Regulation has an important role to play in public services – particularly those, such as the NHS, that manage high levels of risk, where good leadership, processes and governance are of paramount importance to safety. Trust leaders recognise that independent regulation and oversight can play a valuable role in holding up a mirror, providing impartial assessment and challenge, as well as appropriate transparency and accountability for service users and taxpayers. In a nationally-led public service, independent oversight is also important in maintaining focus on national-level priorities, and in providing support and assistance where improvement is needed. These roles complement, but do not replace, the role of the trust board, which provides strong leadership, good governance, and the capacity and capability for self-reflection within the provider organisation. 

This report focuses on trust leaders’ views and experience of regulation during 2023/24. (An NHS trust is an organisational unit within the National Health Services of England and Wales.)

Key points

● This year’s regulation survey was conducted against a backdrop of continuing challenges to performance, finances and care quality, and ongoing industrial action. There have also been significant changes to regulation and provider oversight by the Care Quality Commission (CQC), NHS England (NHSE) and integrated care boards (ICBs). 

● Trust leaders reported an increased regulatory burden this year, particularly noting a lack of coordination between regulators. Some also question whether reporting requirements are realistic or proportionate. Similarly, concerns were raised around whether regulatory activity sufficiently considers the reality of the operating environment. 

● In particular, there is a question as to whether regulators appropriately recognise the level of risk trusts have been absorbing this year in balancing the demands of financial and operational performance. Some respondents also expressed concern about the impact of growing system pressures on regulators’ leadership behaviours.