Care Quality Commission (CQC) - Registration, Regulation and Enforcement

“When it comes to healthcare-related matters, Kingsley Napley LLP is a ‘force to be reckoned with’, and ‘shines as an exemplar of a quality practice"

Legal 500 UK, 2013

Our Regulatory and Public Law  teams are specialists in assisting registered care providers, directors and managers in all matters concerning the Care Quality Commission (CQC). We can guide you through the CQC regulatory scheme, from registration to appeals, including in judicial review challenges.
 

We understand the pressures on those that work in this sector as well as the potential implications of enforcement action or an unfavourable inspection report by the CQC. The timescales to respond are often tight and we react promptly and often in a collaborative manner with the CQC to achieve the most favourable outcome possible.

Specialist lawyers for healthcare regulation

We are independently ranked as specialists in healthcare regulation, having acted in the field for several decades. We act for individuals, organisations and corporates, making our insight into the sector incomparable. We can assist you to:

Challenge a refusal or proposal to cancel registration

Registration with the CQC is required for any person who, or organisation that, provides a regulated activity in England. Failure to register with the CQC when providing a regulated activity constitutes a criminal offence under section 10 of the Health and Social Care Act 2008.

Once an application for registration is made to the CQC, it must consider whether the applicant is fit to provide services and comply with the regulations. If the CQC is not satisfied as to these issues, the application for registration may be refused.

Following an inspection, should the CQC consider that a service provider is no longer fit, it may serve a Notice of Proposal to Cancel Registration. Upon effect of the Notice, the service will be closed.  

In either circumstance, we can help. Prompt action is required as representations are time-sensitive. We will work with you to provide the critical advice and assistance that you need and to progress the matter swiftly to an appeal, should it prove necessary.

 

Challenge a Warning Notice

If it appears to the CQC that a service provider is in breach of the regulations, that care has fallen below the legally required standard, or a breach of a registration condition has occurred, it may issue a Warning Notice pursuant to section 29 of the Health and Social Care Act 2008.

You will have an opportunity to make representations about the matters in the notice, but this must be done within 10 working days.

Whilst the CQC does not routinely publish the full content of any Warning Notice, any information which is published can have a detrimental effect on the reputation of a service provider. Further, enforcement action can attract a fine.

We will guide you through the process and prepare written representations which can make all the difference.    

 

Deal with conditions of registration

The CQC can also impose conditions on a service provider’s registration in circumstances where there are issues as to the delivery of a regulated activity. Such conditions can have a commercial and reputational effect on your business and therefore require a swift and careful response.

In circumstances where the CQC issues a Notice of Proposal to impose a condition on registration, you have 28 days to make representations. We can advise on the strength of the CQC’s case, prepare the representations and liaise with the CQC, in a collaborative manner, if considered in your best interests, and progress the matter to an appeal, should it prove necessary.

 

Challenge an inspection report

The inspection process is very important: the inspectors will speak to members of staff and observe care whilst bearing these five questions in mind regarding the service:

  1. Is it safe?
  2. Is it effective?
  3. Is it caring?
  4. Is it responsive to people’s needs?
  5. Is it well-led?

Following an inspection, the CQC will issue a draft report which will include detailed commentary about the service, a rating in each domain and an overall rating.

You will have the opportunity to challenge any factual inaccuracies at this stage, but this must be done promptly, as the report will be made public soon thereafter. This can be a very important step in the process if there are inaccuracies or omissions which may enhance a rating or the overall tenor of the report.

We can assist by preparing the Factual Accuracy Comments form, which details any inaccuracies with supporting evidence.

We are adept at dealing with rating reviews in circumstances where the CQC has failed to follow its processes for making ratings decisions. Such requests must be submitted within 15 working days of the publication of the report and as such, early instruction of lawyers is advisable.

Should the CQC have failed to follow its own processes or some other legal requirement, or have acted in a way which is irrational, we can advise you on the merits of challenging them by way of a judicial review.

 

Lodge a complaint regarding the inspection process

The complaints process is entirely separate from the process to challenge the factual accuracy of an inspection report. The CQC’s National Complaints Team will consider and respond to matters which relate to issues such as:

  • Unprofessional conduct of its staff
  • Administrative errors
  • A failure to follow procedure

We assist clients with drafting and submitting complaints to the CQC. We liaise with the CQC as to the complaint and provide evidence as required for the investigation. 

 

Enforcement action and judicial review

The CQC has enforcement powers to meet its overarching aim of protecting the users of regulated services from harm and the risk of harm.

Where breaches of the regulations constitute a criminal offence, the CQC can:

  • Issue a simple caution
  • Serve a penalty notice
  • Commence prosecution

Prosecutions are initiated in the Magistrates’ Court and can lead to convictions and considerable fines. We have extensive expertise in dealing with regulatory prosecutions. We will build a team of lawyers drawn from the Criminal Litigation Team as well as the Regulatory Team, meaning that the most specialist lawyers will be involved in securing the very best possible outcome. 

In circumstances where you remain dissatisfied with the outcome of an inspection report/rating following the factual accuracy process, the available remedy is judicial review.

 

Review and/or improve governance and compliance

We are able to work closely with trusted consultants. As a collaborative team we have vast experience in compliance, as well as knowledge and understanding of governance and CQC requirements.

Our work in this area is directed towards turnaround management solutions and assessing compliance in accordance with CQC regulations. We can assist you by:

  • Preparing action plans to achieve compliance in accordance with CQC standards and guidance;
  • Auditing and reviewing policies and procedures;
  • Arranging mock inspections with full feedback; and/or
  • Assisting you to complete a full suite of CQC compliant policies and procedures ahead of registration applications.

 

Deal with concerns as to CQC fit and proper persons requirements

One of the measures used by the CQC to ensure safety and quality of services is that directors of registered providers and any employed staff must be “fit and proper” to enable them to provide the regulated activity. This requirement is contained in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The CQC can take action in circumstances where there are concerns that a registered provider is run by or employs unfit people.

We will guide you through the process providing pragmatic and straightforward advice to deal with any concerns and/or handle any enforcement action.

 

Latest blogs & news

Mandatory Covid-19 Vaccinations for Care Home Workers

This week, the Government announced that Covid-19 vaccinations will be made compulsory for care home staff, raising strong emotions on both sides of the argument.

Health and Social Care White Paper 2021: Where next for patient safety and professional healthcare regulation?

Last week, the Department of Health and Social Care published a white paper, Integration and Innovation: working together to improve health and social care for all (the ‘White Paper’), setting out legislative proposals for a new Health and Care Bill, planned to come into force in 2022. 

Unacceptable Professional Conduct and Conviction cases: avoid the pitfalls of applying the wrong tests to the wrong facts

Wray v General Osteopathic Council [2020] EWHC 3409 (QB)

Mr Wray (‘Mr W’), an osteopath, appeared before a Panel of the Professional Conduct Committee (‘PCC’) of the General Osteopathic Council (‘GOsC’) after self-reporting a series of events he had been involved in.

Fit and proper person requirements for directors in the health and care sector – what does this mean and what are service providers required to do?

All providers registered with the Care Quality Commission (“CQC) must assure themselves that all directors who are responsible for delivering care to service users are fit and proper – in other words, they must be able to diligently carry out their responsibility to ensure the quality and safety of care. This forms part of the providers’ duty to ensure the service is well-led, which is one of the focus points during an inspection. Not only does the CQC monitor compliance at the point of registration, but it is an on-going duty and can lead to enforcement action where it is not met.

CQC guidance and what it means for care providers during the Coronavirus pandemic

The COVID-19 outbreak is new territory, not only for care providers working on the frontline, but also for regulatory bodies. Those that are responsible for caring for vulnerable service users must now do so in an increasingly challenging environment, whilst ensuring that they comply with their professional obligations.

UKCP issues new Code of Ethics and Professional Practice

The new Code of Ethics is a product of four years’ work by the UKCP and replaces the previous version, Ethical Principles and Code of Professional Conduct, which was implemented some 10 years ago. The new Code comes into force on 1 October 2019. This means that any complained-of-behaviour that occurs on or after 1 October 2019 will be judged against the new code but conduct that occurs before that date will be judged against the old code.

Is the BACP’s new Professional Conduct Procedure any less Kafkaesque?

At the end of last year, the BACP finally published its long awaited revised Professional Conduct Procedure (PCP).  Having consulted on amendments to the PCP as far back as 2015, the sheer length of time it has taken to unveil the revised procedure has not gone unnoticed by the Professional Standards Authority (PSA) who only renewed the BACP's accreditation on the condition that the new PCP be published before the end of 2018.  The new PCP only applies to complaints received on or after 1 December 2018.

The Duty of Candour: Telling patients the truth when something goes wrong

A paper published by the Professional Standards Authority (“PSA”) last week entitled “Telling patients the truth when something goes wrong” (“the Paper”) addresses the progress of regulators in the Health and Social Care sector in embedding the professional duty of candour over the past 5 years. The Paper highlights the role regulators have played in the development of the Duty of Candour and it’s recognition throughout the Health and Social Care Sector.

NMC’s reliance on hearsay evidence leads to successful appeal

On 23 May 2018, a Conduct and Competence Committee ("the Committee") of the Nursing and Midwifery Council ("NMC") determined that the appellant’s fitness to practise as a midwife was impaired by reason of her misconduct and that the appropriate sanction was an order striking her off the register.

Court of Appeal reaffirms the need for detailed medical evidence in the event of seeking an adjournment on health grounds

On 13 December 2018, the Court of Appeal handed down its judgment in an appeal by the General Medical Council (the GMC) against a decision made by the High Court to allow an appeal by Dr Hayat. Dr Hayat had been erased from the medical register in February 2017. You can access our blog on the previous High court decision here

3,000 doctors face checks after psychiatrist who practised without a licence is sentenced to a five year prison sentence

The General Medical Council (‘GMC’) is urgently checking the qualifications of foreign doctors who were able to register in the UK under a now defunct provision in the Medical Act 1983 (‘the Act’).

Social Media and the NHS

Efficient and innovative communication within the healthcare sector is a valuable resource and healthcare professionals are becoming increasingly reliant on the use of social media and messaging apps to communicate and share patient information with one another. However, messages composed and sent within seconds can have serious and lasting professional, legal and regulatory repercussions. 

Court of Appeal overturns High Court’s finding of doctor’s dishonesty

Case summary of Raychaudhuri v General Medical Council (Professional Standards Authority for Health and Social Care intervening) [2018] EWCA Civ 2027.

High Court provides guidance on the approach Panels should take in making determinations of fact Teasdale v General Osteopathic Council

[2018] EWHC 1679 (Admin) before Mr Justice Spencer - The Registrant is a registered osteopath who qualified in 2008. Since qualifying, she worked as an osteopath at various clinics both in the UK and abroad. The Registrant was employed by Weaver House, a professional osteopathy and healthcare practice, in November 2015 as an associate cranial osteopath. 

New (over-complicated) professional standards for UKCP and BACP members

The professional standards for both UKCP and BACP members are having a revamp; are they clear, understandable and fit for purpose?

An update on the General Optical Council v Clarke – retirement is not relevant to impairment

Shannett Thompson and Grace Castle provide an update on General Optical Council v Clarke.

Love Island and your professional obligations

The launch of ITV2’s reality TV show ‘Love Island’ amassed an audience of approximately 2.95 million, becoming the highest-rating programme at 9pm across all channels last Monday. Another first for the series is the inclusion of contestants with professional qualifications such as an A&E doctor and a newly qualified solicitor.

The PSA’s Lessons Learned Review – Regulators take heed

The Professional Standards Authority has published its review into the Nursing and Midwifery Council’s (‘NMC’) treatment of a number of serious allegations against Furness General Hospital (FGH) midwives in relation to the tragic deaths of babies and some mothers between 2004 and 2016. Although titled a “Lessons Learned Review”, the report does not hold back in launching criticism at the NMC which identified the need to “address very serious concerns about the way in which it deals with families and patients and whether it is a transparent, open organisation”. Indeed, the PSA report catalogues many issues which other regulators, including those operating outside of health and social care, would be advised to consider.

What’s the buzz?

A recent investigation by The Daily Mail into the illegal supply of prescription only medicines (POMs), has led to the arrest of eight pharmacists.

A new framework for psychotherapy, psychoanalysis and counselling

Last month, the UK Council for Psychotherapy (UKCP), British Association for Counselling and Psychotherapy (BACP) and the British Psychoanalytic Council (BPC) announced the latest phase of their joint collaboration; the creation of an education and practise framework for the counselling and psychotherapy professions.

Care Quality Commission (CQC) - Registration, Regulation and Enforcement Insights

View all

Blogs

The Care Quality Commission (‘CQC’) updates its guidance on meeting the duty of candour – but what’s new?

CQC and EHRC publish new memorandum of understanding agreement

Fit and proper person requirements for directors in the health and care sector – what does this mean and what are service providers required to do?

COVID-19: The Care Quality Commission announces resumption of routine inspections

The consequences of failing to adhere with Care Quality Commission’s regulatory framework for registration

Close Load more

Skip to content Home About Us Insights Services Contact Accessibility