During 2023/24 providers struggled to manage regulatory demands and to meet increasingly stretching government expectations while managing continuing pressures to finances, performance and staffing.
Trusts leaders reported that regulatory requirements remained too high and detached from the reality that trusts are operating within. They also spoke of unrealistic expectations, including in relation to the inherent risks that organisations carry, some of which are beyond their control. There were also concerns regarding the leadership behaviours displayed by the national bodies and ICBs, which were not always in line with their own commitments in this respect, nor with their expectations of providers.
The perception of an increasing regulatory burden continued to dominate the responses and the associated commentary. What is new this year is the level of concern relating to ICBs’ demands, rather than those of NHSE or CQC, being a key driver of increased burden. We continued hearing of duplication of functions and requests, especially between ICBs and NHSE.
Providers’ reflections on CQC continued to identify a lack of trust and credibility, and a perception that the regulator is not sufficiently accounting for the operational pressures they are facing. We heard once more that trusts’ experiences of CQC inspections were highly variable and there was often insufficient expertise among CQC teams. Respondents were also worried about weakening relationships with CQC at a local level, associated in part with the move to the regulator’s new approach.
Additionally, this year we asked trust leaders about their thoughts on CQC’s single-word ratings. While some felt these were clear and helpful for the public’s understanding, the majority supported a move away from this approach, which they saw as too simplistic, and often demoralising for staff and confusing for patients.
While NHSE’s approach to assessment and oversight of providers may be updated under its 2024/25 framework, our survey results are worth reflecting on ahead of its implementation. Trust leaders’ confidence in the 2022/23 framework has declined, and this year a smaller percentage of trust leaders perceived it as a support tool.
Regulation has an important role to play in public services such as the NHS, providing independent assessment and challenge, ensuring transparency and accountability, and supporting providers to improve. Trust leaders welcome the intended move towards a smarter, more streamlined approach to regulation. However, these survey results indicate that these aspirations are still far from being reflected in trusts’ day-to-day experiences, and much more needs to be done before trust leaders have confidence that, overall, the regulatory system adds value.