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Designated settings for COVID-19 patients leaving hospital

24 November 2020
  • Public

CQC is working with the Department of Health and Social Care (DHSC), local authorities and individual care providers to provide assurance of safe and high-quality care in designated settings, which are part of a scheme to allow people with a COVID-positive test result to be discharged safely from hospitals.

These settings are only admitting people who are discharged from hospital with a COVID-positive test. This is to help prevent the spread of COVID-19 (coronavirus) in care homes and will allow for a focus on the care that people who have contracted COVID-19 need. The Government’s aim is for each local authority to have access to at least one designated setting as soon as possible, CQC is working closely with the Department of Health and Social Care to ensure social care designated settings are appropriate.

In order to do this, we use our Infection Prevention Control (IPC) framework which is being used on all care home inspections.

We are inspecting care locations against eight areas and reporting with ‘eight ticks’ on infection prevention control which will give the public an overview including on whether:

  • Adequate PPE is available for staff and residents to control infection safely
  • Staff are properly trained to deal with outbreaks and the proper procedures are in place
  • Shielding and social distancing are being complied with
  • Layout of premises, use of space and hygiene practice promote safety.

Kate Terroni, Chief Inspector of Adult Social Care at CQC, said: "It is our role to ensure that proposed locations for the designated scheme, which is an initiative led by DHSC, are safe for people with a confirmed COVID-19 test result to be discharged into.

"Between October and the end of November we will have completed well over 500 infection prevention and control inspections (545 will be complete), including approved designate locations and measured against 'eight ticks' which are published on our website. We will continue to work with the Department of Health and Social Care, local authorities and care providers to ensure that all locations participating in the scheme are able to provide the high-quality care that people leaving hospital will need."

The Department of Health and Social Care have asked local authorities to speak to local care providers and find suitable designated locations where people that have tested positive for COVID-19 may be safely discharged to. Once these locations have been identified, they contact CQC and we go out and assess the location with an IPC inspection and a specific focus on a service’s ability to zone COVID-19 positive residents with a dedicated workforce and high levels of ventilation.

The results of that inspection will be published on our website through an inspection report, where the public can see how the care provider has performed against our 'eight ticks'. This means we are able to provide assurances on infection prevention control, whether people being cared for are in a designation area or in an existing location.

CQC's infection prevention control (IPC) inspections include three different kinds of inspection as outlined below. The total number of services that will have had an IPC inspection by the end of November is 545.

These include:

  • Inspections of proposed designated facilities
  • Inspections to look at and learn from good IPC practice
  • Inspections in response to risk and information of concern.

This is in addition to our risk-based inspections which are continuing alongside our IPC and designated settings inspection work. So far, we have conducted 1,442 risk-based inspections of Adult Social Care providers since April 2020, as of 17 November.

Designation scheme

As of 18 November, there are 83 CQC-assured designated settings within 74 local authorities. There are a further 27 “alternative settings”, where local authorities have agreed with local NHS partners to make use of NHS settings to fulfil the role of a designated setting. This totals 110 designated settings. The data section provides more detail on the figures. Please note that some local authorities will sharing a designated setting, that is located within another local authority.

Where a setting did not pass the CQC assurance process following inspection, the key reasons are:

  • Location unsuitable – e.g. not enough separation between designated bit of service and the rest of the care home
  • Location not ready - e.g. significant building work planned and impossible to assess until this is complete
  • Staffing - no designated staff team to work exclusively in the designated setting.

We will continue to provide a weekly update on these figures on this website. You can also find more information about Designated Settings on GOV.UK.

Key data

Some local authorities have chosen not to participate in the scheme and in some areas, they have agreed with local NHS partners to make use of NHS settings to fulfil the role of a designated setting. In this instance, it will not be necessary for that NHS setting to be inspected by CQC specifically for the purpose of this arrangement.

The data below highlights what we have laid out above, that there are three main reasons for different areas having varying rates of designated settings approvals: the location being unsuitable, the location not being ready and staffing issues. We’re in discussion with the Department of Health and Social Care, and system partners to address issues of capacity across country, particularly in areas where there is a shortage or lack of designated settings.

Please note that a large number of requests were made in the last few days from the South East region and we are now working through these with local authorities to establish which are suitable locations.

Read the glossary of terms used in these tables
  • Approved setting – a designated setting that has been CQC-assured. (likely a care home)
  • Alternative Arrangement – a designated setting that is linked to an alternative settings such as a community hospital
  • Response Outstanding – Local Authority has submitted and CQC are reviewing the location and where necessary scheduling an inspection
  • Unsuitable – CQC has judged the location to be unsuitable based on the initial application received
  • Withdrawn – the provider of service has withdrawn the location
  • Pending Ext. Info – CQC has requested further information from the Local Authority or the provider
  • Pending Judgement – CQC has inspected and is reviewing information to decide if the location can be assured
  • Not Assured – CQC has inspected and have judged the location to be unsuitable
  • Proposed settings – All applications from CQC plus alternative arrangements NHS settings.
Table 1: Designated setting applications by region
Region Proposed LAs with a designated setting Proposed settings Total proposed beds LAs with an approved setting Approved settings Approved beds Alternative arrangement beds
East Midlands 8 / 9 29 167 7 / 9 11 138 0
East of England 8 / 11 16 187 6 / 11 8 106 0
London 20 / 33 32 384 15 / 33 5 60 311
North East 11 / 12 22 138 7 / 12 8 120 0
North West 18 / 23 39 289 14 / 23 16 183 59
South East 11 / 19 110 1,653 7 / 19 9 141 10
South West 7 / 15 33 121 3 / 15 1 0 77
West Midlands 12 / 14 33 363 5 / 14 5 73 270
Yorkshire and The Humber 14 / 15 41 355 10 / 15 20 202 12
Total 109 / 151 355 3,657 74 / 151 83 1,023 739
Table 2: Approval status of applications by region
Region 1. Response outstanding 2. Unsuitable 3. Alternative arrangements 4. Withdrawn 5. Pending external info 7. Not assured 8. Approved Total
East Midlands 7 9 0 0 0 2 11 29
East of England 1 5 0 0 0 2 8 16
London 1 13 11 0 0 2 5 32
North East 3 8 0 0 0 3 8 22
North West 5 14 3 0 0 1 16 39
South East 85 9 3 1 1 2 9 110
South West 5 23 4 0 0 0 1 33
West Midlands 0 20 5 1 0 2 5 33
Yorkshire and The Humber 10 7 1 0 0 3 20 41
Total 117 108 27 2 1 17 83 355
Last updated:
24 November 2020