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Despite facing criticism, the number of prosecutions by the Care Quality Commission has risen rapidly in recent years
Published on 29 April, 2025
Author: Markel UK
4 minute read
In May 2024, Dr Penny Dash was asked to conduct a review into the operational effectiveness of the Care Quality Commission (CQC), and her insights were damning. Her final findings, published last October, revealed “significant failings” at the CQC, arguing that its single assessment framework for care providers had undermined the health and social care sector’s capability to provide care.
Dash identified major challenges with the provider portal and regulatory platform that has contributed to delayed and poorly drafted inspection reports. The indication that the regulator had lost credibility in the sector echoed longstanding concerns from all those that fall under the CQC’s regulatory remit.
The review made a number of recommendations, including the CQC improving its operational performance, fixing its data infrastructure and increasing the quality and timeliness of its reports. But at a recent evidence session of the Health and Social Care Committee, MPs discovered that there is a backlog of around 5,000 notifications 1 to the CQC, highlighting ongoing operational issues and an apparent failure by the CQC to adequately risk profile the information it receives. Concerns being flagged to the regulator are going months without receiving a response, the committee heard, which is inconsistent with the commitment made by the regulator to effect immediate change.
Professor Mike Richards was commissioned to undertake a more targeted review of the much-heralded single assessment framework. This identified that the updated inspection model had failed to deliver the intended benefits despite initially being welcomed by most providers. Whilst the core concept remained viable, the IT issues, internal failings within the CQC and the lack of clinical oversight had led to significant adverse consequences.
But, despite this backlog in relation to inspection and report writing activity, criminal prosecutions by the CQC surged from 19 between 2009 and 2013, to 98 between 2019 to 2023 2. Total fines levied also skyrocketed to more than £11 million in the five years up to 2023.
Providers are often unaware of the wide prosecution powers at the CQC’s disposal and the relatively low threshold to bring a criminal case for breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The increase could partly be down to regulatory action starting again once post pandemic ‘normality’ resumed and a desire by the CQC to be seen to be making full use of its regulatory powers.
Re-establishing trust
Professor Martin Green OBE, Chief Executive of Care England, which represents care providers, says: “Dr Penny Dash identified that the CQC was a dysfunctional organisation, and it has little credibility when it comes to commenting on the performance of care providers because its own performance has been completely unacceptable. The arrival of a new Chief Executive must be the watershed moment when the CQC re-establishes trust by delivering a recovery plan with key performance indicators and milestones so that we, as providers, can assess the performance of the regulator.
“One of the challenges is the regulation costs a lot of money, and care providers are paying for a service they have not received and there needs to be consideration given as to how we are going to be compensated. The CQC needs to be very careful about how it delivers criticism of services because it is currently, in the words of the Secretary of State, “not fit for purpose”, and it has a mountain to climb to re-establish trust and credibility with the sectors it regulates.”
The CQC needs to be very careful about how it delivers criticism of services because it is currently, in the words of the Secretary of State, "not fit for purpose"
Taking practical steps
Deborah Nicholson, Head of Regulatory at Markel Law, notes that for care providers concerned about an uncertain landscape in relation to the CQC, the focus should remain on ensuring that there is effective leadership, governance and person-centred care, with clear audit trails that evidence not just your processes, but how you embed them within your organisation and monitor compliance.
At Markel, we support the sector holistically. Our advice line is there for immediate assistance, our care consultants provide vital hands-on support to organisations that need immediate support and an independent opinion on how effective regulatory activity is being delivered. Our specialist solicitors in the health and social care sector group at Markel Law regularly support clients in relation to safeguarding investigations, challenges to inspection reports and enforcement notices.
Ultimately, the most effective way for care providers to avoid CQC action is to continue providing the high standards of care that most deliver and keep monitoring the progress made by the CQC to ensure that they are best set up to deliver what the regulator wants.
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