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MoU between the Care Quality Commission (CQC) and HSE


This guidance explains the arrangements for implementing the memorandum of understanding (MoU) between the CQC and HSE. The Local Government Association (LGA) has chosen to express their commitment to this MoU as support, rather than formally sign it. This does not change its approach or individual commitment though. There are a number of significant changes to the revised MoU. It applies to healthcare and adult social care in England only. It originally came into effect from 1st April 2015 to reflect CQC's enforcement powers.


The MoU outlines the

Action - In England only

Referral of incidents and concerns to CQC

(Note: LOLER is mentioned under Annex B for HSE/LA to take the lead in some circumstances. However, LOLER is not required to ensure that care providers repair defects identified, therefore it is not necessary to apply annex B. More general requirements to ensure equipment is in a suitable condition can be used by HSE/LA or CQC.)

Incidents and concerns received from CQC

HSE and CQC are committed to regular liaison meetings at sector level to raise any issues which are not addressed by the MoU. Any issues can be raised by contacting the Health and Social Care Services Team or by emailing the Public Services Account.


Significant changes to the latest revision of the MoU (December 2017)

There has been no change in the enforcement allocation between HSE/LAs and CQC. Following feedback on the operation of the MoU so far, there has been further clarification to assist in determining the correct enforcing body.

It has been made clearer that CQC are the enforcement body in relation to suspected cases of legionella to patients/service users arising from the hot and cold water system at premises registered with them.

Additional examples have been added to Annex A and Annex B in order to assist in determining the correct enforcement body and when joint investigation may be appropriate.

Annex D has been added to set out operational working arrangements including details on how to contact inspectors from each enforcement body and how to escalate should agreement not be reached.

The effectiveness of these arrangements will be subject to an annual review carried out at Director level for HSE and Deputy Chief Inspector level at the CQC.

RIDDORs in health and social care

RIDDOR will continue to apply even though CQC have the lead responsibility for patient and service user safety.

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.



Further references


Updated 2020-12-15