The Hidden Risk: How England’s Lack of Nursing Agency Regulation Puts Care Providers at Risk

It is a little-known fact that nursing and care staffing agencies are not regulated by the CQC or any statutory body. 

An agency can begin supplying healthcare workers into care settings tomorrow without any inspection, licence, or external compliance check. 

There is:  

• No regulator verifying that DBS or right-to-work checks are valid. 

• No standard for how disclosures or competency assessments are managed. 

• No framework ensuring agencies have safe recruitment policies or governance. 

And yet, these agencies operate right inside one of the most tightly regulated sectors in the country. 

This contradiction is largely invisible. Many commissioners, procurement officers, and care provider managers simply assume that agencies are regulated. They are not. 

Rogue operators exploit that misunderstanding — and when things go wrong, it is the care provider, not the agency, that faces the consequences. 

When a care provider engages an agency, the agency supplies workers who deliver care under the provider’s direction and supervision. During any given shift, the agency worker functions, in practice, as part of the provider’s workforce, subject to the provider’s policies, procedures, and management. 

While the agency is responsible for the worker’s recruitment, vetting, and pay, the care provider remains responsible for the quality and safety of the care delivered during that shift. In the eyes of the CQC and employment law, the provider is accountable for what happens on its premises, regardless of the worker’s contractual status. 

Care providers cannot reasonably undertake full compliance checks for every agency worker who attends a shift, so they must rely on their agency to ensure these checks are done properly. This creates a relationship built on trust and assurance. One that only works safely when the agency’s compliance processes are robust, transparent, and verifiable. 

When agencies fail to meet these standards, it is the care provider who carries the risk, not the agency.  

The UK health and social care labour market has shifted dramatically. 

• Post-pandemic shortages and changes to immigration rules opened the door to a rapid influx of overseas care workers. 

• Hundreds of new agencies have entered the market, many built around supplying sponsored workers (who are typically limited to 20 hours per week).  

• Local authorities and care providers, under enormous budget pressures, are being urged to find cheaper sources of staff. 

The result is intense price competition and the emergence of agencies that can undercut established providers by skipping key compliance steps. 

For many buyers, the difference is invisible — until there is a problem. 

When agency staff are deployed into a care provider’s service, they work under that provider’s direction and supervision. This means the care provider is legally and professionally responsible for the quality and safety of the care delivered. 

Safeguarding Risks: If an agency’s recruitment process is weak or non-existent, unfit workers can slip through. A missing DBS, falsified reference, or ignored disclosure can all lead to serious harm for which the CQC will hold the care provider accountable. 

Legal and Employment Risks: If a worker is found to have no right to work in the UK, or if their documentation is invalid, the care provider may face fines or prosecution. The agency is not legally liable for that breach. 

Reputational and Inspection Risks: A single safeguarding incident involving an agency worker can damage years of hard-won trust. Providers risk losing CQC ratings, contracts, and community confidence. 

The cost of one incident can far exceed any savings achieved through cheaper agency rates. 

If this gap is so significant, why is it not more widely recognised? The answer is simple: no one is looking.  

Because agencies are unregulated, there is no governing body actively inspecting their practices. Care providers are already under significant strain, and as a result, most malpractice goes unseen. When incidents do occur, there are no real consequences for the agency. At worst, they may lose business from a care provider, but the matter ends there. This makes it all too easy for both agencies and care providers to overlook or sidestep malpractice-related risks, allowing these issues to remain largely hidden from view. 

In most cases, the consequences of poor practice go unnoticed. Staff may be inadequately checked or poorly trained, but unless something serious happens, no alarm is raised. This creates a false sense of security and allows non-compliant agencies to operate freely, often undercutting those that do things properly. 

This is a back door to large-scale poor practice. 

If the current system continues, the sector faces a stark choice: either lower the standards for everyone, eroding the integrity of the care system, or create a mechanism that allows care providers to identify and engage agencies that meet the necessary standards without imposing an unreasonable due diligence burden. 

Many care providers take comfort from seeing a DBS number on a worker profile.  

Unfortunately, in an unregulated agency market, that number often provides false reassurance. 

The fact that someone has a DBS certificate does not necessarily mean they are safe or appropriate to work. Anyone can obtain a DBS. This includes people with prior convictions for serious offences such as battery, theft, or abuse. What matters is how the information contained in that certificate is interpreted, risk-assessed, and managed. 

In a regulated setting, this process is audited and governed by policy. In an unregulated agency, it is not. There is no scrutiny of how disclosures are handled, and no oversight to ensure consistent decision-making. 

That means an agency could ignore a relevant disclosure and still send the worker into a vulnerable care environment; there is no requirement to record or evidence risk-management decisions; and the only protection for the care provider is their own due diligence in understanding the agency’s policy. 

An Adult First check is a fast-track DBS search of the Adults’ Barred List that allows someone to start supervised work with vulnerable adults while awaiting their full Enhanced DBS certificate. This can be mis-used creating further risk. An unscrupulous or uninformed agency might treat an Adult First check as a green light, deploying staff immediately without waiting for full clearance. They should only be used with full transparency, and deployment decisions remain within the provider’s governance framework. 

DBS checking is not a box-ticking exercise; it is a safeguarding process that requires professional judgment and oversight. Without regulation or audit, that process is dangerously open to abuse. 

In an unregulated market, the path of least resistance often wins. Agencies can save time and money by deploying staff before full compliance checks are complete; using copied or unverifiable documentation; skipping reference validation and competency assessment; and misusing fast-track DBS processes.  

A further and often hidden danger lies in poor DBS disclosure risk management. When a DBS certificate reveals a conviction or caution, responsible agencies undertake a formal, documented risk assessment before the worker is approved for placement. In an unregulated environment, however, many agencies simply ignore or downplay disclosures altogether.  

This means individuals with relevant criminal histories, including offences relating to theft, violence, or abuse, may still be supplied into vulnerable care settings without any proper evaluation or safeguards in place. Effective disclosure risk management demands policies, senior review, and transparency with clients.  

These shortcuts by others are invisible to most clients, until something goes wrong.  

In domiciliary and supported living services, CQC has reported (in their State of Healthcare Report 2022/23) a rising number of concerns relating to coercion, debt bondage, illegal recruitment fees, document retention, wage withholding, and tied accommodation. 

The CQC also reports that changes to immigration visas has “…introduced concerns and increased the risk of mistreatment of both existing workforce and internationally recruited staff. This includes an increased risk of modern slavery and unethical international recruitment practices.”  

These risks are highly likely to exist within unregulated staffing agencies, especially those built around sponsored workers or undercutting practices. 

Because agencies are not regulated in England: 

• No one inspects their recruitment practices. 

• No one checks for coercion or illegal deductions. 

• No one reviews sponsorship compliance. 

• No one audits whether workers are safe, supported, or free from exploitation. 

In regulated nations, inspectorates can intervene. 
In England, no one is watching. 

This leaves providers unknowingly receiving staff from agencies where workers may be unsafe, exploited, or unable to speak up. This has clear implications for safeguarding, right-to-work risk, quality of care and ethical commissioning 

In some services, safeguarding concerns relating to agency workers are addressed by the immediate removal of the worker from the placement. While this may mitigate immediate risk to individuals, it does not in itself constitute an investigation, nor does it provide assurance that concerns are examined, escalated, or addressed if there is concern about widespread poor practice. 

The responsibility for follow-up is unclear between provider, agency, commissioner, and regulator. This creates a risk that serious issues are not identified or appropriate action taken.  

In an unregulated agency market: 

• Agencies are not required to conduct investigations. 

• They are not required to follow a disciplinary process. 

• They are not required to record outcomes. 

• They are not required to notify future clients. 

• They are not required to notify any regulator (because none exists). 

Too often, the agency simply sends the worker to the next service to repeat the behaviours. 

This is a serious safeguarding breach but because there is no regulatory body and no inspection regime for agencies, it goes completely unchallenged. 

The risk falls squarely on residents, providers, local authorities and the integrity of safeguarding systems.  

An unregulated system does not just expose providers to risk. It also leaves agency staff dangerously vulnerable. Without a regulator: 

• There is no independent unfair-practice safeguard. 

• There is no mandated framework for handling allegations. 

• There is no requirement for agencies to support their workers. 

• There is no consistent mechanism for clearing a worker’s name when wrongly accused. 

Who’s the easier one to blame when something goes wrong? The agency worker. Often the agency worker is not even aware they been accused of any poor practice.  

In the absence of any regulatory oversight: 

• Workers can be removed without due process. 

• False allegations can follow them from service to service. 

• Careers can be destroyed without review, representation, or appeal. 

A fair and safe system must protect the people who receive care and the people who provide it. Regulation in Scotland, Wales, and Northern Ireland creates this balance. England’s system does not. 

The lack of regulation in England has not only enabled poor practice to thrive it has also created a climate of deep mistrust toward nursing and care staffing agencies. No-one seems to recognise the route cause is lack of accountability which is lack of scrutiny. However, they do see the impacts of poor practice and simply discredit agencies as a result.  

In this environment, responsible, compliant agencies are judged by the standards of those who cut corners. This blanket condemnation is understandable, but it is also unfair. There is no way for credible agencies to elevate themselves from general perception caused by the widespread malpractice of many agencies who are allowed to get away with it.  

The absence of oversight creates a paradox. It allows bad agencies to flourish in the shadows while also trapping good agencies in the same shadows. There is no formal mechanism to demonstrate their quality. 

With no inspection regime, no public rating system, and no mandatory audit, commissioners and providers have no obvious way to tell the difference. As a result: 

• reputable agencies face unfair scepticism 

• ethical operators must work harder and spend more to prove their standards 

• providers often default to “cheapest wins” because quality signals are invisible 

• the entire sector’s reputation is diminished by the behaviour of a minority. 

The impact on the workforce 

This prejudice does not only affect organisations; it affects people. Agency staff many of whom are dedicated, skilled, and compassionate are often treated with suspicion before they even walk through a provider’s door. They are assumed to be poorly trained, inadequately vetted, or less committed than permanent staff, even when the agency supplying them is exemplary. 

A safe, well-governed system should not stigmatise ethical agencies or the people who choose flexible work. It should create mechanisms that distinguish good practice from malpractice.

Care providers remain responsible for the compliance of every worker in their service — whether employed directly or supplied by an agency.  

To protect their residents, staff, and organisations, providers must carry out due diligence on every agency they use. 

Five Questions Every Provider Should Ask: 

1. Can the agency prove that every worker has a valid, enhanced DBS? 

2. How does the agency manage and document DBS disclosures and Adult First checks? 

3. What is the process for verifying right-to-work documents and references? 

4. Is the agency REC-registered or independently audited for compliance? 

5. Can the agency share its compliance policy and evidence of implementation? 

If an agency cannot clearly and confidently answer all five, the safest option is to walk away. 

Local authorities play a vital role in shaping how care services are delivered, particularly through commissioning and funding frameworks such as Continuing Healthcare (CHC). However, under intense budgetary pressure, many local authorities have turned to low-cost agency supply arrangements that do not adequately consider compliance or safeguarding. 

In some cases, local authorities engage agencies directly to provide staff into care settings without conducting appropriate due diligence — or they require care providers to use specific agencies for one-to-one support as part of CHC-funded packages. 

While this may reduce short-term costs, it introduces significant long-term risk. Many of these mandated agencies are unregulated, have not been audited, and may lack proper systems for DBS management, right-to-work verification, or competency assessment. 

When such agencies supply staff into care settings, the care provider remains legally responsible for the conduct and suitability of those workers, even if the arrangement has been imposed by the local authority. This creates an untenable situation: the local authority makes the decision, but the care provider carries the liability. 

Local authorities should not insist that providers use particular agencies unless they have themselves undertaken formal due diligence and can demonstrate that those agencies meet appropriate compliance standards.  

Historically, the reputation of high-cost “rogue” agencies may have shaped local government attitudes toward the sector. But the market has now swung too far in the opposite direction. Low-cost operators are cutting critical corners, offering little value, and introducing serious risk. 

The solution lies in balance. Not a return to high cost rip-off agencies, or acceptance of low-cost high-risk agencies. Instead trustworthy value built on clear standards, transparent compliance, and measurable quality. Local authorities have the power to influence that shift by integrating compliance assurance into procurement frameworks and recognising the long-term cost of safeguarding failures. 

Ocean Healthcare has supplied trusted, compliant nursing and care staff across the Southwest for over 20 years.  

It maintains this reputation by holding itself accountable to the highest standards: 

• REC Membership: Proud members of the Recruitment & Employment Confederation, whose Code of Practice ensures integrity, transparency, and fairness. 

• Independent Audit: Regular external audits (most recently with Neuven) verify that every element of Ocean’s compliance process meets best practice. 

• Full Vetting: Every worker undergoes enhanced DBS, right-to-work, reference, and competency checks before placement. 

• Ongoing Oversight: Compliance is continuously monitored and reviewed throughout each worker’s engagement. 

• Transparency: Ocean shares all compliance documentation openly with clients, enabling them to evidence due diligence at any time. 

Safeguarding is not optional — it is the foundation of care. 

The current regulatory gap is unsustainable. However, the solution is not necessarily to regulate agencies in the same way as care providers. Agencies do not provide care directly; they supply the people who do. 

Regulating agencies to the same extent as care providers may be a sledgehammer to crack a walnut. However, there must be a mechanism to provide care providers with reassurance that the agencies they engage meet minimum standards. 

An ISO-style quality mark or kitemark would achieve this. It would give care providers confidence that the agencies they use have been independently audited against clear, published standards. Such a framework would not even need to be mandatory. Its absence would be a signal that a provider should proceed with greater caution. 

Until such a kitemark exists, care providers should apply a structured due diligence process when selecting agency partners. To support this, Ocean Healthcare has developed a practical Agency Compliance Checklist. This is a short, evidence-based guide that enables care providers to ask the right questions and verify that any agency they engage is meeting essential safeguarding, right-to-work, and competency standards.  

Used properly, this checklist helps care providers demonstrate their own compliance responsibilities and reduce exposure to the risks created by an unregulated agency market. 

Not all nursing agencies are equal.  

The absence of regulation has allowed a two-tier market to emerge where careful, compliant agencies are undercut by those who cut corners and take risks.  

Care providers must understand that they bear the full burden of those risks. The cheapest option may save money today but can cost reputations, contracts, or even lives tomorrow. 

Ocean Healthcare stands for integrity, compliance, and safety. It welcomes transparency, embraces audit, and believes that the people receiving care deserve nothing less. 

For more information or to access Ocean Healthcare’s free Agency Compliance Due Diligence Checklist, contact the Customer Care Team on 0808 275 9951 or email [email protected]. 
 

Together, we can make care safer.