Reconsidering the approach to regulating NHS services

Leanora Volpe profile picture

17 March 2021

Leanora Volpe
Senior Policy Manager (Health Inequalities and Regulation)


The COVID-19 pandemic placed unprecedented pressures on trusts and their partners in local health and care systems. Many of those challenges are still being felt as we exit the latest peak of the pandemic, support staff to recover and manage a backlog of care. During the pandemic regulators rightly and helpfully scaled back their activity to allow frontline organisations to concentrate their full efforts on patient care. This leaner approach enabled health and care organisations to work together with the shared aim of tackling COVID-19. Trusts also tell us this period accelerated positive change, with an increase in collaborative working and added impetus to deliver care in new and innovative ways.

Regulatory bodies, including Care Quality Commission (CQC) and NHS England and Improvement, are keen to draw on lessons learned from streamlining regulation during the pandemic.

Leanora Volpe     Senior Policy Manager (Health Inequalities and Regulation)

Regulatory bodies, including Care Quality Commission (CQC) and NHS England and Improvement, are keen to draw on lessons learned from streamlining regulation during the pandemic as they develop their approach to regulating health and care services. They are also keen to ensure their methods remain fit for purpose as changes take place nationally to put integrated care systems (ICSs) on a statutory footing.

This year NHS Providers' annual regulation survey provided an opportunity for trusts to share their experience of regulation during COVID-19 and their thoughts as the regulatory frameworks evolve to align with system working. Our survey focuses on trusts' interactions with CQC and NHS England and NHS Improvement, and this blog summarises the key findings. 


Reducing burden during the pandemic


Trusts welcomed the leaner, more streamlined approach to regulation and oversight, particularly during the first wave of the pandemic, with 60% of respondents saying regulatory burden reduced. However, some trust leaders felt the approach was insufficiently well maintained for the duration of the pandemic, particularly going into wave two.

Trusts are keen to take in the learning from the pandemic to ensure that regulation adds value and supports them to deliver safe and high-quality care for their local populations. Clarity of expectation and good, regular, and constructive communication will be key to ensuring regulation remains fit for purpose in a rapidly changing health and care landscape.


Changes to regulation and system-level oversight


As we plan for a future beyond the pandemic, both CQC and NHS England and NHS Improvement are taking the opportunity to examine how they interact with providers. CQC is in the final stages of developing its new strategy to launch from spring 2021 and, encouragingly, trusts are happy with the direction of travel, although they have flagged that the impact of many aspects of CQC's plans at the frontline will only be evident once implemented.

With new legislation to put ICSs on a statutory footing on the horizon, trust leaders see a need for regulators to take the system-wide context into consideration when reviewing services. 90% of trusts who responded to our survey agree that NHS England and NHS Improvement should develop new models of oversight to hold systems to account for the performance of their collective organisations. This likely reflects trusts' work with partners, accelerated during the pandemic, to build relationships and integrate care.

There are however different views on how this will operate in practice: how will the regulators continue their work to reduce burden and duplication, and how can system-focused models of regulation avoid cutting across existing organisationally-focused measures of performance?

Trusts would also welcome a transition period before system-focused models are fully implemented, to allow new ways of working to take shape first.

Leanora Volpe     Senior Policy Manager (Health Inequalities and Regulation)

Trusts would also welcome a transition period before system-focused models are fully implemented, to allow new ways of working to take shape first. At best, regulation of systems can promote strong governance, support local integration, and remove barriers to collaboration. At worst, trusts may face multiple conflicting judgements depending on which system's context is being assessed and be subject to performance management from multiple ICS boards.

Learning from the experience of the COVID-19 pandemic offers an opportunity to strengthen a new and constructive dialogue between providers and the bodies that regulate them in the interests of ensuring high-quality patient care. While there are clear examples of where COVID-19 has been the catalyst for positive change, there will be challenges ahead as the regulators face the task of aligning an organisationally-focused approach with the broader aims, and complexities of collaboration within local systems. 

This blog was first published by HSJ.

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Leanora Volpe profile picture

Leanora Volpe
Senior Policy Manager (Health Inequalities and Regulation)

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