CQC Notice of Decision: urgent compliance support

We know how this feels

If you're reading this with the notice in front of you, you're probably frightened. That's normal. A Notice of Decision puts your registration and your business on the line, and it usually lands after months of pressure.

It can feel unfair, too. Your team gets hundreds of things right every day, then one incident or one missed record and CQC treats the whole service as a risk. Owners have told us it was life-changing. One didn't sleep properly for months.

So we won't pretend it's minor. It isn't hopeless, though. In our experience, providers who acknowledge the problem and get experienced help in straight away do far better than those who wait.

What is a CQC Notice of Decision?

A CQC Notice of Decision is CQC's formal confirmation that it is going ahead with the action it set out in an earlier Notice of Proposal: new or changed conditions, a suspension, or cancellation of your registration.

CQC gives the notice under section 28 of the Health and Social Care Act 2008. The notice must explain your right of appeal and state the conditions or the suspension period. If your service has a registered manager, CQC must send them a copy of the provider's notice, and the other way round.

This page is general information, not legal advice.

Why is a Notice of Decision so serious?

Because CQC has already made up its mind. The representations stage is over, and an independent tribunal now decides any challenge.

If you sent representations against the Notice of Proposal, CQC's National Representations team reviewed them. That team is independent of the inspectors who proposed the action. A CQC decision-maker with delegated authority then adopted the proposal. If you didn't challenge the proposal, CQC issues the Notice of Decision anyway.

Either way, the only route left is an appeal to the First-tier Tribunal. You have 28 days from service of the notice to bring it. That's very little time to prepare an appeal and, just as importantly, to show the service has changed.

Why has CQC come down this hard?

CQC looks at everything through risk. Its enforcement guidance tells staff to judge what would happen if the breach were repeated, and how likely a repeat is. Put together, those rate the breach as low, medium, high or extreme. A high rating points CQC towards cancellation, suspension or more significant conditions.

The guidance also tells CQC staff to look for a pattern: repeated breaches, your history, any failure to assess or act on known risks, and whether your leadership and governance are adequate.

So a missed risk assessment is rarely treated as just one bad day. In our experience, CQC reads it as proof that a process wasn't followed. If it happened once with dozens of people in your care, what stops it happening tomorrow? What else isn't being done?

That's why CQC can seem to go from nought to a hundred. It has the power to stop a service. In our experience, it will use it unless you can show, with evidence, that people are safe.

Why is this so hard to handle on your own?

Because two very different kinds of work have to happen at once. One is the appeal. The Tribunal rules say the appeal must give details of the decision, the result you want and your grounds. Your grounds have to show where CQC got the facts wrong, or why its action goes further than the risk justifies. CQC has to show its decision is justified, but you need evidence that answers its case.

The other is the service itself. CQC's concerns still need to be identified and addressed: governance strengthened, corrective action put in place, and improvements evidenced and embedded so they last. That work matters whatever the Tribunal decides.

You'll exchange bundles of evidence with CQC before the hearing. At the hearing, a judge and two specialist members of the Tribunal hear the case, and CQC is represented by its own lawyer. Each party usually pays its own costs.

Meanwhile you still have a service to run, staff to reassure and commissioners asking questions. In our experience, most providers only bring in proper help after something has gone wrong. With a Notice of Decision, it already has.

How we help at Notice of Decision stage

At this stage providers are more likely to need two distinct kinds of expertise: specialist compliance support and legal help with the appeal. We provide the compliance support. Our legal partners can handle the appeal.

Our focus is the service. We identify and address the concerns CQC has raised, strengthen governance, put corrective action in place, and evidence the improvements so they are embedded and sustainable. That gives a clear, evidenced picture of where the service is now, for CQC and for the Tribunal.

The appeal is legal work, and our legal partners can handle the appeal. We do the compliance and improvement work and the evidence of change, and we work closely with them, so the legal case and the compliance evidence tell the same story.

Does a Notice of Decision take effect straight away?

Not if CQC used the normal procedure. Under section 28(6) of the Act, it takes effect at the end of the 28-day appeal period. If you appeal, it takes effect only when the Tribunal decides the appeal or you abandon it. CQC's guidance says that while you appeal a non-urgent Notice of Decision, you can continue to carry on the regulated activity.

Use that time to keep improving. If CQC has reasonable cause to believe people may be exposed to a risk of harm, it can still use its urgent powers under section 31 to suspend you or impose conditions with immediate effect. Urgent action applies at once and stays in place during any appeal.

Watch for one trap. If you tell CQC in writing that you will not appeal, the decision takes effect as soon as CQC receives that letter.

What happens after you appeal?

You start the appeal with the Tribunal form. CQC, as respondent, must then reply within 20 working days of receiving your application. A telephone case management hearing follows. On that call you usually agree when to exchange documents and witness statements and put together the hearing bundle. The judge then sets a hearing date, and the details go on the Tribunal's list of hearings. Hearings take place in public unless the Tribunal directs otherwise.

If you and CQC reach agreement before the end of the hearing, you can ask the Tribunal to dispose of the appeal with a consent order. If you think the Tribunal got the law wrong, you can ask it for permission to appeal to the Upper Tribunal. Your application must reach the Tribunal within 28 days after it sends you its written reasons, and it must identify the error of law.

How tribunal appeals work

What happens if you do nothing?

If you do not appeal, the decision takes effect at the end of the 28 days.

If CQC cancels your registration, you are no longer registered for that activity. Carrying it on after that is an offence under section 10 of the Act. If CQC imposes conditions, breaching one without reasonable excuse is an offence under section 33. If CQC suspends your registration, carrying on the activity during the suspension is an offence under section 34.

If a company commits one of these offences with a director's or manager's consent or connivance, or through their neglect, that person is guilty of the offence too, under section 91 of the Act. Where failings are serious, CQC can also prosecute, and it may do so at the same time as other enforcement action.

Cancellations and suspensions also go on CQC's website, with the provider's name, the activity, the reason and the address.

A case study

An established adult social care provider with a long record of Good ratings was served a Notice of Proposal to cancel its registration, and its Registered Manager then left without notice. It called us on a Friday morning. By the following Monday we had an experienced interim manager in the service, and our governance team was building the formal reply.

That case was caught at the proposal stage. At Notice of Decision stage the work is the same, with less time and more at stake.

Read the full case study