ICBs are increasing the regulatory burden on NHS Trusts. That’s according to the latest report from NHS Providers, ‘A pivotal moment for regulation: regulation and oversight survey 2024’, which also finds a lack of coordination between regulators leading to concerning duplication of regulatory requirements, functions and requests across the system.
In particular, Trust leaders question the role of ICBs, saying a lack of clarity persists, leading to duplication with NHS England. Whilst 86% of respondents agreed that ICBs should facilitate improvement and peer support among system partners, less than one third are comfortable with the role of ICBs role as performance managers of Trusts.
“ICB role unclear. Difficult to move between regulation to partnership working,” is the comment from one company secretary at an acute Trust.
Trust leaders also point to “unrealistic” expectations and a regulatory system that can be too “burdensome” and detached from the true operational pressures they are facing.
Saffron Cordery, Deputy Chief Executive of NHS Providers says: "As the health and care system continues to face significant challenges, it's vital that regulation adds value and supports improvement rather than creating additional pressure. We look forward to continued engagement with regulators to ensure the system works together for the benefit of patients and service users."
CQC credibility questioned
Respondents to the survey were also critical of the role of the CQC (Care Quality Commission)*. Its credibility was questioned, with comments around lack of objectivity in its judgements and a lack of sector-specific expertise among its inspection teams. The majority of Trust leaders are also in favour of a move away from single word ratings, viewing this approach as too simplistic, demoralising for staff and confusing for patients. Among those who supported single-word ratings, there was a feeling that more frequent review and/or a clear narrative to support the given rating would be appropriate.
Next steps
As Professor Lord Darzi conducts the review of NHS performance ordered by the new Secretary of State for Health and Social Care, Wes Streeting, and the Department works on developing the 10-year plan for the service, led by Dr Penny Dash, which is due to publish in spring 2025, this is truly a “pivotal moment for regulation” in the NHS. NHS Providers says it will maintain the principles for good regulation, set out in its recent report ‘What is good regulation’ as it engages with Dr Penny Dash and Professor Lord Darzi whilst they generate their reports.
The survey that informs this report was carried out during April and May 2024, with input from 122 Trusts (58% of the provider sector) with analysis also informed by NHS Providers’ ongoing engagement with providers.
* The survey preceded the recent admission of failings at the CQC and the new Government’s response.
