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RISK ASSESSMENT FOR VULNERABLE GROUPS AND CLINCALLY EXTREMLY VULNERABLE Including potential work-related exposure to COVID-19 (including those staff who may be living with/caring for vulnerable/shielding family/friend)

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Clinically Extremely Vulnerable staff (CEV) If you do not meet the criteria for CEV, please move to section 2.

Under the new lockdown rules outlined by the government that are due to start on Thursday 5 November 2020 we have been asked to ensure that all clinically extremely vulnerable (CEV) staff are enabled to work from home.

It is important to note that CEV staff differ from those who were asked to shield in the last lockdown. If you were previously shielding and do not fall into any of the CEV categories then you should attend work as normal but take additional care to maintain good infection control and social distancing measures. If you remain concerned please speak to your line manager and complete a new risk assessment.

The list of conditions which would determine if you are CEV are as follows:  solid organ transplant recipients  people with specific cancers: o people with cancer who are undergoing active chemotherapy o people with lung cancer who are undergoing radical radiotherapy o people with cancers of the blood or bone marrow such as leukemia, lymphoma or myeloma who are at any stage of treatment o people having immunotherapy or other continuing antibody treatments for cancer o people having other targeted cancer treatments that can affect the immune system, such as protein kinase inhibitors or PARP inhibitors o 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 chronic obstructive pulmonary disease (COPD)  people with rare diseases that significantly increase the risk of infections (such as severe combined immunodeficiency (SCID), homozygous sickle cell disease)  people on immunosuppression therapies sufficient to significantly increase risk of infection  women who are pregnant with significant heart disease, congenital or acquired  adults with Down’s Syndrome.  adults on dialysis or with chronic kidney disease (stage 5)  other people who have also been classed as clinically extremely vulnerable, based on clinical judgement and an assessment of their needs. GPs

and hospital clinicians have been provided with guidance to support these decisions 1. If you meet any of these clinically extremely vulnerable criteria, please can you notify your line manager today (Wednesday 4 November) 2. If you are clinically extremely vulnerable do NOT attend work from Thursday 5 November 2020 3. Notify the SHaW team on 01279 8207015 Provide your name and contact details, the name of your line manager and details of your condition that you as CEV. Your contact details with shared with your HRBP in order that they contact you and provide support.

4. A member of the absence hub will get in touch with you to confirm your status as CEV. They will identify whether you can return to work or carry out your role from home 5. If your role cannot be carried out from home or other reasonable duties identified, then normal COVID absence terms and conditions will apply.

Managers: If there are any concerns that a service may need to be stood down as a result of the absence of CEV staff please can you escalate with the appropriate director.

It is important to note that at this time we are awaiting additional guidance and will update you as soon as this is available so this approach is subject to change.

We recognise that this is a challenging time for all and would like to remind you that there is a wealth of wellbeing advice to support you which can be accessed via Alex

 Risk Assessment (section 2) Please complete the risk assessment in conjunction with the risk assessment process This risk assessment will assist you to:  Support all colleagues with an underlying health condition  Ensure pregnant staff are managed appropriately  Ensure all colleagues have access to the required and nationally advised personal protective equipment (PPE)  Advise colleagues from a BAME background to seek further advice from their GP surgery regarding Vitamin D levels  Support colleagues to take regular breaks and the importance of doffing PPE when having a break  Support colleagues to be informed and feel safe  Identify if additional support from SHAW is required for those with underlying health conditions or who are anxious Completing the risk assessment:

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This risk assessment must be completed for all staff in the vulnerable groups listed above and can also be used for those living with/caring for people in these groups Please complete the self-assessment in part one of the risk assessment form.

Share the assessment and review with your line manager, with support from SHaW or your HR business partner if necessary. Further support from a clinician will be available from SHaW if required.

Line managers/assessors do not need to know what the underlying health condition is to complete the assessment, just that staff have one.

This assessment will be undertaken by a clinician, with support from SHAW or your HR business partner if necessary.

The risk matrix below will support you to identify if the area of work is low, moderate or high.

There are suggestions below regarding actions in order to minimise any risk identified.

Retain the risk assessment and review if needed (i.e. for pregnant ladies less than 28 weeks’ gestation).

Key considerations: 1. Limit duration of close contact with patients (e.g. prepare everything in advance away from patient).

2. If possible maintain >2m distance from the patient/other staff.

3. Staff member has access to the required and nationally advised PPE. 4. Staff are able to take regular breaks and get out of PPE. 5. Is a move to a non-patient role possible?

6. Remote/homeworking if staff member is enabled including access to equipment/WiFi. 7. Working in areas of poor or unsatisfactory ventilation, i.e. confined areas for long periods of time.

8. Consider whether public transport/rush hour can be avoided through adjustments to work hours.

9. Is further guidance required from SHAW? 10. Consider temporary relocation of staff member using hotel accommodation provided – see intranet for further details.

High Risk Aerosol Generating Procedures (AGPs): Coronavirus is infectious through droplets and when aerosol generating procedures are being undertaken.

- Check the AGP agreed list.

- For dentistry and post mortem - specific advice is available for managers.

- Aerosolisation of blood and bone e.g. surgical drilling is considered as an AGP. - Nebulisers are not AGPs. - The 2m safe distance does not apply when performing AGP on respiratory system and anyone in the room can be exposed.

- Further information may be available in accordance with local Trust communication systems.

- Airway management in an emergency resuscitation event is classed as an AGP.

Vulnerable group staff working in the following areas of work

High likelihood of COVID-19 encounters

Low likelihood of COVID-19 encounters

Areas of work that do not have any patient contact with coronavirus e.g. non-clinical areas.

LOW RISK There is no need to restrict the member of staff.

However, you should still give consideration to the above key considerations as best practice.

As PAH is not a COVID minimised site there is a limited risk of coronavirus exposure with any direct face-to-face patient contact (within two metres).

Therefore, direct patient facing roles should be assessed as moderate risk.

Area where patients with coronavirus are expected to be assessed or admitted e.g. designated wards, respiratory area of ED.

Aerosol Generating Procedures on patients that are suspected/confirmed COVID-19, noting current Public Health England (PHE) guidance to treat all patients as suspected.

MODERATE RISK

HIGH RISK

You may need to restrict the member of staff.

Give consideration to the key considerations above.

Consider redeployment to a lower risk area if possible.

You may need to ask for further advice and guidance from SHAW. Your member of staff may like to speak with a member of the SHAW team.

Staff identified as high risk: -

The staff member should not perform the AGP. They should leave the area where AGP is performed until 20 minutes after the AGP is finished.

If not possible to leave, they should wear a FFP3 mask (or equivalent) whilst AGP is happening and 20 minutes after the AGP is finished.

If the above is not possible, staff member should be temporarily redeployed to a lower risk area.

STAFF MEMBER LIVING WITH/CARING FOR MEMBER OF HOUSEHOLD WHO IS IN THE VULNERABLE GROUP It is recognised that the majority of clinical staff may not be able to work from home. Consideration should be given to accessing hotel accommodation made available for NHS staff in order that staff can relocate temporarily to keep those in their household who are SHIELDING safe – see intranet for up to date details.

If administration and support staff can easily work from home, and this is operationally viable, consideration should be given to whether this can be supported in order to ensure vulnerable/shielding family/friends are not being put at unnecessary risk.

PART 1 RISK ASSESSMENT (to be completed by the individual) Staff Member Name & Signature:

Date of assessment

Staff member’s role:

Assessor & Signature:

Date of subsequent review (if applicable)

Place of work:

Outcome of Assessment agreed : _______________________________________________________________________ VULNERABLE GROUP – tick those that apply Over 70

Risk assessment outcome (to be agreed between the individual and the manager/ assessor) LOW RISK

Underlying Health Condition

MODERATE RISK

Pregnancy HIGH RISK

BAME

This section applies where PPE is recommended- tick those that apply Staff member is trained to use appropriate PPE. Staff member is confident and competent in using appropriate PPE. Staff member is fit tested if required.

Appropriate PPE is available at all times

Where PPE is applicable but not all boxes are ticked the staff member should move to low risk, non-patient facing or work from home role.

PART 2 AGREED ACTION PLAN (to be agreed between the individual and manager/assessor) Tick those that have been agreed (please note that they may not ALL apply) If the at-risk employee feels at risk at any time, they can raise with their line manager, SHAW or another senior member of staff

1. Limit duration of close contact with patient (e.g. prepare everything in advance away from patient, avoid touching etc in line with Infection Protection Control guidance) 2. If possible maintain >2m distance from the patient/colleagues working in the same unit. If not possible consider what PPE is appropriate.

3. Staff member will take agreed breaks 4. Adjustment to work hours so that public transport/rush hour can be avoided.

5. Appropriate PPE is fit-tested/fit-checked in line with infection control guidelines. All staff conducting regular AGP activities should be fit tested 6. Appropriate PPE will be provided for staff member for all interactions with patients or specimens. Staff member advised that if agreed appropriate PPE is NOT available they are NOT to proceed and should contact Ward Manager or On-Call Manager before attending to duties.

7. The staff member will wear FFP3 mask (or equivalent e.g. respirator hood ) in the area where AGP is undertaken on all patients regardless of case status during this current period of sustained transmission and should continue to be worn for the duration that the staff member is in the side room after the AGP has finished.

8. In areas where air changes are less than six air changes per hour (this is any side room or bay excluding Theatres, ADSU, ITU/HDU, RED ED, Endoscopy – for these area, staff should speak to their manager to determine aerosol clearance times). The room should be left for 60 minutes after the AGP has finished (this includes staff going in to clean a room after a room has been vacated by the patient).

9. Redeployment to lower risk area.

10. Remote working if the staff member is enabled (staff member does have access to equipment and Wi-Fi or access has been requested from IT).

11. Refer staff member to SHAW for further conversation if underlying health condition, or if particularly anxious.

12. Others, please specify.

SHAW Support

If you need advice from our SHAW team, please email paht.shawcovid19@nhs.net with COVID-RISK ASSESSMENT in the subject heading, attaching this completed risk assessment, ticking box 11 above. Please make sure you provide an up to date contact number for the individual here: TELEPHONE NUMBER FOR CONTACT: Ext