The Care Quality Commission has some “tricky decisions” ahead on using its powers to shut down failing services, its chair has admitted.

The CQC has the power to suspend and ultimately close services that repeatedly fail to meet the quality requirements necessary to join its register, which trusts will be required to legally sign up to from April next year.   

We don’t think that ‘nuclear option’ is going to be used often because we want to be an improvement process. But at the end of the day there will be some services that just can’t make it

Speaking at the NHS Alliance annual conference in Manchester last week, CQC chair Barbara Young said: “If at the end of the day, in spite of all the improvement processes, the quality of service is seriously unacceptable, we will have to decide whether… as a last resort that service has got to be provided elsewhere and ultimately withdraw registration.

“We don’t think that ‘nuclear option’ is going to be used often because we want to be an improvement process. But at the end of the day there will be some services that just can’t make it,” she told delegates.

However, she said the “big tricky one” will be what to do about failing services that are located in the “middle of nowhere”, and which would be hard for vulnerable patient groups to reach if re-located elsewhere.

“There’s going to be some really tricky judgements for us,” she said.

In reply to a question from conference chair Phil Hammond, Baroness Young also said the regulator had received no guarantees that it would be immune to the Conservatives’ planned quango cuts.