Health regulators and inspectors must take more account of huge day-to-day pressure on NHS services, a majority of trust leaders have said.

Most trusts responding to a survey by NHS Providers said that regulatory burden (52%) and the number of 'ad hoc' requests (59%) grew last year, at a time when services were more overstretched than many leaders can ever remember.

An annual survey of trust leaders about their experiences of regulation over the past year, specifically by the Care Quality Commission (CQC) and NHS England, found that:

• Only slightly more than one in 10 (14%) think that regulators take operational pressures into account.
• More than half (52%) said that regulatory burden and ad hoc requests (59%) had increased.

While backing the aims of CQC's transformation programme, trusts who responded to the survey were concerned about aspects of the regulator's approach, including variable experiences of CQC inspections, a lack of confidence in the skills and expertise of CQC inspectors, and limited opportunities to challenge the process.

Just over one in three (37%) agreed that CQC's approach reflects their sector's needs, down from half last year. Two in three said that CQC's approach did not encourage providers to collaborate and integrate care.

Trust leaders also reported cultural and behavioural challenges in their dealings with NHS England as a regulator. Most (77%) perceived NHS England's current oversight framework as a performance management tool, rather than one helping them to improve services.

Trusts also said that, while they support the potential role of integrated care boards (ICBs) as system partners, they have reservations about the role of ICBs as performance managers, citing confusion and duplication between ICBs and NHS England.

Sir Julian Hartley, chief executive of NHS Providers, said:

"Leaders continue to support the regulators' 'direction of travel' as they develop their approaches. But their support for the underlying principles is in sharp contrast to their experiences of regulation on the front line.

"It has been a particularly challenging year for trusts trying to meet ever growing demand with limited capacity, on top of eight consecutive months of disruptive industrial action.

"And yet in these times of extreme pressure, trusts feel the regulatory burden is going up. It is vital that regulators take these pressures into account as they work with providers, both in their day-to-day dealings with trusts and in their reporting of what they find on the ground. We need proportionate regulation that is focused on helping trusts improve care."