The results of this year’s survey illustrate the striking change in the regulatory landscape over the last 12 months as trusts, and the national bodies, have increasingly focused on local system integration.

In the context of greater collaboration through STPs and ICSs it is essential that further progress is made to ensure alignment across the regulators and other national bodies. Trusts, and their local partners, are looking for clarity on the national policy direction for local systems. As this is developed, it is crucial that assurance and oversight models are streamlined and aligned. 

There is an opportunity for the regulators and the provider sector to co-produce a proportionate approach to oversight that balances the regulation of organisations and oversight of systems, and balances appropriate regulatory intervention with support to providers as they work to transform services.

There is also a sense among respondents to this year’s survey that many of the improvements they reported last year have stalled. It is disappointing that there has been little change in trusts’ perceptions of how well the regulatory system is working or the value for money it offers. The burden of regulation on trusts is still seen to be onerous and there is further progress to be made to deliver a truly proportionate and risk-based regulatory system.

Trusts describe an environment in which their autonomy is increasingly restricted. The continuing reliance on financial regulatory tools risks undermining individual provider boards’ ability to develop and maintain the vision for their organisation, empower staff and drive their own improvements. Despite these concerns, a majority of trusts believe the regulators have a good understanding of the pressures trusts face and trusts remain optimistic about the changes that have been put in place by regulators over the last year.