Quarantine arrangements for exempt nurses arriving from overseas

Contents

1. Red list update, Friday 26 November 2021
2. Travel groups
3. Eligibility
4. Before arrival
5. Transport
6. Accommodation requirements
7. Nurse quarantine requirements
8. Additional services
9. Testing
10. Welcome, wellbeing support and vaccination
11. Hospital and contract staff adherence to COVID-19 guidelines
12. Fire evacuation assistance

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This guidance set out the standards required for NHS trusts to provide managed quarantine accommodation ('hospital managed quarantine') for internationally recruited nurses who are taking up immediate employment in the NHS in England, and who are from or travelling through red-list countries. The exemption does not cover nurses already employed by the NHS or nurses returning from abroad for any other reason (for example, holiday or visiting family).

These nurses are exempt from red-list hotel managed quarantine (also known as 'managed quarantine service' or MQS) if compliant NHS trust-arranged accommodation can be used for the duration of their quarantine period (you'll find details on the length of quarantine related to testing in the 'Testing' section of this document).

Trusts may choose not to use the exemption and to fund MQS as an alternative. If a trust cannot provide compliant accommodation, MQS must be used. We encourage trusts to work on a regional basis to provide compliant trust-arranged accommodation where possible.

NHS trusts are responsible for the safe and effective quarantine of all nurses in hospital managed quarantine and must ensure adherence to these guidelines.

Assessment that accommodation adheres to these standards needs to be signed off by the trust's Infection Prevention and Control (IPC) lead and Director of Nursing. Ongoing compliance must be reviewed on a monthly basis. If changes to the provision of accommodation or standards required means accommodation becomes non-compliant, the trust must not accept further nurses for hospital managed quarantine until compliance is achieved.

Travel groups

When nurses are recruited as a cohort and travel together from and/or through red-listed countries, they may be considered a 'travel group'. This means they will be able to quarantine together and share facilities. Regardless of cohort sizes for flights, on arrival in the UK, travel group numbers should be minimised and be no larger than 6 individuals, as smaller group sizes reduce the risk of many nurses being delayed from starting work should a member of the travel group test positive for COVID-19. All recommended control measures (including maintaining social distancing, wearing face coverings and handwashing) will be required within a travel group throughout quarantine.

Eligibility

The legal exemption from hotel MQS is set out in regulations.

It only covers nurses coming from or travelling through red-list countries to take up immediate NHS employment in England.

Eligibility does not extend to family or dependents. If nurses are bringing children or family, the family unit as a whole will need to quarantine in an approved hotel (MQS).

The red list of countries is regularly updated - check the GOV.UK website regularly to make sure you know which countries are affected.

Guidance

As well as following the guidance in this document, nurses will need to comply with all other guidance on managing the COVID-19 risk. Government guidance is subject to change - always refer to the latest guidance on GOV.UK.

Relevant guidance includes, but is not limited to:

Coronavirus (COVID-19) testing before you travel to England

Fill in your passenger locator form

Entering the UK

(COVID-19) Coronavirus restrictions: what you can and cannot do (post-quarantine)

Before arrival

Before departure the trust will need to provide the nurse with a letter setting out their eligibility for the exemption, for the benefit of Border Force officials on arrival. This letter should include the following details:

• full name
• date of birth
• name of employing trust and trust contact number
• passport number
• Certificate of Sponsorship number
• date of arrival
• arrival airport

A template letter will be sent to trusts to ensure the information is complete and in the same format. Border Force will ensure that the details on the letter match the passport, visa and Certificate of Sponsorship that the nurses will show on arrival.

It is vital that all details are accurate to ensure the nurse has no problems entering the country. Border Force may contact Trust International Recruitment leads directly to confirm planned employment and check details to mitigate fraudulent use of this exemption. Please ensure up-to-date contact details are provided, including out of hours contact details if possible.

Transport

Nurses must be able to travel from the airport to hospital managed quarantine accommodation in COVID-19 secure private (including trust-owned) transport. Coaches or minibuses are to be used as preference to ensure easier social distancing from the driver and, where relevant, other travel groups. Private cars or taxis can be used on an exceptional basis.

Trusts may want to work together on a regional basis to plan transport for travel groups (nurses that are recruited as a cohort and travel together - no greater than 6 per group). More than one travel group may travel on the same coach as long as done so in adherence with guidance outlined below.

Nurses must go straight to meet the trust representative/driver on arrival at the airport. They must not use facilities once through immigration control.

Details of the standards required for secure travel can be found in Coronavirus (COVID-19): taxis and PHVs.

Main points are:

• all travellers and drivers should wear face coverings, regularly clean their hands before and after every contact and maintain social distancing where possible at all times
• ensure good ventilation within the vehicle through open windows and no recirculated air in the vehicle
• ensure a three-row barrier between the driver and all separate travel groups in the same vehicle
• ensure on-board toilet facilities are available for longer journeys
• ensure that transport does not stop at any services (including at the request of passenger), unless in an emergency such as fire. Drivers must ensure adequate fuel in advance of pick-up. Where the journey is more than 4.5 hours long, the driver must take the legally required break, but nurses must remain in the vehicle
• ensure cleaning of the vehicle after use and drop-off

Internal flights must not be used by nurses coming from or travelling through red-list countries

Accommodation requirements

Hospital-managed accommodation for quarantining nurses must be private or trust-provided accommodation and the building must be used exclusively for quarantining. Commercial hotels must not be used.

The accommodation must provide individual en-suite bathroom facilities and individual food facilities for nurses quarantining alone. Where accommodation has communal areas (bathrooms, kitchens) and provisions for travel groups (groups of no more than 6 nurses that are recruited as a cohort and travel together), the communal areas (bathrooms, kitchens) must only be used by one self-contained travel group.

Trusts may want to work together on a regional basis for quarantining travel groups of nurses arriving together to maximise use of the accommodation available.

Wherever possible, accommodation buildings should house only nurses quarantining from red-list countries or nurses quarantining from non-red-list countries. If this is not possible, clearly defined floors/areas of buildings should be identified for red-list and non-red-list quarantine.

One-way systems should be put in place to ensure appropriate separation and social distancing while entering and leaving quarantine accommodation.

All quarantining accommodation must have individual ventilation systems (for example, room or window fan coil units that do not recirculate to other parts of the building) or windows that open (safely).

Nurses who have completed quarantine must be in separate accommodation from quarantining nurses.

Nurses in quarantine must have:

• access to suitable food and drink (taking into account personal, religious or social dietary requirements) either provided by the trust or using facilities provided to access this (for example, refrigerators, kettles, microwaves, hobs, ovens, cutlery and crockery)
• an on-call provision from the trust to check on the nurses each day (this may be informal, for example via WhatAapp or regular phone calls)
• a contact number and access to a telephone for a point of contact at the trust for the duration of the quarantine

Nurse quarantine requirements

From testing on day 2 (when the nurse takes their pre-flight test) to the end of the quarantine period, nurses must follow all control measures in place to minimise the risk of spreading COVID-19.

Nurses quarantining in hospital-managed accommodation must:

• travel directly to their place of quarantine and not leave until 10 days have passed (the day of arrival is counted as day 0 - the day after arrival is day 1)
• isolate or stay with their self-contained travel group
• comply with day-2 and day-8 testing (read more about testing requirements)

Nurses quarantining in hospital accommodation must not:

• have visitors
• leave the premises
• use any communal facilities that have not been allocated to their self-contained travel group
• go outside (unless an outside area has been set aside for use of one self-contained travel group)

Trusts will want to make sure nurses are aware of their personal responsibility to quarantine effectively and to follow control measures following pre-flight testing. Full guidance is provided in How to quarantine when you arrive in England.

Failure to follow these responsibilities may result in disciplinary action for the nurse concerned.

Additional services

Trusts should refer to the full guidance on cleaning, laundry and waste services: COVID-19: cleaning in non-healthcare settings outside the home.

Cleaning

Rooms and communal areas must not be cleaned by trust or contracted staff when occupied. Nurses will be responsible for cleaning their own rooms and communal areas. Trusts must provide:

• suitable cleaning products and cleaning equipment
• basic toiletries (such as hand soap, shampoo, shower gels, hand towels, alcohol gel)
• tissues and wastepaper bin
• regular provision of clean bedding and towels

Laundry

If laundry services are not provided for in quarantine accommodation, the trust will need to provide a laundry service for collection and return to the accommodation, ensuring that:

• hospital staff and contractors wear appropriate PPE (face coverings, aprons, gloves, eye protection) when handling laundry
• individuals put their sheets in a linen bag and leave it outside the room door
• linen bags are collected, and fresh linen left outside the room (care should be taken to handle linen in line with COVID-19 guidelines)

Note that laundry collected during a nurse's stay should be:

• treated as infectious and double bagged
• tagged with the care area and date
• stored in a designated, safe lockable area while awaiting collection or laundering
• laundered in line with local policy for infectious linen - hot wash at 60˚C

Waste collection

General waste should be double bagged and disposed of with normal rubbish.

Waste from a self-contained travel group that is suspected of having, or confirmed to have, COVID-19 should be put in a plastic rubbish bag, double bagged and tied. This should be securely stored for 72 hours and then disposed of with normal rubbish.

Any waste from clinical consumables should be treated as clinical waste.

Waste should be disposed of in accordance with regulations via appropriate services with full compliance of safe COVID-19 best practice protocols.

Testing

Nurses must take a coronavirus (COVID-19) test and get a negative result during the 3 days before travel to the UK (read Coronavirus (COVID-19) testing before you travel to England for more details).

Nurses quarantining in hospital accommodation must take COVID-19 PCR tests on day 2 and day 8. These are the tests ordered at the time of booking travel and are not to be provided by the trust. For more information, read Providers of day 2 and day 8 coronavirus testing for international arrivals.

Nurses must take a COVID-19 test on or before day 2 of the quarantine period. The day of arrival in England is to be treated as day 0 (the day after arrival is day 1). This first test is designed to help identify any potentially harmful variants of COVID-19 at the earliest opportunity.

If a nurse gets a positive result from the day-2 test, they:

• must quarantine for 10 days beginning the day after the test is taken and for the next 10 days after the test was taken (this means until day 13) - their self-contained travel group will also need to quarantine until day 13
• should not take a test on day 8

Nurses must take a COVID-19 test on or after day 8, unless they got a positive result from their day-2 test.

A positive test result from the day-8 test will mean the nurse needs to quarantine until day 19. The self-contained travel group will also need to quarantine until day 19 or even longer if anyone in that bubble tests positive during that time.

Anyone who becomes symptomatic should be able to access a PCR test for diagnostic purposes and needs to be enabled by the trust for them to access NHS Test and Trace.

Once a nurse has quarantined for 10 full days (where day 0 is the day of arrival) and received a negative result to both day-2 and day-8 tests, and are well, they may leave quarantine.

Test to release is not allowed.

Nurses must not leave quarantine to post their tests. Trusts will need to make arrangements to safely provide, pick up and process these tests from the quarantine accommodation.

If a nurse in quarantine receives a positive test result and/or develops coronavirus symptoms, they and any other nurses in the same self-contained travel group should follow PHE guidance for households with possible or confirmed coronavirus (COVID-19) infection.

If a travel group is quarantining for additional days as a result of one (or more) nurse testing positive, any other nurses who become symptomatic should be tested. Any member of the travel group who has not tested positive needs to quarantine for an additional 10 days.

Please ask them to notify the named trust contact so that additional support and advice can be provided.

Following quarantine, internationally recruited nurses will be eligible for twice weekly lateral flow testing along with the rest of the workforce.

Welcome, wellbeing support and vaccination

Welcome pack

A welcome pack to provide information and practical support to nurses during their quarantine should be supplied on arrival. The welcome pack should:

• give an overview of the requirements of the quarantine process
• explain what communal spaces are available for their self-contained travel group
• emphasise the importance of COVID risk assurance with the newly recruited nurses (more information is available at NHS Employers - Risk assessment for staff)
• explain what medical and welfare support is available and how to access this (for more details, see Managed quarantine: what to expect)
• explain what food and refreshments are available, including the delivery process (for example ordering, tray removal and time schedules) and any limitations and restrictions on these processes
• include the usual support package provided to internationally recruited nurses
• provide IT equipment if required to do online learning/induction while quarantining

Wellbeing support

Trusts will need to provide appropriate wellbeing support to the newly arrived nurses. This will include but not be limited to:

• contacts for diaspora support groups
• telephone numbers of local faith groups, the Samaritans and local prescription services
• a trust-based contact for urgent problems and concerns, as well as regular arranged contact, particularly if a nurse develops symptoms and/or tests positive to COVID-19 while in quarantine
• advice on how to access medical services
• SIM cards and access to wifi to be able to maintain social contact by virtual means

Vaccination

Trusts should provide newly arrived nurses with information about the COVID-19 vaccine. For those nurses who have not yet received vaccination for COVID-19 in their home country, arrangements should be made to receive COVID-19 vaccination as soon as possible following completion of quarantine.

NHS staff do not require an NHS number or GP registration to receive a vaccination and should never be denied one on this basis, either when presenting for a vaccine in person, or through the design of booking systems. Please take immediate action to ensure this is not the case in your organisation.

If a staff member does not have an NHS number, employers should vaccinate now, record locally via a paper system and ensure vaccination is formally documented later. We are working on a longer-term solution, but employers should not wait for this before vaccinating.

Hospital and contract staff adherence to COVID-19 guidelines

At all times hospital and contract staff engaging with quarantined nurses must ensure that they are adhering to COVID-19 social distancing rules and must have the correct personal protective equipment (PPE) available to them and be advised how to put on and take off ('don and dof') PPE safely.

Staff must be provided with personal held alcohol gels.

Fire evacuation assistance

The trust will need to ensure they have an agreed fire evacuation plan developed (and adhered to in the instances of an emergency evacuation) with specific measures to ensure social distancing (2 metres distance apart) where possible during any evacuation and at assembly points.

Once safe, nurses should return to quarantine as soon as possible, with social distancing measures (2 metres distance apart) in place where possible, to continue the quarantine programme.

If the accommodation cannot be used the nurses should first be taken to a safe place to keep them dry and warm with refreshments. This may be a local church, community hall, government building, nearby open hotel conference room etc (the decision/plan would depend on how far the guests need to be taken away from the impacted area). There is also a reactive transport plan in line with transport requirements set out earlier.

All documents and fire records are to be updated accordingly.

Published 22 April 2021
Last updated 26 November 2021 + show all updates

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