The perceived burden of regulation

In line with previous years, trust leaders feel the regulatory burden and regulators’ ad hoc requests are increasing:

• 53% believed the overall regulatory burden has increased and 43% believed it has stayed the same, with no significant change year on year.
• While most (52%) said there had been an increase in ad hoc requests this year, more (59%) reported an increase in last year’s survey.
• Maternity services, in particular, were associated with additional regulatory requirements, reflecting CQC’s focus on these services during 2023/24.
• The perceived increase in regulatory burden seems to be driven by the new oversight role given to ICBs: trust leaders are most likely to say the burden from ICBs has increased, rather than that coming from CQC and NHSE.

There was some variation by trust type:

• Members from acute specialist (71%), acute (63%) and community trusts (57%) were most likely to report an increased regulatory burden.
• Similarly, members from acute (78%) and community (67%) trusts were the most likely to say that the number of ad hoc requests from regulators had increased.

"I understand the level of risk is high and the need for assurance is also therefore high, but the burden of regulatory reporting etc is huge with no clearly demonstrable outcomes from either regulator to determine why all of it is required."

Company secretary, acute trust    

Trust leaders’ comments pointed to persistent issues around duplication, frequency of reporting and unrealistic expectations, contributing to the burden of regulation.

"These requests are often duplicated or at least not coordinated with different parts of the system asking for slightly different information sets covering different timeframes or metrics, which increases the burden further."

Company secretary, combined acute and community trust    

For the first time this year we explored regulatory burden and ad hoc requests by regulator, with the inclusion of ICBs due to their role overseeing trust performance.

Respondents were much more likely to say that the burden of regulation and the ad hoc requests coming from ICBs have increased, compared to those coming from CQC and NHSE. Almost three-quarters (72%) said the burden of regulation coming from ICBs had risen, while more said the burden from NHSE and CQC had stayed the same rather than increased.

 

 

"We seem to have introduced another layer of scrutiny and oversight with the creation of ICBs. I am not sure that we have seen much benefit for our communities from this additional introduction."

Chair, combined mental health / learning disability and community trust    

"Very much increased since inception of the ICB."

Chair, acute trust    

Two-thirds of respondents (66%) said that ad hoc requests coming from ICBs had increased, compared to 48% in relation to NHSE and 36% in relation to CQC.

 

 

"The amount of regulation / assurance requirements can be a challenge from ICBs, particularly for organisations such as ours that cover four places and two ICBs. The amount of ad hoc CQC requests has increased..."

Nursing director, combined mental health/learning disability and community trust    

Given their new role in oversight, it is unsurprising to see trusts reporting an increase in ad hoc requests coming from ICBs. However, the responses and comments presented elsewhere in this report indicate that the perception of an increasing burden is also associated with lack of clarity and distinction of roles between ICBs and NHSE, and a resulting duplication of regulatory demands.