Introduction

This report presents results from the NHS Alliance’s first governance and regulation survey, building on similar publications by NHS Providers.

It is the first in a three-part series, focusing on trust leaders’ experiences of the Care Quality Commission (CQC) over the past year. Our second report will focus on ICB and trust leaders’ experiences of NHS England’s (NHSE) oversight and regulatory approach. The final report – which will be available exclusively to NHS Alliance members – will explore ICB and trust leaders’ perceptions of corporate governance.

Conducted in August 2026, the findings and recommendations in this report are based on the 166 responses from 116 trusts (57 per cent of all trusts). All regions and trust types are represented. Respondents included chief executives, chairs, company secretaries, medical directors and nursing directors.

Our analyses and interpretation are supplemented by free-text responses and insights gathered via a series of in-depth interviews and wider engagement with NHS leaders.