Your Care Home Has a Second Regulator — And It Just Prosecuted Someone for Serving the Wrong Food

A care company in Selkirk was prosecuted by HSE in March 2026 — not for a slip, a fall, or an unsafe staircase. For serving the wrong texture food to a resident with documented dysphagia, who then died.

This prosecution matters for every care home in the UK. Not because dysphagia incidents are rare — they're common. Because almost no care home manager knows that HSE can prosecute for failures in care delivery, not just physical safety hazards.

CQC you know. HSE, as a criminal regulator for care homes? Most managers have never considered it.

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What Happened in Selkirk

In March 2026, HSE prosecuted a Scottish care company following the death of a resident with documented dysphagia — a condition affecting swallowing. The resident required modified texture foods as part of his care plan, a system known as the IDDSI (International Dysphagia Diet Standardisation Initiative) framework.

Staff served food that did not meet the required texture standard. HSE's investigation found a failure in the system of work for preparing modified texture meals — not a one-off human error, but a systemic failure in how the care home designed and managed its food preparation process.

HSE brought charges under the Health & Safety at Work Act 1974, specifically the duty on employers to ensure, so far as is reasonably practicable, that employees have safe systems of work. The prosecution was successful.

The fine amount was not publicly disclosed — but the conviction is what matters. HSE prosecutions result in criminal convictions in court. They go on record. They affect CQC ratings. They can disqualify individual managers from holding registered manager status.

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Why Most Care Homes Don't Know This

The UK care sector is regulated by CQC. Every registered manager knows this. CQC inspections. CQC ratings. Good. Outstanding. Requires Improvement. Inadequate.

But CQC is a civil regulator. It can close you down, impose conditions, require improvements. What it cannot do is prosecute you in a criminal court.

HSE can.

HSE's remit includes any workplace activity that creates a risk of serious harm — and that explicitly includes care delivery. A failure in a system of work that results in a resident's death is an HSE matter under Section 2 of the Health & Safety at Work Act 1974. This has always been the case. It is simply under-communicated.

The result is that care homes are carrying criminal liability they don't know exists, for risks they may not have assessed, under a regulator they may never have engaged with.

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What Is Dysphagia — and What Does IDDSI Require?

Dysphagia (difficulty swallowing) affects an estimated 22–68% of nursing home residents in the UK, depending on the study. Residents with dementia, stroke, Parkinson's disease, and motor neurone disease are at particular risk.

The IDDSI Framework — adopted as the UK care sector standard — defines eight levels of food and drink texture, from Level 0 (thin liquid) to Level 7 (regular/easy to chew). Each resident with dysphagia should have a documented IDDSI level in their care plan, and all food preparation should be tested and verified against that level before serving.

What HSE expects a care home to have in place:

• A documented system for identifying residents with swallowing difficulties
• A process for communicating IDDSI requirements to kitchen and care staff
• Training records showing all food-preparation staff have received IDDSI training
• A method for verifying texture before serving (flow test for drinks, fork/spoon pressure tests for foods)
• An incident log for any deviation or near-miss
• Named accountability for the IDDSI system — usually the registered manager or deputy

If your care home is serving modified texture meals without a documented, auditable system underpinning it, you are carrying the same risk that resulted in the Selkirk prosecution.

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The Double Regulator Reality

Most care managers think of compliance as CQC compliance. That is incomplete.

CQC and HSE both have enforcement powers over care homes — and they can act independently.

Regulator	Basis for action	Outcome
CQC	Care Quality Commission Act / Health & Social Care Act	Rating downgrade, special measures, closure, civil enforcement
HSE	Health & Safety at Work Act 1974 / Corporate Manslaughter Act	Criminal prosecution, unlimited fine, prison sentence for individuals

A care home rated "Good" by CQC can still face an HSE criminal prosecution. CQC compliance does not protect you from HSE.

The risks that HSE covers in care homes extend beyond slips and falls to include:

• System of work failures — as in the Selkirk case
• Medication administration errors with systemic root causes
• Manual handling systems (not just individual incidents)
• Infection control failures where a systemic breakdown can be demonstrated
• Lone working protocols that expose staff or residents to harm

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FWA: A Third Regulator From April 7

If double regulator risk wasn't enough, the Fair Work Agency (FWA) formally launches on April 7, 2026 — six days from now.

FWA consolidates HMRC's National Minimum Wage enforcement, holiday pay enforcement, and SSP enforcement into a single body with expanded powers. It has the authority to walk in without prior warning and review pay records.

The care sector is FWA's primary target. HMRC's own data shows care has the UK's highest rate of NMW underpayment — driven by three structural pay traps:

1. Sleep-in shift rates — many care homes still pay below NMW for sleep-in hours
2. Travel time between clients — community care workers' inter-client travel is work time
3. Accommodation deductions — live-in care arrangements that breach offset limits

From April 7, care homes with any of these issues face a single FWA investigation that covers NMW + holiday pay + SSP simultaneously — with a 200% NMW penalty on underpayments (meaning if you've underpaid 10 workers by £2,000 each, that's a £40,000 penalty on top of repayment).

By April 7, every care home should:

• Audit sleep-in rates against NMW (currently £12.21/hour for workers 21+, rising to £12.71/hour from April 1)
• Check that travel time between community care clients is compensated
• Verify accommodation offset deductions don't exceed £70.49/week
• Have records ready for the last six years of pay

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What to Do This Week

Immediate actions (before April 7):

1. Review your IDDSI system — does a documented system exist? Are all food prep staff trained? When were records last updated?
2. Check your HSE self-assessment — when did your care home last engage with HSE guidance on systems of work?
3. Run a pay audit — sleep-in rates, travel time, accommodation deductions
4. Book a management review of your double-regulator risk: CQC + HSE + FWA from April 7

Not sure where you stand? Take our free 3-minute Compliance Score quiz — 20 questions covering employment law, H&S, data protection and sector-specific risks. Instant results, no sign-up required.

👉 compliancealert.co.uk/compliance-score

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How ComplianceAlert Helps

ComplianceAlert Pro monitors HSE, CQC, and FWA enforcement for care providers in real time. When HSE publishes new prosecution guidance, enforcement priorities, or sector-specific alerts, you receive a plain-English summary — before your next inspection.

That includes:

• HSE enforcement alerts — prosecutions, sector-specific enforcement campaigns
• CQC regulatory updates — new inspection frameworks, rating methodology changes, sector guidance
• FWA enforcement notices — from April 7, as the new agency publishes guidance and initiates its first enforcement campaigns
• Employment law changes — NMW increases, SSP changes, holiday pay rules

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FAQs

Can HSE really prosecute a care home for care delivery failures? Yes. HSE's remit under the Health & Safety at Work Act 1974 covers any workplace activity creating a risk of serious harm to workers or others, including residents. The Selkirk case (March 2026) is a confirmed example of HSE prosecuting for a care delivery system failure, not a physical safety hazard.

What is the IDDSI framework? The International Dysphagia Diet Standardisation Initiative framework defines eight levels of food and drink texture for people with swallowing difficulties. UK care homes use it to specify and document the appropriate texture for each resident with dysphagia.

Is CQC compliance enough to protect against HSE prosecution? No. CQC and HSE are independent regulators with separate enforcement powers. A "Good" or "Outstanding" CQC rating does not provide protection against HSE prosecution.

What does FWA mean for care homes? The Fair Work Agency launches April 7, 2026, taking over NMW, holiday pay, and SSP enforcement from HMRC. The care sector is the primary focus due to historically high rates of NMW underpayment. FWA can investigate without prior warning.

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Published March 2026. ComplianceAlert monitors HSE, CQC, FWA and employment law changes for UK care providers. Sources: HSE press releases, gov.uk Fair Work Agency guidance, IDDSI Framework (iddsi.org), CQC enforcement data.

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