Care Quality Commission
Rights of individual must be paramount when deciding visiting plans
We recognise the complex and difficult situation facing social care. The national lockdown has brought additional challenge to our sector. The majority of providers are continuing to do extraordinary work despite the intense pressure of high numbers of people with COVID-19, workforce shortages, managing increased testing and the roll out of vaccinations.
However, we are aware that in some places blanket decisions are continuing to be made against government guidance. Where decisions are being made, whether that is for visiting, people not being allowed to see visiting professionals, testing or vaccinations, the focus must always be on the individual needs and rights of the person.
We understand providers are rightly cautious in order to keep those they care for safe, but they mustn’t wait for the completion of the vaccination program to facilitate visits.
With the announcement that each care home resident in England is to have one regular visitor (with tests required before entry and PPE to be worn on site), visiting guidance is likely to be updated shortly. All decisions need to stay under review as circumstances change.
Kate Terroni, Chief Inspector of Adult Social Care at CQC, yesterday said:
"Blanket bans are unacceptable and people should follow Government guidelines, give sufficient weight to local risks and advice from their Director of Public Health as well as giving consideration to the home environment.
“The individual must be at the centre of the decision and all decisions need to stay under review as circumstances change.”
The importance of visiting
Being able to see loved ones is incredibly important to wellbeing. The pandemic has made this challenging, but for some people in care settings this has meant being separated and deprived of physical contact with loved ones for nearly a year.
Person centred care has never been more important and recognising that part of people’s identity and wellbeing comes from their relationships is critical. Meeting people’s holistic needs requires an individualised approach. The distress caused by not having important relationships maintained can be devastating to mental health, just like our physical health, when it is not attended to – both need to be a priority.
The government guidance on visiting is there to enable safe visits to happen. This guidance will be updated in the next couple of weeks. It currently advises that all care homes, except in the event of an active outbreak, should seek to enable outdoor visiting and ‘screened’ visits. Even in the event of an active outbreak, visits in exceptional circumstances such as end of life care should always be enabled.
When thinking about visiting, for those entering care homes and those leaving to visit other places, providers must:
- work within government guidance
- seek advice from their Director of Public Health and Director of Adult Social Services
- apply appropriate infection, prevention and control measures (IPC)
- consider the home environment
- give sufficient weight to local risks
Are you making a blanket decision at the moment? Within government guidance, we are asking you to inform your local inspector and review all blanket decisions including those on visiting.
Safeguarding and visiting
Where we receive information from the public or through whistleblowing that gives us concern or indicates a closed culture, we may undertake a risk-based inspection. Information related to visiting which could trigger a risk inspection include:
- blanket visiting bans (where there is no active outbreak)
- people being discouraged from having regular calls with loved ones
- people not being effectively supported to communicate with relatives and groups that represent them
- people not being allowed to see visiting professionals
Where we have concerns, we can and will take swift regulatory action. This could include publicly giving a provider actions that they must take, restricting a service’s operation, including by issuing requirement notices and warning notices and in cases of significant concern, placing conditions on a provider’s registration.
Equality and human rights
Blanket bans on visiting can affect people from different protected characteristics in different ways. For example, a reduction in visits to care homes can have a particular impact for:
- people living with dementia
- people with a learning disability and autistic people
- Black, Asian and minority ethnic people living in care homes, if they are more likely to rely on their visitors to have their cultural or language needs met
- lesbian, gay, bisexual people and transgender people living in care homes, if they are more likely to rely on their visitors for their social and community contact
- people in religious minority groups within the care home, if they are more likely to rely on their visitors to have their spiritual needs met
- deaf people who use British Sign Language
There is a need to balance safety through good IPC and the human rights of individuals to see their loved ones - affording people their rights, including the right to life and the right to family life.
Support and good practice on visiting arrangements
We expect everyone to work together across their local system to enable visiting and we have heard many examples of good practice across the country.
The Care Provider Alliance have updated their visitors protocol briefing to reflect recent announcements and highlight issues to consider and support best practice. The protocol supports you to open up your home in a way which is safe and proportionate to your localised understanding of risk. They have also produced a helpful risk management framework for staff movement.
It is more important than ever that there is a culture of clear, open, transparent and regular communications between care providers and the families of their residents. A joint statement published by Relatives and Residents Association, National Care Forum and the Care Provider Alliance shares some good practice to support you.
We call on everyone to seek a proactive personalised approach to supporting contact with loved ones where it is safe to do so.
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