Care Settings: Right to Maintain Contact

09:35:00

I beg to move, That this House has considered the right to maintain contact in care settings. I appreciate you chairing this debate, Ms Butler, and I am grateful for having secured the time to talk about an issue that has touched thousands of people and left a lasting trauma across our country. I start by thanking the extraordinary campaigners from Rights for Residents, John’s Campaign, Care Rights UK and others, some of whom are in the Public Gallery today. I mention Diane, Jenny and Julia in particular, who have supported me throughout my work on this issue. Their tireless advocacy, often fuelled by personal grief, has sustained a powerful call for change. I also thank everyone who has contacted me ahead of this debate to share their stories. I cannot name them all, but together they form a mosaic of heartbreak and courage. Their voices are the reason that we are here today, and I will do my best to honour them. There are moments in our national life that leave deep scars. One of the most painful of these, still raw for so many, was the enforced separation of families during the covid-19 pandemic. In care settings across the country, people were cut off from those they love, for hours, days, weeks, and months—for some, they were cut off until the very end. Families are still living with the trauma of that separation.

One of my constituents, Tracy, came to speak with me at one of my first surgeries. Her mum, Doreen, was one of the individuals my hon. Friend is talking about; she was in a care home during the covid pandemic and was cut off from a lot of contact, and she suffered as a result. Would my hon. Friend agree that it is important those stories are heard as the next steps on this issue are considered?

I am sure my hon. Friend’s constituent will be grateful—as am I—that she has come to add her voice to this campaign. Families are still living with the trauma of that separation, yet even now, people in care settings are still being denied essential human contact. In those early days, we all understood the need for swift and serious measures to protect public health. But not enough was done to balance that need against the harm of isolation on mental health and wellbeing. Somewhere along the way something vital was lost: the right to connection; the right to love; and the right not to die alone. Let us remember what that meant in real human terms. Elderly people were confined to their rooms in care homes, with no familiar face and no hand to hold. Sick and disabled people were denied a trusted advocate when they needed them the most. Ahead of this debate, Val wrote to me. She told me how she was forced to watch her mother’s health decline through the pane of a glass window. Her mother lost weight, she lost the ability to walk and to feed herself, and in time she became deeply depressed and withdrawn. However, when visits were allowed again, Val saw a transformation. With regular contact, and with care and love from a family member, her mother began to return to herself. Val told me that: “It wasn’t the dementia or covid that got her. It was loneliness, isolation and abandonment.” Gemma also shared her story. She described how her mother was kept in solitary confinement-like conditions. When Gemma’s mum’s partner died suddenly, she had to break the news over a stuttering video call, with no family there to comfort her mother as the grief landed. Those stories represent a pattern of suffering that should never have been allowed and must never be repeated.

I would like briefly to mention the case of the Priestman family in my constituency. Paul Priestman, a military veteran, suffered a stroke in 2019 and now requires care. That is being provided in a care home in Rochdale, many miles from the family home. The family have serious concerns about the quality of Paul’s care, but find they are routinely ignored by the care home. Does my hon. Friend agree that the stories he cites and this debate show that, rather than being viewed as essential to the wellbeing of the person in care, families are too often dismissed, ignored or considered an afterthought by care providers?

My hon. Friend totally grasps the seriousness of the issue. It is why campaigners are fighting for a legal right—Gloria’s law—to maintain contact. That would put into law the right to at least one care supporter, a trusted loved one, to provide support and advocacy in all health and care settings, so that no one is ever alone when they need help the most. The campaign is supported by cross-party MPs; more than 100 organisations, including covid-bereaved groups from all four UK nations; charities; disabled rights groups; and bodies such as the National Care Forum. In response to pressure, the previous Government amended Care Quality Commission regulations to make facilitating visits part of the fundamental standard of care. I pay tribute to the hon. Member for Faversham and Mid Kent (Helen Whately) who steered that through Government in the previous Parliament. The newly inserted regulation 9A requires that in-person visiting in care homes, hospitals and hospices and accompaniment to appointments should always be facilitated by providers in line with people’s needs and preferences. Only in exceptional circumstances should that be restricted. Although that is a welcome step forward, it has fallen short. Just like the guidance that preceded it, regulation 9A lacks clarity, oversight and accountability. In practice, it is too often misunderstood, misapplied or outright ignored. This past winter, Rights for Residents received hundreds of calls from distressed families who were blocked from seeing their loved ones. Outbreaks of flu or norovirus were being used as justification to deny all access, in some cases for more than two weeks, despite regulation 9A being in place. I will give a couple of examples. Tina’s mother, who has dementia, was in hospital being treated for pneumonia, when a blanket visiting ban was imposed due to an outbreak of norovirus. It took days of trying before Tina received any update on her mother’s welfare. Days later, she received a voicemail of her mum’s frail voice whispering, “Don’t give up on me, Tina.” Her mental and physical condition deteriorated rapidly during that time, which Tina believes was exacerbated by their separation. Amanda’s mother, who lost mobility after a brain haemorrhage, depends on family support for personal care and emotional wellbeing. During another blanket ban, Amanda, despite quoting regulation 9A, was told that her mother’s right to contact was not worth the risk. By the time visits resumed, her mother had lost weight and become visibly withdrawn. Many similar experiences have been reported to Care Rights UK’s advice line, from people denied access to their friends and family, including when the care provider was aware of regulation 9A, but still chose not to comply with it. For example, the charity recently supported someone living with dementia who had had visits stopped as part of a settling-in process in their care home. The provider failed to recognise the importance of maintaining support from familiar loved ones as a key part of dementia care. To understand the scale of the problem, Rights for Residents ran a national survey between February and May this year. The results are deeply concerning. Four in 10 respondents had never even heard of regulation 9A. One in four reported care settings implementing complete visiting bans since April 2024. Even when family members were aware of and cited regulation 9A, in more than a third of cases that had no effect on visiting arrangements. Many care settings continue to regard regulation 9A as guidance only, which can be ignored without consequence. As Rights for Residents put it: “These findings indicate that the introduction of CQC Regulation 9A has not been effective or sufficient in upholding the visiting rights of those using health and care settings, and that as a result, people are experiencing avoidable harm from unnecessary visiting bans.” The conclusion is clear: without a clearly defined legal right to maintain contact, access will continue to be patchy, precarious and far too easy to deny. The postcode lottery of uneven implementation was unacceptable during the pandemic and is unacceptable now. I stress that this is not about unlimited access. Care supporters would be subject to the same appropriate safety precautions as staff. It is about protecting the principle that the connection with loved ones is not an optional extra, but essential to dignified care. No member of staff, no matter how professional or compassionate, can replace the bond between a parent and child, husband and wife, brother and sister, or with a lifelong friend or partner. Loved ones are more than companions. They are vital safeguards. They are the eyes and ears that notice what others might miss. They protect against neglect, spot subtle signs of distress and speak up when something is not right. To leave this matter to the discretion of individual managers, without clear legal underpinning, is to leave the most vulnerable at the mercy of arbitrary decisions that could severely impact their wellbeing. It is not only a matter of compassion; it is a matter of rights. We all have a right to a family life. That right should not disappear behind locked doors when someone requires care. That is why we are calling on the Government to guarantee the right of every person in a care setting to have at least one essential care supporter—not just guidance and not tinkering around the edges of regulation, but a right, protected in law. During the general election, my party, Labour, promised to make that change in government. That promise must now be delivered. It said: “We will guarantee the rights of those in residential care to be able to see their families.” The only way to guarantee that right is through the law. The review of regulation 9A is due shortly and, from 30 June to 31 July, the covid inquiry will hear evidence on experiences of the care sector during the pandemic. As families relive the trauma of that period, the Government have the opportunity to show them that they have been heard, that lessons have been learned and that action will follow. If we truly believe in dignity and compassion in care, that cannot be delayed any further. We owe it to every family torn apart. We owe it to every patient or resident still facing the risk of being isolated. We owe it to every one of our constituents who fears that when the time comes, they too might be left without a loved one’s hand to hold. This change will cost the Government nothing, but for those it protects, it means everything.

I call Liz Saville Roberts.

09:48:00

Diolch yn fawr, Cadeirydd. I am very glad to see you in your seat, Ms Butler, and I am deeply grateful to the hon. Member for Liverpool Walton (Dan Carden) for bringing this debate forward. He will be aware that this is a hugely important topic for the many of us whose experiences with our families during the covid pandemic have not faded into the past. Visiting restrictions at that time threw a harsh focus on the issue. Between 2 April 2020 and 22 July 2020, UK Government guidance advised against all visits to care homes except in exceptional circumstances, such as “end of life”. End of life? What happens before that matters too. We need to know what the exceptional circumstances in the regulations may have been, because there is obviously room to define them. Fundamentally, though, we need clarification on a legal right. We need to learn from that time. Following the experiences of many families during the pandemic, more and more voices have called out the inconsistency between the treatment of vulnerable or cognitively impaired adults and the treatment of children, who have a right to be supported by their parents in health and care settings. Of course, it is entirely right that children maintain contact with their parents, and we would rightly be appalled were that denied, but somehow the social needs for love and family contact are regarded as a luxury—a “nice to have” but something that is ultimately expendable—for adults in certain circumstances. A clear case emerged at the time for the Government to support giving families and carers of dementia sufferers the same rights that parents of sick children have. The Government should allow for family representatives to stay with such patients at any time of the day, and for their role as carers to be recognised and accommodated. It is recognised that changes in environment for people with dementia, such as going into hospital or moving into care, can cause immense challenges. Just think about it: all familiar things and all familiar routines are left behind, and the routines of the institution take over. What is most convenient for the institution is inevitably the priority. We talk about putting the patient first, but we know how flimsy those words are when health and care institutions feel threatened, liable or under staffing pressures.

I am grateful to the right hon. Lady for raising an issue that I did not touch on: the fact that good institutions and good care homes will want the involvement of families. They do not use blanket bans or try to prevent family members from being part of the care of their residents. The worry is that the most vulnerable in the worst-run care settings are most at risk.

That is exactly the point. The real good that family carers could do for health and care settings that are well run should not be regarded as a nuisance to be fitted in but something that can complement excellent services. Care and nursing homes operate under a number of constraints, financial and regulatory pressures especially. Many are excellent. They are shining beacons of humanity and kindness and provide a welcoming home. Remember, this is a place where people live and a home for the people who live within their walls, but that is not the case for all those who live in care settings. MPs will almost certainly have been approached by family members who are extremely reluctant to raise questions about the care of a loved one in a home, because they are afraid that their loved one will be evicted from that home. That is what the care home owners and managers can do, so it is our role to raise those concerns and be their voices. I pay tribute to the many pressure groups and charities that have drawn attention to this issue. Among them are John’s Campaign, Rights for Residents, and Care Rights UK, which was formerly the Relatives & Residents Association. I am personally immensely grateful to Julia Jones of John’s Campaign and dementia nurse Delyth Thomas for their advice after my mother Nancy’s stroke at Christmas 2020 and her final death from dementia a year later. I would like to read a tiny bit that I wrote at the time: “Many of the key workers with whom we interacted over the last 12 months were extraordinary. We have been beyond lucky to have dealt with a number of nurses, doctors and care workers who had the confidence and humanity to keep to the spirit and not the letter of official edicts. Even so, I touched my mother’s hand only once during the critical six weeks after her first stroke. There were no hugs. Health authority infection policy vetoed family bonds of love as a health hazard to be minimised.” She used hearing aids, and we could only speak to her through the window, but the batteries were not replaced. She could hear nothing, and we know how important hearing is for reducing the effects of dementia. Ysbyty Gwynedd and Ysbyty Bryn Beryl—that is the district hospital and the local community hospital—were signed up to John’s Campaign, which enabled me to be recognised as my mother’s carer. If only I had known that months earlier. I of course bear in mind that this was during the covid period, but people need to know their rights. At one stage in early 2022 the staff at the community hospital asked me to come in specifically to help to take pressure off nurses because there was a covid outbreak. I contributed as a carer—I had a role to play. As a family carer I helped that hospital. I was required to take covid measures—tests and vaccination—exactly as was expected of staff members. That is completely feasible for identified family carers alongside salaried carers—it is an option for us. Family members, as recognised and respected carers, can be a real source of help to hospitals and care settings, if we can only tease apart the web of fear of liability, and a culture that presumes that the human needs of adults with cognitive impairments are limited to food, shelter and a screen in the corner of the room whenever an emergency threatens the organisation that holds their life in its hands. We are social creatures. If we are denied social contact, we are damaged. We need to recognise that as a human right. Regulations expected to be facilitated in undefined emergency circumstances are evidently failing. I am so glad that health and social care was in the Labour party’s manifesto for the last general election. It was in Plaid Cymru’s manifesto too. Health and social care are devolved, but it is a human right, and that is not devolved; that is a reserved power. I hope that now we have learned the lessons of covid we can move ahead and legislate to make health and social care a human right.

09:56:00

Thank you for filling in, Ms Butler, and bridging the gap to enable the debate to go ahead. I thank the hon. Member for Liverpool Walton (Dan Carden) for leading today’s debate. As a strong advocate for stability and comfort for young children, I will focus on young children and those unfortunately in care settings. It is important that we do what we can to make their journey through that stage of their life as secure as possible. It is great to be here to speak on that. I commend the right hon. Member for Dwyfor Meirionnydd (Liz Saville Roberts) for her comments. She cast her mind back to covid and different circumstances, different times, different regulations, and more controlled ways of caring. We do not criticise the covid regulations, because they were important to have in place, but many people were unable to have the last few minutes with their loved ones, who were very much part of their lives. My mother-in-law passed away at the Ulster hospital on her own. My point is that sometimes circumstances do not allow us to do what we would like to do, and that was one of those circumstances. I want to give a Northern Ireland perspective in this debate, as I always do. I know the Minister is always keen to try to help us when we put forward our suggestions. As of 31 March 2024, almost 4,000 children and young people were in care in Northern Ireland. I will focus on that and how important it is to get it right for them. That was the highest number recorded since the introduction of the Children (Northern Ireland) Order 1995. It gives us a perspective on a society and young people in particular in Northern Ireland who are under terrible pressure. The figures are absolutely shocking. We must remember that there are many circumstances that can warrant a child being put into care. Contact within care settings is important to preserve emotional bonds, social interaction and the friendship that biological siblings share. Although they might fight a bit, the fact of the matter is that there is no greater love than that between a brother and a sister, a brother and a brother, a sister and a sister, or whatever it might be. Being removed from a familial setting and placed in a strange and unfamiliar one can be damaging to a child’s cognitive health, which shows why contact is so important for mental stability. Another worrying trend from Northern Ireland is the fact that there are those with mental health issues who are as young as eight years old—my goodness. Can we visualise that at eight years old, when someone is young and innocent? Yet the pressures on an eight-year-old are so great. That is what is happening in Northern Ireland. That is why the numbers are so large. Consistent contact has also been proven to achieve better long-term outcomes for families and assist with the transition back to a family dynamic. I know the Minister is always keen to respond to our queries. What opportunity has she had to contact the relevant Minister in Northern Ireland to ascertain what exchange of ideas, policies, strategies or new approaches there might be to ensure that families can transition back to a family dynamic, which is how it should always be, if at all possible? We live in a fractured society; life is not the same as it was when I was a wee boy. I do not think anybody in this Chamber is as old as me, with maybe one exception, but society as I remember it was so different, and today it is even more challenging. Contact should not be only for parents; it is imperative that sibling contact is looked at and encouraged to create a sense of normality in care. It is not all about the regime, the rules or the conditions of being there; it is about the relationship between siblings and how they can have some normality. An Ofsted study showed that 86% of children in care thought that it was important to keep siblings together—that is a certainty from the young children themselves. I believe in my heart that it is really important. It is not always possible, but we should strive by all means within our power to ensure that children can keep in touch with their siblings. The reality is that often many siblings have had and remain in minimal contact. It is terribly sad when those who were part of the same family unit are suddenly hundreds of miles apart. Nobody is at fault, I suspect, but if it is possible to keep them together, we should. For example, for siblings who may come from abusive households—sometimes those are the ones I am aware of as an MP—shared experiences can create a more positive healing journey. I fear that if the same situation continues without any stops or changes, it will hinder the healing process for young children. When they grow up to be parents themselves, what happened to them in the past will make them focus on bringing their children up in a certain way as well, so let us get it right the children of today—the parents of tomorrow. To conclude, I am a supporter of contact, and I recognise what the hon. Member for Liverpool Walton has contributed in starting this debate. I hope that we can do more to prioritise maintaining contact for young children, parents, siblings and extended families. It is crucial for their mental and emotional wellbeing, and ensuring familiarity can go above and beyond in supporting transitions. There is no doubt that care settings can be incredibly challenging environments. For some children, they are never easy, so let us do what we can—we collectively in this room, and the Government, who have a particular opportunity to make a change, and make the process as stress-free as possible. I look very much to the Minister, as I often do, for further engagement with the devolved institutions. I would appreciate it if she could do that, to ensure that stronger sibling contact can also be maintained. This debate is so important, so well done to the hon. Member for Liverpool Walton for bringing it forward. There might not be a big number of people here today, but that does not reflect the seriousness or importance of this debate. Those of us who have a personal interest in this issue, and all of us as MPs, have an obligation to our constituents who have asked us to make sure that these things are put on the record. I believe that we have a great responsibility as MPs. We have an opportunity to formulate law and to support the Government in amending the direction in which they may go, to ensure that young people—the children of today; the parents of tomorrow—can lead a good life. If we try to do that as MPs, and as a Government, we will be building a better society and a better place for everyone to live in. That is my ultimate goal, and one I think we all share. It is a big challenge—let us see if we can do it.

10:04:00

It is very much appreciated that you have come to chair this important debate, Ms Butler, and I thank the hon. Member for Liverpool Walton (Dan Carden) for securing it. As the hon. Member for Strangford (Jim Shannon) just said, the number of people in this debate is not a reflection of its importance. All hon. Members who have contributed have spoken with real moral authority and have reflected the gravity of what we are talking about: the rights of some of the most vulnerable people in our society—those living in care homes, hospitals and hospices—and their right to maintain contact with and see their loved ones. Throughout the covid-19 pandemic, thousands of people living in care settings in my constituency and across the country were forbidden from seeing those closest to them. That was especially devastating for residents living with conditions such as dementia or severe memory loss, which affect approximately 70% of care home residents. For those individuals, familiar faces are more than just comforting; they are essential to their sense of identity and stability. Let us imagine being cut off from the people we know best, who can calm us in moments of confusion, and who understand our needs in ways that no staff member possibly can. This is not an abstract issue but a painful reality that caused immeasurable harm during the pandemic. Even as the rest of the country began to reopen in 2022, care homes continued to impose harsh restrictions. Data shows that between April and September 2022, 10% of care homes permitted no visitors at all during covid outbreaks, 20% confined residents to their rooms for up to 28 days and nearly half maintained some form of visiting restrictions even without any outbreak present. The impact of those policies was brutal. Vulnerable people in Mid Sussex and across the country were left isolated and confused, their symptoms worsening without the emotional and practical support that only loved ones can provide. I want to share a story that will be distressing to some. Last week, I was horrified to watch a report on BBC South East about a 92-year-old gentleman, Donald Burgess, from East Sussex. Donald was a wheelchair user, having had one leg amputated, and on 21 June 2022, he was reportedly brandishing a knife in his wheelchair, having become irritable and confused. Care home staff failed to resolve the situation and so the police were called. Donald was sprayed with pepper spray, hit with a baton and tasered by police, all while still in his wheelchair. Donald was taken to hospital as a result of those injuries, and he subsequently caught and died from covid-19 a couple of weeks later. On the BBC South East news report last week, Donald’s family were interviewed. Those family members only lived 10 minutes away from his care home. They said that if they had been called, they would have been able to go there and, potentially, calm him and resolve the entire situation. It is beyond tragic that that happened, and that it is how Donald’s life ended. If hon. Members present who are not from the south-east region are interested, the video and reports of the attack on Donald are available to view online. I commend the tireless work of advocacy organisations such as the Relatives and Residents Association, Rights for Residents, Care Rights UK and John’s Campaign. Their efforts have been instrumental in raising awareness and pushing for change. I also commend the way that the hon. Member for Liverpool Walton set out the case for the required change. The Government’s recent introduction of regulation 9A by the Care Quality Commission—a new fundamental standard on visiting and accompanying—is a welcome step forward. But while that regulation aims to ensure that care providers do not discourage visits, and that people can attend medical appointments accompanied by a family member or advocate, it falls short of what is needed. Regulation 9A relies on enforcement by the CQC, an organisation that is well understood to be stretched thin and facing a number of challenges. The CQC cannot prosecute providers for breaches of the regulation, and often lacks the resources for swift and consistent enforcement. Most importantly, the regulation does not create an enforceable right held by the individual resident. That gap leaves residents and their families vulnerable. Without clear legal protections and a statutory right to visitation, we risk repeating the mistakes of the past. That is why my Liberal Democrat colleagues and I are calling on the Government to implement Gloria’s law without delay. Gloria’s law would enshrine in primary legislation the right for every person in a care or health setting to have at least one essential care supporter present, regardless of circumstances. As Rights for Residents says, “only Gloria’s Law will guarantee that none of us will be forcibly separated from our loved ones again”. I urge the Minister to answer the following important questions. First, does she believe that regulation 9A alone is sufficient to prevent isolation and ensure that residents can be supported in times of crisis or future public health emergencies? Secondly, are the Government confident that the CQC and the Department of Health and Social Care have the capacity, resources and real-time data systems to monitor visiting arrangements and act swiftly if restrictions become harmful? Thirdly, will the Government commit to going further by passing Gloria’s law, guaranteeing a statutory right to unrestricted in-person support from at least one essential care supporter? The lessons of the pandemic are clear. Families are not visitors but vital partners in supporting those we love through their most vulnerable moments, so let us act now and give vulnerable people the rights they need and deserve. In doing so, perhaps we will save lives like Donald’s.

10:11:00

It is a pleasure to serve under your chairmanship, Ms Butler. I declare my interest, as an NHS consultant. I know from my own professional experience that hospitals and other care settings can be distressing places for patients and their relatives. Even with our excellent NHS staff on hand, patients want more assurance and familiarity while they undergo care and treatment. For many, that support comes from the family and friends who visit them during their hospital stay, or while they are in a hospice or receiving care in a care home. I pay tribute to the very many excellent staff who work in those settings and provide care around the clock and during public holidays, and put themselves out to care for others. For residents, care homes are just that: their home. They should be entitled to have relatives and friends visit them as they would in any other home. Visitors also improve care. An inability to visit one’s relative in hospital leads to an increased feeling of not knowing how they are this morning—whether they are getting worse or better, whether they are in pain or are comfortable, or whether they can reach what they need to get. Relatives fear not being able to help the resident, and worry about whether they are lonely or stressed because they are not there to support them. That adds to the relatives’ stress. The patient or the person in the care home knows that staff are busy and may not want to bother them for small things, such as reaching a book or their glasses, passing them a drink—which is so important for hydration—helping them eat a meal, moving the curtains so the sun is not in their eyes or providing an extra blanket. Instead, many wait hours for their relative to come. Sometimes, they just want a cuddle and to hold hands with the person they love. Clearly, that is in the best interests of their health and wellbeing. Relatives know the person they are seeing the best, and are able to identify changes in condition that may go unnoticed by staff. I remember visiting a relative of mine who was getting better following surgery and was stepped down from the high-dependency unit to the ward. When I arrived, I realised that he looked grey, pale and unwell. He was indeed in shock and required urgent fluid resuscitation. I shudder to think what would have happened had that not occurred at the beginning of visiting time. It was with those things in mind that the previous Government introduced the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and, in particular, regulation 9A. Like others, I pay tribute to my hon. Friend the Member for Faversham and Mid Kent (Helen Whately) for doing so. The regulations were designed to ensure that patients staying in hospital or residential care settings could receive visitors in a fair and consistent way. They also aimed to ensure that care home residents would not face barriers or discouragement if they wanted to take their visitors outside, and they made provisions for those attending non-residential hospital or hospice appointments to have guaranteed rights for friends or family members to accompany them. However, now that these regulations are in place, we need to ensure that they are working effectively and that systems are in place to detect any attempts to water down or remove the rights that they provide. I want to raise the exceptional circumstances limitation with the Minister. Members will know that the regulations grant visiting rights unless there are exceptional circumstances. The CQC guidance states that providers should base this assessment “on the health, safety and welfare of people using the service or other people involved. This should include giving consideration to the appropriate balance of a person’s rights, the needs of people using their service and any identified risks”. If concerns have been raised about current levels of compliance with visiting regulations, we must begin by identifying how and why this caveat in the rules is being used. Can the Minister tell us what kinds of circumstances private providers deem to be exceptional? Who is making these decisions and who is overseeing that process? The CQC guidance also states that where additional precautions or restrictions are needed, they should represent “the most proportionate and least restrictive option” that is available. Is the Minister confident that this principle is being followed, and what is she doing to provide transparency for patients and their carers about decision making? In summary, can the Minister tell us how many times the exceptional circumstances provision has been used in the last year by each institution and how many visits or accompanying visits have been blocked as a result? Is she monitoring such blocking? What steps is she taking to ensure that those with reduced mental capacity have their rights to visits upheld? It is important that these rules are followed. The vast majority of care settings provide excellent care, but the concern is that the better care settings are more open than others, and as the right hon. Member for Dwyfor Meirionnydd (Liz Saville Roberts) said, sometimes, visiting times may be restricted to cover up poor care, adding to the stress of the patient or resident and their carers. It is important that the Minister does what she can to improve the education and training of staff, and change the culture of settings so that everyone is able to receive the visits they need. Some providers are even using the realms of infection control measures to exclude visitors. Surely, if infection control measures are frequently being used to restrict visiting, that is a red flag that the infection control measures in that institution are not providing adequate safety for residents. What steps is the Minister taking to ensure that staff follow the requirements placed on them and to make sure that individual providers are not being selective in their adherence to the rules? It is clear from what we have heard today that more needs to be done to ensure that patients receive the visits and accompaniments that they are entitled to. If we are serious about putting patients and residents first, more needs to be done to guarantee them the social and emotional support that they need to be comfortable, as well as the best treatment or palliative medical care available. As others have already said, the CQC is not able to prosecute for breaches of regulation 9A, although it can take action such as civil enforcement measures. Does the Minister believe that is a strong enough incentive for providers to meet their obligations, or does she recognise that increased enforcement powers might be needed to ensure that the rights of patients are protected? What other schemes has the Department considered to help providers to better facilitate contact and visiting arrangements? I will finish by saying that I work as an NHS consultant paediatrician, and in paediatrics we always have open visiting for parents. Parents are really helpful in providing the care and looking after the children as part of a teamwork approach between parents and staff. Can the Minister say why such visiting arrangements are not available for people of all ages when they are at their most vulnerable, because I cannot see why they should not be? Indeed, I think that it would help quite dramatically.

10:19:00

Thank you, Ms Butler, for chairing this important debate at such short notice, and I thank my hon. Friend the Member for Liverpool Walton (Dan Carden) for securing it. The Minister for Care, my hon. Friend the Member for Aberafan Maesteg (Stephen Kinnock), has asked me to pass on his apologies; he is unable to represent the Government in this debate as he is currently in session on the Mental Health Bill Committee. However, he joins me in thanking my hon. Friend the Member for Liverpool Walton not only for securing this debate, but for all the work he has done in advocating for relatives and friends to have the right to visit care home residents and patients in hospitals and hospices. I also thank all those who have shared their personal stories and those who are in the Public Gallery today. I can say without hesitation that the Minister for Care and I agree with my hon. Friend on the importance of visiting in care settings. Contact with family and friends is a crucial part of a person’s care. Indeed, there is evidence that supporting people to be actively involved in their own care, treatment and support can improve outcomes and experiences for people receiving care. No one should be denied reasonable access to visitors when they are in a care home, a hospital, or a hospice. That includes receiving assistance from a care supporter or simply going for a walk with a family member or friend. Before the covid-19 pandemic care homes, hospitals and hospices set visiting policies based on their specific local circumstances. During the pandemic, restrictions on visiting were implemented to prevent the spread of covid-19. Those restrictions were in response to clinical advice and were designed to protect people living in care or in hospital, who were often among the most vulnerable to the virus. Visiting and accompanying is one of the fundamental standards against which the Care Quality Commission assesses quality of care. The Government recognise how important visiting is for the health and wellbeing of residents in care homes and patients in hospitals and hospices. We have monitored the position since the new fundamental standard was introduced in 2023. We know that the majority of health and care providers are facilitating visits and recognise their importance. The capacity tracker, a digital tool where adult social care providers self-report data, shows that 99.3% of care home providers are facilitating visits. That figure has been stable since September 2022. However, we also know that there are times when it is necessary for movement in and out of care settings to be temporarily restricted.

Can the Minister clarify what constitutes a visit in those circumstances? Would an hour’s visit once a week count, or is there a specific timeframe that qualifies?

I do not have that data to hand, but I will make sure that it is provided to the shadow Minister afterwards. While there is sometimes the need for temporary restrictions or modifications to minimise significant risks, the Government hope that such instances are a rarity. It is our aspiration to ensure that visiting policy and practice strike the best possible balance between individual wellbeing and public health needs. I have been really moved by, and taken note of, the evidence put forward by many Members that that may not always be the case. The right hon. Member for Dwyfor Meirionnydd (Liz Saville Roberts) talked about her experience with her mother, and brought to life the value that family and friends bring to the emotional wellbeing of the person being cared for and how, as partners in care, they play a key role in delivering that care.

I am interested to hear the Minister talk about visits, but I think the essence of what many of us have discussed today is that there is a role for family carers alongside salaried carers. We desperately urge the Government to find a way to bring that forward in law.

I thank the right hon. Lady for that intervention, and it is noted. The hon. Member for Strangford (Jim Shannon) told the powerful story of his own mother-in-law and his experiences there, and spoke about the importance of family contact, specifically for children in health and social care settings. For the sake of clarity, regulation 9A does not cover children’s homes—there are other regulations for that. We are talking specifically about health and social care settings. We heard powerful interventions from other Members, including my hon. Friend the Member for Altrincham and Sale West (Mr Rand). The Liberal Democrat spokesperson, the hon. Member for Mid Sussex (Alison Bennett), and the shadow Minister, the hon. Member for Sleaford and North Hykeham (Dr Johnson), asked a series of questions: is regulation 9A sufficient? Can the CQC monitor an Act? What are the exceptional circumstances of regulation 9A? Who is making those decisions? What principle is being followed and how is it being properly monitored? The Government are committed to understanding the current position and considering how it can be improved. That is why in April we launched a review of CQC regulation 9A: visiting and accompanying in care homes, hospitals and hospices. All the issues raised today will be explored as part of that review. We want the review to be thorough and will consider the experiences of those receiving care, their families and loved ones, providers and health experts, as well as information from the Care Quality Commission, the Local Government and Social Care Ombudsman and the Parliamentary and Health Service Ombudsman. To ensure that we get a wide range of views, we have also opened a call for evidence and are running focus groups, with the first one taking place later today. The representations made in today’s debate will help to inform the review. I further thank all contributors, and assure them that their contributions have been noted. We are determined to understand whether the expectations set by the regulation are right and that its application in practice works in the best way across care homes, hospitals and hospices, and in relation to visiting and accompanying. I can confirm for the hon. Member for Strangford that we will look at the experience of all UK nations, including Northern Ireland and Scotland, where the Care Reform (Scotland) Bill, which includes Anne’s law, was approved on 10 June. That law requires care providers to facilitate visits to care home residents and to identify an essential care supporter for each resident. I can assure hon. Members that we will reflect on the points made here as we conduct the review. We will move fast and ensure that we do justice to this important issue. We need to understand the problems and gaps if we are to draw the right conclusions from the review. We are pressing on with evidence gathering and focus groups right now. We plan to publish the outcome of the review and any further steps in the autumn.

10:27:00

Thank you, Ms Butler, for getting here so quickly and saving our debate. I also thank the campaigners for coming here today, all hon. Members who participated and the Minister for her understanding of people’s experiences and openness to receiving evidence. I see this as a matter of principle. Sometimes, when the state contracts out services and provision, it oversteps the mark and we forget what really matters, which is the love and care of our families and the people closest to us. No bureaucrat or care home manager has the right to say, “No you cannot maintain contact with the people you love.” That is something that the law needs to put right. If it can be done, it will be to the benefit of all—the families, those needing care and the institutions providing that care. I hope that the Minister, alongside the Minister for Care, will keep an open mind. Question put and agreed to. Resolved, That this House has considered the right to maintain contact in care settings.

10:29:00