Anfonwyd ar ran Llywodraeth Cymru / Sent on behalf of Welsh Government
Saesneg yn isod / English below
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Dr Frank Atherton
Prif Swyddog Meddygol/Cyfarwyddwr Meddygol, GIG Cymru
Albert Heaney
Dirprwy Cyfarwyddwr Cyffredinol
Iechyd a Gwasanaethau Cymdeithasol
At:
Prif Weithredwyr y Byrddau Iechyd
Prif Weithredwr, Iechyd Cyhoeddus Cymru
Prif Arolygydd, AGC
Cyfarwyddwyr Iechyd y Cyhoedd
Cyfarwyddwyr Gwasanaethau Cymdeithasol
Darparwyr Cartrefi Gofal
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7 Ionawr 2021
Annwyl Gydweithwyr,
Fel y gwyddoch, ar 4 Rhagfyr cyhoeddodd y Gweinidog Iechyd a Gwasanaethau Cymdeithasol y byddai Llywodraeth Cymru yn dechrau gweithio tuag at weithredu polisi profi a fyddai'n sicrhau bod yr holl staff iechyd a gofal cymdeithasol rheng flaen yng Nghymru yn cael eu sgrinio'n asymptomatig. Gwneir hyn drwy wneud y gorau o’r cyfleoedd profi cyflym y mae’r Dyfeisiau Llif Unffordd yn eu cynnig inni.
Yn dilyn y cyhoeddiad hwnnw, ar 29 Rhagfyr cyhoeddodd y Gweinidog a'r Dirprwy Weinidog Iechyd a Gwasanaethau Cymdeithasol fframwaith rheoli ar gyfer gofal cymdeithasol sy’n cyd-fynd â'r pedair lefel rhybudd ar gyfer Cymru. Gweler y ddolen isod er hwylustod: https://llyw.cymru/datganiad-ysgrifenedig-fframwaith-profi-rheoli-atal-heintiau-ym-maes-gofal-cymdeithasol
Yn ogystal â phwysleisio'r mesurau atal a rheoli heintiau a ddylai fod ar waith ar draws y gwasanaethau gofal cymdeithasol, mae'r cynllun hefyd yn amlinellu’r profion y dylid eu cynnig i staff, sut i leihau'r risg wrth ganiatáu i ymwelwyr a gweithwyr proffesiynol ddod i’r cartref a sut y dylid rheoli’r risgiau hyn ar bob lefel rhybudd. Ar gyfer lefelau rhybudd tri a phedwar fe welwch yr argymhellir cynnal profion rheolaidd ar weithwyr proffesiynol sy'n ymweld â chartrefi gofal bellach.
Mae'r gwaith o gyflwyno profion i staff iechyd a gofal cymdeithasol rheng flaen bellach ar y gweill, gan ddechrau gyda chyfnod 'braenaru' byr a fydd yn caniatáu i Lywodraeth Cymru ddeall a goresgyn rhwystrau posibl i ddarpariaeth cyn eu cyflwyno'n ehangach yn ddiweddarach y mis hwn. Rydym yn rhagweld y bydd y rhan fwyaf o ymwelwyr proffesiynol â chartrefi gofal yn cael eu profi'n rheolaidd fel rhan o'r rhaglen hon. Fodd bynnag, hyd nes y caiff y rhaglen ei chyflwyno'n llawn, dylai'r cartref gofal ofyn i unrhyw weithiwr iechyd rheng flaen neu weithiwr gofal cymdeithasol proffesiynol nad yw'n rhan o raglen brofi asymptomatig reolaidd ond sy'n ymweld â chartref gofal, i gymryd prawf llif unffordd cyn dod i’r cartref.
Yn amlwg, bydd eithriadau i hyn, er enghraifft mewn perthynas â staff gofal brys neu staff ambiwlans (neu unrhyw ymwelwyr diwedd oes) y byddai aros hanner awr am ganlyniad prawf yn ychwanegu risg sylweddol neu yn cael effaith niweidiol. Gofynnwn i gartrefi gofal ddefnyddio dull gweithredu seiliedig ar risg yn yr achosion hyn.
Mae cartrefi gofal yng Nghymru wedi cael cyflenwad o brofion llif unffordd i baratoi ar gyfer profi ymwelwyr, a gellir defnyddio'r pecynnau hyn i brofi gweithwyr proffesiynol hefyd. Mae staff cartrefi gofal wedi cael hyfforddiant a chanllawiau ar ddefnyddio’r profion llif unffordd sydd ar gael iddynt ers canol mis Rhagfyr a dylent gyfeirio at y ddogfen ganllawiau sydd ynghlwm i'r llythyr hwn. Rydym yn cynghori cartrefi gofal i sicrhau bod nifer o staff wedi cael eu hyfforddi i ddefnyddio'r profion llif unffordd er mwyn osgoi sefyllfaoedd lle nad oes aelod o staff hyfforddedig ar gael i brofi gweithiwr proffesiynol sydd angen ymweld â rhywun sy'n byw yn y cartref gofal.
Yn ogystal, gallai fod yn ddefnyddiol, os yw'n bosibl, i weithwyr proffesiynol roi gwybod i’r cartref gofal ymlaen llaw y byddant yn ymweld, a’u bod yn debygol o fod angen prawf fel y gellir gwneud cynlluniau priodol i sicrhau bod prawf ar gael.
Mae cwblhau'r prawf ac aros am y canlyniad yn cymryd tua hanner awr a bydd angen i'r gweithiwr proffesiynol sy'n ymweld aros am ganlyniad negatif cyn mynd i mewn i'r cartref gofal. Deallwn fod hyn yn arwain at heriau ychwanegol o ran cynllunio llwyth gwaith ond mae’n hollbwysig adnabod unrhyw un a allai gludo COVID-19 i gartrefi gofal.
Mae’r rhaglen brofi ymwelwyr â chartrefi gofal yn galluogi lanlwytho canlyniadau profion llif unffordd yn ddigidol; gall y gweithiwr proffesiynol sy'n ymweld lanlwytho ei ganlyniad unigol yn uniongyrchol ac nid oes angen i'r cartref gofal ei gofnodi. Er nad yw canlyniadau'r prawf llif unffordd yn cael eu hychwanegu at y system Profi, Olrhain, Diogelu eto, mae'r gweithiwr proffesiynol sy'n ymweld yn cael hysbysiad o ganlyniad y prawf, y gellir ei ddefnyddio fel 'trwydded' ar gyfer ymweliadau dilynol â chartrefi gofal.
Argymhellir bod staff iechyd a gofal cymdeithasol rheng flaen yn cael eu profi am COVID-19 drwy brawf llif unffordd ddwywaith yr wythnos, ac felly dylid ystyried bod y 'drwydded' a ddarperir gan neges hysbysu am ganlyniad prawf yn ddilys os yw'n llai na phedwar diwrnod oed. Mae atebion digidol yn cael eu hystyried ar hyn o bryd ar gyfer y staff iechyd a gofal cymdeithasol rheng flaen sy’n rhan o raglen brofi reolaidd sefydledig.
Rydym yn cydnabod bod risg uwch y bydd dyfeisiau llif unffordd yn rhoi canlyniadau negatif anghywir o gymharu â phrofion RT-PCR. Felly, ochr yn ochr â'r rhagofal ychwanegol o gynnal profion ddwywaith yr wythnos, bydd angen cadw at brotocolau sy'n ymwneud â defnyddio cyfarpar diogelu personol (PPE), hylendid dwylo a chadw pellter cymdeithasol lle y bo'n bosibl. Yn ogystal, os ceir canlyniad positif drwy brawf llif unffordd, dylid archebu prawf RT-PCR i gadarnhau’r canlyniad, a byddai canlyniad y prawf hwn yn cael ei fwydo i mewn i'r system Profi, Olrhain Diogelu.
Os bydd gweithiwr proffesiynol sy'n ymweld yn cael canlyniad prawf llif unffordd positif, dylai archebu prawf RT-PCR ar unwaith drwy borth y Llywodraeth neu gysylltu â'i fwrdd iechyd ac archebu prawf RT-PCR ar unwaith mewn Uned Brofi Gymunedol yn lleol. Bydd prawf fel arfer ar gael yn ddiweddarach y diwrnod hwnnw. Cyn cael prawf RT-PCR i gadarnhau, dylai'r sawl sydd wedi cael prawf llif unffordd positif ynysu ar unwaith gan osgoi unrhyw gysylltiad ag eraill. Ar ôl cael prawf RT-PCR i gadarnhau, dylai'r unigolyn fynd adref yn syth ac ynysu hyd nes ei fod yn cael canlyniad ei brawf RT-PCR.
Fel arfer, hoffem ddiolch ichi i gyd am eich gwaith caled a’ch ymrwymiad i sicrhau bod ein hunigolion mwyaf agored i niwed yn cael eu diogelu yn ystod y cyfnod digynsail hwn.
Yn gywir,
 FRANK ATHERTON ALBERT HEANEY
Prif Swyddog Meddygol Dirprwy Gyfarwyddwr Cyffredinol
CC:
Prif Weithredwyr Awdurdodau Lleol
Yr Is-grŵp Cynllunio ac Ymateb Gofal Cymdeithasol
Y Comisiynydd Pobl Hŷn
Y Comisiynydd Plant
Bwrdd Comisiynu Cenedlaethol
Darparwyr Cofrestredig ac Unigolion Cyfrifol Gwasanaethau Cartrefi Gofal yng Nghymru (oedolion a phlant)
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Dr Frank Atherton
Chief Medical Officer/Medical Director NHS Wales
Albert Heaney
Deputy Director General
Health and Social Services
To:
Chief Executives of Health Boards
Chief Executive, PHW
Chief Inspector, CIW
Directors of Public Health
Directors of Social Services
Care Home Providers
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7 January 2021
Dear Colleagues,
As you will already be aware, on 4 December the Minister for Health and Social Services announced that the Welsh Government would start work towards implementing a testing policy which would ensure the asymptomatic screening of all frontline health and social care staff in Wales, by making the most of the rapid testing opportunities presented by Lateral Flow Devices (LFDs).
Further to that announcement, on 29 December the Minister and Deputy Minister for Health and Social Services jointly announced the publication of a control framework for social care aligned with the four alert levels for Wales. Please see the link below for ease of reference: https://gov.wales/written-statement-testing-and-infection-prevention-control-framework-social-care
In addition to emphasising the infection prevention and control measures that should be in place throughout social care services, the plan also sets out the testing that should be in place for staff, how to minimise the risk when allowing visitors and visiting professionals into the home and how they should be managed at each alert level. For alert levels three and four you will see that the routine testing of visiting professionals to care homes is now recommended.
The roll-out of testing for frontline health and social care staff is now underway, commencing with a short ‘pathfinder’ phase which will allow for the Welsh Government to understand and overcome potential barriers to operational delivery before wider roll-out which is planned for later this month. We anticipate that most professional visitors to care homes will be regularly tested as part of this programme. However until full roll-out is complete, any frontline health or social care professional who is not part of a regular asymptomatic testing programme but is visiting a care home, should be asked by the care home to undertake an LFD test before admittance.
There will obviously be exceptions to this, for example in relation to emergency care staff or ambulance staff (or any end of life visitors) for whom a half hour wait for a test result would add significant risk or detrimental impact. We ask that care homes take a risk-based approach in these instances.
Care homes in Wales have been provided with a supply of LFD tests in preparation for personal visitor testing, and these kits may be used for testing of professionals too. Care home staff have had training and guidance on the use of LFD tests available to them since mid-December, and should be referring to the guidance document attached to this letter. We advise care homes to ensure a number of staff have been trained in utilising the LFD tests, so that we avoid scenarios where there is no trained staff member available to test a visiting professional who needs to attend someone living in the care home.
Additionally it may be helpful, where possible, for visiting professionals to notify a care home in advance that they are attending and likely to require a test so that appropriate plans can be made to ensure this is available.
Completing the test and waiting for the result takes about half an hour and the visiting professional will need to await a negative result prior to entry to the care home. We understand that this adds additional challenges for workload planning, but the importance of identifying anyone who could potentially carry COVID-19 into a care homes is paramount.
The care home visitor testing programme has a digital upload of LFD results; individual results can be uploaded by the visiting professional directly and do not need to be recorded by the care home. Although the results of the LFD test are not yet fed into the Test, Trace, Protect (TTP) system, the visiting professional does receive a notification of their test result, which can be used as a ‘pass’ for subsequent visits to care homes.
It is recommended that frontline health and social care staff are tested for COVID-19 by twice-weekly LFD test, and so the ‘pass’ provided by the test notification message should be considered valid if it is less than four days old. Digital solutions for those frontline health and social care staff who have been captured as part of an established regular testing programme, are currently being considered.
We recognise that there is a higher risk of LFDs producing false negative results compared to RT-PCR tests; as such, alongside the added precaution of twice-weekly testing, protocols relating to the use of Personal Protective Equipment (PPE), hand hygiene and social distancing where possible will still need to be observed. Additionally, positive results received via LFD tests should be followed by a confirmatory RT-PCR test, the results of which would be fed into the TTP system.
If a visiting professional receives a positive LFD result they should immediately book a RT-PCR test through the GOV.UK portal or contact their health board and immediately and book a confirmatory RT-PCR test at a local Community Testing Unit (CTU). This will usually occur later that day. Prior to the confirmatory RT-PCR test, those with a positive LD test should isolate immediately avoiding any contact with others. Following the confirmatory RT PCR test, the individual should return home directly and isolate until they receive the result of their confirmatory RT-PCR test.
As ever, we would like to thank you all for your hard work and commitment in ensuring our most vulnerable individuals are protected during these unprecedented times.
Yours sincerely,
FRANK ATHERTON ALBERT HEANEY
Chief Medical Officer Deputy Director General
CC:
Chief Executives of Local authorities
Social Care Planning & Response Sub-group
Older People’s Commissioner
Children’s Commissioner
National Commissioning Board
Registered Providers and Responsible Individuals of Care Home Services in Wales (adults and children)
Hawlfraint y Goron / Copyright © 2021 Arolygiaeth Gofal Cymru / Care Inspectorate Wales. Cedwir pob hawl / All rights reserved.
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