CQC ‘Better regulation’ consultation
10/12/2025
Changes to overall ratings of NHS trusts and location-level ratings of NHS acute trusts and independent hospitals
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I am head of our Health & Care Regulatory team and an experienced regulatory lawyer specialising in health and social care service regulation. I work on contentious and non-contentious matters ranging from advice to regulators on the exercise of their powers, representation in judicial review challenges, regulatory enforcement work in terms of prosecutions and appeals to the First-tier Tribunal, and representation in public inquiry.
I work on quality governance issues including advising clients on quality governance processes and the handling of complex high profile investigations into patient safety and quality issues.
I advise health and social care providers on various aspects of regulatory law. Such advice includes the impact of regulatory considerations on the re-structuring exercises and governance arrangements, the making of applications for registration, issues relating to on-going compliance, and responses to enforcement action taken by the regulator. My experience includes numerous cases in the First-tier Tribunal, regulatory prosecutions and urgent applications to magistrates as well as judicial review challenges to the exercise of regulators’ powers.
I have advised regulators in the health and social care sector since local regulation in the 1990s. Subsequently, I have acted extensively for the National Care Standards Commission and its successors up to and including the Care Quality Commission ("CQC"). I was the recognised legal representative for the CQC in the Mid Staffordshire Inquiry.
I also advise on the conduct of complex investigations and participation in inquires.
Regulatory Support
Examples of support provided include:
Registration
- advice on the regulatory implications of restructuring/ partnership working
- support with making applications for registration
Compliance
- Advice and assurance on quality and information governance arrangements
- Review and advice on key policies and procedures such as: Incident Reporting; 'Being Open’; 'Mental Capacity/DoLS'; 'Raising Concerns/ Whistleblowing' and the Fit and Proper Person Requirement
Inspection
- supporting a NHS trusts in their preparation for comprehensive CQC inspections, including Board workshops and conducting mock inspections and interviews with senior executives and Board members
- supporting providers in making factual accuracy responses to inspection reports
- advising an acute foundation trust over the scope for challenge to a full hospital inspection it received shortly before being taken over by another trust
- supporting trusts in their preparation for a post-inspection Quality Summits
- advising on the implications of CQC's ratings formulae and rules for the aggregation of ratings and bringing challenges to the same
- drafting Quality Rating Review Requests
- representing providers securing independent reviews of inspection reports resulting in changes in ratings
Enforcement
- advising on representations and strategic responses to Notices of Proposal to remove locations
- advising a mental health foundation trust and submitting representations in response to a Notice imposing a condition to close an inpatient unit due to safety concerns
- advising an acute trust on responding to urgent restrictive conditions imposed by CQC in relation to the operation of the A&E Department and EAU
- representation in urgent applications to Magistrates Courts to cancel the registrations of health and social care services.
- Representing clients in numerous appeals in the First-tier Tribunal against decisions to refuse, impose conditions upon, and cancel registrations of health and social care services.
- Representing the CSCI in a judicial review of its regulatory powers – R –v- CSCI (ex parte Walton)
- Representation in regulatory prosecutions – including advising the defendant in the first ever prosecution by CQC of a NHS trust – CQC –v- Southern Health NHS Foundation Trust.
Specialist Healthcare Regulatory Due Diligence
I provide due diligence advice on various regulatory regimes arising in the context of mergers and acquisitions, re-financing and joint ventures and partnerships in the health and social care sectors. Significant transactions include:
- Classic Hospitals – acquisition of ten independent sector acute hospitals by Spire Healthcare.
- Priory – advising Advent International on its acquisition of the UK wide Priory Group of mental health, specialist care and education services.
- Acorn Care and Education – re-financing of a leading provider of fostering services and schools for children with learning disability.
- Pathway Care - advice on acquisition of independent fostering agency in England and Wales, by Fostering Solutions.
- European Care Group - advising bidder on proposed acquisition of care home group.
- Cygnet Healthcare - advising bidder on proposed acquisition of mental health provider.
- Acadia Healthcare - advising bidder on proposed acquisition of 22 Priory and Partnerships in Care mental health facilities.
- Oasis Dental Care - advising bidder on proposed acquisition of over 380 UK dental practices.
Investigations and Inquiries
My work includes advising clients on the handling of complex high profile investigations and participation in public inquires. Experience includes:
- acting as recognized legal representative for the CQC in the Mid Staffs Public Inquiry
- advising Leicestershire County Council in the Independent Inquiry into Child Sexual Abuse
- advising Colchester Hospitals University NHS FT on issues relating to the conduct and publication of an independent investigation into cancer waiting time data.
- advising local authorities and private and voluntary sector care providers in relation to Safeguarding investigations.
Other
I regularly in trade publications such as Health Investor, Care Management Matters and Caring Times and also lectures on many aspects of the law relating to the regulation of care settings.
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Carlton Sadler is quite outstanding.