Purpose and background

This guidance has been developed by the British Association of Social Workers (BASW) in consultation with practitioners, managers and sector leaders to help social workers and their employers manage the risks of home visits during the Covid-19  risk.

Organisations and sector leaders endorsing or supporting this guidance are listed at the end of the document and this will be updated.

Social workers have told us they need consistent guidance whilst undertaking home visits to adults, children and families during this time. This is generic guidance for all social workers across the UK.

Gerry Nosowska BASW Chair and Dr Ruth Allen, BASW CEO have issued an open letter to the Director General for Global and Public Health, Department of Health and Social Care to raise significant gaps in Public Health guidance for social workers during the Covid-19 crisis in relation to Personal Protective Equipment (PPE).  We will also be following up on our letter to PM regarding this urgent matter.

Note: This guidance is on-line and will be reviewed and updated. Please use the online version to ensure you have the most recent version. It will be reviewed at least monthly during the Covid-19 emergency.

The guidance aims to:

  • Help social workers keep themselves safe and well, and reduce risks of infection during home visits
  • Enable social workers to fulfil their duties during the crisis without undue risk
  • Minimise the risk of infection of others by social workers entering homes

The principles of this guidance may be helpful in planning and carrying out face to face activities in other settings (e.g. hospitals or care homes) during Covid-19, but it is written for home visits. BASW will be issuing other guidance for other social work settings and specialisms.

Minimise use of visits, use technology

The guidance is based on the principle that social workers and their organisations will minimise face to face home visits during the pandemic, based on risk assessments.

Organisations should require social workers to make home visits only:

  • When risk assessment deems it absolutely necessary to prevent significant harm and/or
  • To fulfil a statutory duty which cannot be fulfilled in any other way and/or
  • When risks of infection to staff and people visited have been mitigated in accordance with this guidance and national protocols

Organisations and practitioners should optimise use of digital technologies and telephone contacts wherever possible to maintain contact, assess and review. Guidance on digital capabilities, opportunities and ethics from BASW and SCIE can be found here https://www.basw.co.uk/resources/publications-policies-and-reports/digital-capabilities-social-workers

Home working good practice

As social workers are working much more from home during the Covid-19 pandemic, it is essential that managers, supervisors and social workers actively build and maintain team connections and dialogue using telephone and digital communications as needed. This is necessary to support social workers’ wellbeing and practice decisions, to manage risks and to prevent isolation.

Note: This guidance is on-line and will be reviewed and updated. Please use the on-line version to ensure you have the most recent version. It will be reviewed at least monthly during the Covid-19 emergency.

Other useful documents

All practice, ethics and policy advice is available on the BASW website coronavirus pages https://www.basw.co.uk/coronavirus-covid-19-basw-updates

The guidance is grounded in BASW’s ethical guidance for the pandemic as set out in our Covid-19 pandemic ethical guidance https://www.basw.co.uk/covid-19-pandemic-%E2%80%93-ethical-guidance-social-workers

Social workers in England should also be aware of the Department of Health and Social Care’s Ethical Guidance for Adult Social Care https://www.gov.uk/government/publications/covid-19-ethical-framework-for-adult-social-care/responding-to-covid-19-the-ethical-framework-for-adult-social-care

Health and Safety Advice from our partner trade union is here Social Workers Union health and safety advice during Covid-19 https://www.basw.co.uk/swu-health-and-safety-during-covid-19-position-statement

Using the guidance

This guidance provides a professional risk assessment framework to prepare for a face to face home visit during Covid-19. BASW, your professional body, recommends this approach based on best available evidence, latest public health guidance practice experience and expertise.

Please use the guidance to:

  • Guide and inform your practice
  • Request appropriate support and guidance from your employer
  • Raise professional concerns and questions about local practice or guidance with your employer, health and safety representative, trade union and BASW

This guidance does not:

  • Replace public health national (official) guidance
  • Replace regulatory or employer guidance
  • Cover social care workers who are providing hands-on personal care – they should use employer, regulator and gov.uk guidance
  • Cover social workers working in hospitals, care homes, schools or other settings including offices.
    • BASW will issue specific guidance for other work settings; check the website and BASW communications for updates.
  • Cover the risks associated with use of public transport – please follow public health guidance about using public transport
  • Advise on how to manage statutory duties – this is for statutory bodies to advise based on the law, however BASW is developing ethical guidance.

Understanding of health and safety throughout this pandemic is developing. Practitioners should continue to check and must follow public health guidance at https://www.gov.uk/coronavirus. This includes the latest information about self-isolating, shielding and what to do if you have symptoms.

Practitioners should also be aware of the latest information from the regulator and their employer.

Home visit practice guidance

The guidance is not exhaustive. It can be used to underpin specific advice and decision making by your organisation.

  1. Planning a visit

Identify if the purpose of the visit is essential at this time

  • Check with your local organisation what arrangements and guidance on prioritisation have been issued locally. 
  • Check if there is a legal /statutory requirement.
  • Check if the person (or their family / carer where appropriate) needs or wants the visit and explain the possible risks to the person of receiving a visit as appropriate.
  • Clarify what the outcomes and subsequent actions are likely to be and take these into account in your risk assessment and visit planning.

 

For multi-professional visits

Liaise with other agencies (potentially) involved in the visit (e.g. police or health colleagues).

If this visit will be multi-professional, use this guidance and the principles within it to plan:

  • a ‘team’ approach to the visit
  • who will do what and who will be in what proximity to the person/family
  • what Personal Protective Equipment (PPE) each might use (see section on PPE below) to ensure all members of the multi-professional group are protected throughout and know what each other are doing
  • ensure social work ethics and values of respect, appropriate communication and rapport with the household are upheld in multi-professional visits

 

Identify how the purpose of the visit could be achieved while maintaining recommended physical distance of 2 metres.

  • Identify whether the purpose of the visit could be achieved without going into the property.
  • Identify whether the purpose of the visit could be achieved by another practitioner who has to make an essential visit.
  • Consider the most appropriate person to undertake any visit that is essential.
  • Minimise physical proximity by asking what aspects of the visit could be achieved remotely.
  • Check with your local organisation arrangements and guidance

Contact the person that you are visiting (or their family member/carer if appropriate) to seek information about the environment, available space and their health status to help you manage the risk.

This will usually be by a telephone call, but other digital communications may be appropriate according to local protocols and the situation.

When you cannot contact/speak to the household before the visit

There will be occasions when you are required to make a visit and prior contact to gather information from the person or family is not possible (for a variety of reasons).

If that is the case, you (and other professionals involved) should treat the situation as a Covid-19 high risk situation (for practitioners and/or people visited) and take protective infection-prevention precautions as necessary according to Public Health advice.

 

When you contact the person/family before the visit:

  • Explain about coronavirus and why special precautions are needed at this time: to protect them, to protect visiting professionals and protect the community
    • Provide information in a form they can understand and check their understanding
    • Answer their questions and reassure as appropriate
    • Repeat the call another time if necessary to help their understanding
    • Involve family/carers as appropriate to assist and determine if questions can legitimately be answered by another on behalf of the person
  • Ask about their health status,
    • Do they or anyone in the household have confirmed Covid-19?
    • Do they or anyone in the household have any Covid-19 symptoms? (a dry persistent cough; raised temperature; sore throat; loss of smell and taste or other symptoms)
    • Are they or anyone in the household in a higher risk group/shielding (e.g. have cancer or an immune-suppressing condition)?
    • Are they or anyone else in the household in self isolation due to exposure to COVID-19?
  • Explain about social distancing and why it will be needed during the visit.
    • Seek their agreement to maintain distance and explain the benefits for them
    • Explore whether technology could be used instead of a visit to achieve its aims and reduce risk to the person and the social worker
  • Seek the person’s (or relevant carer’s/family member’s view) on how to minimise risk.
    • If there are known risks of infection or higher risks to health that indicate the person should not have visitors, seek advice from your line manager.
    • If the person or family is likely not to comply with social distancing, consider whether other colleagues should be involved, the use of PPE and whether the visit can be undertaken safely.
  • Ensure the person or their family/carer understands (as much as possible) the purpose of the visit and the plan for the visit.
  • Consider sending information to them in advance including in easy read or other formats if required.
    • Where a person may lack capacity (as defined in the Mental Capacity legislation depending on country), ensure that a person’s best interests and support needs are considered by those who are responsible or have relevant legal authority to decide on their behalf.
    • Provide an opportunity for the person to challenge the organisation’s decision if needed and possible.

At this point, weigh up again  the benefits and risk of doing/not doing a visit.

Seek advice and endorsement of your approach from your line manager as needed.

If the visit needs to go ahead, create a detailed risk plan including:

  • Identify and minimise who will be present in the room/household
  • Plan entry and use of space in the home – or remain at the doorstep - to maintain social distancing throughout
  • Identify and secure Personal Protective Equipment (PPE) if indicated: i.e. hand sanitiser, gloves, masks, protective clothing. See section on PPE below.
  • Plan how you will carry out the purpose of the visit whilst minimising the risks of infection.
  • The risks and safety of transport such as infection risks of public transport and sharing cars with colleagues or others. Travelling alone in cars is safest.
  • This list is not exhaustive, and all social workers must make personal judgements about risk and approach

Review the plan with your team manager or colleagues (e.g. on duty) to ensure it is practical and ethical, and that risks are reasonably managed. 

Personal, Protective Equipment (PPE)

At the time of writing, there is no specific Public Health guidance for the use of PPE by social workers. However, there is guidance of relevance to social worker home visits particularly in the most up to date table of recommended use of PPE for primary, outpatient and community care settings (published 02 04 2020), available here:

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/877599/T2_Recommended_PPE_for_primary_outpatient_and_community_care_by_setting_poster.pdf

Social workers undertaking home visits are advised to review this table to match to their situation.

It is likely that the section written for the setting of the Public Health guide ‘Individuals’ own home (current place of residence) – and foot notes 3 and 7 - will be particularly relevant (excluding ‘Home birth…).

In all circumstances, social workers should ensure they maintain social distancing (more than 2m away from any other person) throughout the visit and follow the latest Public Health guidance re recommended PPE for individual home settings.

Updates on guidance for health and care workers from Public Health are available here https://www.gov.uk/government/organisations/public-health-england

The lack/insufficiency of PPE for social workers at time of writing is being raised with government by BASW.

2.  Immediately before the visit

Identify the equipment you will need during the visit so that you can easily find this.

  • Subject to the guidance on PPE above, identify any protective equipment that is recommended by public health, for example use of soap, hand gel, gloves, gown, face mask and make sure that you have access to this.
  • Make sure you know how to use PPE to make it effective and avoid unintended risks
  • If you intend to use PPE that obstructs your face, explain why you are using it to the person/family before you arrive if possible, or upon arrival if necessary
  • Ensure that you have a way of disposing of any protective equipment after the visit in line with public health guidance.
  • Ensure that you have a way of washing your hands prior to and immediately after the visit, for example using hand sanitiser that is easy to access. Check public health guidance.
  • In the absence of necessary equipment to minimise the risk of infection, for example to ensure you can wash your hands, you should review the risk assessment about the balance of risk to yourself and the vulnerability of the person or persons you are planning to visit with your line manager. Seek advice from your line manager.

Ensure you follow your organisation’s lone working policy and have someone you can contact during a visit if you need advice.

  • You will also need the means to contact that person or persons such as a mobile phone.
  • Ensure that your line manager and team are aware of your whereabouts and contact arrangements if someone is late returning.

Review the plan with your line manager/ duty colleagues to ensure it is practical and ethical, and that risks are reasonably managed.

3.  During the visit

Before going into the home, check your information.

  • Confirm who is in the house and the health status of the person you are visiting and any other household members.
  • Speak to the person you are planning to visit to remind them to follow public health guidance to minimise risk.
  • Explain the risk mitigation approach you are taking and why, and explain it is to protect them and you

Follow public health guidance during the visit.

  • Ensure that you have a way of washing your hands prior to and immediately after the visit, for example using hand sanitiser that is easy to access.
  • If public health guidance does not state that you need to wear gloves, wash your hands before going into the home / place of visit for 20 seconds with soap in line with public health guidance or sanitise them.
  • During the visit, minimise the surfaces that you touch, do not put your personal items down on any surfaces, try not to touch your face, ask for the room to be ventilated (e.g. through an open window and door), keep 2 metres or more away from other people and follow any other public health guidance about minimising infection. Check public health guidance.

Keep the visit focused and as concise as possible. If you consider that the risks are not proportionate or being managed, explain why you need to end the visit and how you will plan to follow up.

4.  After the visit

Follow public health guidance immediately after the visit.

  • Sanitise any equipment that you have brought out of the home in line with public health guidance, for example by using disinfectant wipes including phones, laptops etc.
  • Dispose of any protective equipment in line with public health guidance.
  • Wash your hands in line with public health guidance before touching other items, for example using hand sanitiser.
  • Wash your hands before going into another building for 20 seconds with soap in line with public health guidance or sanitise them. Check public health guidance.
  • At the end of the day, remove and wash clothes that may have been exposed to the virus.

Inform your organisation of any concerns or risks that you have identified.

5.  Follow up to the visit

Report back to your colleagues,  or line manager about the visit.

  • Your organisation should ensure there is an option for an immediate debrief. Share any learning that can support practice and your organisation.

Record the visit.

  • Include any amendments to practice that were necessary due to the pandemic.
  • Record any information that is needed to support practice and your organisation.
  • Make sure you provide any relevant guidance for others who may be visiting or planning a face to face meeting at a future date.

Seek support for any professional or personal concerns.

 

Support for practice

BASW information and guidance around Covid-19 https://www.basw.co.uk/coronavirus-covid-19-basw-updates

You can direct questions or concerns to BASW by contacting us:

https://www.basw.co.uk/contact

BASW Survey for feedback on practice during Covid-19

https://www.basw.co.uk/media/news/2020/mar/social-work-during-coronavirus-covid-19-ongoing-survey

BASW virtual activities to provide peer support and learning can be found here https://www.basw.co.uk/events

Professional practice guidance for home visits during Covid-19 Pandemic

BASW

Published 03 April 2020