The health and care environment has changed significantly in the last 12 months. The COVID-19 pandemic caused an unprecedented level of operational pressure for trusts and their colleagues across the health and care sector – from managing the sheer volume of hospitalisations to maintaining rigorous infection control, while also maintaining non-COVID care and supporting staff in a time of unprecedented operational pressure. However, the COVID-19 pandemic also accelerated positive change in many areas of health and care provision, including the increase in mutual aid, collaborative working in systems and innovation through digital channels.

During the pandemic, particularly in the first wave, both NHS England and NHS Improvement and CQC scaled back their regulatory approach substantially. CQC paused all routine inspections and provider information requests and introduced an Emergency Support Framework (ESF) to respond to areas of critical risk or safety concerns. NHS England and NHS Improvement also suspended its core oversight activities during the pandemic, continuing those which were deemed essential for monitoring the COVID-19 response. This has been welcomed by many given the intense operational pressures trusts faced during the pandemic.

Both regulators have since expressed an intention to reconsider their approaches to regulation within the new context, taking into consideration learning from COVID-19 and a rapidly changing health and care landscape which emphasises greater integration and more established systems, underpinned by the recent Department of Health and Social Care (DHSC) White Paper. The regulators are therefore developing plans to consider system working more strongly in future regulatory models and, as a result, trusts are likely to see substantial changes to the way their performance is measured and assessed.

CQC launched its new strategy for consultation in January 2020, identifying four key areas of focus, which set out how it plans to transform its approach to regulation within this new context. A common thread runs throughout of reviewing health and care systems and their focus on reducing health inequalities. CQC highlights the need for its regulatory approach to be more flexible and dynamic in this period of uncertainty. We cover responses on CQC's new strategic approach later in the report, but on the whole trusts are supportive of the direction of travel set out in the new strategy but emphasise the need for CQC to be mindful of the current pressures trusts face and avoid duplicating the work of other organisations. We will use the findings of this survey to inform our response to CQC's consultation.

NHS England and NHS Improvement is also in the process of developing its new system oversight framework, which will be shaped by changes to NHS legislation, and will seek to align system working objectives with oversight arrangements, including looking at local priorities as part of the key oversight metrics and measurement of performance at a system level.

This report highlights the impact of the COVID-19 pandemic on trusts amidst a backdrop of changes happening on a national level. As the regulators continue to adapt and implement new ways of working to align with the move towards integrated care, it is more important than ever that they focus on ensuring regulation is proportionate, coordinated, offers value for money and provides clarity to providers on accountabilities.