Derbyshire County Council has been fined £500,000 by the Care Quality Commission's (CQC) in its first prosecution against a local authority.

In 2015 the CQC was given powers to prosecute health and social care providers for failing to provide safe care and treatment.  

The Facts 

• Miss Allen aged 80 was admitted to the Grange Care Home in Eckington, run by Derbyshire County Council. She was suffering from Dementia and had a documented history of falls. 
• During her stay at the care home she suffered several falls and fractured her ribs. Despite reporting pains in her left side staff took her to bed and did not seek medical advice. The following morning Miss Allen was taken to the hospital after being found unresponsive. 
• Tragically, she died just over three weeks after her fall as the fractures sustained during the fall lacerated one of her lungs leading to a haemorrhage. 
• The CQC's prosecutor Ryan Donoghue stated that the Council, as a provider of the care home service, failed to meet Miss Allen's needs or to adequately assess and reduce the risk of her falling. The council was ordered to pay a £170 victim surcharge and £5,124 costs in addition to the fine.
• Derbyshire County Council pleaded guilty to failing to provide safe care and treatment resulting in unavoidable harm to Miss Allen. They admitted that their falls policy was not fit for purpose and was not implemented properly. 

Current Trends 

In April 2015, the CQC assumed responsibility for prosecuting for all health and safety related incidents linked to healthcare risks in social care settings. 

Since 2015, there is a clear trend of increasing prosecutions of health and social care providers by the CQC with a rise of 16% in civil and 33% in criminal enforcement actions in 2018/2019 compared to 2017/2018. The CQC are clearly more aggressively pursuing civil and criminal penalties, with this prosecution in particular, of an entirely public body, highlighting the risk for providers. 

The CQC's annual report published on 23 July 2019 shows a sharp rise in the CQC taking criminal enforcement action; 211 criminal enforcement actions were taken against providers in 2018/2019 in comparison to 159 in 2017/2018. It is also clear that the CQC are focusing their attention on care homes with the number of prosecutions against care homes per financial year rising from four from 2016/17 to 2018/19 to 6 in 2019/20 (to date). 

The trend in enforcement suggests that the CQC is increasing the use of its powers and therefore it is essential for providers to have up to date risk assessments and control measures in place and for these to be regularly reviewed to ensure they are up to date and properly enforced. 

This increasingly aggressive approach to enforcement by CQC is also evident in CQC's decision to interview four individuals under caution in a criminal investigation into the treatment of approximately 30 elderly people at a London care home. 

In December 2019, the CQC rated Garside House nursing home in Westminster as inadequate following inspections prompted by a whistleblower. The CQC discovered dehydration, serious errors with medicines, wrongful deprivation of liberty and staffing levels cut below the level stipulated in the contract with the City of Westminster. 

Key Lessons

In light of the CQC's expanded enforcement remit, providers of care should pay attention to the CQC's guidance and should strive to conform to best practice. This should include having suitably qualified and experienced staff, comprehensive and documented systems of managing risks to patients and a system of monitoring and auditing to ensure that systems on paper are implemented in practice. 

In the event of an investigation, or for providers who wish to test the adequacy and robustness of existing management systems, Addleshaw Goddard LLP are able to comprehensively advise on compliance in addition to responding to enforcement action and engaging proactively with regulators to identify and mitigate legal risks.