New CQC standards signal the end of fixed visiting times for hospitals, care homes and hospices

The Health and Social Care 2008 (Regulated Activities) (Amendment) Regulations 2023 make significant changes to the rules for visitors at hospitals, hospices and care homes. The new Regulations will come into effect on 6 April 2024.

The new standards that registered operators will have to comply with are set out in full at the end of this blog but the key points are as follows:

1. Operators will have a general duty to facilitate visits for anyone staying overnight in a care home, hospital, or hospice or in longer-term care.
2. A prohibition on a resident having visitors will only be allowed in “exceptional circumstances”;
3. The way in which residents are to be facilitated to have visits, so far as reasonably practicable, reflects the preferences of the patient as opposed to being in accordance with rules set by the operator;
4. Care homes are prohibited from discouraging visits outside the care home and should take such action, or putting in place such precautions, as is necessary and proportionate to ensure that service users may receive visits or be accompanied safely when going out;
5. In making decisions about arrangements for visits, the resident has to be involved; and
6. Even where care and treatment does not involve an overnight stay, hospital and hospice users must be “enabled” to be accompanied by a family, member, friend or supporter.

These new standards appear to require hospitals, care homes and hospices to end fixed visiting times. It thus appears that signs saying that visitors are only permitted between defined hours will need to be taken down unless an operator can say that it is not reasonably practicable to allow visitors at other times. That appears to be a high bar.

From the perspective of residents and their prospective visitors, these are welcome, humane changes which support patients’ and service users’ rights to be accompanied during their care and to enjoy contact with the outside world, both within care settings and outside them. They will be seen as particularly timely given that visiting was so restricted during the pandemic. It will be a matter for the Covid19 Inquiry to express a view on whether those restrictions were justified. The positive duty to facilitate visits appears particularly valuable as it reflects the crucial role service providers can play in ensuring that service users avoid social isolation.

The new standards may be less welcomed by those operating some hospitals and care homes because they appear to require substantial changes to be made to long standing methods of managing visitors.

The text of the new standards is as follows:

Visiting and accompanying in care homes, hospitals and hospices

“9A.—(1) This regulation applies to a registered person in respect of a relevant regulated activity carried on in a care home, hospital or hospice.

(2) Unless there are exceptional circumstances, service users—

(a) whose care or treatment involves an overnight stay or the provision of accommodation in a care home, hospital or hospice, must be facilitated to receive visits at those premises;

(b) who are provided with accommodation in a care home, must not be discouraged from taking visits out of that care home;

(c) who attend a hospital or hospice for the provision of care or treatment which does not involve an overnight stay, must be enabled to be accompanied at those premises by a family member, friend or a person who is otherwise providing support to the service user.

(3) Without limiting paragraph (2), the things which a registered person must do to comply with that paragraph include—

(a) in relation to paragraph (2)(a), securing that service users are facilitated to receive visits in a way that is appropriate, meets the service user’s needs and, so far as reasonably practicable, reflects their preferences;

(b) in relation to paragraph (2)(a) and (c), taking such action, or putting in place such precautions, as is necessary and proportionate to ensure that service users may receive visits or be accompanied safely;

(c) securing that, when making arrangements or decisions in respect of a service user for the purposes of paragraph (2), regard is given to any care or treatment plan for the service user;

(d) involving relevant persons when making any arrangements or decisions in respect of a service user for the purposes of paragraph (2)”

Miranda Butler is a barrister at Landmark Chambers specialising in public law and human rights. She also teaches at LSE University.