Topics covered: care home, CQC, CQC enforcement, CQC inspection, enforcement action, Paul Ridout

Be in no doubt!

The CQC is engaged in the greatest “power grab” yet seen in Health and Social Care. It is comparable to the imperial aspirations of Genghis Khan or Napoleon.

Whatever may be the attractions of the soft sell benefits of CQC’s actions, this is plain wrong. It is a strategy to convert “power” into “absolute power.”

The foundation of good regulated law giving is the traditional troika – Legislature, Executive and Regulator/Judiciary.

The Legislature makes laws in outline which set direction, and, without which there would be disorganized chaos.

The Executive fleshes out the skeleton of legislation and dresses the bones with details which will transform theory in to practice.

The Regulator works with the combined product of Legislative and Executive to ensure that the framework is enforced so that the public may have confidence that the will of the democratically enacted scheme of managing entry, conduct and exit is managed as intended by its other two partners.

When any one or more of this balanced separation of powers seek to trespass into the estate of the others, we should heed the sign as a powerful warning.

CQC is here to enforce the will of Parliament as refined by the Department of Health. It is not there, as a freestanding body, to usurp the roles of its partners. It is neither democratically elected nor accountable.

CQC is not a commissioner or even a customer of services. It is the commissioner/customer who shapes the market by reference to that which it is prepared to purchase. Markets determine products and providers deliver product to suit the requirements of the markets constrained by a regulatory system with a democratic provenance.

CQC has suggested that, if the market knows what CQC wants and will permit, then providers will deliver products which match that suggestion. That is wrong and dangerous sophistry. It is to put the cart before the horse. Investors and providers will support products that they believe will sell, not, products which meet the temporary fashion modes of temporary regulators.

This is a serious danger to existing investors. It militates against plurality of service choices. It will deter rather than encourage future investors. In the end it will work against the interests of those whose needs and expectations, in whose name it is propounded – the users of service.

Proscription of service model extinguishes choice, eradicates plurality and dissuades investment.  An investor must have confidence that his investment will be borne with minimum barriers, flourish with appropriate effort and, in due time, reap the rewards of a satisfying harvest.

By creating doubt as to a justified and bountiful exit CQC will, whether by accident or design, diminish the appetite for innovative investment, and, prevent the experiments which may lead to much needed reduction in operational costs.

The CQC has been emboldened by its successful exercise and stretching of its processes to exclude or enforce. There it has maintained with considerable success that it and its inspectors are infallible and all should accept its requirements as beyond dispute. That is obvious nonsense, but significant numbers of providers and other intended stakeholders have been persuaded that there is merit in this fake proposition. So CQC has morphed from a respected regulator with an important productive role into an aggressive monster determined to enforce its positions without regard to accuracy, proportionality or the need for diversity of service model and innovation.

This has been seen in two specific fields.

  1. Long term care of those with learning difficulties (LD).
  2. Digital healthcare provision which many see as the future for a streamlined and cost-efficient health service.

Some may say that these are fringe or outlier activities. However, it must be right that if CQC in these areas, establishes the right to dictate the market shape, that pressure will hold good for all services.


There has been a steady stream of examples where institutional care of LD service users has been evidenced to be neglectful, abusive or criminal. Those have been highlighted in long term care settings. However, the well-known examples are not typical, in a small but resilient market for those whose difficulties mean that progression into community living will be delayed possibly for ever.

The very plurality of need dictates a plurality of service options.

CQC has seized upon the natural public outrage at the well published examples of neglect and cruelty to promote a vision of a model where all service users are accommodated in small units, not closely linked to others, operating in close proximity to mainstream communities where in the service users will inevitably be integrated. Just as the developers will in CQC’s view invest in the vision so in CQC’s thesis all users will moderate their presenting difficulties so as to fit CQC’s perception! Clearly this is wrong and is borne out of the CQC’s self-perception of infallibility.

The CQC justification for this policy is that it is charged with improving care services. Yes the statute does so provide, but, that is clearly in improving services within the context, that the legislature has designed and the executive has detailed.

If, for those where needs cannot be delivered with CQC’s model, the opportunity to develop in services which are delivered with compassion and still within a setting that benefits from economies of scale, then some of the most vulnerable will have no proper service placement and will cease to be visible, in an unregulated community – just as some were lost in the old asylum institutions.

CQC is acting outwith the law which does not restrict the plurality from which markets will flourish. If barriers to entry are extended and costs of operation within the devised model are not sustainable, investment will be stifled and the options from which many benefit, will be reduced into a one-size fits all service which does not reflect the personalised needs of individuals.


Many see this innovation as a new dawn for Healthcare. Patients can be seen, diagnosed, prescribed medication and, in some cases, treated remotely. Premises costs and professional time can be used more efficiently.

With appropriate safeguards, the moves are welcomed by NHS England, the Department of Health and the GMC. Within the group CQC is missing.

CQC has set its face against online diagnosis and prescribing. Time and time again CQC has found such practice to be unsafe. So uniform is CQC’s judgement that online care is unsafe, one is driven to the conclusion that CQC has decided that all digital healthcare is unsafe.

Digital Healthcare is not unlawful. It is neither illegal nor professionally incompetent for medical practitioners to diagnose and treat online. There must of course be guidelines which are to be followed.

However, such practice is registrable with CQC. CQC has the power and CQC has used that power, in effect, to enforce its position that digital medicine is unsafe and should be restricted.

Clearly CQC is misusing its power as a regulator- not to hold services to account to perform effectively, but, as a quasi-legislator to exclude services which CQC, or its senior officers, consider to be inappropriate.


CQC is misusing its clear power to trespass into the domain of the Legislature and the Executive. CQC may see itself as in a battle with fellow stakeholders to control absolutely the delivery of health and social care. The providers are immaterial in this battle of authorities. Indeed the service users, in whose name these actions are said to be taken, may not really be the top priority. In my two examples there is little evidence that the structure of service, as opposed to individual delivery errors, is not valued by the ultimate user. There is no evidence of dissatisfaction for those who use online services.

However, this does create an atmosphere of uncertainty. Which service will be next to be subject at a CQC service shaping attack? That uncertainty creates a barrier to investment itself. Investors will be more cautious and may chose other investments. Just when we need more investment in healthcare, CQC may be creating a negative backdrop which will leave no alternative to public funding – an increasingly scarce commodity.

CQC currently deploy their tactics in attempting to instruct new entrants and prevent existing providers expanding. They know they will not succeed in an attempt “head on” to close down services. In a further article I will explore how CQC and other stakeholders are using tactical regulation/safeguarding (aka dirty tricks) to try to encourage providers to leave the sector.

Providers and Investors must recognise the danger of the powerful silent monster that is beginning to threaten independent healthcare and use all resources to rein CQC back to its legitimate role as a regulator. As a regulator CQC is needed, and is needed to be strong, effective and to demonstrate that it is well led by constraining its activities to those which are legitimate – holding to account, within the legal structure set by the Legislature and Executive providers, within the sector.

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