This year's survey was carried out during a period of transition for NHS regulation and oversight. It is likely that trust leaders' experiences of the regulatory framework will continue to shift over the next few months as the changes to the national architecture settle in. Nonetheless, our survey paints a picture of the aspirations and concerns among trust leaders for the regulatory framework as it adapts.  


Trust leaders tell us they are optimistic about the potential for new oversight frameworks to hold systems to account for collective performance, and for the alignment of system oversight with regulatory requirements at an organisational level. However, in the absence of legislative change, it will be complex for the national bodies and regulators to reconcile regulation and oversight at organisational level with the policy ambitions for collective accountability at system level.  


Where trusts have been involved in CQC local system reviews, they overwhelmingly report positive benefits of the reviews. There is much that the national bodies can learn from this programme as they progress the development of new models of oversight at system level, particularly the clear value in focusing on supporting improvement across whole systems.


However, it is disappointing to see that the expectations trust leaders reported last year for the new CQC inspection regime have not yet been met. Trust leaders continue to emphasise concerns that CQC inspections divert significant attention and resources away from trust's main duties, and that inspections could offer better value for money with experienced inspection teams. While trusts are optimistic about the potential benefits of CQC's new approach, more work is needed to implement the changes effectively.


It is particularly promising that for the first year since we started running this survey, trusts do not feel the regulatory burden has increased over the last 12 months. There is an indication that the move to greater joined up working between the national bodies, reflecting what is going on at the frontline, is having a positive impact in terms of consistency and coordination between the regulators. It will be important for the national bodies to maintain the focus on ensuring proportionate, risk-based and streamlined regulatory requests during a period of considerable organisational change.


Trust leaders continue to feel that regulation is focused on performance management rather than improvement. However, there are signs that the new NHS England and NHS Improvement regional teams are starting to build productive and supportive relationships and ways of working with trust leaders. The joint working between the two bodies offers an opportunity for the two bodies to reset the culture and shape the values and behaviours for their own organisations and across the NHS.