Government to explore legislating visiting rights for people in health and care

Visiting regulation under review

The Department of Health and Social Care (DHSC) has published the findings of their review of Regulation 9A: visiting and accompanying in care homes, hospitals and hospices. Regulation 9A was introduced as a new ‘fundamental standard’ in the Care Quality Commission (CQC) regulations in April 2024. One year on, DHSC began a review to see how effective the regulation has been.

The review found that family and friends play a vital role for people receiving care, but too many have faced unnecessary barriers to visiting, and have been excluded from key decisions about their care. Regulation 9A sets out requirements on health and social care providers to make sure that patients and residents can see their loved ones, but the review confirms what we hear through our adviceline - that that is not always the case.

New legal right being explored

Setting out the flaws with Regulation 9A, the review commits to exploring proposals for legal changes to promote the importance of family and carers as equal partners in care. This provides important recognition that access to trusted loved ones can only be guaranteed with a legal right that sits with the person receiving care, rather than a duty contained in CQC Regulations. We have long been campaigning for this new right (alongside our campaign partners) and welcome this commitment.

Visitors or partners in care

We have worked closely with the DHSC throughout this review to emphasise the challenges still faced by people that are not resolved by Regulation 9A. One of the key findings from the review is the need to recognise that loved ones are not just visitors, they are partners in care. The report emphasises that access to loved ones supports wellbeing, trust and recovery, with restrictions causing distress, isolation and harm to mental and physical health.

Lack of enforcement

The report finds a lack of appropriate complaint routes available if visiting restrictions are imposed despite Regulation 9A. Though 79% of individuals in care homes responding had challenged restrictions, only 20% felt their issue was resolved.

The review also found that 42% of individuals representing personal views found current complaints routes ineffective, compared to 6% of individuals sharing professional views, and 4% of organisations. This is a clear disparity, and reflects ongoing concerns that we have about the power imbalance for people reporting concerns, where they are afraid to speak out for fear of reprisals. Every day our adviceline hears from people too afraid to raise issues or report concerns to the CQC for fear of repercussions, including visiting restrictions or eviction.

A significant culture change is needed, shifting power towards people drawing on care. Though the report commits to ensuring Regulation 9A duties are factored into the new ways CQC will be inspecting services (their ‘assessment framework’), without more radical change we fear that enforcement will not improve. Despite the expectations being on providers to record decision-making in imposing restrictions,  the report highlights the lack of monitoring and enforcement by CQC for breaches of the Regulation. There is a lack of accountability for restrictions being misused, with respondents calling for stronger enforcement, escalation routes and independent oversight.

Different perspectives

Throughout the report there was a mismatch or contradiction between perspectives of providers and individuals sharing personal views. Care home professionals largely reported receiving no complaints about visiting in care settings, and the report found that when managers were asked about training and support in applying the regulation, they reported that it was unnecessary. This misaligns with most individuals reporting complaints, and with evidence from CQC suggesting that limited staff training on decision-making is contributing to poor practice.

Key Recommendations

Exploring new legal protections

Recommendations of the report include ministers exploring proposals for legislative changes to promote the importance of family and carers as equal partners in care. We have long been campaigning for a new legal right to a Care Supporter – a trusted loved one to act as our eyes, ears or voice when we need them. We look forward to working with DHSC to ensure these vital protections are enshrined in law.

Named person

We are glad to see providers being encouraged to ensure care plans have a named person who should be facilitated to visit or accompany the person, though we know that without broader legislative commitment to ensure this happens, best practice like this often gets lost with high pressures on the sector.

Restrictions on visiting

The report identifies a recurring theme of uncertainty around what defines ‘exceptional circumstances’ where visiting may be restricted. The report references that CQC consider that it is not appropriate to publish specific examples of ‘exceptional circumstances’ through guidance and/or examples, as each case needs to be managed in a person-centred way. However, we know from our adviceline that this often manifests in the opposite way, where person-centred care is lost and the lack of clarity about what is exceptional means that the broad definition is misused.

The majority of restrictions reported were due to infection outbreaks. Other reasons cited include internal care home policies, concerns about visitor behaviour, safeguarding concerns or staff/resource limitations. We must see more accountability to ensure that restrictions aren’t embedded in policies or applied due to resource strain, and that where there are concerns about behaviour, these are investigated and evidence-based.

We have supported many people facing individual bans as part of a settling in process, due to staff opinion or due to family disputes, all against the wishes of the person receiving care. We would like to have seen a greater focus on the impact of individuals being restricted and steps to ensure they are managed appropriately.

Visits vs support

We would also have liked to see greater focus in the report on the lack of access to loved ones in decision-making processes in care. We continually support people who cannot have their trusted loved ones involved in their needs assessment, their care plan, their safeguarding report, their complaint or their CQC referral.

Promoting visiting

We welcome the commitment to raising awareness of the Regulation, so that providers have strong understanding and ability to implement it. This should include training on how visiting is protected as a ‘fundamental standard’ – a basic aspect of good care and a standard below which care must never fall.  

Next steps

We welcome the report and the spotlight it has shone on the weaknesses of Regulation 9A. The commitment to explore legislative change is most welcome, to deliver a truly transformative impact for people receiving care.

We should all be able to have the support of our closest friends or family when we need them. The legal right to a Care Supporter would ensure everyone has access to their trusted loved one when they most need support. We look forward to working with the Government to ensure these vital protections are enshrined in law. This must be taken forward as a priority and must not just be an idea that risks getting lost in wider care sector reform work.

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Read the full report from the Department of Health and Social Care.