Hospital and care home visiting restrictions are “cruel, inhumane and unnecessary”

The Pandemic Response and Recovery All-Party Parliamentary Group met this week, to hear about visiting restrictions still being imposed by many care homes and NHS Trusts. Co-chaired by Rt Hon Esther McVey MP and Graham Stringer MP, the Group listened to evidence about the devastating effects visiting restrictions in hospitals have on patients and their loved ones. MPs also heard how visiting restrictions in care homes, along with the continued use of rolling lockdowns and over interpretation of testing guidelines is leading to isolation, neglect and abuse of the residents.

Leandra Ashton, who co-founded The People’s Care Watchdog, Dr Ammar Waraich, a medical registrar in the West Midlands, Carol Munt, experienced Patient Partner and Advocate  and Dr Ali Haggett, community mental health and wellbeing specialist, told the APPG of the obstacles still in place when trying to visit a loved one and the shocking impact on vulnerable hospital patients, care home residents and their families.

All the speakers voiced serious concerns about why and how obstacles are still in place in some healthcare settings. Politicians heard harrowing accounts of the deleterious effects of isolation and loss of social contact on physical and psychological health, safeguarding issues with medication, dehydration, hygiene and lack of basic care and the failures to uphold existing legislation to protect those who lack capacity.

Leandra Ashton’s mother was arrested in November 2020 for taking her grandmother out of her care home a day before the second lockdown. Two years on, many residents are still being isolated from their loved ones. She told the MPs and Peers: “When I took the video of my mum being arrested taking my nan out of her care home, I did not think it would go viral. So many families got in touch and it led to us setting up The People’s Care Watchdog. We were struck by how much legislation is in place; such as Article 8 of the Human Rights Act, Deprivation of Liberty, the Mental Capacity Act, to protect those in care homes. These laws are simply not being upheld and instead guidelines are being over-interpreted and the legislation even used to keep people in care homes and hospitals as if they were prisons. The public bodies that are supposed to uphold the protective legislation are not doing so.

“There are still obstacles in place when trying to visit a loved one in a care home and the impact has been and continues to be devastating. The safeguarding issues I am seeing and hearing about are atrocious. Residents left for hours in dirty, wet incontinence pads leading to dangerous pressure ulcers. Malnutrition. Dehydration. End of life medication given to patients without their or their family’s consent. Psychological trauma, post traumatic stress and suicides have resulted because of this. Multiple systems are failing, including Local Authorities and the CQC. It is a complex situation that needs a bold approach by both empowering families and galvanising government action to hold public bodies to account and stop private equity firms placing profit over people.”

Listening to the evidence, Esther McVey said: “I am troubled by the evidence presented by our speakers, particularly the safeguarding issues and neglect that care home residents are suffering as a result. In hospitals, we have heard about patients losing hope and refusing treatment without the encouragement of family. We know patients have much better treatment outcomes when they have support from relatives and friends around them.

“Most of the infection control measures that restricted visiting in healthcare settings have been removed, most recently NHS Trusts were told healthcare workers, patients and visitors no longer need to distance in hospitals, so I fail to see why and how these visiting restrictions are still in place in any healthcare setting. I shall be writing to the Secretary of State for Health and Social Care to ask that he makes it absolutely clear that all patients and residents must be able to see visitors.”

Highlighting how visitation is an important and necessary part of healthcare, Carol Munt said: “In the same way that we would not stop prescribed medication and treatments, we should not have stopped visits. Why were decisions taken without any consideration for the need of patients and their families to connect? Why do we still have such variation in compassionate care across the country? There is no uniformity among care homes apart from the need to be profitable for their owners. Some care homes made a superhuman effort to arrange visiting, as did the Bristol Nightingale Hospital. There was good practice in some places so there should be good practice everywhere. We should expect more of these endemic situations and we must be prepared for them.

“I could not comprehend how any Minister for Health and Social Care could allow this to happen and not make the effort to get his department to look at ways that visiting could be facilitated. I heard and continue to hear the most callous reports of relatives dying alone with no visitors. The same goes for hospital patients. Ultimately, I think we need legislation to ensure that visiting rights are enshrined and protected.”

Medical Registrar Dr Ammar Waraich, reported that many hospitals are still preventing visits due to the potential risk of Covid spread: “The policy is cruel, inhumane and unnecessary. Seeing loved ones can be immensely therapeutic and give struggling patients the will to survive. It is deeply traumatic for families to lose loved ones suddenly or see them go through difficult treatment without being there in person. Video calls are not a good enough replacement and we do not have the staff, the time or resources to facilitate calls for all our patients.

“Most infection control measures have been lifted as the level of risk is no longer there. Hospitals can no longer function as detention centres and an inpatient stay should not become a sentence. The policy was one of the major mistakes of lockdown. Visiting sick relatives in hospital is, and must remain, a fundamental right, not to be given up.”

Co-chair Graham Stringer said: “I find it extraordinary that no visiting is allowed in some healthcare settings, even to this day. It is cruel that family members are being denied access to sick and vulnerable loved ones, often not getting regular updates, living in anxiety about what their relatives may be going through, but knowing they are going through frightening and difficult treatment, often at the end of their lives, without being able to be with them in person.

“At the height of the pandemic it was understandable that there were precautions but there is no longer a basis to that argument. All the restrictions have been lifted and NHS Trusts across England have now been told to 'return to pre-pandemic physical distancing in all areas'. The government must take action to resolve this situation.”

Speaking about her experience working in the community throughout the pandemic, Dr Ali Haggett said: “I have spent the last eighteen months with the support group Unlock Care Homes, uncovering the plight of many thousands of families who are still denied regular, meaningful contact with care home residents (and hospital patients). Even before Covid, we knew that isolating people, particularly older people, has a serious impact on physical and psychological health. We have continued to isolate adults in care and in some hospitals almost continuously for two years. The effects have been felt particularly badly by those with dementia. Many residents no longer recognise their families and have been denied the most basic of human needs.

“My concern is that this situation is concealing neglect and abuse on a significant scale. One of my community members sadly died and the hospital has admitted liability partly because he was completely blind and couldn’t reach his food or drink. Had his wife been allowed to visit, this wouldn’t have happened. Families I work with report numerous issues still affecting them, not just visiting restrictions. Rolling lockdowns, over interpretation of testing, PPE requirements resulting in poor communication and fear, lack of ancillary services such as podiatry or physiotherapy leading to huge health problems, residents asked to isolate when one person tests positive, sometimes for 10 days or more and the one significant visitor recommendation being ignored or rejected. Families must be able to visit openly and check the wellbeing of residents.”

Biographies of people giving evidence:

Leandra Ashton co-founded the support group turned campaign: The People’s Care Watchdog following her mother’s arrest in November 2020 for taking her grandmother out of her care home a day before the second lockdown. The media storm put her in touch with hundreds of families all facing the same struggles. The watchdog’s aims are to bring the reality of care homes into the nation’s consciousness; hold those responsible for neglect and abuse to account; and create new systems of care that work for our most vulnerable, their relatives and carers. Leandra has a background in communication both as a linguist and actress. She studied Modern and Medieval Languages at Newnham College, Cambridge before earning a Walls scholarship to the Royal Academy of Dramatic Art (RADA). She has taken various roles in TV dramas including for the BBC and ITV, in UK and US theatres and founded Flying Cloud Theatre in 2009.

Dr Ammar Waraich is a medical registrar in the West Midlands. He obtained his medical degree from Imperial College London and later qualified as a member of the Royal College of Physicians. He was a Fulbright Scholar to Harvard University where he completed a master’s degree in public policy and became a fellow at the Harvard Ash Center for Democratic Governance and Innovation. He is a fellow of the Higher Education Academy and was an Honorary Clinical Lecturer at the University of Birmingham.

Dr Ali Haggett has a background in academia. She worked for 10 years as lecturer and Wellcome Trust Fellow on the history of mental health and wellbeing at the University of Exeter. For the last five years she has partnered with the Sporting Memories Foundation to work in the community, with groups of older men, challenged by isolation, poor mental/physical health and disability. She is a front-facing member of the Health Advisory and Recovery Team (HART), researching and writing about the plight of care home residents isolated from their families during the pandemic.

Carol Munt is a Patient Partner and Advocate, an Honorary Lecturer and Doubleday Affiliate at Manchester Medical School, an Experience of Care Partner and Mentor at the NHS Leadership Academy,  a qualified general and orthopaedic nurse and a member of NHSE/NHSI Co-Production National Advisory Group, NHSE/NHSI Beneficial Changes focus group, National Steering Group Maximising Leadership Learning in the pre-registration curriculum, HQIP Service User Network, Q community and she remains one of HSJ’s Top 50 Patient Leaders. She is passionate about Patient & Public Involvement and Co-Production believing that people with lived experience are a valuable asset to the Health Service. Her talk on Co-Production at the King’s Fund now forms part of the Open University Health & Social Care degree course. As co-Chair of the NHS Thames Valley Patient Experience Operational Group, Carol sat on the board of the NHS Thames Valley Strategy Group. She was part of the Oxford Academic Health Science Network Leading Together programme team presenting at NHS Expo. Following her experience of becoming her mother’s full time carer, become a Patient Partner at the Royal Berkshire Hospital and helped produce the Dementia Handbook for Carers , for in-hospital training in Dementia care and introduced a Carer’s Passport. She organised the highly praised Dementia conference in Reading, a first for the CCG.