News / NHS trusts report increasing regulatory demands

20 July 2023 Martyn Bryson

The report – Improving regulation for the future – found that the majority of trusts surveyed (52%) said the regulatory burden had grown in the past year, and even more (59%) saw an increase in the number of ad-hoc requests from regulators. Many trust leaders felt that requests from regulators were frequently burdensome and, in some cases, found that even more burden was placed on trusts during times of especially high pressure.news_JulianHartley_LANDSCAPE

Most trusts believed that NHS England had good understanding of the pressures that providers are facing, with just 13% describing this understanding as fairly or very poor. But this poor assessment rose to 38% when the same question was asked about the Care Quality Commission.  Perception of the CQC was especially poor among ambulance trusts, with 67% rating the regulator’s understanding of their pressures as poor.

The overwhelming majority of the trusts surveyed supported the role of ICBs across several areas, including fostering a sense of shared responsibility (98%), bringing together system partners (96%), and working with the integrative care partnership (94%). However, many trusts expressed doubts about ICBs’ role as performance managers with only 37% explicitly supporting it. The NHS oversight framework states that, while NHS England retains statutory accountability for oversight of both ICBs and NHS providers, ICBs will lead on the oversight of NHS providers, assessing delivery against six domains.

According to the report, a lack of clarity of the role of ICBs was a chief concern. The introduction of ICBs had also often resulted in overlap and duplication of responsibilities with NHS England, which added to the confusion and placed additional pressure on the trusts.

NHS Providers said there was a need for a shift in culture and more clarity around the purpose of regulation and on the distinct roles each body plays in the process. It also called on the CQC and NHS England to adopt a more open, collaborative approach to regulation.

Its chief executive, Julian Hartley (pictured), said providers support for the underlying principles of regulation was in sharp contrast to their frontline experience. ‘It has been a particularly challenging year for trusts trying to meet ever growing demand with limited capacity, on top of eight consecutive months of disruptive industrial action,’ he said. ‘And yet in these times of extreme pressure, trusts feel the regulatory burden is going up. We need proportionate regulation that is focused on helping trusts improve care.’

Sarah Walter, director of NHS Confederations Integrated Care System Network, said the positive response about ICBs’ role in fostering a sense of shared responsibility and collective endeavour was encouraging. However, she added: ‘Our members will recognise the issues identified in the report around regulation and performance management from the centre becoming burdensome.’

Ms Walter also acknowledged the challenges posed by the recent move to systems working. ‘All parts of the system are undergoing a huge cultural and leadership shift from competition to collaboration and there will be variation in the approaches of ICB leaders, as well as individuals within CQC and NHSE national and regional teams,’ she said.