The must-read stories and debate in health policy and leadership.

The “regulation lite” that became the norm during the pandemic wasn’t to last. According to the latest piece of research by NHS Providers, a little over half of trust leaders have reported that the burden placed on them by regulators has increased over the past year, with ambulance and acute specialist trusts the most unhappy.

Leaders have said “ad hoc” requests have also increased – almost 60 per cent of respondents agreed with this statement – which could include out-of-the-ordinary requests for information and meetings, which divert staff from their usual jobs. “They do not take into account current pressure,” one chief executive officer argued. 

The research, which focused on NHS England and the Care Quality Commission, found that leaders were particularly discontented with the emphasis on finance, rather than care quality and safety.

It’s a time of huge change for both regulators: NHSE is implementing a new operating framework and navigating a merger and the CQC is a new regulatory approach. Perhaps, unsurprisingly, there were concerns about both of these projects.

However, something to keep tabs on in next year’s survey is the changing views on integrated care boards. Trust leaders didn’t hold back in their criticism and suggested ICB leaders were “confused” and were being pushed towards performance management, rather than support. 

Workforce wonga

Much fanfare greeted the launch of the NHS workforce plan last week but discussion of how it will be paid for was conspicuously absent.

Ministers have pledged £2.4bn over five years to cover the expansion of training and education places. After that point, they will have to find the money to employ the massive numbers of new staff the plan envisages, though senior Tories have said only that these decisions will be made closer to the time.

Of course, this raises the prospect of the Treasury kneecapping the more expensive parts of the strategy by refusing to provide adequate funding.

The government’s budget watchdog has warned the plan will be hard to deliver without pushing NHS spending increases past 3 per cent a year above inflation.

The other options set out by the Office for Budget Responsibility include delivering optimistic labour productivity improvements – difficult to see happening without more funding for tech and capital – raids on existing health budgets, or holding NHS pay down below wider economic growth.

Rishi Sunak has insisted the plan is “fully funded”. But in reality, ministers have simply delayed the tough questions about paying for workforce expansion – most likely when they are no longer in government.

Also on today

In The Integrator, Dave West looks at integrated care systems’ patchy record when it comes to creating inclusive partnerships with district councils, and in Comment, Julian Hartley says trust leaders express support for NHSE and CQC’s regulatory changes but raise concerns over increased burden, lack of focus on outcomes and discrepancies in inspections. He offers solutions.