Published: 6 May 2020, 14.45
Last updated: 28 May 2020, 16.30
(The areas highlighted indicate which sections have been added to or significantly modified since 6 May 2020)
Please note that we will be adding more guidance/recommendations for mobile therapists in the near future.
At FHT, we fully appreciate how much COVID-19 has impacted our members and that many of you are eager to return to full practice in order to support your clients’ health and wellbeing and generate much-needed income.
With a number of countries starting to relax their social distancing measures, along with the Prime Minister announcing on 30 April that ‘we are past the peak of this disease’, a growing number of members are now asking us when the FHT feels it will be safe for them to provide treatments again.
As has been the case throughout the COVID-19 pandemic, the FHT will continue to follow the latest guidance from the UK government, NHS and other authorities. As you are no doubt aware, social distancing measures are still in place across the UK to try and limit the spread of COVID-19, as well as reduce the risk of it peaking again in the future.
We will continue to update our coronavirus statement (fht.org.uk/coronavirus) on a regular basis and support our members with information and guidance wherever possible, so please keep checking this link, as well as your weekly newsletters.
Meantime, to help our members prepare for returning to work, we have put together some recommendations that we believe will help to minimise the risk of contracting and spreading COVID-19. However, we would like to stress that these recommendations are not exhaustive and that the FHT are not experts in COVID-19. This is why we feel it is important for members to stay up to date with the latest information and guidance provided by the government and authorities in the country where they live and practice.
We are in a situation that is ever evolving and guidance that may be relevant one day may be superseded the next, as new evidence-based information about the virus becomes available. That is why we have signposted members to websites where they can find relevant information, instead of providing detailed information regarding certain aspects of COVID-19, which may become dated in a matter of days or weeks.
Finally, please note that while many of the recommendations in this document ‘apply to all’, if you are an employee or volunteer, you may need to adhere to protocols put in place by the person or organisation you work for.
We hope you find the information useful and that it helps you to get ‘work ready’ for when the government indicates it is safe to return to therapy practice.
Only use trusted sources of information
With so much conjecture and false information circulating about COVID-19, it is important to stick to trusted sources.
For information about COVID-19 and any measures in place to try and tackle the virus, we would recommend looking at the NHS, government, and World Health Organisation (WHO) websites. You can also access a useful Coronavirus Patient Leaflet on the BMJ (British Medical Journal) Best Practice website.
Before re-evaluating your work practices and returning to work, it is extremely important that you are aware of the latest information regarding:
- how COVID-19 spreads, so that you can minimise the risk of becoming infected or spreading the virus;
- which individuals are considered vulnerable or at high risk if they are exposed to COVID-19;
- the signs and symptoms of COVID-19, so that you can identify if you or a client may have the virus;
- how long people affected by COVID-19 should self-isolate and what is meant by self-isolation;
- how long COVID-19 survives on different surfaces; and
- how to prevent the spread of COVID, including cleaning and disinfecting potentially affected surfaces.
Re-evaluate the way you work
Now is the ideal time to re-evaluate all of your work practices and to carry out a fresh risk assessment, which addresses the risks of COVID-19 (for information about risk assessments, see the FHT Code of Conduct and Professional Practice for some basic guidance, and the HSE website for more details).
This will help you to decide whether you need to adapt any of your work practices or put extra measures in place until COVID-19 is no longer considered a threat to health. This includes (but is not limited to):
- business premises and treatment areas
- hygiene protocols
- the consultation and treatment
- client aftercare advice
- business policies
- insurance requirements
Unless you employ five or more people, you are not required to keep a written record of your risk assessment. However, we would highly recommend that you document your findings and any precautions you intend to put in place in order to minimise the risk of you, your clients and your staff from contracting COVID-19 through your business activities.
Assessing your business premises and treatment space
To get your evaluation under way, our first recommendation would be to literally walk through every area your client is likely to pass through and every item and surface they are likely to come into contact with when they visit you for a treatment.
As you do this, consider removing any items that are non-essential and particularly those that are difficult to wipe down with disinfectant or wash in order to kill the virus. This might include, for example, magazines, cushions, electric blankets, throws and other soft furnishings.
If you work on a mobile basis, think through how you can minimise your risk of contracting or spreading coronavirus in the environments you work in.
Enhanced hygiene measures
FHT members already adhere to high standards of hygienic practice, as outlined in the FHT Code of Conduct and Professional Practice, which includes appropriately cleaning the hands and treatment area between clients.
However, in light COVID-19, it is important that members review and potentially enhance any current hygiene measures they already have in place. As such, it would be advisable to create a checklist of things that need to be washed or disinfected at the beginning and end of each day and in between clients.
On top of the usual therapy items and equipment that require disinfecting and washing (such as couches, fabric couch covers, towels and therapy tools/equipment), this might include:
- a front doorbell or knocker
- handles, handrails and bannisters
- lift buttons and light switches
- toilet and sink area
- chairs in a waiting area
- pens or mobile device screens
- payment terminal
- computer keyboard and mouse.
Make sure you use this checklist between each client. You may also want to show each client your checklist when they arrive for treatment, display this on your treatment room wall, or include it in a special COVID-19 policy, to give them confidence in your hygiene and health and safety protocols. We know that some members are also producing videos to share on their websites and social media platforms, explaining to clients and prospective clients the different hygiene measures they are putting in place for when it is safe to return to work.
When you do start your therapy work again, you may also want to consider:
- asking your clients to bring their own bottle of water, so that you don't have to handle any refreshments
- asking your clients to wash their hands or use hand sanitiser as soon as they arrive for treatment, to help protect you and any staff or family that may be using the premises
- ensuring that any fabric items that are needed for the treatment but cannot be disinfected or washed between each client – such as bolsters - are covered in a non-porous material that can be effectively wiped down with disinfectant and then covered with something soft and replaceable/ washable between clients. (It is important to note that porous materials, such as pillowcases, sheets and couch roll – even if replaced between clients – may not prevent COVID-19 from reaching the underlying objects they are intended to ‘protect’, such as couches, couch covers and towels.) However, please think carefully about whether these items are actually essential, or if something that can be replaced/washed between clients can used as an alternative at this time, such as a rolled up towel in place of a bolster.
- using single use/ disposable alternatives where available and practical, until the pandemic has passed
- ventilating the treatment room between clients, particularly if you work in a confined area
- depending on the current advice from the UK government and health authorities, wearing – and asking your clients to wear - appropriate personal protective equipment (PPE), such as a face mask
- wearing durable, disposable gloves, when cleaning your work premises and treatment space
- using a foot-operated pedal bin with a lid and plastic liner for rubbish
- storing dirty laundry in a plastic, resealable bag that can be dispoded of once emptied
- changing your therapy tunic/top after cleaning and preparing the treatment area for the next client, as an extra precaution (unless the UK government and health authorities have advised the use of a plastic apron or similar).
If you and/or your clients are using any PPE, ensure these are removed and disposed of safely - guidance on how to do this can be found on the government website.
Guidance can also be found on the World Health Organisation and NHS website about hand washing and the use of hand sanitisers and disinfectants.
While it is possible that you or one of your client’s may be ‘asymptomatic’ (carrying COVID-19 without any obvious symptoms) you can help to reduce the risk of exposing yourself or your clients to the virus by some simple pre-treatment checks:
- If you or anyone you are in close contact with has symptoms of the virus, defer seeing clients for the relevant period of time (as outlined by the NHS/government). As an extra precaution, even if you are feeling well, you might like to consider checking your own temperature at the beginning of each workday and if you have signs of a fever, defer clients for the relevant period of time.
- Call your client 24 hours before their planned treatment to check whether they are in self-isolation or have been in close contact with someone who has symptoms of COVID-19. If the answer is yes to either of these questions, defer their treatment for the relevant period of time. You may also wish to ask your client to check their temperature on the morning that they are due to come to you for a treatment, and if this is higher than usual, defer their treatment.
The consultation process and aftercare advice
As a professional therapist, it is important to carry out a consultation prior to ALL treatments, to ensure that the most appropriate treatment is being given to the client and that no new contraindications or contra-actions have occurred between treatments.
Rather than adapt your existing consultation form, you could look to incorporate an additional one, that asks COVID-19 specific questions. This might include (but is not limited to) the following sort of questions:
- Have you tested positive or had treatment for COVID-19?
- Have you, or has anyone you are in close contact with, had any of the following signs or symptoms associated with coronavirus [list latest signs and symptoms]
- Have you been strictly following the social distancing measures outlined by the government during COVID-19?
- Did you check your temperature this morning and was it normal? (If your client is comfortable to do so, you could potentially ask them to carry out a temperature check in front of you, using a forehead strip or ear thermometer.)
You might like to consider switching to online consultation forms to remove the need for handling paperwork and pens. If this is not practical, then ensure that your pen is on your checklist of things to disinfect between clients.
Before your client leaves (or you leave your client, if providing a mobile service), along with any usual aftercare advice you provide, encourage them to stay safe and to be vigilant in terms of any signs or symptoms that they or someone close to them may have COVID-19.
To offer further support, you could point your clients to trustworthy sources of information about COVID-19 and feel free to share with them links to the various self-care articles and videos we have published on the FHT blog (visit fht.org.uk/blog). If you feel your client’s mental health is suffering and this is outside your scope of practice, please consider referring them to an appropriate charity, such as Mind, or an Accredited Register that offers talk therapies, such as counselling or psychotherapy.
As always, make sure you document everything on your client’s records, including a link or attached document that outlines any extra precautions you have put in place during their treatment to minimise the risk of COVID-19 cross-contamination.
Creating a new COVID-19 specific policy
As your business practices will be changing for some time due to COVID-19, we recommend that you create a COVID-19-specific policy outlining what these changes are, for the benefit of your existing and prospective clients. For example, this might include top line information about:
- how you will be monitoring the health of you, your staff and your clients, to reduce the risk of spreading COVID-19
- deferring any treatments if you, your staff or the client is displaying any signs or symptoms of COVID-19 (including your terms of business, if a treatment is cancelled or deferred by either party as a result of COVID-19)
- your hygiene checklist that you will be using between treatments
- whether you will be wearing any PPE, or asking your client to wear PPE, on arrival for treatment
- if you will be adapting or restricting your treatments in any way.
Make sure you have active membership and insurance
As part of your planning to return to full practice, please ensure that your FHT membership and insurance is current and active.
Other things you might like to consider
Give yourself plenty of time between treatments
Build extra time into your schedule to allow for: asking more questions during the consultation process; carrying out enhanced hygiene protocols between clients; and ensuring that clients aren’t leaving and arriving at exactly the same time. If you have a waiting area, or share premises with other practitioners, you will need to ensure that clients are kept a safe distance apart.
Be flexible and prepared for change
It is possible that the government and other authorities may change their guidance on certain matters, from who should be wearing what sort of PPE and in what contexts, to re-introducing social distancing measures if the number of people affected by COVID-19 rises again. Bear this in mind and be prepared to adapt your working practices accordingly.
You may struggle to get hold of products
As the demand for certain products are in high demand and many suppliers are being impacted by COVID-19, deliveries may take longer than usual or you may struggle get hold of certain products and equipment at this time. Build in this extra time and start planning for your supply of these goods.
Will you be comfortable to treat what the government defines as ‘vulnerable’ or ‘high risk’ clients, or those shielding someone who meets the criteria?
If not, outline this in your COVID-19 specific policy, explaining your reason for not treating vulnerable clients, and at what stage you will be reviewing this.
What if you are a vulnerable person or uncomfortable about resuming work?
If you are a self-employed therapist and government guidelines indicate that it is safe for you to resume business but you are concerned for your own health and safety, or that of your family and clients, you are not obliged to return to work. What you would need to consider (and find out) is if this might impact your eligibility to continue receiving any financial support from the government that you were entitled to as a result of COIVD-19. If you are employed and your employer requests you to return to work, we would recommend you seek advice from Citizen’s Advice.