The Care Quality Commission (CQC) continues to actively pursue enforcement against health and social care providers who fall short of regulatory standards. In this article, we look at recent enforcement action by the CQC, which represents a continuation of the regulator’s assertive approach to prosecuting serious breaches.
This article explores the CQC’s enforcement powers, recent prosecution trends and cases, potential changes on the horizon to enforcement and the resulting implications of this for providers of health and social care services.
The CQC has the power to prosecute organisations or individuals who provide health and social care for breaches under the following regulations: the Care Quality Commission (Registration) Regulations 2009 and the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Such enforcement powers are rooted in the Health and Social Care Act 2008, as amended by the Care Act 2014, and are designed to ensure that any enforcement action taken by the CQC is proportionate, transparent, and ultimately aimed at protecting service users.
Broadly speaking, enforcement falls into two categories: civil and criminal:
The CQC’s Enforcement Policy outlines a structured four-stage decision-making process to ensure that enforcement is fair and proportionate. Prosecution is typically considered a last resort, used only when other interventions have failed or when the breach poses a significant risk to service users.
Since the implementation of the Health and Social Care Act 2008, the CQC has undertaken at least 114 prosecutions against registered providers, many involving multiple charges. Over half of these prosecutions have occurred in the last three years alone, reflecting a growing willingness from the CQC to pursue the most serious of criminal sanctions available to it where standards of care have been seriously compromised.
Recent prosecution activity by the CQC has secured multiple convictions of two registered providers and one registered manager. These cases are particularly illustrative of the regulator’s readiness to act when care failures result in harm or death. The circumstances of these cases are summarised below:
The CQC prosecuted Nottingham University Hospital NHS Trust for serious failings in maternity care, breaching Regulations 12 and 22 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The case involved six separate charges and centred on the deaths of three newborns between April and July 2021 - Adele O’Sullivan, Kahlani Rawson, and Quinn Lias Parker. The investigation identified multiple care failings, including inadequate fetal monitoring (CTG), poor staff handovers, delays in escalation and transfer to the delivery suite, missed placental abruption, and faulty equipment, as well as poor coordination between ambulance and hospital staff. The trust was fined a total of £1,667,944 – one of the biggest total fines in the CQC’s prosecution history.
The CQC prosecuted Maldon Lodge Care Home Ltd and its former registered manager, Lisa Stolworthy, for breaches of Regulations 12 and 22 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The case involved two separate charges following the death of Mr Brian Aspinall, an 87-year-old resident admitted to The Lodge in July 2021 after an urgent GP referral for dementia assessment. Despite concerns regarding his memory, frailty, and wandering, a formal assessment was not pursued. In October 2021, Mr Aspinall accessed an unsecured kitchen door leading to a stairwell and suffered a fatal fall. He died later that month from his injuries. The total fine imposed was £53,841.
While the CQC has not formally announced any strategic shift toward increased prosecutions, recent developments suggest that the regulatory landscape has the potential to evolve in that direction. For example, under Section 90(2) of the Health and Social Care Act 2008, prosecutions must currently be initiated:
However, CQC Chief Executive Julian Hartley, has publicly criticised these time constraints, lobbying to the Health Secretary Wes Streeting, to remove the three-year limit. Hartley has argued that the time limit is outdated and inconsistent with the powers of other regulators, such as the Health and Safety Executive, who are not subject to the same restrictions.
It appears Hartley’s efforts have somewhat materialised, with the government recently confirming in its 10 Year Health Plan for England that it will change the time limit for the CQC to bring legal action against a provider.
For registered providers of health and social care services, an extension or removal of the three-year statutory time limit for the CQC to bring a prosecution could have significant implications. It's likely to significantly alter the enforcement landscape, allowing for more time for comprehensive investigations, potentially increasing the likelihood of prosecution in cases where evidence takes time to surface, and potentially impacting the likelihood of convictions being secured.
The time constraint has also acted as a safeguard against delayed enforcement action previously. Its extension or removal means that serious incidents will be placed in an extended window for prosecution, potentially exposing providers to legal action long after the original incident. It may introduce prolonged periods of uncertainty where the Care Quality Commission (CQC) is considering enforcement following serious incidents.
In light of these changes, it's more important than ever for health and social care providers to adopt a proactive and preventative approach to regulatory compliance. Recommended actions include:
Routine audits help identify areas of non-compliance early, allowing registered providers to take corrective action before issues escalate. These audits should be thorough, documented, and ideally benchmarked against CQC standards and previous inspection outcomes.
Robust record-keeping is essential not only for day-to-day operations but also as evidence event of an investigation. Accurate documentation can demonstrate compliance, support decision-making, and provide evidence of good governance and accountability.
Providers should treat CQC feedback as an opportunity for improvement. A transparent and responsive approach to inspections, including implementing action plans and tracking progress, can demonstrate a genuine commitment to quality and safety, which may mitigate enforcement risks.
Legal advice should be sought at the earliest indication of non-compliance or CQC involvement in a serious incident. Early intervention can help providers effectively investigate incidents, understand their regulatory exposure, manage communications with the CQC, and prepare for potential enforcement or proceedings.
At Ashfords we have a team of dedicated regulatory solicitors with a wealth of experiencing in supporting regulated organisations in regulatory investigations and prosecutions. If you require legal advice or wish to be supported through these processes, please contact our business risk and regulation team below.
