Key actions: winter workforce preparedness
Last updated: December 2021
As winter approaches, line managers play a crucial role across the NHS in supporting and engaging with our NHS people and helping each other to prepare for the ongoing challenges of COVID-19, alongside seasonal influenza, and other prevalent infections.
We are all facing these challenges against a background of continued increased demand, and in that context staff safety, health and wellbeing are of paramount importance. We know that we need to look after our people in order for them to be able to look after our patients and service users.
This page provides practical guidance on the holistic approach we are taking to ensure our workforce is well supported and our services are as resilient as possible. This guidance should be adapted and locally adopted with board level oversight to complement local support for our NHS people. Line managers have a crucial role to play in creating a safe environment and a culture of care within the teams they lead, which includes following the guidance and evidence as to what works which highlighted in this resource.
As part of a continuous improvement process, providers are encouraged to track and monitor their staff’s experience of support, including staff that may not benefit from traditional information cascades such as contracted and agency staff. The national Pulse survey, which is run monthly and now used by most NHS trusts, is one way to do that.
To support winter workforce preparedness line managers should consider the following:
1) Staff are supported:
- Ensure that every member of your team has a one-to-one health and wellbeing conversation (recognising these may not all be with the line manager) and ensure that staff know how to access wellbeing resources. Also, managers are encouraged to create an atmosphere of openness and transparency to ensure that staff feel able to raise concerns safely. For new joiners and international recruits ensure a comprehensive induction and support.
- For anyone struggling with their mental health, consider forming wellness action plans for them and signposting staff who need it to the mental health and wellbeing hubs.
- Encourage staff to take their annual leave and ensure it is planned regularly and usefully for all staff and there every effort is made to minimise cancellation of leave due to departmental pressures.
- Be aware of the potential signs of stress, exhaustion and burnout, and what adjustments you may be able to make to support staff and prevent burn out. These include managing shift patterns and breaks, and signposting to occupational health services and other sources of support, such as mental health and wellbeing hubs.
- Be aware of the potential impact of the menopause and perimenopause for any colleagues who may be affected and use resource such as the Chartered Institute of Personnel Development (CIPD) guide to menopause and wellbeing as appropriate. This may include access to additional toilet breaks, cold drinks, or outdoor space for those wearing full personal protective equipment (PPE). Capture any related sickness absence as ‘menopause’ on the Electronic Staff Record (ESR).
- For some people coronavirus (COVID-19) can cause symptoms that last weeks or months after the infection has gone. The term ‘Long COVID’ includes both ongoing symptomatic COVID-19 (5-12 weeks after onset) and Post-COVID-19 Syndrome (symptoms continuing 12 weeks or more after onset).
- For staff members affected by Long COVID, have a supportive conversation about their concerns and consider the impact of Long COVID on staff health, wellbeing, and resilience. Support the use of occupational health review and/or access to Long COVID services if appropriate and ensure a strategy is in place for managing symptoms in staff returning to work while recovering from Long COVID. Signpost to support resources and plan a phased return if appropriate.
2) Ensure staff are vaccinated:
- Continue to ensure an accurate record of staff vaccination for COVID-19 and reinforce the importance of a second dose if not already given (allowing for an eight-week minimum timeframe). If there are exemptions to vaccination (eg anaphylaxis), consider implication for risk assessment and/or occupational health review in order to best protect staff wellbeing.
- The government consultation outcome announced on 9 November 2021 that individuals undertaking Care Quality Commission-regulated activities in England must be fully vaccinated against COVID-19 to protect patients no later than 1 April 2022, regardless of their employer, including secondary and primary care unless they are exempt. The government regulations are expected to come into effect from 1 April 2022, subject to parliamentary process. This means that unvaccinated individuals will need to have had their first dose by 3 February 2022, to have received their second dose by the 1 April 2022 deadline.
- To note a letter has gone out to the service from the Chief Executive, Chief Professional Officers and Medical Director for Primary Care on 10 November to acknowledge the government announcement and reinforce the importance of increasing vaccine uptake in the lead up to implementation and highlighting resources available for support.
- Support timely flu vaccination, by minimising barriers to access and enabling staff to make an informed choice through 1-2-1 conversations.
- As of September 2021 staff have been able to access booster doses of COVID-19 vaccine, six months after their primary course. We recommend prioritising staff who are in high risk workplaces or who have high personal risk for access to vaccination doses. Please see the guidance from the Joint Committee on Vaccination and Immunisation (JCVI) which prioritises healthcare workers and the clinically vulnerable group. Immunosuppressed staff may be able to access a third dose as part of their primary course, this can be given eight weeks after their second dose.
3) Ensure staff are risk assessed:
- All staff should have a current risk assessment. Consider referring to the occupational health service if further expertise is required (eg a complex medical history).
- For staff who are identified as at greater risk, consider whether there could be any adjustments to usual working arrangements after consideration of the individual’s circumstances, any specific concerns they have, workplace risk and local prevalence.
4) Ensure staff wear appropriate PPE:
- All staff should be up to date with local PPE policy and training including what PPE to wear in each environment, standard infection control, transmission-based precautions as well as donning and doffing procedures. Staff required to wear filtering face piece (FFP) reusable respirators undergo training that is compliant with the UK Health Security Agency (UKHSA) national guidance and a record of this training is maintained and held centrally.
- Where applicable, staff should be fit tested for locally available FFP3 masks and able to undertake fit checking. Fit testing should be repeated at least every two years. To increase resilience, aim to fit test all staff to two-to-three masks. If local supply changes, alert staff and arrange further fit testing.
- Ensure availability of alternatives to FFP3 respirators, eg hoods or reusable respirators, for those staff who fail a fit test or who are unable to be fit tested/wear tight fitting FFP3 masks.
- If reusable devices are used as part of respiratory protective equipment (RPE), ensure there is a process for ordering consumables such as filters, and a validated process for the decontamination of the various component parts.
- Ensure workplace risk assessments are carried out and are based on the measures as prioritised in the hierarchy of controls and infection, prevention and control (IPC) guidance.
- When an unacceptable risk of transmission remains following the risk assessment, consideration should be given to the extended use of RPE for patient care in specific situations.
5) Ensure staff are tested:
- Ensure that staff follow all applicable local and national testing policy and guidance, including to undertake a PCR test if symptomatic, and to participate in the NHS asymptomatic testing programme.
- Staff who have tested positive for SARS-CoV-2 by PCR in the community or at work should self-isolate for at least ten days after illness onset. The isolation period includes the day their symptoms started (or the day their test was taken if they do not have symptoms) and the next ten full days. We acknowledge that some members of staff may struggle with their mental wellbeing during isolation and encourage managers to stay in touch with their staff, and signpost them to the health and wellbeing offers outlined in section 1B.
- Staff who are contacts of COVID-19 positive cases should follow current isolation guidance according to their vaccination status. Household contacts must continue to isolate unless a local risk assessment has been undertaken which deems them vital for service provision. Ensure that a robust mechanism is in place for staff to notify their employer of a positive result in a timely manner, to enable prompt cover of shifts as required.
- Consideration should be given to whether staff who are isolating due to being contacts of a positive case can make adjustments to their role to continue to be able to work remotely if they are willing and able to do so.
- If staff have been notified that they are a contact of a confirmed case in a health and care setting, follow UKHSA published guidance.
- Provide staff with accessible information regarding the local process for routine asymptomatic testing and proactive communications to encourage staff uptake of regular testing in accordance with policy at the time. Employers should put in place monitoring processes to ensure all staff are complying with testing requirements.
- Ensure that staff fulfil statutory responsibilities to record the results of all LFD tests undertaken on themselves or patients / relatives, according to local policy.