CQC is considering 31 NHS prosecutions, new chief reveals

In his first interview with HSJ, the CQC’s new chief executive Ian Trenholm took a tough stance on bringing prosecutions where trusts breach the regulator’s fundamental standards, brought in after the Mid Staffordshire care scandal.

Mr Trenholm told HSJ the CQC would not compromise on safety. He warned the time “was undoubtedly coming” when the regulator sought to send a signal on breaches of the fundamental standards: “You will see the number of prosecutions increasing.”

He also revealed the CQC would not be suspending inspections during winter, which it did last January, on “safety grounds”, adding: “Safety is not something we are going to compromise on. I understand it will be a tough time for people, but we need to keep looking at places and being in places where we have the most concerns.”

Mr Trenholm, who replaced Sir David Behan as CQC chief executive earlier this year, told HSJ: “I can’t excuse unsafe care. If we think a provider is unsafe, we have got to call it out and in a number of cases we will take enforcement action.

“If we have to get to a place where we have to close a place or take enforcement action, it’s because we think someone’s life might be at risk, and we can’t walk away from that.”

He said the CQC currently had 163 possible prosecutions lined up against adult social care providers and 31 potential prosecutions against NHS organisations. Mr Trenholm said not all of them would end up in court.

“I am keen to do more enforcement,” Mr Trenholm said. “We have just hired 11 evidence review officers who are ex-military police and ex-civil police officers to help us with looking at and reviewing the quality of evidence we are generating to make sure we can prosecute more people and do that much more effectively.

“It wouldn’t distress me overly much if we lost a few prosecutions because it would mean we are pushing the envelope. I need to balance that with sensible use of public money. I don’t want to see more prosecutions but, if we see breaches of the fundamental standards and there is evidence of that, then we will take action.”

Since the new regulations were introduced in 2015, the CQC has only ever prosecuted one NHS trust, Southern Health, on safety grounds.

Mr Trenholm said the aim of regulation was to keep people safe and that required a whole package of organisations working together. But he added: “Without regulation people can convince themselves they’re doing very well because they’re working really hard. Our role is to kind of hold a mirror up to that and say honestly, ‘Are you really doing the right things?’”

He said the fact there were some organisations which had failed to improve “demonstrates the value of regulation because what we are doing is calling out places that are not working and talking very specifically about what is not working”.

Mr Trenholm continued: “A hospital does not exist in isolation. It exists in the context of primary care and social services.

“One of the things I have found quite disturbing is the lack of appreciation within the NHS for the role that social care plays and the role [that] primary medical services and mental health providers play.

“We have a focus around acute hospitals as being the be all and end all of healthcare but the way people experience healthcare is through a range of providers that come together to give them their experience.”

Ahead of winter, Mr Trenholm said the CQC was concerned about safety in accident and emergency departments. He urged providers to take “a whole system approach” adding: “We tend to focus on what happens in the ambulance bay but flows throughout the hospital are absolutely vital. Patients can deteriorate in a dark corner of a ward just as much as they can in a dark corridor of an ED.”