This report outlines the results of our fourth regulation survey, which was carried out in January 2018. Our annual regulation survey explores NHS trusts and foundation trusts’ experiences of regulation over the preceding 12 months and their views on the future of regulation, and identifies trends over time.
As the strategic and operational context for the NHS evolves, providers have continued to experience changes in the regulatory environment over the last year. Many trusts are playing central roles in establishing new ways of collaborative working through STPs and ICSs. NHS trusts, with other local partners including commissioners and local authorities, are working through the practical complexities of local system working. They are increasingly feeling the pull between the current institutionally-focused regulatory model, and policy ambitions to develop methods of oversight for local systems.
Further to setting out its five-year strategy in 2016, CQC has implemented its new approach to regulating NHS trusts and foundation trusts including changes to its inspection and monitoring models. NHS Improvement has continued to develop its role and approach to regulating and supporting providers since its formation in 2016, with further work to define its operating model currently being undertaken under its new leadership. The two regulators are progressing in their aim to achieve greater alignment in the discharge of their respective functions, most visibly through their approaches to assessing trusts’ leadership and use of resources. They have also been working to align their approaches and messages with other arm's-length bodies, particularly NHS England.
The two regulators are progressing in their aim to achieve greater alignment in the discharge of their respective functions, most visibly through their approaches to assessing trusts’ leadership and use of resources.
The consequence of the changing NHS system architecture is that trusts are juggling a growing number of roles and expectations. Trusts are seeking to meet rising demand and incredibly stretching operational and financial targets, and at the same time, transform services in their local health economies through local integration and collaboration. Additional regulatory intervention and burden at this time risks overloading providers, and a risk-based and proportionate regulatory system is more important than ever. So too is the regulators’ approach to how they balance the need for regulatory intervention with the need to support improvement in order to help the provider sector meet the challenges it is facing and deliver local change.
Our findings show that trusts welcome the regulators’ continued focus on coordinating their approaches. They are optimistic about the potential positive impact of the regulatory changes introduced in the last year, but this has not yet translated into improvements in trusts’ experiences. While there is support among providers for increasing collaboration locally, the lack of clarity about how the regulatory model is adapting to system integration, and the risk of additional regulatory burden, is of significant concern.
Trusts are seeking to meet rising demand and incredibly stretching operational and financial targets, and at the same time, transform services in their local health economies through local integration and collaboration.
The responses suggest that improvements reported in last year's survey have stalled, with little change in trusts’ experiences of the regulatory system over the last 12 months. Trusts report that their autonomy is increasingly confined and regulatory intervention does not always feel proportionate. Regulation and oversight continues to stretch trusts’ capacity and impact heavily on time and resources. The findings indicate that the sector has experienced additional regulatory requirements and reporting in the last year.
Where we refer to the regulators we mean CQC and NHS Improvement. This survey also reflects on trusts’ experiences of interacting with NHS England.
For the purposes of analysis, when splitting the data by trust type they have been grouped into acute (acute, acute and community and specialist trusts) and non-acute (ambulance, community and mental health trusts).
About the survey
This report outlines the results of an online survey of NHS Providers’ members - NHS trusts and foundation trusts - carried out in January 2018. The survey collected qualitative and quantitative information about trusts’ experiences of the regulatory system over the last 12 months, and their perspectives on topical issues.
The survey questions were shared with NHS Improvement and CQC prior to the circulation of the survey. Each organisation had the opportunity to provide feedback on the questions, with suggested changes taken into account and reflected where possible.
We received responses from 86 trusts, representing 37% of the sector. Of the respondents:
- 46% were chairs and chief executives
- 37% were company secretaries
- the remaining 17% were other board-level directors.
Just over half (47%) of respondents had a received a CQC rating of 'outstanding' or 'good', and 51% were rated as 'requires improvement' or 'inadequate'. The remaining 2% were either classified as 'no evidence to rate', or had not yet received a CQC rating.
The survey collected qualitative and quantitative information about trusts’ experiences of the regulatory system over the last 12 months, and their perspectives on topical issues.
Of the respondents, 62% had been allocated to segments 1 or 2 (maximum autonomy or targeted support), of NHS Improvement’s SOF (NHS Improvement, 2017) with the remaining 38% in segments 3 and 4 (mandated support or special measures).
Please note that not all questions were answered by all respondents.