Our revised plan and approach for transformation

Published: 21 December 2022 Page last updated: 21 March 2023

Earlier this year we laid out our approach to how and when we would take the next steps in delivering our strategy. We said at the outset that we would adapt our approach along the way.

We are making complex and important changes:

  • introducing a new regulatory approach for health and care providers, integrated care systems and local authorities
  • establishing a new Regulatory Leadership team to shape our priorities and drive improvement
  • changing how our operational teams are structured to better deliver our regulatory activity
  • delivering a new and improved provider portal.

Our strategic ambition is clear and remains the same. We want to drive improvements across the health and care system, helping to tackle health inequalities. But we need to make sure that we’re able to do this as smoothly as possible, particularly as providers continue to experience persistent pressures. This means taking time to work in partnership with our stakeholders. It also means being clear about what is changing, and importantly what is not, so providers can be clear about what they need to do at every step.

We had said that we would introduce our new assessment approach for providers in January 2023. Following a full review of our timeline we have decided this will not happen until later in 2023.

What we’ve learned

Over the last couple of months, we’ve been reviewing what we’ve heard from stakeholders alongside our timeline for implementation. Some key feedback included:

  • the importance of giving providers time to prepare for the changes to make sure it goes as smoothly as possible. It was important for us to consider the pace at which we were proposing to implement the complex changes.

As we started to roll out changes in a limited and targeted way earlier in 2022, we decided that we needed to:

  • do more testing of the changes we’d already released and take feedback on board, before extending them to other services
  • spend more time testing and developing future changes to make sure providers would be able to adapt to them smoothly.

What’s happening now

It remains vitally important that we keep people safe while we’re changing. We were flexible in our approach during the pandemic, and as we emerge we still need to be pragmatic.

While we continue to develop our new approach, in addition to our regular inspection programme, these priorities will support us to make sure we maintain a proper view of quality and risk:

  • Our national programme of inspections in maternity services. To-date, we have carried out 28 location inspections with a further 52 planned by 31 March 2023.
  • Our ‘People First’ resource. This aims to help all parts of the urgent and emergency care (UEC) pathway. 
  • We continue to complete monthly reviews of services. These are based on information we know about them, which in some cases will indicate we may need to take further regulatory action. In 2022, we’ve carried out almost 7,000 direct monitoring calls with services as a result. We’ll continue doing this until we introduce our new assessment approach.

We’re also sharing what we’ve found in our ‘test and learn’ activity for integrated care systems and local authority assessments which we have incorporated into our approach and methodology. 

During this period providers will not see any changes to their local relationships with us. Over time, providers will engage with our local teams in different ways.

What will happen next

We’ll continue to implement our new approach in phases, making sure each phase is properly implemented before moving to the next.

From spring we’ll focus on:

  • making sure the technology we need is in place and that we’re able to test it with providers
  • being confident that our new regulatory approach is ready to launch.

Knowing that services are under pressure, we will minimise the changes we make and focus on mainly internal priorities.

As well as this, our new Regulatory Leadership team will set out their priorities across their sectors, including thematic reviews. We’ll be regulating as normal using our current sector-based approaches, strengthened by the priorities listed.

We’ll also start to understand more about what is happening locally when we start looking at how care is provided at a system level. We will share further updates on our approach to local authority and integrated care systems in early 2023.

In summer we’ll launch our new online provider portal. We’ll do this is in stages and provide support and guidance. In the first stage:

  • providers will be able to submit statutory notifications
  • we’ll improve how our enforcement process works.

This is the start of gathering evidence in a new and structured way that will help inform our assessments, making it much easier for providers to interact with us. It also allows us to test and refine how the provider portal and our internal technology works to support our new approach.

Towards the end of 2023 we’ll gradually start to carry out assessments in the new way. This means using our new assessment framework. It will be powered by our new integrated assessment teams and supported by our new technology. Providers will be able to apply to register with us and make ongoing changes to registration through the portal. By this point all of our online interactions with providers will be on the portal. These will be simple and intuitive, allowing providers to focus on their core activity of delivering high-quality care.

How we’ll work together

We’ll provide regular updates and more detail during the year. We aim to help providers, integrated care systems, local authorities and other stakeholders to prepare for the changes. Before we make any major changes, we’re fully committed to giving providers plenty of notice to prepare fully and will be engaging with them throughout to ensure they feel they have the right information at the right time.

We have already engaged extensively on many elements of our new approach but want to take time to make sure it works for everyone. We’ll be engaging about more of the detail early in the New Year, along with more user research and testing.

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