MoU between the Care Quality Commission (CQC), HSE and LAs in England
- Open Government Status
- Fully Open
- Publication date
- Review date
- Guidance owner
- Operational Strategy Division, Public Services Sector, Health and Social Care Service Unit
- Target Audience
- All Field Operations Directorate (FOD) operational staff (e.g. inspectors, occupational health inspectors, administration staff), the Concerns and Advice Team, LA Environmental Health Officers in England, and HSE’s Duty Officers
This guidance explains the arrangements for implementing the memorandum of understanding (MoU) between CQC, HSE and LAs as applied to healthcare and adult social care in England only. It comes into effect from 1st April 2015 to reflect CQC’s new enforcement powers.
The MoU outlines the
- respective responsibilities of CQC, HSE and LAs when dealing with health and safety incidents in the health and adult social care sectors in England (paragraphs 5 – 8 and Annex A);
- types of incidents where more specific and exceptional criteria may apply (paragraph 9 and Annex B);
- principles for effective liaison and information sharing (paragraphs 10 – 12 and Annex C).
There are additional illustrative examples and, where appropriate, further supporting information in appendices 1, 2 and 3 of this guidance.
Action - In England only
- All relevant FOD operational staff and LA inspectors should become familiar with the MoU, and implement it when dealing with healthcare and adult social care providers/organisations.
- Patient / service user incidents occurring before 1 April 2015, including those notified after that date should be investigated by HSE and LA inspectors in line with the enforcement policies in place at the time of the incident. The CQC legislation is not retrospective.
Referral of incidents and concerns to CQC
- All RIDDORs and details of any other health and safety incidents related to patient or service user harm that are received in HSE/LA offices, should be forwarded by staff in those local HSE/LA offices to CQC by email. It should be security marked as ‘official sensitive’.
- If staff are unsure, they should speak to their Principal Inspector or LA equivalent.
- The Concerns and Advice Team (CAT) should record reports of patient or service user fatalities as currently happens, and forward the information to CQC as at 3 above. Other patient and service user incidents, concerns and requests for advice should be redirected to CQC’s National Customer Service Centre. The telephone number is 03000 616161.
Incidents and concerns received from CQC
- For the first year of operation, to allow real-time monitoring of the MoU, CQC have been asked to direct all health and safety incidents or concerns outside their remit to HSE via the Public Services Account.
- The Sector will review the information received on a daily basis, pass it on as appropriate within HSE/LAs, and provide feedback to CQC.
CQC’s changing role
From 1 April 2015, CQC will have new enforcement powers which will enable it be an effective enforcement body for patient / service user health and safety matters, including investigating incidents, in England.
HSE’s investigation policy will remain unchanged – but as CQC will now become the better placed regulator in most instances, HSE will defer to CQC and will not investigate such incidents. The MoU confirms this for both HSE and LAs (in respect of residential care homes registered with CQC).
HSE’s guidance for the health and social care sector has been revised to reflect this.
There are limits to CQC’s remit, however, depending on the nature of the activities. There is no equivalent to HSWA Section 7, for instance. Therefore in a limited number of cases, CQC will correctly return certain incidents or concerns to HSE/LAs. This will be relatively rare, however, and may occur after the registration details have been checked by CQC, or after initial enquiries have been made by CQC. It has been agreed that these will be returned to a single point in HSE for monitoring and checking against the MoU criteria. Some incidents may require joint or co-ordinated investigation
If there has been an incident at a provider that is not registered with CQC, but should be, then CQC can only deal with the non-registration aspect, and HSE/LA would deal with the specific non-compliance issue in line with its published policies. If the provider is not required to be registered with CQC, then the incident falls to HSE/LAs.
RIDDORs in health and social care
RIDDOR will continue to apply even though CQC will have the lead responsibility for patient and service user safety from 1 April 2015.
Health and adult social care providers in England are statutorily required to report similar incidents to HSE and CQC. However, CQC may not learn of fatalities sufficiently quickly.
This duplication with RIDDOR is not ideal, but the solution requires changes in statutes and this cannot be achieved in the short term.
Appendix 1: Incidents that fall to HSE/LAs
- The injury is to a worker or visitor, not a patient or service user,
- Nurses have developed dermatitis which is related to glove use
- The injury is to a patient or service user but this is outside CQC’s remit
- A service user died from choking in a day care centre
Comment: Some day care centres are not a regulated activity under CQC’s remit.
- More specific HSWA-related legislation applies
- A service user contracts Legionnaires disease in a health / adult social care facility. This was linked to contamination of the hot water system. Failure to follow established standards as set out in the Approved Code of Practice and guidance ‘Legionnaires Disease: The control of legionella bacteria in water systems’ published by HSE.
Comment: The ACOP relates to HSWA legislation.
Note: The specific legislation may not be relevant in some cases. For instance, most hoisting accidents can be adequately enforced by CQC on the basis of training and unsuitable equipment, rather than on the detail of LOLER.
Appendix 2: Incidents that fall to CQC
- The injury was to a patient or service user
- A patient / service user fall from a window
- Patient known to be allergic to penicillin was given penicillin and died as a result.
- There was minor injury to a worker but much greater risk to the patient / service user from the same incident
- A care worker suffers an over seven day injury whilst attempting to support a service user falling from a sling. The wrong sling was being used. This could have had potentially fatal consequences for the service user.
Appendix 3: Incidents where joint or co-ordinated investigations may be necessary
For example situations where:
- (i)There may be failings by duty-holders enforced by both HSE/LAs and CQC (e.g. commissioners1 and providers)
- A disabled man with severe learning difficulties and epilepsy drowned in a bath at a residential care home. The assessment of his needs and risk management plan completed by the local authority made no mention of the risk of drowning during bathing. In this case, the local authority (the commissioner) did not pass on the information to the residential care home.
Comment: CQC has no powers in relation to commissioners, therefore one for HSE. CQC will still need to look at the home.
- Both workers and service users are put at risk by the same incident
- The malfunction of an X ray machine due to poor maintenance leads to patients and workers being exposed to much greater than expected levels of radiation.
Comment: Co-ordinated investigation