Mythbusters: Enforcing safety – roles and responsibilities of CQC and HSE

Page last updated: 22 September 2023
Organisations we regulate

Myth 1: HSE and LAs still have enforcement responsibilities for the safety of patients and people who use services

No they don't – except in those few circumstances where activities aren’t registered with CQC. The memorandum of understanding between CQC, the Health and Safety Executive (HSE) and local authorities (LAs) makes clear that from 1 April 2015, HSE and the LAs won't normally lead this work.

The new regulations allow CQC to take enforcement action when we identify issues that we were previously unable to take action against. The fundamental standards are more focused, with the following regulations allowing us to prosecute directly when they are breached as they constitute a criminal offence. This enables CQC to move directly to prosecution without first serving a Warning Notice when those regulations are breached and it is deemed appropriate to hold the provider to account.

  • Need for consent
  • Safe care and treatment
  • Safeguarding service users from abuse
  • Meeting nutritional needs
  • Duty of candour
  • Display of ratings

Myth 2: A specialised team in CQC is responsible for taking enforcement action

No. Enforcement action is the responsibility of all our operations staff, most immediately our Inspectors, Inspection Managers and Heads of Inspection. The Deputy Chief Inspectors and Chief Inspectors should be involved when it is appropriate, and this is detailed on our scheme of delegation.

CQC does not have a central team responsible for managing enforcement activity; the Enforcement Inspectors and Managers offer advice and support only to the Lead Inspector or Inspection Manager. However, CQC has a National team that provides assurance on the quality of our enforcement activity and provides expert input on specific subjects.

Myth 3: HSE and LAs still respond to RIDDORs

No, they no longer do this.

The memorandum of understanding between the Care Quality Commission, the Health and Safety Executive and Local Authorities in England has been in effect since 1 April 2015. CQC's Inspectors now receive Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 reports (RIDDORs), which are forwarded to us by HSE or LAs. We assess the information in the same way that we do for information obtained from any other source, carrying out initial enquiries such as contacting the provider, reviewing information that we already hold (inspection reports or notifications) or contacting other stakeholders (CCGs, Police, Local Authorities) where necessary. Our Inspectors then apply the enforcement decision tree to determine the most appropriate action to take.

Myth 4: CQC inspectors don't need to gather evidence any differently to how they do currently

It's important that our Inspectors understand the purpose of the inspection:  whether it is to gather evidence to inform a rating or whether it is to gather evidence to take enforcement action (civil or criminal).

When gathering evidence with the intention of taking enforcement action, Inspectors need to gather and manage evidence to the standards set in the Criminal Procedure and Investigations Act 1996 (CPIA) and the Police and Criminal Evidence Act 1984 (PACE). This is especially the case where there is a potential breach of a regulation that constitutes an offence and where we may want to prosecute, as evidence needs to be gathered and managed in a way that ensures it is admissible in court.

When gathering evidence to inform a rating for a provider, the CPIA and PACE standards do not need to be met, but inspectors need to gather enough evidence to provide assurance about how a provider is meeting the key lines of enquiry (KLOEs).

Myth 5: CQC inspectors share information with Local Authorities and Environmental Health Officers

Yes, this is correct. Our Inspectors and Inspection Managers should be engaging with Local Authorities and Environmental Health Officers. They should share information and contribute to discussions where it involves concerns about people using services registered with CQC.

Myth 6: CQC doesn't use incident selection criteria to decide when to proceed to enforcement

Yes, this is correct. CQC does not have separate incident or case selection criteria. The framework for deciding what incidents, notifications or reports we will investigate further has been embedded into the decision tree and the prosecution criteria, which is in our enforcement policy.