- This year’s regulation survey was conducted against a backdrop of continuing challenges to performance, finances and care quality, and ongoing industrial action. There have also been significant changes to regulation and provider oversight by the Care Quality Commission (CQC), NHS England (NHSE) and integrated care boards (ICBs).
- Over the past year we have been encouraged by the openness of the regulators to working constructively with trusts. As regulatory approaches continue to develop over the coming year, we look forward to our continued engagement and collaboration in ensuring the system works together for the benefit of patients and service users.
- Trust leaders told us that they have experienced an increased regulatory burden this year, particularly noting a lack of coordination between regulators. Some also question whether reporting requirements are realistic or proportionate. Similarly, concerns were raised around whether regulatory activity sufficiently considers the reality of the operating environment.
- In particular, there is a question as to whether regulators appropriately recognise the level of risk trusts have been absorbing this year in balancing the demands of financial and operational performance. Some respondents also expressed concern about the impact of growing system pressures on regulators’ leadership behaviours.
- This survey reflects the first full year of statutory integrated care boards (ICBs). Against this backdrop, trust leaders reported an increase in the overall burden of regulation. 72% said that the burden of ICB regulation had increased, compared to 48% from NHSE and 36% from CQC. We will consider this further next year as new ways of working continue to embed.
- In our regulation survey last year, respondents were much more supportive of the role ICBs played as system partners and conveners than as performance managers. Our findings this year are consistent with this, with less than a third of trusts comfortable with the role of ICBs as performance managers of trusts and 62% seeing their activity as duplicating that of NHSE.
- Respondents questioned CQC’s credibility, feeling its judgements were not objective enough, and its inspection teams lacked sector-specific expertise. This year trust leaders also pointed to weakening relationships at a local level, partly due to changes in CQC’s approach to inspection and regulation.
- This year we also asked trust leaders about their thoughts on CQC’s single-word ratings. The majority would like to see a move away from this approach, seeing it as too simplistic, often demoralising for staff, and confusing for patients.
- 23% of trusts perceived NHSE's oversight framework for 2022/23 as a support tool, while 77% saw it as a performance management tool. Overall, the results show a decline in confidence among trust leaders in the oversight framework when looking at its metrics, segmentation descriptions and decision-making.
- Encouragingly, more respondents this year (44%, up from 32% last year) thought that NHSE's operating framework has clarified the respective roles of ICBs, and NHSE regional and national teams. We will be keen to review trusts' perceptions next year, following the roll out of the new oversight framework for 2024/25 and the further implementation of the operating framework.