- This year's regulation survey report reflects the changing context in light of the pandemic, the rapid development of system working, and the intention set out by both Care Quality Commission (CQC) and NHS England and NHS Improvement to develop models of regulation and oversight which take account of new ways of working.
- The emergence of new regulatory models from both CQC and NHS England and NHS Improvement provides an opportunity to re-evaluate how regulators interact with providers and ensure a regulatory model which is responsive and proportionate and delivers for patients.
- Successive surveys have highlighted the need for better alignment between national policy aimed to advance collaborative working in systems and regulatory requirements which are currently organisationally focused. Importantly, trusts are encouraged by the direction of travel towards more system-focused models of oversight, though some respondents flagged the need for any new role for Integrated Care Systems (ICSs) as a performance manager to be accompanied by a proportionate reduction in oversight from other parts of the system.
- Encouragingly, there is strong support among trusts for many of the core proposals in CQC's new draft strategy, but trusts are clear that CQC will need to ensure it avoids duplication with other national bodies, does not overstep its core regulatory role, and continues to work with providers to understand the impact of new approaches.
- 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.
- The importance of sustaining dialogue between providers and the two regulators moving forwards 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.