- The results of this year’s survey illustrate the striking change in the regulatory landscape over the last 12 months as trusts and national bodies have increasingly focused on local system integration through sustainability and transformation partnerships (STPs) and integrated care systems (ICSs).
- Our survey findings show that trusts are concerned that the regulatory framework is not keeping pace with the developments taking place on the ground. They highlighted that the oversight of STPs and ICSs risks becoming an extra layer of performance management. Respondents also questioned whether STPs and ICSs can take on oversight and assurance roles for local systems without a statutory footing.
- The results demonstrate that there is a lack of clarity about the national policy direction for the system architecture, which only one in five (20%) trusts believe is clear. Trusts feel that the regulators and national bodies could do more to support them to work in collaboration with local partners and were in favour of NHS Improvement and NHS England working more closely together and developing new models of oversight at local systems level.
- Trusts also expressed an interest in co-producing a proportionate approach to oversight in partnership with the regulators and national bodies. This approach should balance the regulation of organisations and oversight of systems, and balance appropriate regulatory intervention with support to providers as they work to transform services.
- There has been no change since last year in the proportion of trusts reporting that the overall regulatory framework is working 'well' or 'very well' (down from 44% to 43%) or in the proportion who believe the regulatory system is good value for money (up from 7% to 8%). There is a sense that the improvements reported in last year’s survey have stalled.
- Respondents reported that there has been an increase in the regulatory burden and in the number of ad hoc requests from the regulators over the last 12 months, with 67% reporting an increase. While the regulators have taken steps to coordinate their approaches with each other and other national bodies, these efforts have not yet been reflected in trusts’ experiences. Trusts report that they continue to experience duplication in the requests from the regulators and other national bodies.
- There are mixed views among providers about how well the regulators understand the pressures trusts are facing and how well the regulators have engaged with them over the last 12 months. The proportion reporting that Care Quality Commission (CQC) has a 'very good' or 'good' understanding has increased in the last year (from 48% to 62%), however providers believe NHS Improvement’s understanding of the sector has declined (from 89% to 75%).
- On the whole, respondents report feeling 'very satisfied' or 'satisfied' with the way the regulators’ regional teams have engaged with them over the last 12 months. However, while this has increased for CQC (from 61% to 70%), it has declined for NHS Improvement (from 80% to 73%). Some trusts felt that changes in staff in the regional NHS Improvement teams had made it difficult to develop relationships and others suggested there is scope for improvement in the alignment of the regional and national teams.
- When asked about NHS Improvement’s roll out of the single oversight framework (SOF) trusts said that it is working well and is well understood. However, respondents felt that the SOF still feels like a performance management tool rather than a support tool, and the proportion of trusts that believe NHS Improvement strikes a good balance between respecting trusts’ autonomy and support has gone down from 58% last year to 47% this year.
- There is optimism about the potential positive impact of changes to CQC’s inspection model over the last year and the majority of respondents agreed that the new inspection approach would enable CQC to prioritise inspections more effectively and help them improve services and quality of care. However, many trusts believe it is too early for improvements to have been felt in practice and nearly two thirds (62%) of trusts were concerned that the new inspection approach will not reduce their administrative burden.