- This year's regulation survey was conducted against a challenging backdrop, marked by unprecedented operational and workforce pressures, increasing demand for care and industrial action. It took place as trusts and their partners adapted to statutory system working, and to new regulatory requirements introduced by NHS England (NHSE) and Care Quality Commission (CQC). Nevertheless, we received responses from 50% of our membership.
- Trusts continue to be supportive of the direction of travel indicated by the regulators. Around eight in 10 respondents supported the changes initiated by CQC to deliver more risk-informed and responsive regulation, and nearly six in 10 appreciated the clarity of the segmentation descriptions and the oversight metrics in the NHS oversight framework.
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However, support for these principles contrasts with trust leaders’ experiences of regulation at the frontline. Only 14% agreed that regulators took operational pressures into account. The majority said that regulatory burden (52%) and ad hoc requests (59%) had increased.
- While supportive of the aims of CQC's programme of transformation, respondents had concerns about aspects of CQC's current approach. Trusts' concerns include: variable experiences of CQC inspections; a lack of confidence in the skills and expertise of CQC inspection teams; and a strong view, held by some, that the regulator's processes are flawed. Only 37% of respondents agreed that CQC's approach reflects the needs of their sector, down from 50% last year; and two-thirds disagreed that CQC's approach encourages providers to collaborate and integrate care.
- Trust leaders also reported cultural and behavioural challenges in their interactions with NHSE as a regulator. A majority of respondents (77%) perceived the NHS oversight framework as a performance management tool, as opposed to an improvement tool (31%).
- Respondents were very supportive of the potential role of integrated care boards (ICBs) as system partners and convenors, but held reservations about their role as performance managers, citing varying levels of maturity, and confusion and duplication between ICBs and NHSE.