Foreword from Ian Trenholm, Chief Executive

This past year has again been one of turbulence and uncertainty, with the services we regulate continuing to be under significant pressure. Our regulatory response has, for the second year in a row, been focused on offering the public as much assurance as possible, while taking opportunities to accelerate improvement.

Our transformation programme has continued at pace. We have begun to make the necessary policy, technical and organisational changes necessary to deliver on the strategy we launched at the start of the year.

While COVID-19 does not pose the same level of threat as it once did, it is still with us and continues to place a strain on the providers we regulate. We have flexed our work to accommodate the practical challenges we have seen on the ground.

During the year we deliberately focused on higher risk providers, and refined the way we define risk. Alongside this we saw another 50% year-on-year increase in information we receive from the public and those who work in services – it has become a major driver of how, and when, we decide to inspect.

Our work in the earlier part of the year was inevitably focused on struggling providers, alongside very specific areas such as infection prevention and control. We also carried out work to identify services that could add capacity to the health and care system – either because they had improved, or because we could offer assurance that they could safely look after those coming out of hospital without a negative COVID test.

As the year progressed, we started to return to potentially higher performing providers and those who had improved. We also began to carry out more work that resulted in ratings, as a means of increasing capacity in some areas. This planned progression back to a more balanced approach to regulation was delayed by the Omicron surge and the vaccination programme over the turn of the calendar year and the last quarter.   

The exceptional nature of our work this year has meant that we have been able to deliver our work well within our budget. We have not needed to travel as widely, or use support from specialist advisors, to the same degree as in a more typical year. We have, however, continued to spend on plan in our transformation programme. This long-term investment should put us in a good position to support longer-term recovery right across health and social care. We were also able to freeze fees again for 2022/23.

During the year, the Health and Care Bill made progress through Parliament, receiving Royal Assent in May 2022 to become the Health and Care Act 2022. This Act is arguably the largest extension of our powers in the last decade and will enable us to link the regulation of providers to regulation of whole health and care systems. We are aware of growing health inequalities in some areas, and these new powers will help us to shine a light on them. We have started work over the last year to create a new single regulatory approach for both providers and systems.

The relatively specialist nature of our work has meant we continue to recruit and retain employees with a range of diverse skills and backgrounds. As with other organisations, recruitment of those with digital, data and change skills has required particular effort. We expect this to remain a challenge into 2023 as we draw heavily on people to support the next phase of our transformation work. Recruitment remains the biggest recurring risk to progress in this area.

In summary, this year has been another challenging and uncertain one. We have been responsive and flexible to ensure we can regulate in a proportionate and appropriate manner. We have managed to remain within planned budgets and continue to make progress with our transformation efforts. Alongside this, we have started work on our future direction, as we plan to expand our activity to make use of the new duties and powers given to us as part of the Health and Care Act.

Ian Trenholm
Chief Executive