Consultation on our guidance on visiting in care homes, hospitals and hospices

Introduction 

Visiting people in health and care services is vital to their health and wellbeing. We therefore welcome the Government’s response to the consultation on visiting in care homes, hospitals, and hospices, and the finding that most people supported the proposal to introduce a fundamental standard on visiting that care homes, hospitals and hospices must meet. 

The COVID-19 pandemic brought existing concerns about visiting and being accompanied to appointments into the spotlight, as restrictions were imposed to control the risk of transmission of this new virus that was not well understood.  

The restrictions meant that people sometimes died or went through extremely difficult experiences without their family or friends by their side. This added to their distress. It also made grieving more difficult for their families and friends. 

We are still learning about the long-term impact of the restrictions on visiting. But it is widely reported that the restrictions on visiting in care homes had a detrimental effect on the health and wellbeing of residents, their families and their friends.  

We also know that restrictions to visiting can have a disproportionately negative effect on certain groups, such as people with a learning disability and people living with dementia. These groups may rely on the support offered through visiting to communicate and advocate for their health and wellbeing. 

We have seen examples of the creative ways in which many health and social care providers helped facilitate visiting during the pandemic, at a time when they found national guidance about requirements and obligations unclear. But we also saw, in some instances, unreasonable restrictions that negatively affected people’s lives for longer than necessary. 

Now that the government has published the amendment to to the Health and Social Care Act 2008 (Regulated Activities) Regulations 2023 to add a regulation on visiting and accompanying, we are seeking your views on our draft guidance for providers to comply with the law and help them understand people’s right to receive visits.

The new fundamental standard 

The government’s consultation in summer 2023 invited comments on plans to introduce secondary legislation to ensure that visiting is protected and prioritised in care homes, hospices and hospitals registered by CQC. 

The consultation, which received around 1,400 responses, found that most people supported the proposal to introduce a fundamental standard.  

Following the consultation, the Department of Health and Social Care (DHSC) has laid a new Regulation 9A in Parliament which sets out a new fundamental standard on visiting and accompanying that will apply to care homes, hospitals and hospices.  

The regulation aims to make sure: 

• people staying in a care home, hospital or hospice can receive visits from people they want to see 
• people living in a care home are not discouraged from making social visits outside the home 
• people attending appointments in a hospital or hospice, that do not require an overnight stay, can be accompanied by a family member, friend or advocate if they want someone with them. 

These are necessary for people’s health and wellbeing and to protect the rights of each person to receive visits and to be accompanied, following an assessment of their needs and preferences. 

The new fundamental standard is intended to highlight the importance of visiting for people using health and social care services, and that visits should never be unreasonably restricted.

Visiting should only be restricted in exceptional circumstances, such as where a visit would pose a serious risk to the health, safety or welfare of the person using the service or other people on the premises.  

The regulation will come into force in April 2024. 

Our guidance on the new fundamental standard 

We have a legal duty to issue guidance on compliance with the fundamental standards. 

We have therefore drafted proposed guidance to help providers and other stakeholders understand the new standard on visiting and their roles and responsibilities under it. It also sets out what people using relevant health and social care services and their families, friends or advocates can expect. 

The addition of visiting as a new fundamental standard in Regulation 9A recognises its importance and ensures that we can take timely action when services unreasonably restrict visiting. 

The new fundamental standard puts a focus on visiting and helps providers understand the process for decision making about enabling visits, and gives us a clearer basis to clarify our expectations and take action where required, including: 

• identifying a breach by a provider 
• being able to use our civil enforcement powers to take action when it is necessary and proportionate to do so 
• recognising good practice.  

We will apply our human rights approach to regulation when assessing whether providers have met their responsibilities under the new fundamental standard. 

We have a legal duty to consult when we make substantive changes to our guidance, and we invite views through this consultation.