Hundreds of cosmetic surgery providers have breached Care Quality Commission rules by failing to respond to a national inquiry into patient outcomes and deaths.

The National Confidential Enquiry into Patient Outcome and Death also found there were “fundamental weaknesses” in the delivery of cosmetic surgery, largely carried out in the private sector.

Of the 760 sites obliged to participate in the audit, 399 (52 per cent) did not return the questionnaire designed to monitor practice in the industry and 13 refused to participate. All providers are registered with the CQC and must comply with national audits including NCEPOD.

NCEPOD chair Bertie Leigh said patient safety was being put at risk: “This failure to participate means that they are not complying with CQC rules. The CQC should insist that those it regulates are properly equipped and adhere to appropriate standards.”

Of those providers that did respond, NCEPOD found only a third of sites gave patients time to consider their initial decision to undergo treatment, a process considered good practice by the General Medical Council, often for major surgical procedures.

Lead report author Alex Goodwin highlighted that only 35 per cent of providers provided psychological evaluation for patients “who may be vulnerable or have unrealistic expectations, before they consent to treatment”.

More than half of the sites were not fully equipped to deliver surgery safely, and 18 per cent did not have a policy to readmit patients who have complications after surgery, the report said

CQC director of operations Amanda Sherlock said greater regulatory powers were being introduced next month. She said: “Cosmetic surgery providers should know that they face fines and even prosecution if they are found to be breaching safety and quality standards.”