Impact assessment

Health Bill: promoting visiting - equality impact assessment

Published 9 September 2026

Applies to England

Introduction

The general equality duty that is set out in the Equality Act 2010 requires public authorities, in the exercise of their functions, to have due regard to the need to:

• eliminate unlawful discrimination, harassment and victimisation and other conduct prohibited by the act (equality aim 1)
• advance equality of opportunity between people who share a relevant protected characteristic and those who do not (equality aim 2)
• foster good relations between people who share a relevant protected characteristic and those who do not (equality aim 3)

The general equality duty does not specify how public authorities should analyse the effect of their existing and new policies and practices on equality but doing so is an important part of complying with the general equality duty.

In addition, the Secretary of State for Health and Social Care has a duty under the NHS Act 2006 to have regard to the need to reduce inequalities between the people of England with respect to the benefits that they can obtain from the health service.

This document therefore considers the impact of the Health Bill (‘the bill’) on people who share each of the 9 protected characteristics, as well as additional factors that have been strongly linked to inequalities related to the health service.

Summary of policy

Maintaining meaningful contact with family, friends and carers is essential for the health and wellbeing of people in health and care settings.^{[footnote 1]} The National Institute for Health and Care Excellence (NICE) guidelines about shared decision-making note that shared decision-making is critical to ensuring people are genuine partners in decisions about their care and support. Family, friends and carers often play an essential role in providing assistance, support and advocacy for those accessing care.

The COVID-19 pandemic showed how visiting restrictions can impact people. While these measures were necessary to protect the most vulnerable, evidence shows that visiting restrictions were associated with increased loneliness, depression and behavioural deterioration among people receiving care.^{[footnote 2][footnote 3]} They also had a significant impact on their families, friends and carers.

More broadly, the absence of family, friends and carers can negatively affect clinical outcomes and quality of care. For example, family presence has been linked to reduced incidence of delirium and lower use of sedative medication, while absence of visitors is associated with increased confusion, sleep disturbance and poorer pain management.^{[footnote 4]} Evidence indicates that increased family involvement in care homes is associated with improved quality of life and reduced behavioural symptoms for people living with dementia.^{[footnote 5]}

Family, friend and carer involvement also supports effective communication and shared decision-making. Restrictions on visiting are shown to delay critical decisions, including at end-of-life.^{[footnote 4]} This is particularly important for people with cognitive impairments, a learning disability or communication needs, who may rely on others to support decision-making and day-to-day care.

In addition, family, friends and carers can contribute to care delivery, provide reassurance and emotional support, and support co-ordination of care, which may improve patient experience and reduce pressure on staff.^{[footnote 4]}

Following the COVID-19 pandemic, the Department of Health and Social Care (DHSC) introduced Regulation 9A through the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Regulation 9A is a Care Quality Commission (CQC) fundamental standard on visiting and accompanying in care homes, hospitals and hospices. The regulation places duties on health and care providers to facilitate visiting and accompanying as standard unless there are exceptional circumstances in which the visit would pose a significant risk to health, safety or wellbeing which cannot be mitigated.

Separately from Regulation 9A, in response to the challenges brought about by the COVID-19 pandemic and the recognition that hospital restrictions impacted the presence of health and care partners, NHS England developed a health and care partner policy for the NHS in England. The health and care partner policy was co-designed, tested and developed in partnership with people with lived experience, patients, carers and staff. It is aimed at consistently recognising and involving health and care partners, acknowledging their unique contribution to achieving the best outcomes and experiences. It also enhances the role of families and friends in the care process and supports loved ones to be seen as ‘partners in care’. This enables them to contribute to the care needs of individuals while they are in hospital.

In April 2025, DHSC, in partnership with NHS England and CQC, launched a post-implementation review of Regulation 9A to consider whether it has been effective in meeting its objectives. The review considered the experiences of those receiving care, their families and representatives, providers and health experts. It also considered information from CQC, the Local Government and Social Care Ombudsman, the Parliamentary and Health Service Ombudsman and the devolved governments.

DHSC published the outcome of the Regulation 9A review on 18 March 2026. The review found Regulation 9A has reinforced the principle that visiting is integral to care. It has clarified expectations and given families, friends and carers greater confidence to challenge restrictions. However, consultation responses and focus groups showed that it has not led to consistent change across the system. Awareness and understanding remain variable, and there are gaps in data, monitoring and escalation. Without government intervention, visiting policies are assumed to remain inconsistent and people may not receive the full benefits.

To build on the actions already committed to as a result of the review, the relevant provisions in the bill:

• introduce a new duty on integrated care boards (ICBs) to promote appropriate opportunities for people who are provided with accommodation arranged by them to receive visitors and, where appropriate, to have someone accompany them when attending hospitals and hospices as a patient
• amend the Care Act wellbeing principle to require local authorities to have regard to the importance of:
  • involving other people in decisions and those people receiving information to do so
  • receiving visitors
  • for care home residents, having appropriate opportunities to take trips outside the care home

These duties are intended to:

• support greater consistency in how visiting, accompanying and involvement in care decisions are considered locally
• embed visiting as a system-level priority, ensuring a consistent approach across health and care settings

This complements existing provider-level requirements under Regulation 9A by strengthening system leadership, oversight and accountability for visiting and involvement. It will help ensure people in health and care settings can maintain meaningful contact and have those close to them involved in decisions about their care. It also recognises the role of families, friends and carers as partners in care.

This is a fundamental component of the high-quality, person-centred and compassionate care that is critical in supporting people to have genuine choice and control and, for many, essential to dignity, wellbeing and recovery.

These duties will be underpinned by statutory guidance for ICBs and local authorities to clarify expectations for promoting the importance of visiting within their functions. Guidance will set out expectations, aligned to existing ICB and local authority functions, covering:

• supporting providers: disseminating information and guidance to share best practice, identify issues and take steps to address them to support providers to embed a culture where visiting and the involvement of family, friends and carers are recognised as integral to high-quality, person-centred care
• information and advice: ensuring people and their carers have access to information they need to understand and support their care needs, including what they can expect from providers and how to make a complaint
• continuous improvement: using existing and future intelligence to identify patterns and take appropriate action where issues arise
• commissioning: considering information gathered on compliance with visiting regulations when exercising commissioning duties

This approach is designed to integrate with the current regulatory framework. It is proportionate to the scale of the issue and avoids creating any significant new burdens. The approach aims to:

• support a culture of open visiting and clear decision-making across health and social care
• improve the quality of care
• provide people with greater choice and control

These new duties are intended to complement, not override, Regulation 9A and existing provider responsibilities. Regulation 9A establishes that visiting should be facilitated as a normal part of care, with restrictions only considered in exceptional circumstances where a significant risk to health, safety or wellbeing cannot be mitigated. Providers will continue to be responsible for individual visiting decisions and may impose proportionate restrictions in exceptional circumstances where necessary to manage specific risks. Decisions about visiting should remain person-centred, reflecting the individual’s wishes, preferences and rights, and taking account of any relevant legal frameworks.

Intended aims

The policy objective is to strengthen visiting rights and recognise the role of families, friends or carers, so that people receiving care can maintain meaningful contact and have those close to them involved in decisions about their care. This is essential for the health and wellbeing of people in health and care settings.

By placing duties on commissioners to complement those on providers under Regulation 9A, we will embed visiting as a system-level priority in strategic planning and commissioning. This aims to ensure that visiting is consistently considered by local authorities and ICBs and prioritised at every level of the health and care system. In doing so, the policy will:

• give visiting greater visibility and status as a core component of high-quality, personalised care
• reinforce the role of families, friends and carers as essential partners in care
• improve consistency of visiting practice across health and social care settings by reducing variation and unjustified restrictions

This approach will:

• support a shift in culture
• mitigate the risk of inappropriate restrictions arising
• limit the need for reactive enforcement

By facilitating regular contact with family, friends and carers, it will also improve the wellbeing and care outcomes of people with care needs and help ensure that their rights are upheld in practice.

This primary legislative change will be supported by statutory guidance to ICBs and local authorities, setting out expectations for how they should promote the importance of visiting and contact with family, friends, carers and representatives through their existing functions. The legislation alone would be unlikely to achieve the intended cultural and behavioural change across the system. As the legislation is intended to operate alongside this guidance, the equality impacts presented in this assessment are indicative of the combined effect of the legislative change and the implementation of the accompanying guidance.

These new duties are intended to complement the existing provider duties under Regulation 9A. However, this equalities impact assessment and the corresponding impact assessment aim to consider the impact of the commissioner duties set out in this policy alone.

For ease of reference, this assessment may at times use the term ‘visiting’ as a collective description of the activities supported by the proposed duties. Unless otherwise stated, this includes opportunities:

• to receive visitors
• to be accompanied when attending hospitals and hospices, where appropriate
• for care home residents, to take trips outside the care home

References to visiting should also be read alongside the separate duty relating to the involvement of family, friends and carers in decisions about care, where relevant. This terminology is not intended to alter the distinct legal effect of each duty.

Effect on how local authorities and ICBs deliver services

Impacts will mostly be administrative, as local authorities and ICBs will need to incorporate the new duties into their existing roles. This may require some additional tasks such as:

• familiarisation with the new legislation
• updating public information materials
• considering visiting rights and the involvement of family, friends and carers as part of routine oversight and engagement with providers and their local population

Actions could include:

• disseminating visiting guidance
• engaging with providers to identify and address visiting issues
• ensuring public information on visiting rights and complaints is available
• considering available information about visiting practices of local providers during commissioning

Wider ICB changes happening beyond this bill include establishing a clearer role in the health and care system, reducing running costs and implementing ICB boundary changes. These changes will support ICBs to implement the shift towards neighbourhood health, with a greater focus on preventing illness.

Therefore, the ability of ICBs to make these changes proposed as part of this bill, while also undergoing these wider changes, will influence how successfully they can deliver the policy. This could introduce short-term service delivery risks for ICBs as they adapt to new working practices. The model ICBs blueprint and the Strategic commissioning framework (including the strategic commissioning development programme) mitigate this risk, by providing guidance and support to ICBs to achieve these changes.

However, these duties align with pre-existing responsibilities to promote wellbeing, quality and person-centred care. We expect any added workload to be limited and manageable, as the required activities align with commissioners’ routine functions. There is no evidence of any differential impact on staff with protected characteristics. Standard workplace policies will continue to protect and support staff as needed.

Effect on patients and residents

The legislation is expected to have a positive impact on wellbeing and outcomes for people in health and care settings by strengthening visiting rights and recognising the role of friends, families or carers. Having commissioners promote visiting will provide greater assurance and consistency, so that patients and residents can maintain important relationships, access support and advocacy, and, where appropriate, involve those close to them in decisions about their care.

For residents in care homes and patients in hospitals or hospices where visiting has historically been restricted, increased promotion from commissioners should lead to more consistent facilitation of visiting and family, friend and carer involvement in decisions, improving emotional support, social connection and quality of life. By promoting a culture of open visiting and reinforcing the expectation that restrictions should only be used where proportionate and justified, the duties may provide patients, residents and those close to them with greater confidence that visiting arrangements will be applied fairly, communicated clearly and kept under review. This may give patients and residents greater confidence that their rights will be respected.

Regular contact with families, friends and carers can also enhance patient outcomes - for example, reducing loneliness and potentially contributing to better recovery or shorter hospital stays. While hospices were found to be largely compliant with Regulation 9A and many health and care settings already promote visiting, the new duties will provide assurance that these arrangements are maintained, with clear expectations and protections should future restrictions be necessary.

Any potential risks, such as an unwanted visitor causing distress to residents or patients or exposure to infection for clinically vulnerable individuals from additional visitors, are expected to be minimal and are mitigated by existing safeguards and safe visiting practices under Regulation 9A and the UK Health Security Agency (UKHSA) guidance on supporting safer visiting in care homes during infectious illness outbreaks. Overall, the policy is expected to improve consistency and confidence in visiting access across all settings. The positive impacts may be felt disproportionately by some groups of people, such as disabled people, children and older adults, but the benefits should extend to all people.

Effect on visitors (family, friends and carers)

This policy supports and recognises the role of family, friends and carers who visit or accompany people who draw on care and support. Families, friends and carers will benefit from clearer, stronger assurances that they can visit with ease and regularity based on the person’s needs and preferences. It reinforces the importance of their involvement, meaning commissioners will help ensure information and support is available for carers.

This, in turn, is likely to strengthen relationships and reduce the stress of separation when someone is receiving care, treatment or support in a health or social care setting. By explicitly acknowledging carers as partners in care, the policy should improve their ability to advocate and provide support without bureaucratic barriers. The impacts of this policy on visitors with particular protected characteristics are considered in detail in the analysis below.

Effect on care home, hospital and hospice staff

For staff in provider settings, the legislation’s direct effect is limited, as it does not impose new duties on them beyond what is already required under Regulation 9A (facilitating visits). Providers already have duties to facilitate visiting and should have flexible and open visiting policies in place. The new commissioner duties are intended to support greater visibility, consistency and system oversight of visiting, rather than change providers’ existing responsibilities for making individual visiting decisions. Where providers are already fulfilling their duties appropriately, no additional impacts on providers are expected. Where providers are not fully meeting those duties, any activity needed to facilitate visiting would be consistent with the level of activity already expected and accounted for under Regulation 9A, rather than an additional impact arising from this legislation.

However, this is expected to be manageable and minimal. In the review of Regulation 9A, most providers and care home professionals reported that they had open visiting policies and were already following visiting guidance. Many providers reported that Regulation 9A was low burden for providers and that health and care providers want to support visiting, with one care home professional saying:

[We] have always welcomed families into the home… it isn’t a problem.

Additionally, family carers often assist staff during visits (for example, by helping at mealtimes or providing companionship), which can free up staff time.

In practice, no significant additional burden is expected for care staff, since no large surge in visitor numbers is anticipated. The new duties include supporting providers through guidance, and providers retain discretion to manage visits safely. As a result, any impact on staff workload or workplace safety should be negligible. There is no evidence of any differential impact on staff with particular protected characteristics. Standard workplace policies will continue to protect and support staff as needed.

Engagement and involvement

Evidence and testing

Sources of evidence considered include:

• published research and reports (including national studies, international comparisons, and lessons from COVID-19 on visiting restrictions)
• data from Capacity Tracker on visiting in care homes (Capacity Tracker is a data capture platform used by DHSC and NHS England to collect information from care providers in real time. Note that we do not have a similar mechanism for collecting data from hospitals and hospices because it is difficult to meaningfully measure visiting in those settings)
• feedback from stakeholders through a public consultation on visiting in care homes, hospitals and hospices
• stakeholder feedback and engagement as part of the review of Regulation 9A - this included a call for evidence and focus groups with people who draw on care and support, relatives, carers, providers, regulators and advocacy organisations to gather quantitative and qualitative evidence on the impact of visiting policies and any equality considerations

Extensive stakeholder engagement was undertaken in partnership with NHS England through formal evidence-gathering activities as part of the review of Regulation 9A, which has informed the development of this policy.

Before Regulation 9A was introduced, DHSC ran a public consultation on visiting in which people who draw on care and support, families, unpaid carers, health and care providers, advocacy groups and system partners (NHS and local authorities) provided feedback on their experiences and needs (linked above). These inputs demonstrated the crucial role of visiting for wellbeing and highlighted inconsistencies in practice under pandemic restrictions.

Subsequently, the review of Regulation 9A engaged a wide range of stakeholders. Engagement included people with lived experience, families and carers, advocacy groups, patient representative organisations, provider organisations, health and care providers and regulatory bodies such as CQC. These organisations played an important role in helping DHSC to understand and reflect the experiences and views of people who draw on care and support. The review process included:

• a public call for evidence
• focus groups
• analysis of visiting data (from Capacity Tracker)
• desk research on approaches in other countries

Review findings reiterated that visiting is essential for the welfare of people who draw on care and support, but also that awareness and implementation of existing visiting guidance remained variable across the system. This indicated the need for additional support in interpreting guidance during outbreak situations and a stronger, system-level approach. This evidence base underpins the proposed policy, ensuring it responds directly to stakeholder insights and addresses identified gaps.

Alongside the development of Regulation 9A, NHS England undertook work to promote the role of health and care partners and address variation in visiting practices across NHS settings following the COVID-19 pandemic. This included development of the NHS health and care partner policy, which recognises the important role that family, friends and carers can play as partners in care.

Shaping policy

Stakeholders also helped to shape the design of the visiting policy. The findings from the review of Regulation 9A and earlier consultation were used to refine the policy. For example, commissioner-level duties were developed to address gaps in system oversight that stakeholders had identified. A steering group (comprised of policy officials, NHS England, UKHSA, CQC, charities and organisations representing people with lived experiences and care sector representatives) was convened after the review to take forward commitments from the review and support policy development.

DHSC engaged internally with relevant government partners, including teams in DHSC, the Ministry of Housing, Communities and Local Government (MHCLG) (on local government impacts) and CQC, to align the proposal with existing duties and to help ensure it complements the current regulatory framework. While this specific policy has not had a standalone public consultation, it is grounded in comprehensive prior stakeholder engagement, and its focus on local authority and ICB promotion of visiting and the involvement of family, friends and carers in decisions about care reflects direct recommendations from that process.

Analysis of impacts

The following analysis considers the expected impacts of the policy on each protected characteristic. These impacts are primarily indirect, operating through system-level oversight, guidance and commissioning, rather than direct service delivery.

This policy will benefit all people who draw on care and support regardless of their protected characteristics, as the duties to promote visiting and the involvement of family, friends and carers in decisions about care apply universally. No person should be adversely impacted by the policy.

Disability

We expect a disproportionately positive impact on disabled people.

Disabled people form a large proportion of those receiving health and social care and are therefore likely to benefit most from the new duties on commissioners. However, this policy will benefit all people who draw on care and support regardless of whether they have a disability, as the duties to promote visiting and the involvement of family, friends and carers in decisions about care apply universally.

Evidence from the review of Regulation 9A highlighted the benefits of visiting for disabled people, including reduced loneliness and additional practical support that visitors can provide. For example, some people with a learning disability may need help with daily activities such as communication, decision-making, personal care, attending appointments and managing money, much of which is provided by their families, friends or carers. Disabled patients and residents may find health and care settings unfamiliar, worrying or physically challenging to navigate. Having the support of family, friends or carers who understand their individual needs, preferences and communication requirements can provide reassurance, support decision-making and help ensure their needs are understood and met. We also know that visiting is good for mental wellbeing, and research shows that social contact can help slow deterioration in conditions such as dementia.^{[footnote 6]}

Disabled patients, visitors and carers, including those with visual impairments, hearing impairments or communication needs, may be adversely affected if information about visiting arrangements and rights is not accessible. This risk can be mitigated through the provision of information in accessible formats and through reasonable adjustments to communication, helping ensure people can understand and exercise their rights and responsibilities in relation to visiting.

A potential consideration is the risk of transmission of infectious diseases to clinically vulnerable individuals. People in hospitals, care homes and hospices are more likely to have underlying health conditions which may increase their vulnerability to infection. However, we do not expect a large surge in visitor numbers. Where there are additional visitors, existing safeguards under Regulation 9A, together with established infection prevention and control measures and guidance on safer visiting during outbreaks, are intended to support providers to identify proportionate mitigations. These will enable visiting to continue wherever possible while protecting people from avoidable harm.

Introducing new duties on commissioners to promote visiting and the involvement of family, friends and carers in decisions about care is expected to further improve visiting practices and have a positive impact on disabled people. It will increase opportunities for social contact and personal support, especially in settings which may not be compliant, thereby reducing isolation and enhancing wellbeing.

Care home residents

The DHSC Adult social care activity report, England: 2024 to 2025 shows that:

• 56.1% of individuals receiving local authority-supported long-term adult social care in residential or nursing settings have physical support needs
• 10.5% have learning disabilities support needs
• 11.9% have mental health support needs

While these service categories are not exact proxies for disability, they indicate a high prevalence of disability among social care users (Census 2021 data shows 17.7% of the overall England population is disabled). There is also growing demand for working-age adult care, partly due to more severely disabled people living longer into adulthood. All residents in care settings, whether disabled or not, will benefit from this policy.

Hospital patients

Data on disability among hospital patients (from Hospital Episode Statistics) is limited. However, many patients in mental health hospitals have severe mental illness and/or a learning disability that significantly impair their functioning, and may identify as disabled. All patients, whether disabled or not, will benefit from this policy.

Hospice patients

Most hospices are independent charitable organisations, so data on hospice patients’ disabilities is not available. However, given the nature of hospice care, all hospice patients will have a life-limiting illness that is often accompanied by impairments or severe health conditions. All hospice patients, whether disabled or not, will benefit from this policy.

Sex

We expect a marginally disproportionately positive impact on women relative to men.

This policy will benefit all people who draw on care and support regardless of sex, as the duties to promote visiting and the involvement of family, friends and carers in decisions about care apply universally. However, women make up a slightly larger proportion of affected groups (people drawing on care and support, visitors, and staff), so they may experience a relatively greater share of the benefit in practice.

Care home residents

The adult social care activity report 2024 to 2025 shows that women constitute 60% of individuals receiving local authority-supported long-term adult social care in residential or nursing settings, compared with 51.6% of the general 18 and over population in the Census 2021 (see Office for National Statistics (ONS) Census 2021 sex by age data set).

Hospital patients

NHS hospital admitted patient care activity, 2024 to 2025 shows that around 55% of admitted hospital patients were women.

Hospice patients

Data from Hospice UK indicates that 54% of people receiving hospice services in 2024 to 2025 were female (see Hospice UK: key facts about hospice care).

Visitors

In our public consultation on visiting in care homes, hospitals and hospices, 560 female respondents stated that they had visited a loved one in a care home, hospital or hospice, compared with 138 males. Additionally, Census 2021 data indicates that in England, 10.3% of females provide unpaid care compared with 7.6% of males. These figures could be used to assume that women are more likely to be visitors and be involved with the care of residents or patients than men.

Sexual orientation

We expect no disproportionate impact in relation to sexual orientation.

The policy will benefit people who draw on care and support equally regardless of their sexual orientation, since the duties to promote visiting and the involvement of family, friends and carers in decisions about care apply to everyone. However, for some people of different sexual orientations, including lesbian, gay, bisexual and other minority sexual orientations, trusted partners or friends may play a particularly important role in providing advocacy, emotional support and assistance during periods of care and treatment.

We do not currently have specific data on sexual orientation among people who use health and care services, but there is no reason to expect any group would be disproportionately advantaged or disadvantaged.

However, some lesbian, gay and bisexual people may experience barriers when accessing health and care services, including lower levels of trust and concerns about stigma or discrimination.^{[footnote 7]} By promoting an inclusive approach to visiting and reinforcing the importance of involving family, friends and carers, regardless of their relationship status, the policy may contribute to a more supportive and person-centred experience for some lesbian, gay and bisexual people.

Some responses to our public consultation on visiting in care homes, hospitals and hospices raised that lesbian, gay and bisexual individuals may have particular needs related to visiting - for example, some may have a ‘chosen family’. The importance of being able to choose who is involved in a person’s care, and who may or may not visit them, is relevant to all individuals regardless of protected characteristic. Regulation 9A already requires providers to take account of a person’s wishes and preferences regarding visiting arrangements. The proposed duties are intended to reinforce person-centred and inclusive practice across the system. By reinforcing this and promoting inclusive practice, the new duties may help support lesbian, gay and bisexual people to benefit equally from personal support networks. In this way the policy helps advance equality of opportunity between heterosexual and non-heterosexual people.

Race

We expect no disproportionate impact in relation to race.

A positive impact is expected across all people who draw on care and support equally regardless of their race. There are no expected differences by colour, nationality, national origin and ethnic groups, with no particular group disadvantaged. While some ethnic groups, including Black people in mental health inpatient settings, are overrepresented in particular health and care settings, we have not identified evidence that they currently experience visiting restrictions at a higher rate or would benefit disproportionately from the proposed duties.

Care home residents

The Local Government Association client level data insight report indicates that White and Black British individuals are slightly overrepresented among those receiving local authority-supported long-term care (85.9% of care users are White and 5.2% are Black, compared with 83.3% and 3.8% respectively in the general adult population).

Hospital patients

Data on hospital admission activity in 2024 to 2025 (table 1) indicates that Mixed ethnicity individuals are underrepresented and ‘Other’ ethnicity individuals are slightly overrepresented among inpatient episodes relative to the general population benchmark.

Table 1: hospital admission activity by ethnicity in 2024 to 2025

Ethnicity	Finished admission episodes	ONS population	Admissions per 100,000 population
All people with known ethnicity	15,937,397	56,490,048	28,213
White	13,228,662	45,783,401	28,894
Mixed	288,771	1,669,378	17,298
Asian	1,367,959	5,426,392	25,209
Black	623,084	2,381,724	26,161
Any other ethnic group	428,921	1,229,153	34,896
Unknown	2,531,459	No data available	No data available

Note: table 1 shows admissions presented alongside ONS population data, and admission episodes scaled per 100,000 population. This rescaling assumes that the omitted and present ethnicity information have the same distribution.

Mental Health Act statistics, annual figures, 2024 to 2025 show that known rates of detention under the Mental Health Act for the Black or Black British group (262.4 detentions per 100,000 population) are almost 4 times those of the White group (65.8 per 100,000 population).

When considering all admissions (not just people detained under the Mental Health Act), the mental health bulletin, 2024 to 2025 annual report shows that Black African or Caribbean or Black British people are most overrepresented in admissions to mental health hospitals (see table 2 below).

Table 2: mental health hospital admissions by ethnicity in 2024 to 2025

Ethnicity	Admissions	ONS Population	Admissions per 100,000 population
All people with known ethnicity	91,701	56,490,048	162
White	66,278	45,783,401	145
Mixed or multiple ethnic group	4,229	1,669,378	253
Asian or Asian British	7,419	5,426,392	137
Black, African, Caribbean or Black British	9,632	2,381,724	404
Other ethnic groups	4,143	1,229,153	337
Not stated or unknown	9,285	No data available	No data available

Note: table 2 uses the same method as table 1 to calculate admissions per 100,000 population (see note above).

Hospice patients

As most hospices are independent charitable organisations, there is variation in how they collect and share data on protected characteristics. Office for Health Improvement and Disparities (OHID) data shows that ethnic minorities are underrepresented in hospices when measuring based on place of death.

Table 3: deaths in hospices by ethnicity, 2021^{[footnote 8]}

Ethnicity	Percentage of deaths in hospices	Percentage of deaths in all settings
White	92	89
Asian or Asian British	1.6	3.5
Black, African or Black British	1.5	1.9
Mixed	0.5	0.4
Other	0.4	0.3
Not known	3.9	4.8

Age

We expect a disproportionately positive impact for older adults.

The policy will benefit all people who draw on care and support equally regardless of their age, since the duties to promote visiting and the involvement of family, friends and carers in decisions about care apply to everyone. However, older adults (aged 65 and over) are expected to benefit disproportionately, as they make up a larger proportion of those who use health and social care services and may be more vulnerable to social isolation.

Evidence shows that loneliness in later life is associated with poorer health and wellbeing outcomes, while maintaining social connections can help mitigate these effects.^{[footnote 3][footnote 9][footnote 10][footnote 11]} The policy is therefore expected to support the wellbeing, autonomy and quality of life of older people by helping to protect access to their family.

Children and younger people in health and care settings are also expected to benefit from consistent visiting practices and greater involvement of family. Although they represent a smaller proportion of the affected population, evidence suggests that parental and family presence supports children’s wellbeing, sense of security, understanding of treatment and engagement with care, and is recognised as a core component of family-centred care^{[footnote 12][footnote 13]} Maintaining contact with parents and families can be particularly important in supporting children’s care, treatment and recovery.

No adverse impacts on any age group have been identified. Overall, the policy is expected to support social connection, wellbeing and involvement in care decisions across all ages, while providing particular benefits for groups at greater risk of isolation or who rely more heavily on family, friends and carers for support.

Care home residents

The ‘Adult social care activity report 2024 to 2025’ (linked above) shows that 83.6% of individuals receiving local authority-supported long-term adult social care in residential or nursing settings were aged 65 or over, compared with 23.3% of the general 18 and over population (as of the ONS Census 2021: sex by age data set, linked above).

Hospital patients

‘Hospital admitted patient care activity, 2024 to 2025’ (linked above) shows that 44.4% of patients admitted to hospital were aged 65 and over, compared with 18.6% of the population (as of the ONS 2021 profile of the older population living in England and Wales).

Hospice patients

According to data from Hospice UK, of people receiving hospice services in the UK in 2024 to 2025:

• 76% were aged 65 or over
• 21% were aged 19 to 64
• 4% were aged 18 or under

(Source: ‘Hospice UK: key facts about hospice care’ (linked above)).

Gender reassignment

We do not expect a disproportionate impact on transgender people.

There is limited quantitative data on transgender people in care homes, hospitals or hospices, but the policy is anticipated to benefit transgender individuals in the same way as other people who do use these services by reinforcing a supportive, person-centred approach to visiting.

Some responses to our public consultation on visiting in care homes, hospitals and hospices indicated considerations for transgender individuals who may rely on supportive friends or ‘chosen family’ rather than biological relatives. Existing standards (Regulation 9A) are clear that a person’s visiting preferences must be considered, including who they may or may not want to receive as a visitor.

Care home residents

There is some evidence that transgender people might face particular barriers to taking up formal care. For example, a 2019 scoping review concluded that social care environments appeared as a focal point for inequities and that formal care environments could seriously compromise the identity and relationships of older lesbian, gay and bisexual people.^{[footnote 14]}

Hospital patients

Data on hospital patients and gender reassignment is not available.

Hospice patients

Data on hospice patients and gender reassignment is not available.

Religion or belief

We do not expect a disproportionate impact in relation to religion or belief.

The policy is designed to accommodate and respect the religious or belief needs of all people who draw on care and support. While data on religion in health and care settings is not routinely collected, stakeholder feedback underlined that spiritual support is important for many people.

Existing standards (Regulation 9A) support a person-centred approach to visiting that takes into account the individual’s wishes, preferences and support needs. This approach can support consideration of visits from clergy, faith leaders or others providing spiritual support where this is important to the individual. No negative or differential impacts related to religion or belief are anticipated. Individuals of all faiths or none will benefit equally from strengthened visiting.

Pregnancy and maternity

We expect a disproportionately positive impact on pregnant individuals and new mothers, particularly in hospital settings.

The new duties are expected to benefit pregnant women and new mothers by aiming to support them to have their partners or companions accompany them to appointments and can receive visitors if they are in hospital, reinforcing existing good practice in maternity care.

‘Hospital admitted patient care activity, 2024 to 2025’ (linked above) showed that episodes for females aged 20 to 39 were nearly 3 times those of males in the same age groups (largely due to maternity services), so consistent visiting and accompanying policies will be particularly relevant for them. The policy primarily ensures that pregnant women’s and new mothers’ rights to support and visitation are upheld and given appropriate priority across the system.

The National Maternity and Neonatal Investigation also found that women, birthing people and families are not always listened to within maternity services and that concerns raised by partners and family members can be overlooked. The report highlighted the importance of involving those close to an individual in communication and decision-making, particularly during urgent or emergency care. By supporting accompaniment and family involvement, the policy may help promote safer, more person-centred maternity care by enabling partners and advocates to raise concerns, support communication and participate in decisions about care.

Marriage and civil partnership

We do not expect a disproportionate impact in relation to marriage and civil partnership.

The policy supports visiting in all personal relationships, including visits by a spouse or partner. It benefits married people and those in civil partnerships who are in health and care settings, by helping them maintain contact with their partner.

Care home residents

Census 2021 data on legal partnership status in communal establishment residents shows 80% of individuals aged 65 and over resident in communal establishments were unmarried. Communal establishments in this case include student halls, boarding schools, armed forces bases, hospitals, care homes and prisons. It is likely that restricting to those aged 65 and over increases the chance that these individuals are resident in care homes, but we cannot determine exactly which communal establishments these individuals are residing in.

As a comparison, in the 2021 Census data on legal partnership status, 43% of the general 65 and over population were unmarried.

Hospital patients

Data on the marital status of hospital patients is not available.

Hospice patients

Data on the marital status of hospice patients is not available.

Other identified groups

These are not covered by the Equality Act 2010.

Socioeconomic background and geography are routinely included in considerations on health and social care policy. This is due to health inequalities, which are differences in health outcomes that are unfair and avoidable, and which are rooted in socioeconomic background and geography.

Poor mental health is considered to be closely linked to health inequalities and is therefore also routinely included in considerations of health and care policy.

Socioeconomic background and geography

We expect a positive impact in relation to socioeconomic background and geography.

Although the available evidence does not directly quantify the effects of visiting restrictions by deprivation level or region, there is strong evidence that inequalities in health and social care are shaped by socioeconomic circumstances and place. National data from the Health Inequalities Dashboard: September 2025 data update shows persistent inequalities across England by deprivation and local area. The CQC report on the state of health care and adult social care in England 2024 to 2025 identified geographical variation in access to publicly funded long-term social care and notes that access varies not only with deprivation and disability but also with characteristics of local areas, including the size of the older population.

People living in rural areas and those on lower incomes may also face some practical barriers to visiting, such as:

• longer travel distances
• higher travel costs
• limited or less frequent public transport links
• reduced flexibility to take time away from work

The policy does not directly address these wider practical barriers to visiting.

The duties on local authorities and ICBs are expected to have a positive impact by promoting visiting and the involvement of family, friends and carers more consistently across local systems. This should help reduce variation in practice and reduce the risk that access to meaningful contact and advocacy depends on where a person lives or the resources available to them and their support network. However, we recognise that the scale of any benefits is likely to depend on local implementation and wider factors affecting access to health and social care services, and the ease of visiting to begin with.

Mental health

We expect a positive impact on people’s mental health.

Evidence consistently demonstrates that maintaining contact with family, friends and carers supports psychological wellbeing and can reduce loneliness, anxiety and depression. Research undertaken following the COVID-19 pandemic^{[footnote 3]} found that visiting restrictions were associated with increased loneliness, depression, distress and behavioural deterioration among people receiving care.

In mental health settings specifically, evidence indicates that involving family members and carers may improve patient outcomes, support recovery and contribute to safer care.^{[footnote 15]} Investigations into serious incidents, including suicides, have highlighted the importance of effective communication and involvement with families and carers.

The proposed duties on local authorities and ICBs are therefore expected to have a positive impact by promoting more consistent access to meaningful contact and encouraging the involvement of family, friends and carers in decisions about care. This may be particularly beneficial for people receiving mental health care, who may rely on trusted individuals for emotional support, advocacy and assistance in navigating services.

Summary of analysis

This policy sits within the existing framework established by Regulation 9A, under which visiting should ordinarily be facilitated and restrictions should only be imposed in exceptional circumstances where significant risks cannot be adequately mitigated. Regulation 9A was designed to secure better outcomes for all people who draw on care and support regardless of their protected characteristics.

Evidence from stakeholder engagement and analysis indicates that the policy will have either disproportionately positive impacts or no disproportionate adverse impacts across the protected characteristics considered, with no negative impacts expected. This assessment is based on the new duty, set out in primary legislation, and complementary statutory guidance. Some groups, particularly disabled people, older adults and pregnant women and new mothers are expected to benefit most due to their higher representation among people who draw on care and support and carers. These groups are expected to see improved wellbeing, reduced isolation and better support in healthcare decision-making because of more consistent visiting access. No adverse differential impacts have been identified.

In areas where evidence is limited (such as sexual orientation, gender reassignment and religion), existing standards (Regulation 9A) ensure that needs are respected. Any potential risks, including for clinically vulnerable individuals, are expected to be limited and mitigated through existing safeguards and commissioner-led promotion of safe visiting practices.

By making visiting and involvement of family, friends and carers a system-level priority, the policy will support inclusion and help remove barriers to meaningful contact, support and involvement in decisions about care. Strengthening visiting rights and requiring commissioners to promote the involvement of carers and representatives supports the elimination of potential discrimination, harassment, victimisation and other conduct prohibited by or under the Equality Act 2010. It helps ensure that access to personal support is not unfairly restricted. This policy also advances equality of opportunity by removing barriers so that everyone can equally benefit from the presence and advocacy of family, friends and carers.

Additionally, by acknowledging family, friends and carers of residents and patients as partners in care, the policy may help foster good relations between people who share a protected characteristic and those who do not, including providers, people who draw on care and support, and communities. It encourages trust, understanding and collaboration, leading to better relationships and outcomes for people across all backgrounds. The new duties are expected to enhance fairness and inclusion while any remaining risks are addressed through proportionate safeguards and guidance.

Overall impact

The evidence indicates that the policy will have a primarily positive overall impact, with some differential benefits reflecting existing patterns of service use. Groups more likely to use health and social care services (including disabled people, older adults and pregnant women and new mothers) are expected to experience disproportionately positive impacts through improved social connectedness, support and involvement in care decisions.

Some variation in awareness and implementation has been identified across local areas. The policy addresses this by placing clear duties on commissioners (local authorities and ICBs) to promote consistent approaches to visiting and family, friend and carer involvement.

Addressing the impact on equalities

Any potential risks, including those related to clinically vulnerable individuals (such as infection risk), are mitigated through existing safeguards under Regulation 9A and reinforced through commissioner-led guidance and oversight.

Local authorities and ICBs will promote inclusive, person-centred visiting approaches, including recognising diverse family structures and supporting the involvement of carers and representatives in decision-making.

Through existing functions such as commissioning, information provision and engagement with providers, commissioners will take proportionate action to address barriers to access and ensure equitable implementation. This approach:

• supports the elimination of discrimination
• advances equality of opportunity by reducing barriers to support and advocacy
• fosters good relations by strengthening collaboration between services, individuals and their families, friends and carers

Monitoring and evaluation

We will monitor the policy as part of DHSC’s wider visiting policy programme, assessing how effectively it strengthens the visiting rights introduced through Regulation 9A.

Monitoring will draw on a range of existing intelligence sources, including:

• Capacity Tracker data
• CQC
• the ombudsmen
• stakeholder engagement
• correspondence

Monitoring will also be used to inform proportionate evaluation of whether the policy is achieving its intended effects in practice. This will include considering whether:

• local authorities and ICBs are embedding visiting and family, friend and carer involvement within relevant commissioning, oversight and improvement activity
• people receiving care and those important to them experience clearer information, more consistent practice and improved routes for raising concerns
• there is evidence of unintended consequences, continued non-compliance, or uncertainty about roles and responsibilities between providers, commissioners and regulators

In response to findings from the review of Regulation 9A that highlighted limitations in existing monitoring arrangements, we will seek to strengthen the quality of available data. This will include:

• reviewing and refining Capacity Tracker visiting questions and associated completion instructions
• improving consistency of interpretation
• ensuring providers have a clearer understanding of what constitutes a visiting restriction

This is expected to improve the reliability and usefulness of data collected from care home providers to support with better identification of emerging trends and potential compliance issues.

We are also working closely with CQC to ensure visiting duties are embedded within relevant elements of their ongoing reform and improvement programme. This includes:

• consideration of visiting and access to family, friends and carers within the new assessment framework
• inspector training and internal guidance
• future data and intelligence developments to consider how feedback in relation to visiting can be captured and used to inform monitoring and support regulatory oversight and policy evaluation

Additionally, assurance will be provided by CQC and DHSC. CQC assesses local authority duties under part 1 of the Care Act 2014 and will therefore play a role in assessing how well local authorities discharge these new duties. Through the bill, performance assessment of ICBs will transfer to the Secretary of State who must assess each ICB against how it has discharged its functions, including this new duty.

Conclusion

The equality impact analysis indicates that the policy is expected to:

• support the elimination of discrimination
• advance equality of opportunity
• foster good relations

It will do this by promoting inclusive, person-centred approaches to visiting and involvement in care.

By strengthening system-level promotion of visiting and involvement, it will support inclusive, person-centred care and help ensure individuals can maintain important relationships while receiving care.

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4. Morgan JD and others. An integrated review: connecting COVID-era hospital visiting policies to family engagement. Frontiers in Public Health 2023: volume 11, page 1249013. ↩ ↩² ↩³

5. Kasugai S and others. Family visits among nursing home residents during the COVID-19 pandemic: a cross-sectional study. BMC Geriatrics 2025: volume 25, issue 1, page 517. ↩

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11. Laermans J and others. Friendly visiting by a volunteer for reducing loneliness or social isolation in older adults: a systematic review. Campbell Systematic Reviews 2023: volume 19, issue 4, page e1359. ↩

12. Miller L and others. Parental presence at the bedside of critically ill children in the paediatric intensive care unit: a scoping review. European Journal of Paediatrics 2022: volume 181, pages 823 to 831. ↩

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