There are a number of organisations with some regulatory responsibility for providers, including the Health and Safety Executive (HSE), the NHS Counter Fraud Authority (NHSCFA) and the Home Office. The main regulatory bodies overseeing the day-to-day operation of NHS trusts and foundation trusts, however, are the Care Quality Commission (CQC) and NHS England (NHSE).
CQC was established in April 2009. It is responsible for the registration, inspection and monitoring of heath and adult social care providers, including independent providers. CQC's role is to set out what good and outstanding care looks like, and to make sure services meet fundamental standards below which care must never fall.
The regulator published its latest strategy in 2021 and committed to a more risk-based and proportionate approach, providing a more up-to-date view of quality. Following the passage of the Health and Care Act 2022, CQC is now also responsible for assessing the performance of integrated care systems (ICSs), and local authorities with regard to their duties under the Care Act 2014. CQC's new single assessment framework provides a new basis for regulating all providers, ICSs and local authorities.
The Health and Care Act 2022 brought together NHS England and NHS Improvement (formerly Monitor and the NHS Trust Development Authority) into a single organisation, with responsibilities for regulation, oversight and improvement support. The new NHSE also incorporates the functions previously held by Health Education England (HEE), NHS Digital and NHSX. NHSE's operating framework, published in 2022, sets out its ways of working in the context of this wider remit, and the establishment of statutory system working.
The main tool through which NHSE regulates providers is the NHS provider licence, which was updated in April 2023, now applying to NHS trusts, as well as foundation trusts. NHSE's oversight and performance management is primarily exercised through the NHS oversight framework, which applies equally to providers and integrated care boards (ICBs). Under this framework, trusts and ICBs are allocated to one of four 'segments', ranging from segment 1 (no specific support needs) to segment 4 (requiring mandated intensive support).
While the statutory accountability for the oversight of both ICBs and NHS providers remains with NHSE, ICBs are now responsible for the day-to-day oversight of individual providers within their system, seeking to resolve issues locally, before escalation,
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