Health and care regulation is changing to reflect the formal adoption of system working and the new statutory framework provided by the Health and Care Act.

Our survey shows that providers welcome the regulators’ shift towards a more system focused approach, which is more flexible and accounts for local contexts. As the membership organisation for trusts, we would observe that CQC and NHS England are open to challenge and willing to co-produce and co-design their approaches with bodies such as ours, and those they oversee.

However, this survey also demonstrates that what trusts experience locally does not yet fit with the policy direction being set out at a national level.

Providers do not yet feel that the approaches of CQC and NHSE/I have encouraged them to collaborate and integrate care. Trust leaders contrast CQC’s focus on organisations over systems with their own changing responsibilities. They would like to see more clarity from NHS England on the respective responsibilities and accountabilities in the new system architecture, in particular between NHS England and ICSs when it comes to the oversight of trusts. And, they identify a gap in the existing regulatory framework relating to provider collaboratives.

Members recognise that the system is changing and regulators’ approaches are yet to fully develop, but there is a clear sense that national bodies need to do more to take into account the ongoing challenges trusts face, and become part of the solution. Just as collaboration is now a core expectation for trusts, it should also be the guiding principle for the future of regulation – one that is developed in the interests of patients and the public, and in the spirit of co-design and co-production with trusts and other providers.

We look forward to working with CQC and NHS England over the year ahead, on behalf of and alongside trust leaders, to further develop the approach to regulation following the passage of the Health and Care Act.