Recommendation 29

Offence for death or serious injury to patient

It should be an offence for death or serious injury to be caused to a patient by a breach of these regulatory requirements, or, in any other case of breach, where a warning notice in respect of the breach has been served and the notice has not been complied with.  It should be a defence for the provider to prove that all reasonably practical steps have been taken to prevent a breach, including having in place a prescribed system to prevent such a breach.

We agree that there should be serious consequences for any organisation that breaches basic quality standards in the provision of care.

In its response to the inquiry, Patients First and Foremost, the government committed to draw up a new set of fundamental standards of care that will sit within the legal requirements that providers of health and adult social care must meet to be registered with Care Quality Commission. The fundamental standards of care set a clear bar below which standards of care should not fall and focus on the very basics of care that matter to people and will be easily understood by all. These fundamental standards will be consulted on soon, and further details of this are set out in recommendation 13.

There will be immediate, serious consequences for services where care falls below these standards.  Subject to the passage of regulations, the Care Quality Commission will have new powers during 2014, including the ability to prosecute a provider for failing to provide fundamental levels of care, without having to issue a formal warning first. See recommendation 28 for further details.


The Care Quality Commission have made progress in ensuring that providers can be held to account where they provide care that is of an unacceptable standard.

When the new fundamental standards come into force in April 2015, the Care Quality Commission will publish a new enforcement policy for all providers. This will allow the Care Quality Commission to take the most appropriate action straight away. For example, the Care Quality Commission will be able to prosecute a provider without first issuing a warning notice, where appropriate. The Care Quality Commission will use these new arrangements to protect people who use regulated services from harm and the risk of harm and to hold providers and individuals to account for failures in how the service is provided.

The changes to the Care Quality Commission’s enforcement policy do not mean that the principles that underpin effective enforcement will change. The effective use and deployment of the Care Quality Commission’s powers are achieved through robust evidence gathering at the outset, consideration of the range of enforcement tools available and taking action that is proportionate to the concerns identified and the impact on people who use services.