How Does regulation contribute to improvement? Ella Jackson Policy Advisor 12 October 2018

NHS Providers – who we are

Regulation and oversight of NHS providers NHS England NHS Improvement Care Quality Commission Competition & Markets Authority NHS Resolution MHRA NHS Digital Commissioners Royal Colleges Local authorities Professional regulators

A provider’s improvement journey Outstanding Reaction to initial inspection report/rating Leadership NHS resolution Cultural change Vision and values Governance Improving safety Commissioners Royal Colleges Patient and public involvement Special measures Local authorities Professional regulators Looking outwards CQC engagement Driving Improvement, CQC, 2017

Contribution of regulation – the positive impacts Outstanding Reaction to initial inspection report/rating √ Recognition and validation of good practice √ Boosts staff morale and credibility with stakeholders √ Brings focus to areas requiring improvement √ Uncovers pockets of hidden good practice √ Evidences need for culture change and prompts self-reflection √ Helps boards engage clinicians Leadership NHS resolution Governance Improving safety Commissioners Royal Colleges Special measures Local authorities Professional regulators Looking outwards CQC engagement

The danger that regulation stifles improvement Only 26% said CQC inspection highlighted areas of concern the board was not aware of 67% said ad hoc requests from regulators had increased over the last 12 months 39% think the benefits of inspection did not justify the cost 51% believe support has been appropriately tailored to their sector 56% said reporting requirements are not proportionate to the level of risk they manage 36% felt the regulators had coordinated effectively NHS Providers regulation survey, 2018

Special measures experience – the negative impacts Outstanding Reaction to initial inspection report/rating X Scrutiny and requests ‘Feeding frenzy’ X Unrealistic expectations and demands X Erosion of board autonomy X Variability of improvement support X Focus on quality or on finances X Model assumes problems lie in individual organisations Leadership NHS resolution Cultural change Governance Improving safety Commissioners Royal Colleges Special measures Local authorities Professional regulators Looking outwards CQC engagement

What providers would like to see from regulation and support √ Focussed on assurance that boards are leading organisations effectively √ Aligned, coordinated and proportionate scrutiny and requests √ Realistic expectations √ Sector-specific √ Based on up-to-date data √ Models inclusive and compassionate leadership √ Takes into account local system context √ Support tailored to providers’ needs, taking account of priorities identified by staff √ Facilitates peer support and sharing good practice

Q&A THANK YOU