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

  • respective responsibilities of CQC, HSE and LAs when dealing with health and safety incidents in the healthcare 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 14 and Annex B);
  • principles and mechanism for information sharing (Annex C).
  • operational working arrangements (Annex D)

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.
  • CQC legislation is not retrospective. There may be rare occasions when HSE/LA are notified of a historical patient/service user safety incident occurring prior to the 1st April 2015. These should be considered in line with the relevant policies in place at that time.

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'.
  • Very occasionally, LAs have not been able to use this route due to local IT policies. LAs may wish to send RIDDORs etc. to CQC via a Secure File Transfer Procedure (Secure FTP) instead. Some LAs may already have such arrangements in place. Those LAs wishing to use this method should email CQC service provider Atos requesting that a Secure FTP account be created for the CQC email address [email protected].
  • If staff are unsure, they should speak to their Principal Inspector or LA equivalent.
  • The Concerns and Advice Team (CAT) may be contacted by external notifiers in relation to patient/service user safety issues. Where CQC are the appropriate enforcement body in accordance with the MoU, notifiers should be asked to directly contact CQC's National Customer Service Centre. The telephone number is 03000 616161. CAT may seek further advice from the Sector.
  • The police may occasionally notify HSE/LA when in attendance at a patient/service user fatality or serious incident. Information will normally be passed on to operational teams for consideration. If CQC are the appropriate enforcement body in accordance with the MoU, the notifier should be asked to directly contact CQC's National Customer Service Centre as above. If a RIDDOR report is subsequently received for this incident, this should be forwarded to CQC by email as above.
  • HSE/LAs may receive reports of thorough examination under the Lifting Operations and Lifting Equipment Regulations 1998 (LOLER), where there is a defect in the equipment involving an existing or imminent risk of serious personal injury (also known as adverse insurance reports). Where the lifting equipment is primarily used for lifting patients/service users eg patient hoist, a scanned copy of the report should be sent to CQC by email as above. For lifting equipment used by everyone eg passenger lift in a hospital, these will remain with HSE/LA.

(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

  • 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, pass it on as appropriate within HSE/LAs, and provide feedback to 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


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Updated 2023-10-12