Apparent bias in CQC inspections: lessons from R (Cygnet Health Care Ltd) v CQC (2025)

A recent judicial review, R (Cygnet Health Care Limited) v Care Quality Commission (2025), has cast a critical spotlight on the Care Quality Commission’s (“CQC”) handling of conflicts of interest, raising significant questions about regulatory fairness and impartiality.

Cygnet Health Care brought the case against the CQC after learning that an inspector, known as AA, had previously been detained as a mental health patient at two Cygnet hospitals and had made serious complaints about his care.

Despite the CQC’s Conflicts Policy, which bars inspectors from assessing providers they have a personal connection with, AA was assigned as the inspector for Cygnet’s London hospitals. He played a key role in multiple inspections, leading to seven adverse reports and four enforcement actions, including placing one hospital into special measures.

The test for bias

Cygnet argued that AA’s involvement created apparent bias and that the CQC failed to follow its own policies. The court applied the legal test for apparent bias, which considers whether a fair-minded observer would see a real possibility of bias.

The court found that:

• AA’s past complaints against Cygnet created a serious risk of bias
• The CQC did not properly apply its Conflicts Policy, meaning senior officials failed to review AA’s involvement
• Despite these concerns, the inspection reports were well-supported by evidence and multiple layers of oversight.

The High Court ruled that CQC’s decisions were affected by apparent bias but did not overturn all inspection reports or enforcement actions. Instead, the ruling required:

• Reconsideration of the inspection report and rating for only Cygnet Acer Hospital
• A declaration confirming apparent bias in CQC’s decision-making
• No further action on other reports or enforcement decisions, as the outcome likely would have been the same
• The CQC to cover 90% of Cygnet’s legal costs.

This case has major implications for the healthcare sector, serving as a clear warning for both the CQC and healthcare providers. Regulators must strictly enforce conflict-of-interest policies to prevent bias and maintain public trust, while the CQC may need to strengthen its governance to ensure inspectors remain impartial and its regulatory processes are transparent and fair.

Healthcare providers are now likely to scrutinise inspections more closely and challenge decisions where bias or procedural unfairness is suspected. The ruling also opens the door for further legal challenges, as other providers may review past CQC decisions and take similar action. While the CQC plays a vital role in ensuring patient safety, this case reinforces that its authority must withstand legal scrutiny, and providers must be prepared to defend their interests when necessary.