Survey shows NHS trusts feel over-regulated despite recent improvements
Most NHS trusts feel that demands from regulators are still too high in number and provide poor value for money.
Two thirds of trusts (68%) reported an increase in demand from regulators including NHS Improvement and the Care Quality Commission (CQC). But there is encouraging evidence that regulators are getting better at coordinating their approaches.
Two thirds of trusts (68%) reported an increase in demand from regulators. But there is encouraging evidence that regulators are getting better at coordinating their approaches.
More than half (56%) of respondents to NHS Providers’ third survey of NHS trusts's views of the current regulation system said it provided ‘poor’ or ‘very poor’ value for money. A similar proportion (55%) reported that regulatory requirements including requests for information and inspections felt disproportionate to the level of risk they were managing and did not help them to overcome the underlying challenges they face.
An NHS trust chair said: “Regulators must not be seen by the government as a sticking plaster to handle the huge financial and operational risks that the NHS faces. The big issue is to recognise and address these risks either by appropriate funding or changes in services requirements.”
Trusts received more ad hoc requests for information (69%) at a time of unprecedented pressure in terms of demand, restoring performance against targets, transforming services and balancing their books.
Although trusts welcome steps taken by regulators to create a more supportive approach, many are concerned that they are having to absorb the costs. As the CQC moves towards a new inspection regime it has the opportunity to strengthen the value of and sustainability of its regulatory approach.
Commenting on the findings, the director of policy and strategy at NHS Providers, Saffron Cordery said:
“Trusts appreciate the changes that regulators have made to improve how they work together, and to coordinate how they oversee and support trusts, particularly given the many changes to the regulatory system itself this year. But there is much more to do to reduce the demands from regulators and to improve the value they deliver.
“For the third time, trusts are telling us that the burden is still increasing in terms of the costs and staff time associated with meeting regulators' requests.
Patient safety and service quality must remain the priority for regulators, but we risk diverting time and attention from where it is most needed - on the frontline.
“Patient safety and service quality must remain the priority for regulators, but we risk diverting time and attention from where it is most needed - on the frontline.
“Regulation is complex, and it is timely for regulators to consider these findings as they develop their approach to oversight of STPs as set out in the recent Next steps on the NHS five year forward view. Regulators must make sure these align with the existing approach.
“Our survey shows there are improvements to build on and the roll out of the CQC’s new inspection regime in April and the development of NHS Improvement’s single oversight framework both provide opportunities to do this. We look forward to working with regulators and trusts as the year progresses. ”
About the regulation survey
There were 76 responses to the survey (22 NHS trusts and 54 NHS foundation trusts), representing 32 per cent of NHS trusts. 41 per cent of respondents were trust chairs and chief executives, 47 per cent were company secretaries and 12 per cent were other board level directors.
Just over a third (38 per cent) of respondents had received an ‘outstanding’ or ‘good’ rating from the CQC, with two thirds rated as ‘requires improvement’ or ‘inadequate’. 71 per cent of respondents were in segment 1 or 2 of the NHS Improvement’s Single Oversight Framework (maximum autonomy or targeted support), with the remaining 29 per cent in segments 3 and 4 (mandated support or special measures).
The survey was conducted in January 2017.
The survey findings revealed:
- 56 per cent of trusts responding indicated that the regulatory system provides ‘poor’ or ‘very poor value’ for money for taxpayers.
- 55 per cent did not feel that the current reporting requirements of the regulators were proportionate to the levels of risk.
- Two thirds of respondents (68 per cent) felt that the regulatory burden had increased over the last 12 months.
- 69 per cent of respondents stating they have experienced a rise in the number of ad hoc requests from regulators over the last 12 months.
- 44 per cent of respondents felt that there has been effective coordination between the regulators.
- Almost half – 47 per cent – considered the advice received from national bodies to be either ‘very’ or ‘fairly consistent’.
Read our interactive report.
Read a blog post by Cristina Sarb which outlines the key findings and the next steps for trusts.