The recent convictions of the owners of the CareFirst 24 agency raise an interesting set of questions around agency working, local authority oversight, process and protocols and the powers of the CQC .Mahendrasing Caussyram and his wife Saraspedy ran CareFirst 24, a CQC registered agency that supplied nurses and carers to a number of public and private health care organisations. This organisation was raided by police and UKBA in January 2013 over allegations that a significant number of their staff had worked illegally in the UK for the company between 2011 and 2013. This month, following a trial at Croydon Crown Court Mr Caussyram was jailed for three years for  breaches of immigration law and was disqualified from being a company director for five years; his wife was given a 12-month sentence, suspended for two years, with 150 hours community service. It has not been publicised whether a corresponding order was made under the Proceeds of Crime Act and/or whether any assets were seized that were obtained as a consequence of the offending.

The agency was paid almost £500,000 by Sutton Council for care services over six years, with workers being paid £450 a week for providing 24-hour home care. During the trial it was revealed that CareFirst 24 provided services for Woking and Walton hospitals in Surrey, Surrey Primary Care Trust and Surrey County Council as well as Merton and Sutton councils in south London. The court heard that Mr and Mrs Caussyram received "significant income" as directors of the Sutton-based company with most of the workers  were overseas nationals from countries outside the European Union, in particular the Philippines. None of them paid tax or National Insurance and some were working for less than half of minimum wage. This case will serve as an additional reminder for those in the private and public sector that are looking to contract and/or enter into joint ventures that initial due diligence and ongoing monitoring is key, particularly where the service involves children/vulnerable adults.

The immediate shutdown of CareFirst24 had tragic implications for Gloria Foster, an 81 year old lady who suffered from dementia, high blood pressure and type 2 diabetes that were publicised during her inquest. Following the raid, there were no subsequent visits to Ms. Foster's home by carers for 9 days. She had a contract in place where she paid £2,000 per month for carers to visit her to provide support and assistance four times per day. She was found by a visiting nurse 9 days later suffering from dehydration, starvation, bed sores and kidney failure; she never regained consciousness and died in hospital.

At an inquest into her death, the coroner determined Ms Foster had died of ‘natural causes contributed to by neglect’as Surrey County Council ("the Council")failed to take over her care. The police appeared to have discharged their duties by providing the Council with a list of Carefirst24's clients prior to the raid so that a urgent plan for care could be put in place. The failing occurred when the social worker responsible for contacting Ms Foster assumed that self-funding clients could ‘manage their own care or have help from someone else to arrange it’. After attempting to contact Ms Foster unsuccessfully by telephone, there was no follow up. The serious case review identified systemic and individual failings with a recommendation of improved inter-agency communication as well as internal disciplinary proceedings against the members of staff involved. As this was prior to the new offences of neglect introduced in  s.20 – 25 of the Criminal Justice and Courts Act 2015, there was no consideration as to whether the Council fell under the category of "care provider". Given their prior knowledge of the raid there is a strong argument to say that had the same offence have been committed now, they could have been prosecuted under this provision. A duty of care to the victim is established in both common law and statute and the inquest found the failing as a contributory factor to the death. Would this be enough to constitute a gross breach of their duty under the current law?

There are questions to be asked about whether, in circumstances like this, the CQC should be empowered to take a more active role given their knowledge of specific organisations and the services they provide to ensure that there are no assumptions and strict processes and protocols are enforced. It appears that in the majority of cases, the regulatory offences will be side-lined where there is evidence of more mainstream criminal offending. Thankfully the Caussyrams should never be able to run a health or social care business again as they could not satisfy the fit and proper test under Regulation 5  of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. For the wider health and social care community, this case serves to highlight the importance of due diligence, monitoring systems and compliance on so many levels that it should serve as a salutary reminder of what can go wrong and the impact it can have on vulnerable adults where failures are compounded.Therefore having a robust procurement process is essential in protecting those entrusted into your care, your organisational reputation and your standing contractually, should you need to litigate in the event of a significant breach.