CQC Notice of Proposal: urgent representations support

We know how this feels

A Notice of Proposal uses words you never expected to see written about your service: cancel, suspend, conditions. If you're reading this with the letter open, you're probably scared and angry at the same time. Both are normal.

It can feel wildly out of proportion. Your staff get hundreds of things right every day, and the notice is about the few things that went wrong. Owners have described what follows as life-changing, and it can drag on for a long time.

So we'll be straight with you. This is serious. CQC has set out what it wants to do, and the 28 days after service are your window to show it what has changed before it decides. It isn't hopeless. In our experience, providers who acknowledge the problem and bring in experienced help straight away give themselves the best chance.

What is a CQC Notice of Proposal?

A CQC Notice of Proposal is formal written notice, under section 26 of the Health and Social Care Act 2008, that CQC proposes to take action on your registration. Depending on the notice and the statutory power used, that action may include imposing or varying conditions, suspending or cancelling registration, or refusing an application. The notice itself states the proposed action and the reasons for it.

A Notice of Proposal is not a final decision. You can make written representations against it, and CQC has to consider them before it decides.

This page is general information, not legal advice.

Is your Notice of Proposal about a registration application?

Some Notices of Proposal relate to a registration application, not enforcement against an existing service. They are serious for the applicant, but they are generally about a proposed refusal of registration, without the potentially existential implications of cancellation for an operating provider.

If you have received a Notice of Proposal in relation to a refused registration, please read more about our registration support below, or call us to speak to our Registrations team.

CQC registration support

Why is a Notice of Proposal so serious?

Because it puts your registration itself on the table. CQC's enforcement decision tree recommends cancellation, suspension or more significant conditions when it rates a breach as high seriousness. That's one step below the extreme cases that get urgent action. A medium seriousness breach can also lead to conditions.

It's also the last point where you're dealing with CQC itself. If CQC adopts the proposal, it serves a Notice of Decision, and the only challenge left is an appeal to the First-tier Tribunal. That's a legal case in front of a judge, with its own 28-day deadline. A credible, compliance-led response now gives you the best chance of resolving things at this stage.

And CQC doesn't need you to reply. Its guidance says you don't have to challenge a Notice of Proposal, and if you don't, it will issue a Notice of Decision.

Why do the 28 days matter so much?

Because they're the only time CQC looks at your side before it decides, and it decides on paper. Section 27 of the Act gives you 28 days from service of the notice to make written representations. CQC counts them as calendar days, and it won't accept verbal representations.

Everything has to go in at once. CQC's guidance says you must submit your full representations and all the supporting evidence you want considered within the 28 days. You can't send a holding letter and follow up with the real thing later.

Your representations go to CQC's National Representations team, which makes a recommendation. A decision-maker with delegated authority then decides whether to adopt the proposal. Both are independent of the inspection team that served the notice. They decide on the notice, your representations and your evidence, and they may also look at public material such as CQC's published inspection reports.

So the file you send is what they have to go on. The people deciding weren't part of the inspection. If an improvement isn't in your evidence, they have nothing to weigh.

Why has CQC come down this hard?

CQC sees everything through risk. Its decision tree asks two questions about a breach: how much harm would follow if it happened again, and how likely is a repeat? A major potential impact with a possible repeat rates as high. So does a moderate impact with a probable repeat.

Then CQC looks for a pattern. Repeated breaches, your track record, any failure to act on known risks and the quality of your leadership can all move the action up a level, or down.

In our experience, CQC will usually read a single incident as proof that a process wasn't followed. If it happened once with dozens of people who use your service, what's to stop it happening tomorrow? What else is being missed? That's how one bad incident becomes a proposal to cancel.

There's a lever in that test, though. CQC rates the chance of a repeat as remote when control measures are in place, even if they're new and not yet embedded. Strong representations are built around evidence that the risk is now controlled.

Why is this so hard to do on your own?

Good representations work through every point in the notice, one by one, with documents behind each answer. They acknowledge what CQC has got right, correct anything that's inaccurate and show what you've changed since. Then they prove the change is working. All of it has to land inside the window.

Owners are usually too close to it. A first draft tends to be angry, or it apologises for everything. Neither helps. The decision-maker wants evidence that people are safe now and will stay safe.

And you're doing it while running a service under pressure, sometimes without a registered manager. There is a great deal to do, and it's hard to know what to tackle first. That's where we come in.

How we approach a Notice of Proposal

Our approach is collaborative and compliance-led. We acknowledge the concerns CQC has raised, address the shortfalls behind them, evidence the improvements and show CQC that they are embedded in day-to-day practice. Our priority is the best regulatory outcome, achieved through practical improvement and credible evidence.

That doesn't mean accepting everything. Where a finding is inaccurate or unsupported, we challenge it, with the evidence to back it up. There is little benefit in an adversarial position unless there is a strong, evidence-backed basis for it. In our experience, a service that has clearly understood the concerns and put them right makes a far stronger case.

At this stage our focus is a compliance-led response, ideally one that avoids the need for legal intervention altogether. Where legal input is needed, we work with our trusted legal partners.

A case study

An established adult social care provider with a long record of Good ratings was rated Requires Improvement, then served a Notice of Proposal to cancel its registration. 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. Our senior leadership was overseeing the regulatory response, and our governance team was building the formal reply to the notice.

The work has since grown into an ongoing programme of operational and compliance improvement.

Read the full case study

What happens after you make representations?

There's no legal deadline for CQC to decide. Its guidance says it aims to respond within 40 working days, counted from the working day after it receives your representations.

If the delegated authority decides not to adopt the proposal, CQC withdraws the notice and doesn't take the action. That isn't always the end. CQC can still serve a new Notice of Proposal where it thinks that's justified, and the representations process starts again.

If it adopts the proposal, CQC sends you a Notice of Decision. The letter tells you when the decision takes effect and how to appeal to the First-tier Tribunal. You'll have 28 days from service of that notice to appeal.

Keep the improvement work going while you wait. 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, which take effect immediately.

What a Notice of Decision means

What happens if you do nothing?

CQC issues a Notice of Decision. Once the 28 days have passed, the law lets CQC decide whether or not you've said anything.

From there, the only way to stop the decision is a tribunal appeal. If a cancellation takes effect, carrying on the regulated activity is an offence under section 10 of the Act. Carrying on while suspended is an offence under section 34. It goes public too. Unless the Tribunal overturns it, CQC must publish a cancellation or suspension once the appeal window closes or the appeal ends.

If a company commits one of those offences with a director's consent or connivance, or through their neglect, the director is guilty as well, 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.