As in previous surveys, we asked trusts whether the overall regulatory burden experienced by their organisation had increased, stayed the same, or decreased over the last 12 months. The regulatory burden that NHS trusts and foundation trusts experience remains excessively high and is building up over time – overall, two thirds of respondents (68%) felt that the regulatory burden had increased over the last 12 months, a further 26% felt it had stayed the same and only a small minority (7%) felt it had decreased (figures 7a and 7b). This is the third of our surveys in which respondents have reported an increase in regulatory demands.
The pressure on trusts is exacerbated by growth in ad hoc requests, with 69% of respondents stating they have experienced a rise in the number of these requests over the last 12 months (figures 8a and 8b). Consistent with previous survey findings, views of increased burden were more predominant among respondents from foundation trusts than NHS trusts, indicative of the reduction in autonomy for foundation trusts.
Respondents attributed the greater volume of regulatory requests, often with shorter response times, to increased levels of scrutiny and a greater regulatory ‘grip’ in the face of a more challenging context operationally and financially. There was a strong sense that managing regulatory demands created additional workload, with a need to allocate additional resources in response to the proliferation of regulatory requirements. It was also emphasised that there is a lack of visibility around how regulators used the data they receive to inform the development of realistic and effective solutions.
“Additional ad-hoc requests. Additional weekend and bank holiday reporting. Less quarterly returns. Increase in financial reporting.”
“Significantly increased number and shorter and shorter response times.”
“Having to put more and more resources in to manage regulatory demands.”
“Particularly about operational delivery at a time when the focus should be on operational delivery.”
Figure 7a
Figure 7b
Figure 8a
Figure 8b
Proportionality
It is important that the regulatory system is proportionate and risk-based and focused on assurance that boards are leading their organisations effectively.
In light of this, it is of concern that over half of respondents to this year’s survey (55%) did not feel that the current reporting requirements of the regulators were proportionate to the levels of risk their organisation faces, a position that has hardly shifted since 2015 (figure 9). When breaking down the results by foundation trust status, a lower proportion of respondents from foundation trusts (32%) felt that the reporting requirements were proportionate.
Respondents also felt that the increase in regulatory requirements did not necessarily support their trust to better manage risk. Crucially, while regulation may in the current context be relied upon as a tool to implement national policy decisions, one respondent explicitly noted the need to be honest about what regulation can achieve and that the system cannot rely on regulatory compliance and performance management as a means of addressing the underlying challenges it is facing or to implement national policy changes.
“Regulators mustn’t 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.”
“Broadly – but whether rising reporting requirements enable better management of risk is a moot point.”
Figure 9
Impact of regulation
Regulation was often seen as time consuming and resource intensive, pulling management and staff away from delivery and improving services, creating a distraction or resulting in added pressure at an already challenging time of having to cope with increased demand.
“Staff are extremely busy meeting the increased needs of patients and much greater regulatory requests for involvement and information just increase the burden to the point of breaking the energy and morale of the staff.”
“More reporting and less ability to manage things ourselves.”
“Lots of last minute ‘urgent’ requests that interfere with other duties. Lots of time taken away from trying to improve services. Multiple reporting of the same information to different bodies. No real, effective support from national bodies to address national issues.”
“Additional resources required. There have been occasions when there have been constructive discussions with the regulators and this has helped with the delivery of our strategic aims and objectives. However, reporting requirements are a distraction especially at a time when there is a clear direction to meet control targets.”
“In some areas a distraction, in others has provided helpful insight or prompted required focus.”