Domiciliary care workers are demanding clarity from health trusts on how to deal with clients who are Covid-19 positive.

The demand comes as allegations emerged that the Belfast Health and Social Care Trust and the South Eastern Health and Social Care Trust — which extends as far as Twinbrook and Poleglass — have different rules for home carers.

In Belfast, health chiefs have accepted, after repeated lobbying by home care providers, that any carer who is visiting clients with the coronavirus should not then enter the home of a client who is virus-free. 

In the South Eastern Board area, however, it is believed that carers can still move between both cohorts.

Last night, Connected Health Director Ryan Williams said his company had taken the decision — regardless of trust area — that home-carers working with Covid-19 clients would not also deal with clients who are virus-free. 

One domiciliary care worker said the "mixed messages" from the trusts were adding to the pressure on home carers. "We are very much on the frontline," she said. "Until this week, the focus was entirely on hospitals. It has now moved to nursing homes but those who are providing support to the vulnerable still living in their own homes or in an assisted living setting are entitled to the same dignity and resources as everyone else. We went the very best for our clients and it's unbelievable that in Twinbrook you could have one approach and in Ballymurphy another. No client should have to worry that their carer is bringing Covid into their home - and no matter how much PPE or sanitiser or hand washing is used, it's impossible to deal with a Covid client and be absolutely certain you're not bringing the virus into the next home."

FRONTLINE: Connected Help home-carers Lois McCallan, Julie Cordner, Judith Marcus and Martina Graham
FRONTLINE: Connected Help home-carers Lois McCallan, Julie Cordner, Judith Marcus and Martina Graham

Ryan Williams, a director with Connected Health, yesterday paid tribute to his team of carers. "We have been through a hell-storm," he said. "PPE was a big issue but through our own efforts and now through the Trusts, we are getting all the PPE we need. We also took a decision early on to divide our teams up so that some carers are dealing only with Covid-19 clients and others with clients who are virus-free."

Mr Williams said the risk of infection in the home setting was not as great as in a care home. "Our staff are only in homes for a short period and they can wash their hands and change PPE between each visit so the risk of transmission is less than in a care home because they are not immersed in the same way," he said. Testing of staff had also improved radically over the past week, added the Connected Health director. "Staff who have been self-isolating with symptoms are able to access the testing site at the SSE Arena and as a result we were able to bring 25 self-isolating staff who tested negative back into the workforce."

One West Belfast health professional said reports of differing policies being implemented by neighbouring health trusts were "surreal". "The fact is that for 1.9 million people, we have too many trusts, too many Local Commissioning Groups, too many GP federations, and while we only have one Health and Social Care Board that is one too many as it was supposed to have been scrapped years ago. It's too easy for the Minister of Health to pass the buck to someone else when what we need is for the Health Department to control everything for a population which is less than that of the borough of Brooklyn. The dithering and confusion is the last thing we need when people are dying."

A spokesperson for the South Eastern Health and Social Care Trust said: "The South Eastern Trust has set up a dedicated domiciliary care team for people who have been discharged from hospital and have been COVID positive and need domiciliary care . This team will focus on short term care and support until such times as the person can transfer to a non-covid team for their ongoing care. For existing clients trying to maintain the continuity and the relationship with their carer is important particularly at this time when many clients and their families are anxious.

"As the  COVID-19 virus has become more widespread in the community our staff are more likely to see people who have symptoms and people with the virus. The Regional  Personal Protective Equipment (PPE) guidance has changed to reflect this and therefore all domiciliary care workers are now wearing PPE when visiting their clients if carrying out direct care. This PPE is changed between clients and, along with rigorous hand hygiene, minimises the risk of cross contamination. I can assure you that we are committed to supporting vulnerable people in their homes and also our community teams in the valuable work they do to provide the care required."

This story has been updated to include a response from the South Eastern Trust at 2:56 on Thursday.