional measures, employers need to take this advice into account to ensure they do not become subject to unfair or constructive dismissal claims.

In short, the advice is that employees talk to their employers but if this does not resolve the situation, they can recourse to the normal arbitration procedures.

Will local support groups be coordinated centrally? How will people know where their local support hubs are?

People will be contacted by their local hubs if they have registered for support via the national helpline or the national phoneline. (If it is not possible for others to help you to get food or medication, go to www.gov.uk/coronavirus-extremely-vulnerable or call 0800 028 8327. ) The phoneline can direct people to their local hubs if they don’t already have this information. Food deliveries are being arranged by central government and suppliers.

What support is the government funding for the extremely vulnerable? Will it include funding and support for getting shopping and medication? What other services are being provided to support extremely vulnerable people?

Prescription deliveries, food deliveries, additional care (where needed) and mental health support (where needed) are being put in place.

What action is NHSE/I taking to ensure Clinical Commissioning Groups (CCGs) have established a dedicated home visiting service across a patch?

NHSE/I are establishing home visiting services commissioned by CCGs and local authorities. They are working with a range of partners to support the delivery of the COVID-19 hospital discharge requirements, which will include supporting community health, home care, and volunteer networks to work together to maximise the capacity of systems to provide community-based support.

What guidance is there for extremely vulnerable people who must receive treatment, for example for cancer?

You can still go to hospital or medical appointments, if absolutely essential. If you can access medical assistance remotely, then do that where possible. Talk to your GP or specialist to ensure you continue to receive the care you need and help determine further arrangements.

What advice is there for people without gardens on getting enough Vitamin D during these 12 weeks, especially for those at high risk of low bone density?

For those not in the ‘extremely vulnerable’ group, you can do one form of exercise a day, for example a run, walk, or cycle - alone or with members of your household. This would be a good opportunity to get some Vitamin D.

Those considered ‘extremely vulnerable’ should not leave the house. PHE is not planning specific advice on Vitamin D for these people, however those with a private garden should make use of this space, ensuring they keep a safe distance from others. For those without a private garden, vitamin supplements may prove effective. Anybody concerned about their condition should contact their GP for further advice.

What advice does the government have for people with spectrum conditions (conditions that effect some more than others with the same condition) who may not be sure what category they are in or what advice to follow?

Anyone required to shield for 12 weeks will receive a letter and a text message from NHSE alerting them that they are in this group. Everyone else should follow the latest government advice – do not leave your home apart from to exercise once a day (at a safe distance from others), to get essentials like food and medicine, and to go to work if you are a key worker.

Anybody still unsure about what situation their condition put them in should contact their GP and discuss what is best for them.

Social care workforce and safety

What are the government’s plans to ensure personal protective equipment (PPE) for primary and community care staff?

Millions more items of personal protective equipment (PPE) for frontline staff have been delivered to NHS services across the country in the last few days as part of the fight against coronavirus.

Hospitals, ambulance trusts, GP practices, pharmacists, care homes and hospices have all been receiving additional supplies over the past week, sourced by the Department of Health and Social Care and its suppliers, with the kit drops set to continue to match demand.

From this week the army will play its part by offering service personnel to help to manage and offload supplies in busy NHS settings, helping to distribute and deliver urgent contractor PPE supplies to the frontline during the coronavirus epidemic.

Hospital trusts and other healthcare organisations are being told that while the aim is to deliver supplies in usual working hours, given the volume and scale of the operation, they will also be receiving deliveries at evenings and weekends.

Nonetheless, the Prime Minister and Secretary of State are in constant discussions about levels of equipment and the resilience of the supply chain. The Health and Safety Executive (HSE) are also conducting a review which will inform the government’s guidance around how and when to use PPE. More guidance will be issued shortly.

Does the Government’s job retention scheme cover social care providers whose staff might be off unwell or self-isolating?

Yes, the Government’s job retention scheme will cover social care providers.

When will social care staff be tested as a priority?

We are increasing testing – yesterday we tested over 10,000 people and this will increase to 25,000 a day over the next month which will allow for more capacity to test staff and their families who have symptoms. At the moment, people in critical care, ITUs are rightly being prioritised for testing as we need to focus on saving lives, once more capacity is available staff will be tested. We will shortly be announcing collaboration with the private sector to fast-track the testing of staff.

Mental health

What guidance has been issued for mental health service providers following the advice that people using these services should contact their care coordinator to review their care plans?

NHSE will be issuing guidance for mental health professionals shortly on ‘Managing capacity and demand within inpatient and community mental health, learning disabilities and autism services for all ages’. The guidance will deal with managing capacity within inpatient and community mental health, patient and family/carer engagement and communication, workforce considerations, and legal guidance on applications of the Mental Health Act and COVID-19 Act.