CQC Criminal Prosecutions: What Can The Regulator Do & How Do I Handle It?

Being faced with any kind of prosecution is daunting and worrisome, but understanding the Care Quality Commission’s (CQC) powers is crucial in understanding how to approach this kind of action.

The CQC has a range of civil and criminal enforcement powers available to it when providers fail to meet regulatory requirements. Understanding these powers and how the CQC may approach a potential prosecution can help providers respond appropriately.

CQC’s Enforcement Powers

Providers will be all too aware of the CQC’s civil enforcement powers. We have all seen and heard of Requirement Notices and Warning Notices, as well as the suspension, cancellation and change to a provider’s conditions of registration.

Lesser known are the cautions, fixed penalty notices and prosecutions that constitute the CQC’s criminal enforcement powers.

Providers should be aware that the legislation underpinning the health and social care sector, including the Health and Social Care Act 2008, the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Care Quality Commission (Registration) Regulations 2009, contains multiple prosecutable offences that providers should be familiar with.

Bringing the Prosecution

The CQC can prosecute where a breach has resulted in avoidable harm to a service user, or where a service user has been exposed to a significant risk of such harm. For example, CQC can prosecute for a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 where a failure to provide safe care and treatment results in avoidable harm or exposes a person to a significant risk of harm.

The CQC will focus its attention on gathering information and evidence to establish whether an offence has been committed if a prosecution is pursued.

In bringing a prosecution, the CQC must have regard to the Code for Crown Prosecutors, which sets out general principles to be applied when making decisions about prosecutions. The CQC must consider whether there is a realistic prospect of conviction based on the evidence and whether it is in the public interest to prosecute.

Further similarities with police procedure arise when considering how the CQC must gather information and evidence related to a prosecution. The CQC may use powers under the Police and Criminal Evidence Act 1984 (“PACE”) when investigating potential criminal offences.

Members of the CQC’s investigations team may offer a provider suspected of an offence the opportunity to attend a PACE interview under caution, or to submit a written response to set questions around the offence. Providers should take legal advice as soon as such a request is made.

Fines and Sentencing

At an early stage in the prosecution process, the accused provider or registered person will be given the opportunity to enter a plea of “Guilty” or “Not Guilty”.

An early guilty plea can result in a reduction in the sentence imposed by the Court. The level of any fine will depend on the circumstances of the offence and the sentencing guidelines, and fines for certain offences can be unlimited.

Recent CQC prosecutions demonstrate the potentially significant financial consequences for providers. For example, in 2025, Nottingham University Hospitals NHS Trust was ordered to pay more than £1.6 million following a prosecution relating to failures in maternity care.

Whilst fines are a common outcome of a prosecution by the CQC, there are also offences which can attract a custodial sentence. The CQC confirms that some offences, including carrying on a regulated activity without being registered, can attract imprisonment.

Both outcomes are potentially catastrophic for the commercial viability and reputation of a health and social care business.

How should a Provider React to a Prosecution?

In most cases, the CQC will contact a provider to alert them to the fact that its investigations team is considering a prosecution as a consequence of a breach.

Normally these letters will not require any further action and may act as a notification only, but there will be occasions where the correspondence asks the provider to supply the CQC with documentation pertaining to the alleged breach.

The threat of prosecution should always be treated with extreme caution and legal advice should be sought at the earliest opportunity – certainly before any documentary evidence is provided to the CQC. The provider needs to consider the context of the allegation and what information the CQC is likely to already have in its possession.

It is not unusual for the CQC to rely on witness evidence or its own interpretation of documentation, which may not always provide a complete picture of the circumstances.

It is crucial that providers remember that the CQC must bring a prosecution within three years of the date of the offence. This also requires consideration of the nature and reliability of any evidence that the CQC has, particularly where the alleged offence occurred some time ago.

A legal adviser will reflect on the allegations made and the information being requested by the CQC. Often, the CQC’s request for information will amount to no more than an attempt to get the provider to help build its case. Providers should take pause before participating without taking advice, as anything provided could potentially be used by the CQC in its case against the provider.

Providers should clarify the grounds on which information is being sought. Where the CQC requests information under its statutory powers, providers should ensure that they understand the basis of the request and their obligations before responding. Failure to provide certain information requested by the CQC can itself constitute an offence.

Given the potential impact of any evidence provided, it is crucial that all documents are carefully reviewed by a legal adviser and a position determined before engaging substantively with the CQC.

Conclusion

Providers facing criminal prosecution should take all correspondence of this nature from the CQC extremely seriously. A prosecution is likely to relate to a serious incident that has already been subject to regulatory scrutiny or even civil enforcement action.

As such, providers should ensure that documentation around incidents is detailed and comprehensive. It is also advisable to ensure that all remedial work and lessons learned around any incident are captured, as this could prove to be invaluable mitigation in the event of a prosecution.

Early advice is crucial and will dictate case strategy, approach to evidence, and preparation of either mitigation or defence.