Establishing the impact of COVID-19 on the health of domiciliary care workers in Wales: developing a model for UK service planning and carer support

家庭护理工作者(DCW)受雇于公共和私营部门，以支持家中的成年人。他们提供的支持各不相同，但通常包括个人护理，这需要护理人员和被支持者之间的密切联系。自新冠肺炎大流行开始以来，英格兰和威尔士医疗部门的工作人员经历了较高的新冠肺炎感染死亡率。寄宿和家庭护理环境中的社会护理人员受到的影响尤其严重，涉及新冠肺炎的死亡率大约是卫生保健人员的两倍。我们不完全了解对家庭护理人员死亡率的全面影响，新冠肺炎如何更广泛地影响工作者的健康，以及导致这些影响的风险因素。关于国家统计局死亡的现有证据依赖于职业分类。然而，对于许多被报告与新冠肺炎有关的死亡个人，有关职业的信息缺失(男性和女性分别为18%和40%)。因此，新冠肺炎对家居护理人员的健康可能产生相当大的影响，包括对新冠肺炎感染本身、精神健康和呼吸系统疾病的影响。我们的目标是根据护理人员的观点，通过将护理人员的注册数据与常规健康数据联系起来，快速生成高质量的证据。我们可以利用这些信息为公共卫生干预提供信息，以实现更安全的工作实践和对护理人员的额外支持。我们的研究将采用研究方法的结合。我们将使用现有的行政数据，包括护理员的专业注册记录和健康护理记录。我们对这些数据的分析将在一定程度上受到定性访谈的指导，这些访谈将在威尔士对家庭护理工作者进行。访谈将涉及护理人员在大流行期间的经历。威尔士护理工作者的注册数据将安全地从监管机构威尔士社会关怀(SCW)转移到斯旺西大学的安全匿名信息链接(SAIL)数据库。这些数据将与SAIL数据库提供的匿名健康记录结合起来。在这一过程中，可能被用来识别个别护理人员的信息将被删除。我们预计这将创建一个关于威尔士所有家庭护理工作者的研究数据库，大约有17,000人。我们还将从这一组中确定大约30名护理人员，通过SCW与他们接触，参加定性访谈。在我们的分析中，我们会在研究资料库中描述护理员的社会人口统计特征，例如他们的平均年龄。我们将确定疑似和确诊感染新冠肺炎的护理人员人数。将探索感染新冠肺炎对关键健康结局的影响，包括工人是否入院或死亡。我们还将探讨新冠肺炎疫情爆发前和疫情期间医护人员的健康状况。我们将使用采访护理人员所获得的信息来指导我们分析护理人员的健康记录的方式。最后，我们将研究我们对威尔士护理人员的分析结果在多大程度上可以被用来指导英国其他国家的护理人员可能发生的事情。为了确保我们的发现对从事社会护理工作的人最有用，我们将与实施参考小组合作。该小组将包括关键利益相关者，如来自英国各地监管机构的代表。与该小组合作，我们将提供快速建议，以推动护理人员安全的公共卫生倡议。这可能包括改变工作做法和较长期的服务规划，以支持护理人员的健康需求。

Domiciliary Care Workers (DCWs) are employed in both public and private sectors to support adults at home. The support they provide varies but often includes personal care, which demands close contact between care worker and the person being supported. Since the start of the COVID-19 pandemic, people working across the care sectors in England and Wales have experienced higher rates of death involving COVID-19 infection. Social care workers, in both residential and domiciliary care settings, have been particularly badly affected, with rates of death involving COVID-19 approximately double that for health care workers.We do not fully understand the full impact on domiciliary care worker mortality, how COVID-19 has affected worker health more broadly, and the risk factors which contribute to these. Existing evidence on deaths from the ONS relies on occupational classification. However, for many individuals reported as dying with some COVID-19 involvement, information on occupation is missing (18% and 40% missing for males and females respectively).The impact of COVID-19 on the health of domiciliary care workers (DCWs) is therefore likely to be considerable, including on COVID-19 infection itself, mental health, and respiratory illnesses. We aim to generate rapid high-quality evidence based on the views of care workers and by linking care workers' registration data to routine health data. We can use this information to inform public health interventions for safer working practice and additional support for care workers. Our study will use a combination of research methods. We will use existing administrative data involving carer professional registration records as well as health care records. Our analysis of these data will be guided in part by qualitative interviews that we will conduct with domiciliary care workers in Wales. The interviews will address the experiences of care workers during the course of the pandemic. Registration data for care workers in Wales will be securely transferred from the regulatory body, Social Care Wales (SCW) to the Secured Anonymised Information Linkage (SAIL) Databank at Swansea University. These data will be combined with anonymised health records made available from the SAIL databank. Information which could be used to identify individual care workers will be removed in this process. We expect that this will create a research database of all domiciliary care workers in Wales, approximately 17,000 individuals. From this group we will also identify about 30 care workers to be approached via SCW to take part in a qualitative interview. The interview sample will be chosen so that it includes workers from a variety of backgrounds.In our analysis, we will describe the socio-demographic characteristics of the group of care workers in the research database, for example, their average age. We will establish the number of care workers with both suspected and confirmed COVID-19 infection. Will explore how infection with COVID-19 has impacted on key health outcomes, including whether workers were admitted to hospital or died. We will also explore the health of care workers before and during COVID-19 pandemic. We will use the information gained from interviews with care workers to guide the way we analyse the health records of the care workers. Finally, we will examine how well the results from our analysis of care workers in Wales can be used inform what may be happening for workers in other countries in the UK.To ensure that our findings will be of most use to those working in social care, we will work with an Implementation Reference Group. The group will include key stakeholders such as representatives from regulators from across the UK. Working with this group, we will provide rapid recommendations to drive public health initiatives for care worker safety. This may include changes in working practices and longer-term service planning to support care worker health needs.