CQC: Prosecutions will be rare but help learning and safety

Ian Trenholm profile picture

20 November 2018

Ian Trenholm
Chief executive
Care Quality Commission


In my interview with the HSJ, I was asked why, since the fundamental standards were introduced following the Mid-Staffordshire NHS inquiry in 2015, the Care Quality Commission (CQC) had only prosecuted one NHS provider for not providing safe care. My answer was that across health and social care we have about 190 live investigations at the moment - the majority in adult social care, the largest sector we regulate.

Since then, I have been contacted by chief executives asking if this reflects a new approach for CQC - it doesn’t. Our purpose has always been to ensure services are safe and high quality and it has always been our desire to understand why problems have occurred in order to learn from them so that we can provide information to others. It also reflects the powers we inherited from Health and Safety Executive (HSE) in 2015 to take action in cases where systemic failings have resulted in serious harm or death. The number of investigations in healthcare - 31 across the NHS and independent sector - is relatively small, and I would anticipate that we learn from every single investigation but take forward very few prosecutions.

Our purpose has always been to ensure services are safe and high quality and it has always been our desire to understand why problems have occurred in order to learn from them.

Ian Trenholm    Chief executive

We use our civil powers to ensure safer care for people every day - but in the rare cases where people receive care that results in harm or death that could have been avoided as a result of systemic failings, we have a duty to explore whether criminal prosecution is appropriate. Prosecution is not about scapegoating individuals. It is about ensuring that where boards and leadership teams have not acted on repeated warnings, and there has been unsafe care that results in harm, there are consequences. The investigation work we do as part of our responsibility to explore potential prosecutions ensures that where things have gone wrong, lessons can be learned and used to drive change - and ultimately, that care is improved as a result.

We will maintain our focus on encouraging improvement and sharing best practice - the number of times we highlight good practice will always outweigh the enforcement action we take.

Ian Trenholm    Chief executive

We know that everyone wants to provide and receive good, safe care. In the cases where people have been seriously and avoidably harmed by systemic failure, it is in everyone’s interests that we take robust action to prevent this happening again. But alongside our duty to protect people from avoidable harm, we will maintain our focus on encouraging improvement and sharing best practice - the number of times we highlight good practice will always outweigh the enforcement action we take. Our Driving Improvement publications and the Under Pressure report that Professor Ted Baker highlighted in last week’s blog are all examples of how we celebrate success and work with providers to encourage improvement, and will continue to do so.

About the author

Ian Trenholm profile picture

Ian Trenholm
Chief executive

Ian was chief executive of NHS Blood and Transplant from 2014 until his appointment as CQC's chief executive in 2018. He was previously chief operating officer at the Department of Environment Food and Rural Affairs (Defra). Prior roles included chief executive of the Royal Borough of Windsor and Maidenhead and strategic director for resources at Buckinghamshire County Council.

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