Dr Caroline Johnson

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.