CQC to be given new powers and more time to initiate proceedings against providers
The CQC will be given new powers to protect patient safety and more time to initiate proceedings against providers who fail to provide safe care, as part of the new NHS ‘modernisation’ bill.
The Government said that the bill aims at ‘strengthening patient safety’ and that extending the time limit for CQC to initiate proceedings from three years to five will ‘give more families the justice they are seeking’.
The bill will also abolish the Health Services Safety Investigations Body (HSSIB) and transfer its functions to the CQC. Powers currently held by HSSIB safety investigators will be carried over to CQC, including powers of entry and the ability to demand and secure documentary and other evidence.
However, the Government said that the legislation will not make these changes immediately, but will only bring into force the transfer of functions when the Government is ‘satisfied CQC has improved’ and that it is being ‘supported and held to account to recover its effectiveness’.
It follows two damning reviews of the CQC published in 2024, which said its ‘significant failings’ had led to ‘a substantial loss of credibility’.
The new legislation was announced last week as part for the Health Bill and will underpin the single patient record and render ICBs the strategic commissioners’ for primary care when NHS England is abolished.
The bill will amend the Health and Social Care Act 2008 giving CQC up to five years for bringing proceedings against providers ‘for failure to provide safe care or treatment or carrying out regulated activities without proper registration with CQC’.
The 2008 act set a limitation period for CQC offences, but the Government said that in complex cases, the three-year period runs out before CQC can complete their proceedings and access all relevant information to initiate legal proceedings.
In a policy paper explaining the patient safety implications of the bill, the Government said: ‘The extended timeframe is expected to prevent that from happening, giving more families the justice they are seeking.
‘The current 3-year time constraints put significant pressure on CQC’s legal and enforcement teams, and proceedings may conclude at or near the limitation date.
‘The extended 5-year limitation period is expected to avoid that from happening, giving more families the justice they are seeking.
‘Evidence from CQC states that the enforcement team needs at least 9 months remaining on the limitation clock to investigate fully, meaning that proceedings must start within 2 years and 3 months of the incident, increasing the potential for delays in complex cases.’
HSSIB’s role in education and training in patient safety investigation skills for NHS and healthcare staff will also be transferred to the CQC.
HSSIB was established in 2023 as a non-departmental body and carried out independent patient safety investigations into any patient safety incident linked to NHS-provided or privately provided healthcare in England, with ‘a focus on learning not on blame or liability’.
The Government said: ‘System users will be clearer about who does what in the system and how to effect change. It will increase the effectiveness of patient safety recommendations and lead to more consistent system-wide learning and tangible improvements in patient safety outcomes.
‘Having CQC undertake investigations (through a discrete function) will mean that the prominence of the investigation recommendations will be increased by virtue of being part of the sector’s regulator. The safety recommendation will therefore be heard clearly by providers across the system. Transferring investigation powers to CQC will be an opportunity to strengthen CQC itself.’
In written evidence to the House of Commons health and social care committee, the CQC raised concerns about the transfer, especially around the conflict of interest in ‘protecting the safe space between
proposed investigatory and regulatory arms’.
It said: ‘The transfer could bring challenges to our ability to carry out our own existing functions. It is important for there to be legal certainty within the clauses in the relevant Bill, otherwise the legislation will put us at significant risk and in ways that may not be adequately resolved by operational and governance solutions.
‘The investigation function will hold information that the regulatory function is unaware of and cannot act on. This will introduce reputational risk, as well as inequity of approach in applying regulatory powers.’
Since the bill was announced, GP leaders and data experts expressed concern that the legislation is an ‘exercise in raw political power’ which gives the health secretary far-reaching authority to share patient data with private companies, researchers, and across all parts of the NHS, while failing to clarify the issue of data controllership.
Next month, the CQC will start piloting its new assessment framework specific to primary care, with inspectors using ‘Word templates’ initially while new digital systems are built.
