What does a nominated individual actually do in a care service?

What is a nominated individual?

If an organisation registers with CQC, it has to name a nominated individual. CQC's guidance on what registration involves says this person acts as the main point of contact with CQC, and must be employed as a director, manager or secretary of the organisation. They must also hold a position that carries responsibility for supervising the management of the regulated activity, so they can speak with authority on behalf of the organisation about how care is provided.

Individuals and partnerships that register in their own name do not need one. Everyone else does.

The legal basis is Regulation 6 of the 2014 Regulations. CQC's guidance on it says the nominated individual is responsible for supervising the management of the regulated activity provided. The provider must take all reasonable steps to make sure that person is of good character and has the qualifications, competence, skills and experience to do that properly.

How is it different from the registered manager?

The two roles are often confused, especially in smaller providers where the same few people do everything.

	Registered manager	Nominated individual
How they are registered or named	Applies to CQC and must satisfy CQC about their fitness	Named to CQC by the provider
Legal basis	Regulation 7	Regulation 6
Core job	Manages the carrying on of the regulated activity	Supervises the management of the regulated activity
Accountability	Shares legal responsibility with the provider as a registered person	Speaks with authority for the provider about how care is provided
Day to day focus	Care, staff, records and the running of the service	Oversight, support and challenge for the manager, and the provider's grip on quality

CQC's guidance on Regulation 7 says its intention is that people's needs are met because the regulated activity is managed by an appropriate person. The nominated individual makes sure that management is itself being supervised.

Can the manager also be the nominated individual?

It is allowed, but CQC is clear that it is not ideal. Its registration guidance says that in very small organisations the same person may need to be both, but this should be avoided where possible. The reason it gives is practical. When there are concerns about how a regulated activity is managed, CQC sometimes needs to speak to someone more senior in the organisation, and that is more difficult when the manager and the nominated individual are the same person.

I would add a second reason. A manager who is also their own supervisor has nobody to test their thinking with. That is a lonely place to be when something goes wrong.

Why do providers get the role wrong?

One way the role goes wrong is treating it as a name on a form. A director is nominated at registration, then gets on with running the rest of the business. The manager carries everything, and the nominated individual hears about problems when CQC does.

The second is choosing someone without the knowledge to do it. The Regulation 6 guidance says the nominated individual should show appropriate knowledge of the 2014 Regulations and relevant guidance, and understand the consequences of failing to act on set requirements. A finance director with no care background may be the right person to sign off budgets. That does not make them the right person to supervise care.

The third is having no rhythm. Oversight that only starts when something has gone wrong is crisis management, and it comes too late.

What should a nominated individual do each month?

Regulation 17 guidance says governance systems must include scrutiny and overall responsibility at board level or equivalent. In many care providers, I would expect the nominated individual to be at the heart of that scrutiny.

In practice, I would expect a monthly rhythm that covers a few honest questions:

1. What has changed for the people we support this month, for better or worse?
2. Which actions from audits, incidents and complaints are overdue, and why?
3. Are the same issues coming back, in this service or across our services?
4. Does the manager have the staff, time and support to do the job?
5. Have we sent CQC every notification we should have, on time?

The nominated individual should also visit. The point is to see the service at different times of day, talk to people and staff, and test whether what they hear in meetings matches what they see.

And they should write it down. If CQC asks how the provider oversees quality, a record of these monthly conversations, with what was found and what was done about it, is the answer.

What if nobody senior has the time or the background?

Some providers do not have a director with the time or the care background to do the role well. In that situation, the answer is to appoint or develop someone inside the organisation who can, not to borrow a name.

The rule to remember is in Regulation 6 itself. The nominated individual must be employed as a director, manager or secretary of the organisation and be responsible for supervising the management of the regulated activity. So whoever holds the role has to be genuinely part of the organisation, with real authority. An outside consultant cannot hold it on the provider's behalf. If a person cannot speak with authority for the provider, they cannot do the job CQC expects.

What an outside adviser can bring is distance. They have not built the systems the nominated individual is checking, so they are more likely to notice when those systems have drifted, and they can help the nominated individual ask sharper questions.

When is this not the answer?

If your nominated individual is already visiting, asking hard questions and following up on the answers, you do not need to change the structure. Small refinements may be enough.

If you are an individual or a partnership registered in your own name, you do not need a nominated individual at all, although the same oversight still has to happen somewhere.

If you are thinking of changing your nominated individual, or appointing someone new, check CQC's current notification requirements before you make the change. Where a contract or employment question is involved, take advice from a solicitor or HR adviser as well.

Where should I start?

Write down who your nominated individual is, when they last visited the service, and what they did with what they found. If any of those answers is vague, that is your starting point.

If you need support, my nominated individual services can strengthen the person already in the role, and my personal mentorship supports managers and nominated individuals who want someone to test their thinking with. When you are ready, book some time with me and we can talk about how oversight works in your organisation.