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A pivotal moment for regulation
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A pivotal moment for regulation

8 August 2024

Regulators need to take better account of the escalating operational pressures that trusts are facing, following the findings of NHS Providers' latest annual regulation and oversight survey.

A pivotal moment for regulation shows trusts are experiencing intense pressures on quality, finances, performance and staffing against a backdrop of 'unrealistic' regulatory demands. Trust leaders report that regulators are not doing enough to understand and help address the complexity and challenges of the operating environment.

With NHS regulation going through a significant period of change and renewal, trust leaders are also concerned about duplication of functions and requests across the system, especially between integrated care boards (ICBs) and NHS England (NHSE). Trusts are also sceptical about the credibility and objectivity of the Care Quality Commission (CQC).

Other key findings
  • The majority of respondents (53%) reported an increasing regulatory burden, which was most strongly associated with ICBs. 72% said the burden from ICBs has increased compared to 48% from NHSE and 36% from the CQC.
  • Less than a third of trusts are comfortable with ICBs' role as performance managers, with 62% seeing ICB activity as duplicating that of NHSE.
  • Concerns were raised about CQC's credibility, objectivity, and sector-specific expertise. Trust leaders also report weakening relationships with CQC at the local level.
  • The majority of those who commented would like to see CQC move away from single-word ratings, viewing them as overly simplistic, often confusing for patients and demoralising for staff.

Saffron Cordery, deputy chief executive at NHS Providers said:
"Regulators have shown openness to working constructively with trusts, but this year's survey results indicate that regulatory requirements are detached from operational realities. Regulation needs to take better account of the level of challenge and risk trusts are managing, and better enable them to focus on improving quality of care.
 
"Trust leaders are particularly concerned about unrealistic expectations and the burden of meeting what are at times duplicative regulatory requirements.

"As the health and care system continues to face significant challenges, it's vital that regulation adds value and supports improvement rather than creating additional pressure. We look forward to continued engagement with regulators to ensure the system works together for the benefit of patients and service users."
Notes to editors
  • The survey was carried out during April and May 2024 and received responses from 122 trusts accounting for 58% of the provider sector and representing all regions and trust types.
  • The analysis in this report is also informed by ongoing engagement with providers.

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