A new report by NHS Providers on trusts' experience of NHS regulation highlights strengths and weaknesses in the approaches taken by Care Quality Commission (CQC) and NHS England and NHS Improvement in response to the COVID-19 pandemic.

Reconsidering the approach to regulation concludes that both organisations implemented welcome changes in response to the onset of the pandemic, scaling back their activity to allow trusts to concentrate their full efforts on patient care. 

CQC paused all routine inspections and provider information requests and concentrated its activities on areas of critical risk and safety. NHS England and NHS Improvement also suspended its core oversight activities, continuing those which were deemed essential for monitoring the pandemic. This leaner approach enabled health and care organisations to work together, delivering care in new and innovative ways.

However during the second wave many trusts felt that reporting requirements and other regulatory activity increased disproportionately, indicating "a perception that the regulators do not necessarily have a strong enough understanding of the impact of COVID-19 pressures".

The survey found that 60% of respondents felt CQC's scaled back approach helped them focus on managing COVID-19, but the comments received – both positive and negative – suggest that regulatory activity in the second wave "created a greater sense of pressures at the frontline than it did during the first wave".

The report highlights how both CQC and NHS England and NHS Improvement are taking the opportunity to examine how they interact with providers.

Saffron Cordery    Interim Chief Executive

The report highlights how both CQC and NHS England and NHS Improvement are taking the opportunity to examine how they interact with providers. CQC is in the final stages of developing its new strategy to launch from spring 2021 and the survey findings show trusts are encouraged by the direction of travel, including its intention to take the system-wide context into consideration, in order to support greater collaboration. 

Similarly, a large majority of respondents agreed that NHS England and Improvement should develop new models of oversight to hold systems to account for the performance of their collective organisations. However, the report also notes concerns that changes to regulating systems should not be made “too hastily” before the full impact of legislative proposals to put ICSs on a statutory footing are seen.

Responding to the survey, the deputy chief executive of NHS Providers Saffron Cordery, said: "There are clearly lessons for trusts and the regulators to learn from the COVID-19 period.

"The regulators both implemented welcome changes to their approach at the start of the pandemic, to reduce burden and help trusts to focus on the COVID-19 operational response.

"While trusts' experiences of regulation during the first wave were largely positive, this was not reflected uniformly across the sector particularly during the second wave, where many trusts felt reporting requirements and other regulatory activity increased disproportionately once again.

Trust leaders welcome the move towards more system-focused oversight, but there are important unanswered questions on how this will operate in practice.

Saffron Cordery    Interim Chief Executive

"Trust leaders welcome the move towards more system-focused oversight, but there are important unanswered questions on how this will operate in practice, for example how regulators will continue their work to reduce burden and duplication, respond proportionately and how system-focused models of regulation avoid cutting across existing organisationally-focused measures of performance.

"The importance of sustaining dialogue between providers and the two regulators underlies all of this year's findings. We look forward to continuing to work constructively and closely with CQC and NHS England and NHS Improvement colleagues, and our members, at this time of considerable change."