Published 18th March 2026

We are publishing this response from John’s Campaign as it offers a balanced and powerful reflection of what the review of Regulation 9A will mean in practice for patients and their loved ones. It recognises the intent behind the work led by the Department of Health and Social Care, while also setting out clearly why many of the proposed measures risk falling short of the meaningful change people have been waiting for.

Through focus groups we delivered to inform the review for NHS England, we heard directly from patients and carers about the impact of inconsistent visiting arrangements — including unclear communication, blanket restrictions, and being excluded from decisions about care. While it is encouraging that the review reflects some of these experiences, as John’s Campaign highlights, good intentions alone are not enough. Without clearer rights, stronger accountability and more definitive action, people may continue to face the same barriers to being with those who matter most at times of greatest need.

You can also read the response on the John's Campaign website.

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Review of Regulation 9A: visiting and accompanying in care homes, hospitals and hospices

Response from John’s Campaign

Good intentions, inadequate solutions

Members of the team, mainly from DHSC Adult Social Care, which has prepared this report have obviously listened to the best of their ability to the information provided via survey responses, focus group discussions and other email conversations. There is no doubting their sincerity and their wish to make improvements.  Their report exposes many of the shortcomings of Regulation 9A but fails to offer any tangible solutions. A working group is not a solution.

An unambiguous commitment to empower individuals to maintain their closest relationships at times of greatest need is the crucial outcome that we and 108 other groups, including those bereaved by covid-19, are seeking. This will require something a good deal more definite than the undertaking to strengthen visiting rights ‘by exploring bringing forward proposals for legislative changes that promote the importance of families and carers as equal partners in care as part of wider reform work, when parliamentary time allows.’

Time scales

Production of this review report commenced in April 2025. It will finally be published March 18^th 2026. Yet separations between people at their most vulnerable and those who care for them most deeply, whose love gives their lives continued meaning, are still being enforced by unconnected third parties every single day. Adult members of our society are still being told, ‘No, you may not see your daughter, your husband, your life partner, your dearest friend, your trained and expert carer today.’  This may be due to hospital overcrowding, to an infectious outbreak elsewhere in the place where they live, to an allegation that the person they love has behaved rudely towards a member of staff or has complained about the standard of care. There may be exclusions at meal times, strict visiting hours, a policy of no contact for x days after admission to ‘help you settle’. One ward sister says no, another says yes.

We would no longer treat children like this. Why are we inflicting such state-sanctioned separations on adults? Surely our fellow-citizens in hospital, hospital, care home, hospice or (most) mental health units should be entitled to the support of whichever special person they nominate as vital to their well-being. This is where we now need legislation – for our own sakes and for the sake of those we love. We were looking to the government to bring this forward unambiguously as part of the essential culture change that will restore trust and will put the patients / resident / service user right back where they belong at the heart of each service. This, we suggest, will also improve holistic care quality and ultimately benefit staff.

Structural inadequacy of Regulation 9A

Was regulation 9A ever going to achieve this? It was introduced with the best intentions by the outgoing Minister of State for Care and her team in the last government. The ministerial foreword to this review is provided by the current Minister of State for Care and though it is co-signed by two of his colleagues there is very little evidence of input from any other department other than adult social care. Mental health is particularly conspicuous by its absence.  An issue of this importance – the right of everyone to be supported by some one they love in time of need should be a whole department initiative, led by the Secretary of State. He is said to support this through personal experience. He needs to show this to the rest of us. The actions from this review matter to us all. They need to be department wide and led from the top.

Timescale

It’s mildly ironic that those with long memories will recall that Regulation 9A, which only required secondary legislation, was put in place by the then Minister for Care because she was advised by her civil servants that she didn’t have sufficient parliamentary time for anything more ambitious. Now, 17 months into a new government, there is this caveat ‘when Parliamentary time allows’. The DHSC talks blithely about a Ten Year Plan which will include empowering patients and other service users. This government needs to make better use of time because whether or not they have ten years is up to the electorate.

Johns’ Campaign advocates primarily for people living with dementia and their families. Many of those people either living or being treated in health and social care settings don’t have ten years to wait.  There are also many people who are looking to the government for decisive action as they are still affected by the separations inflicted during the pandemic period. The promises of

• Improvements to the capacity tracker
• new communications and awareness resources
• materials to supplement existing training (what existing training?)
• closer working with the CQC on their long tern reforms
• continued monitoring of the situation

will not heal their continuing deeply felt trauma.

For visitors or for essential carers?

Regulation 9A was designed to protect ‘visiting’ – quite a wide concept. Those who took notes from the focus groups and surveys have, generally, listened and understood the crucial difference between social visiting and essential relationship-based care. This is reflected at intervals with the report. It doesn’t seem to have pointed to any course of action. In good hospitals there are very often two distinct sets of arrangements: one for general visitors, the other for ‘carers’.

Although the word carer can sometimes cause misunderstanding (the specific long-term role of the ‘unpaid carer’ vs a possibly temporary ‘care partner’ or ‘personal supporter’) the work of the NHS health and care partner policy was developing a person-centred way forward. It should never have been paused: it should be being implemented now. It is mistaken to suggest (as this report does) that this parallel track has no relevance to regulation 9A. On the contrary, the principles which were being articulated via the NHS Health and Care Partner policy should be understood across all health and care settings, precisely to discriminate between social visitors and essential supporters. This review has put its finger on the crucial difference, so why choose to ignore work already being developed on a potential dual way forward? Visitors and care supporters (essential caregivers, care partners, family carers) are both important but they are not the same.

The DHSC should  

1. Improve the working of regulation 9A for all people and their visitors. The report has identified that regulation 9A has shortcomings which should be addressed

• lack of awareness by visitors and patients / residents / service users in all health and care settings and also by providers / managers
• poor communication and relationship management that can too easily divide staff and visitors into mutually suspicious camps to the detriment of the patient / resident / service user. This can sometimes lead to the ‘banning’ of a visitor.
• extreme variability between settings
• uncertainly about ‘exceptional circumstances’
• poor (or non-existent) complaint and queries system (perhaps especially in social care)
• failure to monitor, respond, enforce (failure of CQC)
• apparent inability of outside agencies (particularly UKHSA and local public health officers to understand that they too have responsibilities towards individuals. The report acknowledges that separations during the pandemic period caused ‘unintended harm’. Now that lesson has been learned, harm resulting from externally enforced separations can no longer be forgiven as ‘unintended.’ 

2. Press ahead with primary legislation to reassure every adult citizen in this country that, if they need to enter a hospital, care home, mental health unit or hospice they will never be prevented from seeing the person on whom they depend, emotionally or practically.  Encourage people to nominate their chosen care partners / personal supporters. Use the significant amounts of good practice work already in existence from hospitals, care homes, mental health units, hospices who already extend this welcome because they know it to be right – to implement this care supporter legislation and embed the culture change we need.

Look for the gaps and use good practice examples

Although the adult social care team at the DHSC is to be thanked for their readiness to listen to advocates and campaigners such as ourselves, Rights for Residents, Care Rights UK, and the Patients Association, once this becomes a whole department undertaking, expertise should be sought from a much wider range of specialist organisations. The complex situations of people in supported living were largely ignored during the pandemic and remain essentially unaddressed here. I’m sure Mencap would guide DHSC staff through these differentiations (perhaps they are already).

An even more glaring omission are the very varied groups of people being treated in mental health units. FINDME, a three-year NIHR funded project, has already conducted a national survey of carers experiences in dementia mental health, ethnographic observations and interviews including staff interviews. They would have much to contribute to a working group. The work already undertaken by the NHS Health and Care Partner Policy team has been mentioned. At Johns Campaign we have run a system of voluntary Carers Welcome pledges for over ten years. Voluntary pledges have not proved sufficiently robust yet we can offer the experiences of people who contact us and also the proactive work of approximately 70 ambassadors who consistently do their best to represent their hospital or care home’s welcome to family carers.

Conclusion

We thank the Adult Social Care team at the DHSC for the work they have done to produce this review. We now ask that the Secretary of State takes a lead in invigorating his whole department to take tangible actions with shared time scales. The department needs to use the existing expertise of committed organisations both to effect immediate improvements in the working of regulation 9A and to present legislation which will help to heal the wounds of the past and build trust for the future. Ensuring that none of us will be denied the support of the person we love at our time of greatest need.

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