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

住家护理员（DCWs）受雇于公营和私营机构，在家中为成年人提供照顾。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的人之间的密切联系。自2019冠状病毒病大流行开始以来，英格兰和威尔士各个护理部门的工作人员因感染COVID-19而死亡率更高。居住和家庭护理机构的社会护理工作者受到的影响尤为严重，与COVID-19有关的死亡率大约是卫生保健工作者的两倍。我们并不完全了解COVID-19对家庭护理人员死亡率的全面影响，COVID-19如何更广泛地影响工人的健康，以及造成这些影响的风险因素。国家统计局关于死亡的现有证据依赖于职业分类。然而，对于许多与COVID-19有关的死亡报告而言，职业信息缺失（男性和女性分别缺失18%和40%）。因此，COVID-19对居家护理人员健康的影响可能相当大，包括COVID-19感染本身、精神健康和呼吸系统疾病。我们的目标是根据护理人员的意见，并通过将护理人员的注册数据与常规健康数据联系起来，快速产生高质量的证据。我们可以利用这些信息为公共卫生干预措施提供信息，以实现更安全的工作做法，并为护理人员提供额外支持。我们的研究将采用多种研究方法。我们将使用现有的行政数据，包括护理人员专业注册记录和医疗记录。我们对这些数据的分析将部分由我们将与威尔士的家庭护理人员进行的定性访谈指导。访谈将涉及在大流行期间护理工作者的经历。威尔士护工的注册数据将从威尔士社会护理监管机构（SCW）安全地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相结合。在这个过程中，可以用来识别个人护理人员的信息将被删除。我们期望这将建立一个威尔士所有居家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约30名护理人员，通过SCW与他们接触，参加定性访谈。面试样本的选择将包括来自不同背景的员工。在我们的分析中，我们将描述研究数据库中护理工作者群体的社会人口特征，例如，他们的平均年龄。我们将确定疑似和确诊感染COVID-19的护理人员人数。将探讨COVID-19感染如何影响关键的健康结果，包括工人是否住院或死亡。我们还将探讨COVID-19大流行之前和期间医护人员的健康状况。我们将使用从与护理人员的访谈中获得的信息来指导我们分析护理人员健康记录的方式。最后，我们将检查我们对威尔士护工的分析结果如何可以用来告知英国其他国家的护工可能发生的事情。为了确保我们的研究结果对从事社会关怀工作的人最有用，我们将与一个实施参考小组合作。该小组将包括来自英国各地监管机构的代表等关键利益相关者。我们将与该小组合作，迅速提出建议，推动有关护理人员安全的公共卫生举措。这可能包括改变工作做法和长期服务规划，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.