- Both Care Quality Commission (CQC) and NHS England and NHS Improvement (NHSE/I) have recently updated their regulatory frameworks to signal a shift in approach in line with the move to system working.
- Our regulation survey was carried out in April-May 2022, when trusts were preparing to become part of statutory integrated care systems (ICSs), taking stock of the COVID-19 pandemic, and dealing with unprecedented operational pressures. Nonetheless, 63% of all trusts, across all regions and trust types responded, demonstrating providers’ sustained interest in effective regulation.
- Trusts expressed strong support for the policy direction being taken by regulators. An overwhelming majority supported CQC’s planned shift towards a more risk-based approach, data monitoring, and its intention to update ratings more frequently. Similarly, a large majority of trusts were supportive of the collaboration and system focus seen in NHSE/I’s new system oversight framework (SOF) and its oversight metrics.
- However, trusts did not report experiencing the benefits of this shift in strategic direction in practice. Trust leaders reported an increase in the regulatory burden and the number of ad-hoc requests from regulators over the past year. Many felt that regulators were not mindful of the ongoing pressures they were facing linked to the COVID-19 pandemic and its after-effects. This was especially true for mental health and learning disability trusts.
- While they support CQC’s new approach, trust leaders did not feel that the benefits of their most recent inspection justified the cost in terms of time and resource. Many commented on the need for CQC to develop further its approach to assessing systems and pathways of care, rather than individual providers in isolation, as well as the need for it to focus on supporting trusts to improve and collaborate.
- Although positive about the direction of the new SOF, trusts still perceive it as a performance management, rather than a support tool. They expressed concerns over the number of metrics, the justification of segmentation decisions, and the clarity of criteria for moving between segments.
- Trust leaders recognise that changes will take time to develop and become embedded. However, this survey suggests there is more work for regulators to do to clarify responsibilities and accountabilities in the new statutory framework, to become more transparent, and to consistently model the right behaviours, skills and expertise.
- We look forward to working with CQC and NHS England over the year ahead, alongside trust leaders, to further develop the approach to regulation, as ICSs become embedded following the passage of the Health and Care Act.