The health and care system faces another period of significant change given the acceleration of system working and the introduction of the Health and Care Bill, as integrated care systems (ICSs) are put on a statutory footing with new responsibilities around the planning and co-ordination care. This has created a burning platform for the national regulators – Care Quality Commission (CQC) and NHS England and NHS Improvement – to adapt their regulatory models to more effectively align with new ways of working, taking into account the growing range of collaboration between trusts and non-NHS partners, and the impact of wider system issues when regulating NHS services.
One of two core ambitions running through the proposals outlined in CQC's new five-year strategy, A new strategy for the changing world of health and social care, is to assess how care is provided across a local system, rather than just within an individual provider. We expect this to be underpinned by legislative changes proposed by government during the Bill's passage through parliament. There is an increasing emphasis on how CQC can offer transparency to the public about the performance of ICSs, including how ICS leadership and decision-making contributes to quality at place level, and within individual providers.
NHS England and NHS Improvement has also introduced its NHS System Oversight Framework 21/22, which reinforces the system-led coordination of integrated care. It sets out for the first time how ICSs will be assessed and held to account for performance and quality ahead of, and in anticipation of, being placed on a statutory footing. ICSs will also play an increased role in the oversight of individual providers, in partnership with regional and national NHS England and NHS Improvement's teams.
This briefing sets out the key implications of the evolving nature of regulation on trusts, outlines opportunities for regulation within this new context, and draws out important unanswered questions regarding the shift towards regulation within and of systems. It describes some principles for effective regulation that can be applied in a system context, both to individual organisations and to ICSs, as the national regulators develop their future models. For the purposes of this briefing, the term 'national regulators' refers to CQC and NHS England and NHS Improvement as the primary organisations with regulatory influence over trusts.