NHS trusts have warned that how they are being regulated is not keeping pace with the move towards delivering more integrated care for patients.

Just one in five trusts who responded to an NHS Providers survey are clear about the future direction of the health and care system in regards to how providers will be regulated to ensure high quality and safe services for patients and service users. And despite investing significant time into sustainability and transformation partnerships (STPs) and integrated care systems, trusts say there is a lack of clarity about what is expected from them from the regulators. 

Just one in five trusts are clear about the future direction of the health and care system in regards to how providers will be regulated to ensure high quality and safe services for patients and service users.

This lack of clarity about how local health and care systems will be regulated risks increasing the burden on trusts by duplicating regulatory activity, and is also likely to result in confusion in terms of who is responsible for holding trusts to account for quality of care and financial performance at a local system level.

The findings are published in NHS Providers’ fourth regulation survey. Eighty six trusts responded to the survey (37 per cent of the provider sector). Other key findings include:

• While many trust leaders are optimistic about the changes put in place by regulators over the last year, almost two thirds (62 per cent) believe they will not reduce the administrative burden on trusts.
• The level of regulatory burden reported by trusts has risen for the fourth year of this survey, with 67 per cent reporting an increase this year. Almost two thirds (62 per cent) report an increase in ad hoc requests from the regulators in the last 12 months.
• Over half of trusts (56 per cent) do not feel that the level of intervention from regulators is proportionate to the level of risk they manage.
• Only 8 per cent of trusts agree that the current regulatory system is ‘good value for money’.
• Fewer than half (43 per cent) think the current system is working ‘well or very well’.
• The number of trusts that believe the regulators have co-ordinated their approach effectively has also fallen in the last year (from 45 to 38 per cent).
• Value for money remains a key concern as the CQC rolls out its new fee structure for 2018/19, alongside its more targeted and risk-based approach to inspections. This year 75 per cent of trusts will see some reduction in their fees (an average reduction of 29 per cent). However, the remaining quarter will experience a substantial increase (an average increase of 52 per cent).

Despite these concerns, trust leaders remain optimistic about the changes put in place by regulators over the last year, and a majority believe the regulators have a good understanding of the pressures trusts face. In particular, trusts are broadly positive about how NHS Improvement is using the Single Oversight Framework and they are also optimistic about the CQC’s new approach to inspections, with 81 per cent of respondents agreeing that it will lead to more effective inspections.

Commenting on the findings, Amber Jabbal, head of policy at NHS Providers, said:

“The views of trust leaders show that the demands of regulators continue to place considerable strain on trusts’ time and staff, diverting resources away from the frontline and patient care. At a time when trusts are under tremendous pressure to meet ambitious financial targets, address workforce challenges and meet rising demand, it is disappointing to see the burden and the number of ad-hoc requests from regulators increase again. Patient safety and quality of care must remain the priority but we risk diverting time and attention from where it is most needed – on the frontline. 

Our survey shows that trust leaders feel more clarity is needed about what regulators will expect of trusts as they move towards providing more integrated care for patients.

“Despite this, trusts are optimistic about the new approaches being developed by the regulators. They must build on this and work with trusts to ensure we build a regulatory system fit for integrated care, and ensure high quality and safe health and care services for patients. Our survey shows that trust leaders feel more clarity is needed about what regulators will expect of trusts as they move towards providing more integrated care for patients. Many feel that the regulatory environment in which they operate is not keeping up with this pace of change.”

Read the full report - The changing nature of regulation in the NHS.

About the survey: 

This is the fourth regulation survey carried out by NHS Providers. Previous surveys were carried out in 2014, 2015 and 2017.

Of the respondents, 46% were chairs and chief executives, 37% were company secretaries, and the remaining 17% were other board-level directors. 

Just over half (47%) of respondents had a received a CQC rating of ‘outstanding’ or ‘good’, and 51% were rated as ‘requires improvement’ or ‘inadequate’. The remaining 2% were either classified as ‘no evidence to rate’, or had not yet received a CQC rating.

Of the respondents, 62% had been allocated to segments 1 or 2 of NHS Improvement’s Single Oversight Framework (maximum autonomy or targeted support), with the remaining 38% in segments 3 and 4 (mandated support or special measures).