Regulatory burden and value

Regulation inevitably places demands on organisations. Providing information, supporting inspections and responding to findings all require resources, as well as board and staff time. The critical question is whether that burden is proportionate to the risk and justified by the value regulation provides. Our findings raise concerns on both fronts.

One acute and community trust chair said inspections require ‘very significant documentation required in a short timescale’. Others highlighted the pressure this adds in an already stretched operating environment.

There are signs that this burden is growing. Nearly a third (29 per cent) of trust leaders said the overall burden from the CQC had increased over the previous 12 months, with the same proportion reporting an increase in ad-hoc requests. Just 4 per cent reported an overall reduction in regulatory burden.

More concerning still is the limited value that leaders feel is generated in return. Only 13 per cent of trust leaders agreed that the benefits of their most recent inspection justified the resource costs, while half (50 per cent) disagreed.

Some trusts reported the opposite problem: too little regulatory activity and engagement given the large annual CQC fees. This was particularly a frustration for trusts left with outdated ‘requires improvement’ ratings.

Taken together, these findings point to a problem of targeting, proportionality and value. The objective should be to focus CQC resources and provider time where independent scrutiny can identify risk, provide meaningful assurance or support improvement.