Salop Medical Services (UK) Limited & Robert James Wallace v Care Quality Commission -[2019] UKFTT 645 (HESC)- (28 October 2019)

Key Facts

Issues

• The Service Provider argued that the CQC's delayed delivery of the January 2019 inspection report (until July 2019) and the subsequent eight-week improvement period, which overlapped with summer holidays, undermined procedural fairness. The Tribunal considered if this delay, coupled with the unavailability of contractors and training, prejudiced the Service Provider's ability to address concerns. However, the Tribunal found no evidence of prejudice or valid challenge to the CQC's findings, concluding the process was lawful.
• The Service Provider claimed the CQC's reports contained multiple inaccuracies due to the nature of the work and staff status, which would change the report's conclusions. The Tribunal noted that the Service Provider provided no specific evidence or details to substantiate these claims. Without supporting documentation, the Tribunal accepted the CQC's findings as accurate and sufficient to justify the cancellation order.
• The Tribunal addressed the legal justification for the Care Quality Commission's (CQC) cancellation order under Section 30 of the Health and Social Care Act 2008. This issue centered on whether the CQC demonstrated a serious risk to service users' life, health, or well-being if the registration of Salop Medical Services (UK) Limited and Mr. Robert Wallace as manager was not cancelled. The Tribunal evaluated evidence from inspections, including deficiencies in ambulance equipment, staff qualifications, and infection control protocols, to determine if the CQC's actions were lawful.

Holdings

• The Tribunal found that the Service Provider's ambulances had critical safety defects, including unsecured equipment and stretchers lacking adequate strapping, which posed a serious risk to service users' life, health, or well-being during emergency stops or accidents.
• The Tribunal concluded that the Service Provider failed to ensure staff were suitably qualified, trained, and vetted, violating Regulations 13 (Safeguarding) and 18 (Staff Competence), with specific concerns about missing staff files, unaddressed criminal history of a staff member, and lack of safeguarding training.
• The Tribunal determined that ongoing failures in infection control, including outdated training records and unimplemented hand audits, created a serious and continuous risk of cross-infection for service users.
• The Tribunal confirmed the Care Quality Commission's (CQC) order to cancel the Service Provider's registration under Section 30 of the Health and Social Care Act 2008, dismissing the appeal due to unresolved safety and compliance issues.
• The Tribunal found no evidence of proper incident policies or risk assessments, and inadequate record-keeping for critical events like oxygen administration, leaving service users vulnerable to harm.

Remedies

• The Tribunal dismissed the appeal against the cancellation order, upholding the decision made by the Magistrates Court to cancel the registration due to serious risks to life, health, or well-being.
• The Tribunal confirmed the order under Section 30 of the Health and Social Care Act 2008, resulting in the cancellation of Salop Medical Services (UK) Limited and Robert Wallace's registration as a service provider and manager, respectively.

Legal Principles

• The Tribunal applied the standard of 'reasonable cause to believe' in assessing the CQC's evidence. This standard lies between the balance of probability and 'reasonable cause to suspect,' requiring a reasonable person to believe the alleged matters based on available information.
• The Care Quality Commission (CQC) bore the burden of proof in the appeal, as established by the Tribunal. This principle was central to determining whether the CQC's decision to cancel the registration met the legal threshold required.

Cited Statute

• Health and Social Care Act 2008
• Tribunal Procedure (First-tier Tribunal) (Health, Education and Social Care) Rules 2008
• Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

Judge Name

• Ms. P Mcloughlin
• Ms. M Daley
• Ms. Rabbetts

Passage Text

• The Service Provider did not provide a witness statement or any further evidence in compliance with the directions neither did he substantially challenge the evidence in the application.
• The Tribunal finds that the breaches are serious and that unless the order is made, there will be a serious risk to a person's life, health or well-being serious as to expose any person to risk of harm.
• We consider that the CQC has discharged the evidential burden.