Covid-19 update: hearing care - 4 April 2020

Clinical update

On 19 March, NHS England, as part of its Covid-19 response, recommended children and adult audiology services be ‘stopped’, with some exceptions.

The NCHA, Action on Hearing Loss and other stakeholders have explained why audiology should services should not be stopped, with the NCHA requesting NHS England consider moving audiology to a ‘partial stop’. For example, we explained essential care was still necessary and could be delivered safely – for example, remotely – through the crisis period.

This week the NHS updated its original guidance and moved audiology to a ‘partial stop’, reflecting the importance of essential audiology services – e.g. helping people to remain connected and safe during the pandemic.

The NCHA had also raised concerns about ‘microsyringing’ in the original guidance. The original advice did not fully capture other methods of managing impacted wax, as set out in NICE guideline (NG98), nor ENT-UK advice on the risk of aerosol generating procedures and official public health advice on risk-mitigation during the Covid-19 pandemic. We therefore welcome the insertion of the phrase “Where clinically appropriate” and the removal of ‘microsyringing’ as the only method in this section of the guidance.

Members are encouraged to read the full 2 April guidance notes for audiology. Page three covers audiology for children and young people and page nine covers audiology services for adults.

We are also aware that there is some misinformation and confusion about what has changed between the versions. You can access the 19 March version here to make direct comparisons. You should, however – as is the case with all guidance and especially during the Covid-19 pandemic – follow the most current guidance.

Please note that, as per our previous Covid-19 updates:

• The UK governments include community audiology clinics on the essential premises list
• Routine hearing care remains suspended during the pandemic
• Members providing essential, urgent and emergency care must continue to follow official public health advice at all times.

Members should now also familiarise themselves with new PPE guidance (see below).

If you provide medical ear care services and/or urgent audiological care, you should review current BSO guidance on otological procedures during the Covid-19 pandemic. Please pay particular attention to ‘other otology procedures’ and ‘additional guidance for microsuction’ on page two. Throughout the pandemic you should also continue to follow applicable ENT-UK Covid-19 resources.                     

NEW: Personal Protective Equipment Guidance 

On 2 April, the UK published new personal protective equipment (PPE) guidance during the Covid-19 pandemic.

The guidance is issued jointly by the Department of Health and Social Care (DHSC), Public Health Wales (PHW), Public Health Agency (PHA) Northern Ireland, Health Protection Scotland (HPS), Public Health England and NHS England as official guidance pan-UK and sectors/settings. It therefore applies to all audiology services in the UK.

Individuals in charge of infection control policies in your organisation should read the full guidance and keep up to date with all official guidance. The new guidance includes tables which describe PPE use across different clinical settings and advice on correct usage and other safety measures.

• Table 1 PPE in secondary care inpatient clinical settings
• Table 2 PPE for primary, outpatient and community care settings
• Table 3 PPE for ambulance, paramedics, first responders and pharmacists
• Table 4 PPE where Covid-19 transmission is sustained.

Regarding these summary tables, the guidance notes:

• “It is recognised that provision of healthcare is dynamic and in a single care episode more than one context may be encountered, PPE should be changed (upgraded) as appropriate.”

As well as those in charge of infection control procedures who should read the guidance in full and develop protocols for the wider team, we recommend that all staff read the following sections of the PPE guidance:

• Main changes to previous guidance 
• Safe ways of working
• Risk assessment
• PPE covering primary care and outpatient settings (section 8.9) 
• Patient use of PPE
• Using PPE best practice non-aerosol generating procedures and if required for aerosol generating procedures.

The PPE requirements are in addition to suspending routine care and all other infection control procedures – e.g. best practice handwashing and social distancing remain vitally important.

Please keep up to date with the extremely vulnerable list – last updated 30 March.

Financial support for hearing care providers

In the 23 March alert and 27 March alert we provided hearing care providers with details about financial support that was available during the Covid-19 crisis. The government has now published additional guidance on various schemes and updates are provided below for ease of reference.

UK-wide

Coronavirus job retention scheme

Further details of eligibility and how much you can claim to cover wages for furloughed employees can be found here. The HMRC claims portal is expected to be operational by end of April 2020.

Deferral of VAT payments due to coronavirus (Covid-19)

UK VAT registered businesses that have a VAT payment due between 20 March 2020 and 30 June 2020 can either defer the payment until a later date or pay the VAT due as normal. VAT returns must be submitted to HMRC on time.

If you choose to defer your VAT payment as a result of coronavirus (Covid-19), you do not need to tell HMRC that you are deferring your VAT payment but you must pay the VAT due on or before 31 March 2021. Further information about how to repay the deferred VAT will be announced by HMRC soon.

HMRC will continue to process VAT reclaims and refunds as normal during this time.

Pause in income tax payment

If you are due to make your second self-assessment payment on 31 July 2020, this is an automatic deferment offer with no applications required. No penalties or interest for late payment will be charged if you defer payment until 31 January 2021.

During the deferral period you can set up a budget payment plan to help you pay the deferred payment on account when it comes due.

Sick pay

Legislation to enable the scheme is awaited. We will update members on how to make a claim as soon as guidance is updated.

Coronavirus Business Interruption Loan Scheme (CBILS)

CBILS is being extended to all viable small businesses affected by Covid-19 – not just those unable to secure regular commercial financing – should they need finance to keep operating during this difficult time. The expanded scheme will be operational with lenders from Monday 6 April 2020.

Personal guarantees for loans under £250,000 will no longer be required by lenders.

Support for larger providers

Under the new Covid-19 Corporate Financing Facility, the Bank of England will buy short term debt from larger companies. The Covid Corporate Financing Facility Limited will purchase Commercial Paper during a defined period each business day. The Bank’s intention is for the facility to operate for an initial period of 12 months.

Eligible companies:

• Will be UK incorporated companies, including those with foreign-incorporated parents and with a genuine business in the UK
• Will provide significant employment in the UK or with their headquarters in the UK
• Will generate significant revenues in the UK, serve a large number of customers in the UK or have a number of operating sites in the UK.

Further details.         

England

Cash grants for retail businesses

As before, this scheme provides retail businesses with a cash grant of up to £25,000 per property based on the rateable value.

Eligible businesses will usually be contacted by their local authority, though some local authorities have decided to operate an applications process.

Enquiries on eligibility for, or provision of, the grants should be directed to the relevant local authority.

Northern Ireland

Small Business Support Grant Scheme

The NI Executive is providing a one-off grant of £10,000 to businesses currently receiving Small Business Rate Relief (SBRR), that is business properties with a rateable value below £15,000.

Vacant properties are not eligible for this grant.

Business with multiple premises will only be eligible for one grant of £10,000 in total.

Further details and the online application form.

• £25,000 grant for business ratepayers in the retail sector

The NI Executive is providing a one-off grant of £25,000 to business ratepayers in the retail sector on a property with a rateable value between £15,000 and £51,000.

Further details about how to access the grant will be published soon.

Scotland

As well as the UK-wide measures above, the Scottish government has a number of relevant initiatives:

Non-domestic rates relief

All non-domestic properties in Scotland will receive a 1.6% rates relief. This relief effectively reverses the change for 2020-21.

Retail businesses will receive 100% rates relief only if a property is occupied. Properties that have closed temporarily due to the government's coronavirus advice will be treated as occupied.

This relief will automatically be applied to your bill by your local council.

Grants

Retail businesses with a rateable value between £18,001 and up to and including £51,000 can apply for a one-off grant of £25,000.

A one-off grant of £10,000 will also be available to small businesses that receive:

• Small Business Bonus Scheme relief
• Rural Rate Relief 

If you have applied for Business Growth Accelerator Relief, Disabled Persons Relief or Fresh Start but are eligible for the Small Business Bonus Scheme you may also receive a one-off grant.

If you are eligible for a grant, you do not need to repay it.

To apply you will need to complete an application form, available on your local council website.

Wales

The Welsh government has set out a range of support measures for business:

Business Rate Relief

Retail businesses with a rateable value of £500,000 or less will receive one year business rates relief in the financial year 2020 to 2021. This will be administered through the business rates system. This relief will automatically be by your local authority.

Grants

Retail businesses with a rateable value of £12,001 and £51,000 will receive a grant of £25,000.

All businesses with a rateable value of £12,000 or less are eligible for Small Business Rates Relief and will receive a grant of £10,000.

These grants will be administered through the business rates system. Further details available from your local authority.

Economic Resilience Fund small business grant

Small businesses that employ up to nine people (including sole traders with staff) can apply for a grant up to £10,000. You can apply in mid-April. Details will be available shortly.

Small and medium sized businesses that employ between 10 and 249 people can apply for a grant up to £100,000. You can apply from next week. Details will be available shortly.

MESSAGE FROM THE MANAGING DIRECTOR

We have been working on your behalf seven days a week since this crisis began and will continue to do so.

At the NCHA we have also worked with Hearing Loss and Deafness Alliance members to try and coordinate a sector response to the crisis. We have done all we can to support the sector effort, including by sharing information, analysis and other intelligence with sector partners.

It is more important than ever that as a sector we work together to protect patients, staff and the wider public during this pandemic.

I know many of you have been in touch in recent weeks sharing great examples of collaboration across traditional boundaries, redeploying teams and sharing capacity to offer remote care and support. Please continue to share the great work you are doing so others can see what might work locally.

Some of you have contacted me directly in recent weeks to express disappointment about conduct on social media. Again, we encourage all audiologists to work collaboratively during this pandemic and also to adhere to regulatory standards on the use of social media. At this time, it is vital that all your resources and ours are focused on the Covid-19 effort. We would encourage you to ignore social media posts where possible and instead only follow official health and public health advice.

If we could be doing anything more to support you, please contact me or the team directly by emailing:

[email protected]
[email protected]
[email protected]

We are here to help every single member every day, so do not hesitate to get in touch at any time. We will do whatever we can to assist you during this difficult time.