How we work

We provide strategic leadership and practical help to the sector, supporting and holding providers to account to achieve a single definition of success.

To achieve this, we:

We also hold boards to account, and sometimes it will still be necessary to intervene. But our primary purpose is clear: ensuring providers have the support they need to deliver.

We work closely alongside providers

In the short term, the scale of financial and operational challenges across the sector means we need to take a more involved and direct approach with more providers than we intend to in the future. As the sector comes back into balance, we will adopt a longer term oversight model with more and more providers. 

In this model, we support first, building deep and lasting relationships. We work closely alongside providers, giving hands-on support and helping create a culture and environment that nurtures improvement.

To help us achieve this, providers will be segmented based on how closely they meet our single definition of success. Higher performing providers will be allowed greater freedoms, including fewer data and monitoring requirements and simpler processes for transactions. More challenged providers will be given more direct and tailored support to help stabilise and improve their performance. 

Well-performing providers will be recognised as leaders, they will be put forward as demonstrators of good practice and will be encouraged to share their learning, skill and expertise with others.

Improvement capability and capacity need to be successfully embedded, valued and supported in all provider organisations. With the development of an expert improvement faculty, we will support providers and existing improvement agencies to develop leaders, and empower the workforce to invest in improvement and develop improvement capabilities.

Our leadership is advised by advisory panels of chief executives and chairs from across the NHS, as well as an expert faculty of improvement.

We also work with national partners to create the conditions for providers to flourish

We are committed to working closely with the Care Quality Commission (CQC), NHS England and other partners, including professional regulators, at national, regional and local levels.

We recognise that providers are frustrated by the fragmentation of national system-level organisations and the inconsistencies and extra burdens this brings. 

We will:

  • collaborate with other arm’s-length body colleagues to streamline the data requests made of providers and reduce the burden of regulation across the board
  • ensure a shared definition of quality and efficiency with CQC, and undertake the new use of resources assessment on CQC’s behalf
  • work with NHS England to ensure greater alignment between the financial levers for commissioners and providers
  • align with CQC and NHS England to create a single and simple definition of success for providers.

We have developed a single definition of success

We've introduced the single oversight framework that is, as above, based on the principle of earned autonomy and that segments providers according to the extent to which they meet our single definition of success. 

Having a single, shared view with our partners of what we are asking providers and the sector to achieve will allow us to focus as much of our resources as possible on providing support for improvement. 

Our single definition of success incorporates:

Quality
We will use CQC’s quality assessment, and five key questions (safe, effective, caring, responsive and well-led), supplemented with real-time information. Success will represent a CQC rating of 'good' or better. 

Finance and use of resources
NHS Improvement and CQC are co-developing a methodology for assessing providers’ use of resources. This will reflect the recommendations of the Carter Review.

Operational performance
We will focus on delivery of a small number of core NHS standards and targets for acute, mental health, community and ambulance trusts. 

This may include A&E waiting times, referral to treatment times, cancer treatment times, ambulance response times, access to mental health services and progress on implementation of seven-day services.

Leadership and improvement capability
We will build on existing governance tools like the well-led framework to set out a single, shared system view on what good leadership looks like.

Strategic change
We will develop an assessment, jointly with partners on the Five Year Forward View (5YFV ) board, of how well trusts are delivering the strategic changes set out in the 5YFV. 

This will include new care models, based on areas’ sustainability and transformation plans and, where relevant, devolution.

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