The CQC’s Annual Report and Accounts 2021/2022 (the ‘annual report’) was published on 18 July 2023. The aim of this publication is to look at the CQC’s progress during the 2021/2022 financial year and identify any areas of focus for the year ahead (2022/2023).
Since the Covid-19 pandemic began and during the winter months, the CQC states that it has aimed to prioritise and fast-track registration applications from providers of services which provided additional health and social care capacity; contributed to the control of the pandemic or the treatment of people who contracted Covid-19; or supported winter pressure planning for NHS trusts, clinical commissioning groups or local authorities. However, with an increasing number of applications for registration over the last few years, this has clearly had an impact on the timelines for considering such registration applications.
The CQC’s annual report confirms that 53,165 registration applications were received by the CQC in 2021/2022, which equated to an increase of around 7.5% from the previous year with 3,709 more applications. Of those 53,165 registration applications, it is reported that 33,229 were completed (around 62.5%).
The CQC also confirm that the average processing time for these applications ranged from 25.8 days for ‘simple’ applications to 121.3 days for more ‘complex’ applications. The CQC had previously set a target for 2021/22 to reduce the time taken to complete applications by 15% (compared with the previous year's average). The annual report confirms that the CQC only achieved a 4.7% reduction in the time taken to complete ‘simple’ applications and an 8.1% reduction for ‘normal’ applications. However, for more ‘complex’ applications, which included where notices of proposal to refuse registration were issued or registrations were granted with conditions, the timeline increased by 16.1%.
Notice of proposal to refuse registration
The CQC has the power to refuse an application for registration under Section 12 of the Health and Social Care Act 2008 if it is satisfied that the requirements of the regulations under section 20, and the requirements of any other enactment which appears to the CQC to be relevant, are not being and will continue to not be complied with (so far as applicable) in relation to the carrying on of the regulated activity.
The CQC will often refuse an application for registration if it has identified concerns with a provider’s proposed policies and procedures; staffing arrangements; premises; or medicines arrangements, to name a few. The CQC may also not be satisfied that a director or proposed manager is a ‘fit and proper person’ to oversee or manage the regulated activities. Inspection and compliance histories of other registered locations, which are owned or run by the same provider, may also have an impact on the CQC’s assessment of the application.
Before refusing the application, the CQC must issue an applicant with a notice of proposal to refuse their application for registration, which must detail their reasons for the proposed refusal. An applicant is then given a period of 28 calendar days to make written representations against this proposal.
This is a provider’s opportunity to respond to the CQC’s concerns and provide any additional evidence or information in support of their application. It is important that a provider reviews each reason carefully and takes a careful and measured approach; this is only a proposal at this stage and there is still time to persuade the CQC to grant the registration.
Where a provider disputes the reasons provided, it is important that robust submissions are made to challenge those reasons with supporting documentation, and with reference to any applicable legislation; guidance; or case law. If any of the reasons provided are accepted, providers should consider how they can rectify or address those concerns in a timely manner and provide assurances to the CQC about their future compliance, particularly before any final decision on the registration is made. For example, updated policies and procedures; updated documentation or records; photographs; or independent inspection reports could be provided as evidence of any improved compliance or to demonstrate that the CQC’s concerns have been satisfactorily addressed.
In some circumstances, providers may feel that they are unable to rectify or address the CQC’s concerns in a reasonable timeframe and may wish to withdraw their application at this stage. Whilst this may be advisable in some cases, providers need to bear in mind that if they withdraw their application and re-apply later on, the registration process will start again from the beginning and may be subject to long delays, especially if it is a ‘complex’ application. This may not be a financially viable option for some providers and could mean the loss of vital contracts which are awaiting CQC registration. Our experienced CQC lawyers are well-versed in advising providers on the prospects of successfully challenging registration refusals and can provide practical guidance on how to strengthen a provider’s registration position.
Appealing against a CQC notice of decision to refuse registration
After assessing any representations and evidence submitted at the notice of proposal stage, the CQC will decide whether it remains proportionate and necessary to proceed with their refusal of the registration.
If the CQC decides to adopt their proposal, the CQC will issue the applicant with a notice of decision confirming their proposal to refuse the application. The applicant has a right of appeal against this decision to the first-tier tribunal (care standards chamber) and the appeal has to be made in writing within 28 calendar days. These appeals can take a number of months to conclude and in order to stand any prospect of success, providers need to ensure that they are able address any of the CQC’s remaining concerns as quickly as possible and can support any appeal grounds with clear and robust documentary evidence.
Successfully challenging a CQC notice of proposal to refuse registration
Our specialist CQC registration lawyers have extensive experience of assisting health and social care providers to successfully challenge a notice of proposal and appeal against a notice of decision to refuse applications for registration with the CQC. To find out more about some of our recent cases, you can view our case studies page.
If you have received a notice of proposal or notice of decision from the CQC to refuse your registration as a service provider or manager, we have a specialist team of CQC lawyers who would be happy to help you. You can contact our CQC lawyers now for a no-obligation discussion on 0161 696 6250 or via our online enquiry form.
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