Regulation and oversight of local systems

Ella Jackson profile picture

09 May 2018

Ella Jackson
Policy Advisor - Regulation


Sustainability and transformation partnership (STPs) and integrated care systems (ICSs) are seen as the vehicle for leading transformation, implementing service change and supporting the long term sustainability of local health economies. This provides an opportunity for an honest conversation about what an effective regulatory and oversight framework could look like and how it could support local systems to deliver these improvements and ensure they work for local people and communities.

NHS trusts, CCGs, local authorities and other local partners are developing plans for how they will work in collaboration to improve services across their health economies. But they are doing so in the context of existing legislation and regulatory frameworks, which are based on the statutory responsibilities of individual institutions and in some cases, individual directors – not the performance of whole systems. It is unlikely we will see legislative change anytime soon. That means the regulators and national bodies – NHS Improvement, the Care Quality Commission (CQC), and NHS England – will need to explore how local systems can be held to account for their collective performance, while also maintaining their duties to regulate organisations.

The regulators and national bodies will need to explore how local systems can be held to account for their collective performance, while also maintaining their duties to regulate organisations.

Ella Jackson    

The proposal floated in the recent NHS planning guidance refresh is that local system leaders (usually the STP or ICS lead) will be involved in the oversight of organisations within their footprint. Alongside the regulators and national bodies, local system leaders will play a role inagreeing the remedial action to be taken if an organisation has financial or quality issues.

 

The role of local system leaders

On one hand, this approach rightly reflects the importance of local systems taking ownership for local delivery and decisions being made as close as possible to where care is delivered. Local system leaders understand their local context and, through STPs and ICSs, have the opportunity to work together and propose population-wide solutions to the challenges facing services – rather than working against each other.

Local system leaders understand their local context and, through STPs and ICSs, have the opportunity to work together and propose population-wide solutions to the challenges facing services – rather than working against each other.

Ella Jackson    

On the other hand, this approach presents challenges as well as opportunities. It could lead to some interesting dynamics that require very sensitive relationship management. In some areas, existing trust or CCG leaders are combining their existing roles with the STP/ICS lead position and are being encouraged to take accountability for other organisations in their local system. In other areas, independent leaders are being appointed. Either way, many systems are still building relationships and trust which could be undermined if local leaders are then expected to take on the role of regulator.  

Many systems are still building relationships and trust which could be undermined if local leaders are then expected to take on the role of regulator.

Ella Jackson    Policy Advisor - Regulation

The emerging system architecture also presents an opportunity to rethink the role of commissioning. Many CCGs within STP/ICS footprints are coming together to take on more of a strategic commissioning function - managing population healthcare at a local level - rather than focussing onday to day contract management and oversight. This offers another opportunity to rationalise oversight within the system. However, while the architecture may be changing, the danger is we are simply shifting responsibility and lines of reporting from one part of the system to another, and in some cases increasing the risk of duplication, if the regulatory framework does not evolve in parallel.

 

Experiences of the regulatory framework

Our recent survey of NHS trusts’ experiences of the regulatory framework showed that only 8% of trust leaders believe the current regulatory system offers value for money. Many feel it is overly burdensome, with 67% reporting that the burden had increased over the last 12 months, but only slightly more than a third agreeing that the current reporting requirements are proportionate to the level of risk they manage. There was a clear picture of concern among trusts that many of these problems will be compounded by the move to systems working if the regulatory system does not adapt to support collaborative working.

There was a clear picture of concern among trusts that many of these problems will be compounded by the move to systems working if the regulatory system does not adapt to support collaborative working.

Ella Jackson    

There has been a striking change in the landscape over the last 12 months and trusts tell us the regulatory framework is not keeping up with the pace of change on the ground. In the move to design a new framework, there is also a danger that we focus only on organisation’s ‘upwards’ accountability to the national regulators and lose sight of NHS organisations’ responsibilities to local people and communities, and to each other. 

 

This article was first published by Healthcare Leader on 8 May 2018.

About the author

Ella Jackson profile picture

Ella Jackson
Policy Advisor - Regulation

Ella leads our regulation policy work and manages our programme to spread the learning from the new care models. Ella has held a variety of policy and programme roles with health membership organisations and medical royal colleges. Prior to joining NHS Providers Ella led national programmes at NHS England and the Royal College of Physicians on the personalisation of healthcare services. Read more

We use cookies to ensure you have the best possible experience on our website. By continuing we’ll assume that you are happy to receive them. Close