Consultation outcome

Visiting in care homes, hospitals and hospices

Updated 20 December 2023

This was published under the 2022 to 2024 Sunak Conservative government

Applies to England

Ministerial foreword

Visits from loved ones are vital to the health and wellbeing of people receiving care in care homes, hospitals and hospices. We know how much these connections matter, whether through the practical care an individual provides to a loved one, support and advocacy during a difficult medical appointment, or the comfort provided from a held hand or a hug. It is not a ‘nice to have’, but a vital part of providing individuals with the high-quality care everyone deserves. We want everyone to be able to see and support the people they love in health and care settings.

We know that there have been concerns about visiting restrictions in health and care settings for several years, and the restrictions introduced in response to the COVID-19 pandemic exacerbated these concerns. While those restrictions were in place at the time to control the risk of transmission and keep people safe, we understand how detrimental it was for loved ones to have been kept apart or not to have had someone supporting them in hospital. We constantly sought to enable safe visiting wherever possible and made it clear that end of life visiting should always be possible regardless of the setting. Guidance is now clear that visiting should be encouraged and facilitated in all circumstances.

We recognise the considerable efforts that so many health and care settings have made to get back to normal on visiting. However, we know that some restrictions continued beyond the lockdown periods, and we continue to hear of heart-breaking instances where care home residents and hospital patients were unable to see their family and friends for prolonged periods of time or be accompanied when they attend hospital. We understand the harm this can cause to the health and wellbeing of those receiving care as well as how distressing this is for their friends and families visiting and, in many cases, providing vital care, advocacy and support to loved ones.

This consultation therefore seeks views on introducing secondary legislation to protect visiting as a fundamental standard across CQC-registered settings so that no one is denied reasonable access to visitors while they are resident in a care home, or a patient in hospital or a hospice. This includes accompanying people to hospital appointments (outpatients or diagnostic visits).

We urge you to respond to this consultation. The consultation will ensure that we hear directly from those most likely to be affected by this policy proposal and will help us to gather the evidence required to determine what action should be taken on visiting in health and care settings.

Helen Whately, Minister for Social Care

Will Quince, Minister for Health and Secondary Care

Maria Caulfield, Minister for Mental Health and Women’s Health Strategy

Introduction

Visiting plays a crucial role in maintaining good health and wellbeing for both people living in care homes and patients attending hospitals, including mental health settings and hospices. The government is clear that visiting should be encouraged, supported and made as straightforward as possible to allow care home residents (residents) to maintain a meaningful connection with others and spend quality time with the people who are special in their lives.

Similarly, the government recognises the contribution that visiting makes to the wellbeing and care of patients attending hospitals (patients) as well as the emotional wellbeing of their families. No patient should have to attend hospital on their own unless they choose to. References in this document to hospital visitors therefore cover not only inpatient care but also the enabling of patients attending hospital for outpatient, emergency department and diagnostic services to be accompanied by someone if they need or wish to be.

The COVID-19 pandemic brought visiting into the spotlight due to the restrictions that were necessary at the height of the pandemic to control the risk of transmission from a new virus that was not well understood. We know the impact of the restrictions meant patients sometimes died or went through extremely difficult experiences without their loved ones by their side. This exacerbated distress and made the grieving process worse for family members. We are still learning about the long-term impact the restrictions on visiting had. It is also widely recognised that the restrictions on visiting in care homes had a hugely detrimental effect on the health and wellbeing of residents and their families and friends. We also know that restrictions to visiting can have disproportionately large effects on certain groups, for example people with a learning disability who may struggle to communicate and advocate for themselves.

As we moved away from the emergency pandemic measures, we know that both care homes and hospitals have made great efforts to return to pre-pandemic visiting. On 19 May 2022, Amanda Pritchard, NHS England CEO, wrote to all NHS hospital trusts reminding them that NHS England’s national principles for hospital visiting remain the absolute minimum standard and setting out her expectation that they should be moving back towards visiting in line with pre-pandemic policies - with the default position being that no patient has to be alone unless through their own choice.

For the purposes of this document, ‘hospitals’ includes all NHS hospitals, including acute hospitals, mental health and learning disability settings, as well as independent (private sector) healthcare providers. As above, references to visiting patients includes accompanying patients to hospital outpatient and diagnostic appointments and to hospital emergency departments. Additionally, ‘hospices’ refers to settings registered with CQC as a hospice.

Similarly, care homes have made extraordinary efforts under very challenging circumstances to reopen following the impacts of the worst of the pandemic. Following the transition to the government’s Living with COVID-19 strategy, the Department of Health and Social Care (DHSC) continues to stress the importance of visiting to care providers through guidance, and we know that the vast majority of care homes are following this guidance and only restricting visiting in the most exceptional circumstances. Data collected in the Capacity Tracker, which is a mandatory monthly collection of data from care homes, shows that in the week ending 14 April 2023, 99% of care homes in England were able to accommodate residents receiving visitors, a figure that has been stable since September 2022. However, we think more can be done to ensure that visiting is always facilitated wherever it is safe.

Current guidance and legislation

There is a host of existing guidance, legislation and associated policies that seek to facilitate visits in health and care settings and offer guidance for situations which require, as a last resort, restrictions to be implemented, as well as guidance on what to do if patients, residents or their friends and family have concerns. These are set out below.

Guidance for care homes

Infection prevention and control guidance on visiting arrangements in care homes from DHSC is clear that all care homes in England are expected to facilitate visits and to do so in a risk-managed way. Providers should use risk assessments to make proportionate and appropriate judgments in collaboration with other health professionals such as health protection teams and the local authority in response to challenges such as safeguarding concerns or outbreaks of infection. This may result in changes to visiting such as a recommendation that a face mask is worn by visitors to reduce the risk of infections spreading, or a reduction in the number of visitors allowed at a given time. End of life visiting should always be supported.

DHSC keeps guidance for care homes under review. The guidance is intended to enable and encourage providers, families, and local professionals to work together to ensure that the benefits of visiting on wellbeing and quality of life are well-balanced with protecting residents and staff from the risk of infections.

On 15 December 2022, DHSC announced updates to guidance to enable care homes to initiate their own risk assessments in the event of a COVID-19 outbreak, should they feel able to do so, in order to ensure that any measures implemented are timely and proportionate. This enables care homes to remain fully open for visiting if their risk assessment determines it is safe to do so.

DHSC also works with local health protection teams to ensure that best practice advice is given to care homes to ensure that any restrictions on visiting are used only as a last resort. On 16 December 2022, DHSC’s response to the Joint Commission on Human Rights (JCHR) report was published, highlighting visiting as a priority for the department. This was in response to the commission’s recommendations that DHSC ensures a proportionate approach to visiting which minimises restrictions on visiting and ensures that care homes do not implement blanket bans on visiting, but rather base restrictions on individualised risk assessments.

DHSC continues to review the data collected by the Capacity Tracker to ensure that visiting in care homes is being effectively monitored. By looking at the data, DHSC can more easily identify any issues in specific areas and can address any barriers that may be affecting visiting in care homes. This helps to create an accurate picture of visiting as a whole.

Guidance for hospitals

Similarly, NHS England has published national guidance that sets out the minimum expectations for NHS trusts regarding hospital visiting. This recognises that providers need to facilitate visiting in a risk-managed way, and the health, safety, mental health and wellbeing of patients, communities and staff remains the priority.

Subject to that, there is an expectation in the guidance that - as a minimum standard - patients should be allowed visiting for at least one hour per day, ideally for longer, for 2 visitors at the bedside.

The guidance also includes an expectation that patients can be accompanied where appropriate and necessary to support effective communication and decision making and to assist with their healthcare, physical, psychological, emotional, religious or spiritual care needs. Where visiting is not practical, the guidance states that virtual visits should be supported and facilitated.

Separate guidance for maternity services is provided and additional considerations are also set out for supporting visiting at end of life.

Chapter 11 of the Mental Health Act 1983 code of practice also sets out statutory guidance on visiting patients detained under the Act in hospital.

Following a request from DHSC, NHS England has amended the NHS Standard Contract, which applies to all providers of NHS services (other than primary care), to include a requirement that providers have in place a clinically appropriate policy for hospital visiting. This is required to, at a minimum, meet the standard described in the existing NHS guidance on hospital visiting.

While there is no regular data collection on each NHS trust’s visiting policy and/or status, DHSC regularly engages with NHS England about hospital visiting to seek assurances that trusts are adhering to the national guidance visiting principles as a minimum expectation and that any restrictions are reasonable and proportionate. NHS England expect to update the current guidance later this year and anticipate extending it to introduce a health and care partner policy. They are encouraging providers to move to a more open, person centred and flexible approach to visiting.

CQC regulations

The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (CQC Regulations), set out fundamental standards which must be upheld by all Care Quality Commission (CQC) registered providers.

CQC assesses health and care providers against the fundamental standards and other requirements set out in CQC regulations. Providers are required to comply with certain fundamental standards of care which implicitly cover visiting. These include the following:

• regulation 9 (1) - person-centred care: the care and treatment of service users must a) be appropriate, b) meet their needs, and c) reflect their preferences
• regulation 9 (3)(a) - person-centred care: the things which a registered person must do to comply with regulation 9 (1) include carrying out, collaboratively with the service user, an assessment of the needs and preferences for care and treatment of the service user
• regulation 10 (2) - dignity and respect: a registered person is required to comply with a) ensuring the privacy of the service user, b) supporting the autonomy, independence and involvement in the community or the service user and c) having due regard to any relevant protected characteristics of the service user

CQC carries out assurance regarding visiting as part of their regulation of health and care settings.

In their explanation of the fundamental standards, CQC describe the standard of ‘person-centred care’ as the requirement for an individual to have care or treatment that is tailored to them and meets their needs and preferences. The standard of ‘dignity and respect’ sets out that individuals must always be treated with dignity and respect, including being given support to remain independent and involved with their local community. These standards implicitly include visiting as an option for enabling this.

Although visiting is not explicitly mentioned in the current CQC regulations, it is considered best practice that visiting is not normally restricted, and that any restrictions should be reasonable, proportionate and time limited. This is consistently noted in DHSC guidance on visiting arrangements in care homes and is also expected by CQC, unless there is proportionate rationale. CQC guidance on regulation 17(2)(a) states that all providers should read and implement nationally recognised guidance and be aware that quality and safety standards change over time when new practices are introduced.

CQC has enforcement powers to protect people who use regulated services from harm, the risk of harm, and to protect people’s rights and welfare. Details of these powers can be found in CQC’s table of regulated activities and in the CQC enforcement policy. The majority of regulations are enforced by CQC using their civil powers. This means that where a regulation is breached, CQC can enforce the standards by issuing requirement or warning notices, imposing conditions, suspending a registration, or cancelling a registration. Any action taken in response to breaches of visiting policy without reasonable explanation would be reasonable and proportionate in line with CQC’s enforcement policy.

Other legislation

In addition to the fundamental standards, other legislation may allow individuals to take legal action against their providers. For example, all public authorities in the UK must respect the rights contained in the Human Rights Act 1998, such as respect for private and family life. Under the Human Rights Act, NHS patients have rights which may be extended to independent sector providers where they provide publicly funded care through contractual arrangements, and residents whose placement in a care home is funded by a local authority can directly enforce their rights against the local authority by way of public law proceedings.

Additionally, all care home residents have consumer rights to help ensure that they are treated fairly and are protected if things go wrong. They have these consumer rights whether they pay all the costs of their care, or whether any portion of costs are paid for by their local authority, NHS or health and social care trust. However, these rights are balanced against other rights, such as their right to private and family life, and the rights of other people. This means that there may still be circumstances where a care provider can restrict or even refuse visitors.

Raising concerns

If an individual has any concerns regarding visiting or they believe that a health or care provider is not complying with requirements set out in CQC regulations, they can follow set procedures to provide feedback or raise a complaint. We also recognise that some individuals, particularly the most vulnerable, are not always able to follow these complaints procedures themselves and may need someone to advocate on their behalf. All providers regulated by CQC must have an effective and accessible system for identifying, receiving, handling and responding to complaints. This is a requirement of the CQC regulations (regulation 16) which CQC measures compliance against. Within social care, individuals can raise a complaint to their local authority if the placement is funded by the authority, or they can approach the integrated care board (ICB) if the placement is funded by the NHS. To make a complaint about any aspect of NHS care, treatment or service, individuals should follow the NHS complaints process. The patient advice and liaison service (PALS) can also be used for free, confidential and independent advice to help resolve issues with the hospital in the first instance.

If an individual is not happy with the response from the health or care provider, they are advised to contact the Local Government and Social Care Ombudsman in the case of social care or, where care is NHS funded, the Parliamentary and Health Service Ombudsman. Both bodies can provide more information and support with the complaints procedure, including how to escalate a complaint to the ombudsman where appropriate. The individual is also advised to share information with CQC to inform them of any concerns via their give feedback on care service. CQC does not routinely investigate individual complaints however all feedback is used in the ongoing assessment of providers. CQC’s regulatory approach is risk based, allowing CQC to target their activity where the risk of harm is greatest. CQC continue to monitor providers on whom they have information regarding visiting concerns.

Policy intention and proposal

DHSC wants to ensure that visiting is protected and that it remains a priority for care home providers, hospitals and hospices. We are therefore considering putting visiting on a more mandatory footing.

It is important that any visiting requirement is workable, reasonable and proportionate. We therefore propose to do this by introducing secondary legislation (regulations) to amend CQC regulations to include a specific visiting requirement. This could be done either by introducing a new regulation specifically for visiting, or by amending an existing regulation to include visiting, such as ‘person centred care’ or ‘dignity and respect’.

We are proposing using CQC regulations because CQC inspections are a key vehicle for maintaining standards in health and care settings, and enshrining visiting in legislation would demonstrate to providers the fundamental importance of visiting. It would provide CQC with a clearer basis for identifying a breach by a care home or hospital and apply more pressure to providers who may not be following existing government guidance on visiting. CQC would be able to use civil enforcement powers to address the breach, which would be consistent with action CQC can take in relation to breaches of other regulations - but noting that CQC considers its regulatory response carefully in relation to any breach of regulation and would use its civil enforcement powers only when it is necessary and proportionate to do so.

In addition, the proposed legislation has the potential to support other work DHSC is doing around patient safety. The department recently launched an independently chaired rapid review into data on mental health inpatient settings. The purpose of the review was to investigate the way that data and information is used in relation to patient safety in mental health inpatient care settings and pathways and provide recommendations about how it could be improved. This has included how patient and carer voices are heard and used to identify risks and failings in care. Strengthening the expectation for providers to allow visiting can improve transparency regarding the care being provided and support family, friends, unpaid carers and advocates to provide feedback.

We want the legislation to have as far a reach as possible to health and care settings where visiting is applicable. Therefore, our proposal is for the new visiting requirement to cover CQC-registered settings. This would include:

• hospitals - including NHS hospitals (both acute and mental health trusts) and independent sector providers (again, covering both acute and mental health settings). This would also include accompanying patients to outpatient or diagnostic appointments and to emergency departments at hospitals
• care homes - the requirement would also apply to settings which provide accommodation for persons who require nursing or personal care, where that regulated activity is being carried out in a care home. This would include care homes for both working age and older adults. CQC also regulate the activity ‘personal care’ in other adult social care services such as supported living and extra care housing. However, these settings generally have ‘exclusive possession’ regarding visiting meaning that individuals can decide who can enter their accommodation, and when
• hospices - the requirement would apply to hospice settings providing inpatient palliative and end of life care

This consultation is regarding visits from family, friends and volunteers such as befrienders and includes accompanying patients attending hospitals. It is not considering access to visiting professionals. Any change made regarding visiting would not override pre-existing statutory arrangements regarding visiting professionals, such as the entitlement for people detained under the Mental Health Act 1983 to meet independent mental health advocates (IMHAs) in private if they wish to.

Through this consultation, DHSC wants to better understand the views of those who would be affected by a legislative change, and the most effective way of ensuring that patients and residents can receive visitors whenever it is reasonable and safe. DHSC will also consider the impacts of a legislative change including costs and benefits to hospitals, patients, care providers, residents, their loved ones and to society.

Questions

Current practice in care homes

Question

To what extent do you agree or disagree that there have been unreasonable barriers to visiting people in care homes in the last 3 months?

• strongly agree
• agree
• neither agree nor disagree
• disagree
• strongly disagree

If you answered strongly agree or agree, what do you think these barriers are? (select all that apply)

• residents are concerned about infection risks from visitors
• concern or hesitancy from care homes
• infection prevention control measures (for example, an outbreak of COVID-19)
• insufficient staff capacity
• insurance concerns
• local public health advice is not allowing visits except in exceptional circumstances
• cleaning burden
• administrative burden
• physical space limitations (for example, small corridors, insufficient space)
• strict visiting times
• government guidance is not clear enough
• other (please state, maximum 50 words)

Current practice in hospitals

Question

To what extent do you agree or disagree that there have been unreasonable barriers to visiting people in hospitals in the last 3 months?

• strongly agree
• agree
• neither agree nor disagree
• disagree
• strongly disagree

If you answered strongly agree or agree, what do you think these barriers are? (Select all that apply)

• patients are concerned about infection risks from visitors
• concern or hesitancy from hospitals
• infection prevention control measures (for example, an outbreak of COVID-19)
• insufficient staff capacity
• cleaning burden
• administrative burden
• physical space limitations (for example, small corridors, insufficient space)
• strict visiting times
• NHS guidance is not clear enough
• other (please state, maximum 50 words)

Current position in guidance and legislation

Question

If you have a concern about visiting care homes, how effective do you think the current routes are in resolving them? Please explain your answers, referring to specific routes for raising concerns if relevant. (maximum 200 words)

• effective
• somewhat effective
• somewhat ineffective
• ineffective
• I don’t know

Question

If you have a concern about visiting hospitals, how effective do you think the current routes are in resolving them? Please explain your answers, referring to specific routes for raising concerns if relevant. (maximum 200 words)

• effective
• somewhat effective
• somewhat ineffective
• ineffective
• I don’t know

Introducing secondary legislation

DHSC is proposing to introduce secondary legislation which would amend CQC regulations, either by explicitly referring to visiting as part of one of the existing fundamental standards of ‘person-centred care’ or ‘dignity and respect’, or by introducing visiting as a new fundamental standard. These standards are explained in the ‘CQC regulations’ section above. There would not be any practical difference in enforcement between whether visiting is included as a new standard or as part of an existing standard.

This amendment would apply to providers who are registered to provide the regulated activity ‘accommodation’ for persons who require nursing or personal care - in practice this would cover care homes, both with and without nursing. The standard would also apply to CQC-registered hospitals which carry out a regulated activity (such as treatment for disorder, disease or injury). This would provide a clearer basis for CQC to take enforcement action where visiting was being restricted without a reasonable explanation.

DHSC could set out in legislation that relevant health and care providers may restrict visiting (and accompanying outpatients) only when either they have a reasonable explanation or when specific exceptions, which would be set out in the legislation, apply. The ‘exception-based’ approach would be specific and limited, for example stating that visiting may only be restricted if there is an outbreak of infectious disease in the care home or hospital, or if the resident or patient does not wish to have a visitor. A ‘reasonable explanation’ approach would be wider and would depend on the facts of a particular case.

DHSC’s current preferred option is to include visiting (and accompanying those attending hospital) as a new fundamental standard in regulations. This would include a requirement that a relevant provider does not restrict visiting without a reasonable explanation, based on a dynamic risk assessment and carefully considering the needs of the resident or patient. The legislation could set out examples of what those reasonable explanations could be, and the provider would need to be able to justify their decision to CQC (if required). We are also considering a further requirement for care homes that, in the event of visiting restrictions being introduced in line with the conditions above, they must continue to allow a minimum of one visitor per resident in order to maintain contact between the service user and their friends or family, in line with the service user’s needs and preferences. We would expect there to be very few circumstances where one visitor at a time per resident is not facilitated.

Question

To what extent do you agree or disagree with amending the CQC regulations to include visiting as a standard which will also include accompanying those attending hospital?

This could either be as a new fundamental standard, or as part of an existing standard like ‘person-centred care’ or ‘dignity and respect’.

• strongly agree
• agree
• neither agree nor disagree
• disagree
• strongly disagree

If you answered agree or strongly agree, which of the options below would you prefer?

• having ‘visiting and accompanying those attending hospital’ as a new and separate standard in regulations
• amending the existing ‘dignity and respect’ standard to include visiting
• amending the existing ‘person centred care’ standard to include visiting
• I don’t have a preference
• I don’t know

If you answered disagree or strongly disagree, which of the following reflects your view on introducing legislation to amend CQC regulations to include visiting (or accompanying those attending hospital)?

• it goes too far - current visiting guidance and practice is sufficient
• it does not go far enough
• other (please state, maximum 50 words)

DHSC could introduce a legal requirement that a provider does not restrict visiting (or accompanying those attending hospital) without a reasonable explanation. While this option would not require an exhaustive list to be included in legislation, we would set out a list of acceptable reasonable explanations in guidance, and where the explanation is not covered in the list, the onus would be on the provider to explain why the decision is reasonable, if asked by the CQC.

Alternatively, DHSC could introduce a legal requirement which states that providers can only restrict visiting (or accompanying those attending hospital) if a specific exception applies, and regulations would set out what those exceptions might be. These exceptions would help to ensure that residents, staff and visitors remain safe, and to account for some practical considerations. Further information on reasonable explanations and exceptions is in the next section.

Question

If legislation were introduced on visiting, which of the following amendments to CQC regulations would you support if any? (select all that apply)

• visiting (including accompanying those attending hospital) is only restricted if there is a reasonable explanation
• visiting (including accompanying those attending hospital) is only restricted if a specific exception set out in the legislation applies
• if visiting (including accompanying those attending hospital) has been restricted health and care providers should assess how they can still facilitate some form of visiting
• providers should notify CQC if they are imposing visiting restrictions
• none of the above
• other (please state, maximum 50 words)

Question

Which settings do you think the amendment to CQC regulations should apply to, if any? (select all that apply)

• care homes
• NHS hospitals (acute)
• NHS hospitals (mental health)
• independent hospitals (non-NHS acute)
• independent hospitals (non-NHS mental health)
• hospitals or services for substance misuse or rehabilitation
• hospices
• other (please state, maximum 50 words)
• none

Question

Do you think there are other options that would help facilitate visiting in care homes and hospitals instead of introducing legislation?

• yes
• no

If you answered yes, which other options do you think would help instead of introducing legislation?

• stronger and more consistent advice in government and/or NHS guidance
• clearer and more accessible information for visitors to inform them of how and when to visit, produced by care providers or hospitals (for example, information leaflets, posters, emails, correspondence)
• accessible information provided by DHSC which informs visitors how and when it is appropriate to visit
• other (please state, maximum 50 words)
• none

Question

If the regulations were amended to apply to hospices, are there any special considerations that you think should be made? (maximum 250 words)

Reasonable explanations and specific exceptions

DHSC could introduce a legal requirement that a provider does not restrict visiting without a reasonable explanation, with the onus being on the provider to explain why the decision is reasonable, if asked by the CQC.

Alternatively, DHSC could introduce a legal requirement which states that providers can only restrict visiting if a specific exception applies, and regulations would set out what those exceptions might be. These exceptions would help to ensure that residents, staff and visitors remain safe, and to account for some practical considerations.

Health and care providers must follow public health guidance and advice on how to keep residents and staff safe and protected from anything that could cause them harm. Certain situations may arise where the protection against risks will outweigh other harms such as those caused by visiting restrictions. We would expect that, as a rule, end of life visiting would always be accommodated by providers, and therefore these exceptions may not apply.

If we take an exception-based approach, exceptions to the requirement that a provider does not restrict visiting (including accompanying those attending hospital) unless an exception applies could include the following situations.

If the resident or patient does not wish to receive a visitor

A resident or patient may not wish to receive a visitor due to feeling unwell or through personal choice, or if the resident or patient lacks the mental capacity to determine if they should receive a visitor, a best interests decision not to receive a visitor may be made on their behalf. It is up to health and care providers to ensure that the person’s wishes are respected by staff and potential visitors. If a person lacks capacity to make a decision about receiving a visitor, visits should still be enabled unless this is not in the person’s best interests. In this situation, a best interests decision should be made and recorded in line with the best interest checklist in section 4 of the Mental Capacity Act 2005 by considering all relevant circumstances, including the person’s wishes and feelings, beliefs and values, the views of their family, and what the person would have wanted if they had the capacity to make the decision themselves. More information can be found in the Mental Capacity Act guidance.

If a visitor is confirmed to have an infectious disease or is confirmed to be a contact of someone who has an infectious disease

Visitors may be suffering from or carrying an infectious disease that would pose a threat to individuals living in the care home or hospital. This is because some people receiving care are likely to have a higher risk of developing a severe illness from infectious diseases, and these settings tend to be enclosed settings where infection may spread quickly. A visitor may be denied access to a care home or hospital if they pose a known and immediate risk of spreading an infection which would pose a risk to the health and safety of individuals within the care setting or hospital.

If the person being visited has an infectious disease or there is an outbreak in the care home or hospital

If a care home resident or a hospital patient has an infectious disease where there is a risk of transmission, this may put those who visit them at risk of contracting that disease, as well as spreading it to the wider community. If this would pose a significant public health risk, there may be circumstances where the care home or hospital may wish to consider some limited restrictions on visiting. In this situation they should be able to explain the reasons for any visiting restrictions, ensuring that these are proportionate to the risks and that they have considered ways to maintain visiting, such as ensuring that a minimum of one visitor is still allowed.

If a visitor is a risk to the physical and/or mental health and wellbeing of residents, patients and/or staff

Examples of this could include a visitor who:

• has been physically or verbally abusive to staff, residents or patients at a care home or hospital
• has stolen or damaged property or been financially abusive to a resident or patient
• is behaving erratically or is under the influence of alcohol or drugs
• is supplying a resident or patient with drugs
• is a visitor refusing to follow infection prevention and control processes put in place by the health or care setting such as practicing hand hygiene or wearing appropriate PPE

Providers must have robust procedures to prevent people using the service from being abused by staff or other people, including visitors, and to protect the health and wellbeing of service users, staff and other visitors. Where an individual lacks the capacity to decide if they should have contact with a named individual a best interests decision should be made and recorded in line with the best interest checklist in section 4 of the Mental Capacity Act by considering all relevant circumstances, including the person’s wishes and feelings, beliefs and values, the views of their family, and what the person would have wanted if they had the capacity to make the decision themselves. As laid out in the Mental Capacity Act code of practice, it may be appropriate to seek a decision from the Court of Protection if it is suspected that a person who lacks capacity to make decisions to protect themselves is at risk of harm or abuse from a named individual.

If a patient’s treatment plan does not include visiting, in order to aid their recovery

In some circumstances a patient’s treatment plan may include not having visitors for a short amount of time, for example in a rehabilitation facility as visitors may put their recovery at risk. In this situation the restrictions should be proportionate to the risk posed to the patient by receiving visitors.

If a visitor is requesting to visit at a time outside standard, reasonable, visiting hours (such as late at night or early in the morning)

An individual may wish to visit someone at a time which does not fit standard, reasonable, visiting hours. This may be disruptive to the person receiving the visit, or to other residents or patients. The length of a visit may also be taken into consideration as it may not be appropriate for a provider to accommodate a visitor for long periods of time such as a whole day. Providers would need to be able to demonstrate what made a certain time unacceptable, for example if it interfered with their ability to provide necessary care or was disruptive to other residents or patients. If this exception was included, we would expect that providers would offer alternative visiting times that are convenient, where visitors cannot make normal visiting hours (if applicable) and that consideration would be given to how far relatives may have to travel to visit if, for example, someone has been placed ‘out of area’. It is worth noting that what constitutes ‘reasonable visiting hours’ will differ across health and care settings and would need to be established based on the setting - for example some hospital wards will need to have more limited visiting hours than care homes.

If there is an unforeseen emergency occurring in the home or hospital and visiting cannot be safely accommodated

There may be times where it is unsuitable for anyone, including visitors, to go to certain parts of a care home or hospital or an unforeseen circumstance or emergency requires closure of a care setting or hospital. These could include, but are not limited to, a fire being identified and dealt with, an ongoing medical emergency, a resident or patient behaving violently or police involvement.

If the care home or hospital does not have the capacity to receive a large number of visitors

If the care home or hospital only has capacity for a certain number of people to be in the building or available space, then by default, the setting would be unable to accommodate a large number of people, including visitors. For example, if it would be impractical for a single resident or patient to receive a large number of friends or family at one time.

Question

What would you describe as an ‘unreasonable time’ to accommodate visiting in a care home? (maximum 100 words)

For example, after 8pm when residents will be preparing for sleep, during meal times, or if there is an emergency happening at the care home.

Question

Which of the following, if any, should be included as an exception enabling visits to be restricted in care homes? (select all that apply)

• if the patient does not wish to receive visitors
• if a visitor is confirmed to have an infectious disease or is confirmed to be a contact of someone who has an infectious disease
• if the person being visited has an infectious disease or there is an outbreak in the relevant part of the hospital
• if a visitor is a risk to the physical and/or mental health and wellbeing of patients and staff
• if a visitor is requesting to visit outside standard, reasonable visiting hours
• if there is an unforeseen emergency occurring at the hospital
• if the hospital/ward does not have the capacity to receive the number of visitors wishing to visit
• if a patient’s treatment plan restricts visitors in order to aid their recovery
• other (please state, maximum 50 words)
• none of the above

Question

DHSC is considering a specific requirement that care homes must, as a minimum, allow one visitor at a time per resident, as far as is safe.

Are there any circumstances in which you think it would be appropriate for care homes not to allow one visitor at a time per resident? (select all that apply)

• if the resident does not wish to receive visitors
• if a visitor is confirmed to have an infectious disease or is confirmed to be a contact of someone who has an infectious disease
• if the person being visited has an infectious disease or there is an outbreak in the relevant part of the care home
• if a visitor is a risk to the physical and/or mental health and wellbeing of residents and staff
• if a visitor is requesting to visit outside standard, reasonable visiting hours
• if there is an unforeseen emergency occurring at the home
• if the care home does not have the capacity to receive the number of visitors wishing to visit
• other (please state, maximum 100 words)
• none of the above

Question

What would you describe as an ‘unreasonable time’ to accommodate visiting in a hospital? (maximum 100 words)

For example, after 8pm when patients will be preparing for sleep, or during meal times.

Question

Which of the following, if any, should be included as an exception enabling visits to be restricted in hospitals?

(select all that apply)

• if the patient does not wish to receive visitors
• if a visitor is confirmed to have an infectious disease or is confirmed to be a contact of someone who has an infectious disease
• if the person being visited has an infectious disease or there is an outbreak in the relevant part of the hospital
• if a visitor is a risk to the physical and/or mental health and wellbeing of patients or staff
• if a visitor is requesting to visit outside standard, reasonable visiting hours
• if there is an unforeseen emergency occurring at the hospital
• if the hospital does not have the capacity to receive the number of visitors wishing to visit
• other (please state, maximum 50 words)
• none of the above

Question

In the event that a care home or hospital is restricting visiting, are there any steps that you think they should take to continue to facilitate some form of visiting? (select all that apply)

• visits being supervised
• visiting only allowed to take place in specific areas that are isolated from other residents or patients
• limiting the number of visitors
• allowing minimum of one visitor
• visitors submitting notice before visiting
• requiring PPE, socially distancing or other additional infection prevention and control measures if there is a risk of the transmission of infectious diseases
• facilitating ‘virtual’ visits for example by video
• other (please state, maximum 50 words)

For those detained under the Mental Health Act, chapter 11 of the Mental Health Act 1983 code of practice sets out statutory guidance on visiting patients in hospital and circumstances where it may be necessary to consider the exclusion of visitors. All patients detained under the Mental Health Act 1983 have a right to maintain contact with family and friends and to be visited, subject to carefully limited exceptions. The act gives certain people the right to visit patients in private and hospital managers have the right, under certain circumstances to restrict or refuse visitors, or require them to leave.

Question

If amendments to CQC regulations were also applied to mental health inpatient settings, would any further specific exceptions need to be considered for detained patients?

• yes (please state, maximum 100 words)
• no
• I don’t know

Visiting out

This section is only applicable to care homes. It is not applicable to hospitals.

DHSC expects and encourages providers to facilitate residents to take part in visits out of the care home. This could be:

• for a short walk
• to attend a place of worship
• for education
• to attend work
• or for a longer visit, including an overnight stay to see family and friends

Just like with care homes receiving visitors, there should not normally be any restrictions to residents wishing to take part in a visit out of a care home, unless the provider can provide a reasonable explanation, based on a risk assessment and the needs of the person using the service.

Data collected through the Capacity Tracker indicates that out of the care homes that responded ‘yes’ to being able to accommodate visiting, 90.9% of those were also able to accommodate visits out of the care home setting. Visits out of the care home are an important part of life as they provide opportunities for residents to stay connected with friends, family, and their wider community. As such, they should be encouraged and promoted.

The proposed introduction of secondary legislation would amend regulations to introduce a new legal requirement for visiting out for care home residents. Care home residents who have the capacity to make decisions about leaving the care home should not be prevented from doing so unless there is proper legal authority to do so. If a person lacks capacity to make a decision about leaving the care home, visits out should still be enabled unless this is not in the person’s best interests. To make this decision, a best interests decision should be made and recorded in line with the best interest checklist in section 4 of the Mental Capacity Act by considering all relevant circumstances, including the person’s wishes and feelings, beliefs and values, the views of their family, and what the person would have wanted if they had the capacity to make the decision themselves. More information about the Mental Capacity Act can be found on the CQC website. A Deprivation of Liberty authorisation must be in place, following the Deprivation of Liberty Safeguard (DoLS) process, or some other legal authority such as a Court of Protection order, if a care home wishes to prevent a resident from leaving their grounds when they wish to do so.

As with the general visiting requirement, our preferred approach is to state that ‘visiting out’ must be allowed unless the care home can provide a reasonable explanation as to why it is not. However, alternatively we could state that ‘visiting out’ must be allowed unless a specific exception, set out in the legislation, applies. The exception-based approach would be more specific and limited, for example stating that visiting out may only be restricted if the resident’s needs cannot be met outside the care home. A ‘reasonable explanation’ would be wider and would depend on the facts of a particular case. The care home would need to be able to justify their decision to CQC if assessed. We would expect any risk assessment to be completed in a timely fashion, and risk assessments not being completed should not usually constitute a reasonable explanation.

Question

Do you think that DHSC should include provision in regulations to state that care homes should allow residents to go on visits out of the care home?

For example, a visit out might refer to a resident wishing to visit the home of a family member or take a walk through the park.

• yes - unless the care home has a reasonable explanation for not allowing it
• yes - unless a specific exception applies
• no
• not sure
• other (please state, maximum 50 words)

If you answered yes - unless an exception applies, which of these do you think should be specifically outlined in regulations? (select all that apply)

• if a resident would like to visit someone who is confirmed to have an infectious disease or is confirmed to be a contact of someone who has an infectious disease
• if the resident has an infectious disease
• if the person the resident would like to visit is a risk to the physical and/or mental health and wellbeing of the resident
• if a resident is requesting to leave the care home at an unreasonable time
• if the resident requires accompaniment and staffing levels are too low to safely accommodate this
• if the resident’s care needs cannot be met outside of the care home
• none
• other (please state, maximum 50 words)

Impact and implications of the policy

DHSC wishes to understand how the policy can be managed to protect all those who are employed by a healthcare setting, receiving care or who wish to visit a healthcare setting. In particular, due to there being a vast diversity and range of people receiving and providing care, DHSC is very interested to understand what more can be done to ensure that people with protected characteristics: would not be differentially impacted by this new policy.

Protected characteristics are:

• age
• disability
• gender reassignment
• marriage and civil partnership
• pregnancy and maternity
• race
• religion or belief
• sex
• sexual orientation

It is against the law to discriminate against someone because of these characteristics.

When answering the following questions, please consider those with protected characteristics in particular. We would also like you to particularly consider how the policy may impact individuals with a lower socio-economic background, or individuals who are carers.

Question

Do you think there will be an effect on care homes if they are legally required to facilitate visiting under CQC regulations?

• yes
• no

Question

If care homes were legally required to facilitate visiting by CQC regulations, how would these settings be affected? (select all that apply)

• care homes would need to employ more staff to safely accommodate more visitors
• where additional employment is not feasible, the extra burden of accommodating visitors would fall to existing care home staff
• care homes would need to conduct and provide more paperwork and administration to cover the relevant regulations
• care homes would be under more pressure to accept visitors in all circumstances, with an effect on staff
• there may be an added cost to ensuring that additional requirements are complied with
• care homes will be more prepared to expect and accommodate visitors
• better opportunities to build relationships with residents and their families and friends
• care homes would have a clearer understanding of supporting visiting in relation to other care activities
• care homes would feel more confident about allowing visiting in difficult situations, such as an outbreak of an infectious disease
• there would be no significant impact
• not sure
• other (please state, maximum 250 words)

Question

If care homes were legally required to facilitate visiting under CQC regulations, how do you think this would affect residents? (select all that apply)

• added pressure on residents to accept visitors who they do not want to see, or at times they do not want to see visitors
• residents’ preferences may not be met if they are unable to communicate their opinion on receiving visitors
• improvement in residents’ wellbeing as they can receive visitors and make social plans
• residents will feel less lonely and will be more engaged with their day-to-day life
• residents will be more mentally stimulated
• residents will be able to build and retain stronger ties with friends and family
• if a resident is ill or unhappy, this may be noticed sooner as visiting friends and family may recognise if something is wrong earlier than staff would
• residents with communication difficulties will be more able to share their wishes or raise concerns due to support from friends and family
• residents who have difficulty advocating for themselves will be more able to share their wishes or raise concerns due to support from friends and family
• no significant impact
• not sure
• other (please state, maximum 50 words)

Question

Do you think there will be an effect on hospitals if they are legally required to facilitate visiting under CQC regulations?

• yes
• no

Question

If hospitals were legally required to facilitate visiting by CQC regulations, how would these settings be affected? (select all that apply)

• hospitals would need to employ more staff to safely accommodate more visitors
• where additional employment is not feasible, the extra burden of accommodating visitors would fall to existing staff
• hospitals would need to conduct and provide more paperwork and administration to cover the relevant regulations
• hospitals would be under more pressure to accept visitors in, with an effect on staff
• there may be an added cost to ensuring that additional requirements are complied with
• hospitals will be more prepared to expect and accommodate visitors
• hospitals would have a clearer understanding of the importance of supporting visiting
• hospitals would feel more confident about explaining why visiting needs to be restricted in exceptional circumstances
• there would be no significant impact
• not sure
• other (please state, maximum 250 words)

Question

If hospitals were legally required to facilitate visiting under CQC regulations, how do you think this would affect hospital patients?

• added pressure on patients to accept visitors who they do not want to see, or at times they do not want to see visitors
• patients’ preferences may not be met if they are unable to communicate their opinion on receiving visitors
• improvement in patients’ wellbeing as they can receive visitors and make social plans
• patients will feel less lonely and will be more engaged with their day-to-day life
• patients will be more mentally stimulated
• patients will be able to build and retain stronger ties with friends and family
• if a patient is ill or unhappy, this may be noticed sooner as visiting friends and family may recognise when or if something is wrong earlier than staff would
• patients with communication difficulties will be more able to share their wishes or raise concerns due to support from friends and family
• patients who have difficulty advocating for themselves will be more able to share their wishes or raise concerns due to support from friends and family
• no significant effect
• not sure
• other (please state, maximum 50 words)

Question

What do you think the effect would be on visitors (including those accompanying patients attending hospital)?

• friends and family would be more able to build and retain close relationships with loved ones
• friends and family would better understand the standard of care their loved one is receiving
• would improve friends and families’ relationships with the care home or hospital and its staff
• visitors would feel more confident making a long journey to see a friend or relative in a care home or hospital
• friends and family would have more opportunities to advocate for their loved one
• no significant impact
• not sure
• other (please state, maximum 50 words)

Questions on care homes only

The next few questions only apply to respondents who either work or have worked in a care home or are the registered manager of a care home.

Question

With the introduction of these changes, what do you think care homes would need to spend more time on? (select all that apply)

• administrative procedures
• facilitating visits (for example, escorting visitors around the building, equipping them with the correct PPE)
• cleaning for infection prevention control
• other (please state, maximum 50 words)
• not sure

Question

What is the expected additional time taken per visitor?

Question

What is the current estimated length of an average supervised visit?

Question

What is the current estimated length of an average non-supervised visit?

Question

What is the estimated percentage of visits that require supervision per care home?

Question

Will this change lead to care homes needing additional PPE?

• yes
• no
• not sure

Question

If you answered yes, what is the additional cost of PPE is expected to be per week?

Question

Approximately how many visitors per resident would care homes expect to receive per week?

Questions on hospitals only

The next few questions only apply to respondents who have stated that they either work or have worked in a hospital or are on a hospital board.

Question

With the introduction of these changes, what do you think hospitals would need to spend more time on? (select all that apply)

• administrative procedures
• facilitating visits (for example, escorting visitors around the building, equipping them with the correct PPE)
• cleaning for infection prevention control
• other (please state, maximum 50 words)
• not sure

Question

What is the expected additional time taken per visitor (or person accompanying someone attending hospital)?

Question

What is the current estimated length of an average supervised visit?

Question

What is the current estimated length of an average non-supervised visit?

Question

What is the estimated percentage of visits that require supervision per hospital?

Question

Will this change lead to hospitals needing additional PPE?

• yes
• no
• not sure

Question

If you answered yes, what is the additional cost of PPE expected to be per week?

Question

Approximately how many visitors per patient would hospitals expect to receive per week?

Further information

Question

Is there any evidence or quantitative research on the benefits to residents and/or patients from receiving visitors that you wish to refer DHSC to? (maximum 250 words)

Question

Do you have any further comments about anything that this survey has covered? (maximum 500 words)

Please do not include information that could identify an individual or member of the public.

How to respond

The easiest way to respond is by completing the online survey.

If you have any problems with using the online survey, please email [email protected]. Do not send your consultation answers or any personal information to this email address.

Next steps

We are aware that the proposed visiting requirement may impact the hospital and care sector. We intend to undertake a full impact assessment to inform the final policy and decision to proceed, in order to assess benefits and costs to care providers, as well as to residents, their loved ones, and society. This will be published in due course.

Privacy notice

Summary of initiative or policy

The Department of Health and Social Care (DHSC) are proposing to introduce secondary legislation to amend the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 to add visiting as a fundamental standard which Care Quality Commission (CQC) inspect care and health settings against. This would provide a clearer basis for the CQC to take enforcement action against providers who are unduly restricting visiting.

The government wants to ensure that visiting is protected and remains a priority for health and care providers. A care home is, and should feel like, home for residents, always allowing reasonable and proportionate access for visitors. Health settings should also have reasonable and proportionate access to visitors as they can play a key role in promoting the health and recovery of patients. Being able to see friends and family can help patients feel more at ease and provides opportunities for social interactions.

The inclusion of a specific visiting fundamental standard would provide the CQC with a clearer basis for identifying a breach at care or health settings. It is important that any regulations are realistic, attainable, and proportionate.

Data controller

Department of Health and Social Care is the data controller

What personal data we collect

We will collect data on age, geographical location, sex and gender. This will help us to understand whether there are any links between these characteristics and experiences of or opinions on visiting.

How we use your data (purposes)

The aim of publishing a public consultation is to gain a better understanding of what the impacts of legislative change would be and to seek thoughts and opinions from those who would be affected. We want to better understand the most effective way of ensuring that individuals residing in care homes or are receiving care in health settings can receive visitors whenever it is safe. Any data processed will allow us to better understand how different groups will be affected by the change and allow us to ensure that groups are not disproportionately affected (for example those with particular protected characteristics).

We are hoping to collect the relevant data on this subject in the form of a consultation document or survey. The answers provided will help us to gather more information on key aspects of the proposed introduction of secondary legislation. The anonymised data will be analysed, collated, and aggregated by DHSC, and the summarised results and outputs published as part of the government’s response to the consultation.

Legal basis for processing personal data

Under Article 6 of the United Kingdom General Data Protection Regulation (UK GDPR), the lawful base we rely on for processing this information is:

• (e) Necessary task in the public interest or controller’s official authority

Data processors and other recipients of personal data

NHS England (NHSE) - the consultation seeks views from people with experience (personal or professional) of visiting in the health sector, so it may be appropriate to share some of the responses with NHSE.

International data transfers and storage locations

Information will only be kept within the UK.

Retention and disposal policy

Responses will be anonymised, and we will retain the data for no longer than 3 years.

How we keep your data secure

DHSC uses appropriate technical, organisational, and administrative security measures to protect any information we hold in our records from loss, misuse, unauthorised access, disclosure, alteration and destruction. We have written procedures and policies which are regularly audited and reviewed at a senior level.

Your rights as a data subject

By law, data subjects have a number of rights and this processing does not take away or reduce these rights under the EU General Data Protection Regulation (2016/679) and the UK Data Protection Act 2018 applies.

These rights are:

1. The right to get copies of information - individuals have the right to ask for a copy of any information about them that is used.

2. The right to get information corrected - individuals have the right to ask for any information held about them that they think is inaccurate, to be corrected.

3. The right to limit how the information is used - individuals have the right to ask for any of the information held about them to be restricted, for example, if they think inaccurate information is being used.

4. The right to object to the information being used - individuals can ask for any information held about them to not be used. However, this is not an absolute right, and continued use of the information may be necessary, with individuals being advised if this is the case.

5. The right to get information deleted - this is not an absolute right, and continued use of the information may be necessary, with individuals being advised if this is the case.

Comments or complaints

Anyone unhappy or wishing to complain about how personal data is used as part of this programme, should contact [email protected] in the first instance or write to:

Data Protection Officer
1st Floor North
39 Victoria Street
London
SW1H 0EU

Anyone who is still not satisfied can complain to the Information Commissioners Office. Their website address is www.ico.org.uk and their postal address is:

Information Commissioner’s Office
Wycliffe House
Water Lane
Wilmslow
Cheshire
SK9 5AF

Automated decision making or profiling

No decision will be made about individuals solely based on automated decision making (where a decision is taken about them using an electronic system without human involvement) which has a significant impact on them.

Changes to this policy

This privacy notice is kept under regular review, and new versions will be available on our privacy notice page on our website. This privacy notice was last updated on 21 June 2023.