By Lucy Philips
10 June 2010
Former Audit Commission chief executive Steve Bundred said he had ‘one more big job left in him’ – and he got it. The new chair of rapidly expanding NHS regulator Monitor talks to Lucy Phillips about working in the fast lane
A shake-up of the NHS on the advent of a new government hardly came as a shock. Quick off the mark, the coalition introduced a new health Bill just two weeks after the Cameron-Clegg partnership began, paving the way for a health service that is freer from central controls. This includes creating an independent board to oversee the allocation of budgets and commissioning of care, and making GPs responsible for their own contracts.
But it is the other major change that is raising the most eyebrows. In a drive ‘to improve efficiency and outcomes’, Monitor, the independent watchdog for NHS foundation trusts, will be made into a full blown economic regulator – managing access, competition and price-setting across the service. The role of the Care Quality Commission will also be ‘strengthened’, although in essence its job will be to inspect care standards and pass on reports to Monitor.
Steve Bundred, who took up the post of chair of Monitor at the beginning of May, has been plunged right into the middle of it all. He caught many people by surprise late last year when he announced his departure from the helm of the Audit Commission, but was clear that, aged 57, he wanted ‘one more big job’. It has now emerged as a particularly canny move given Monitor’s wider remit and the cuts in line for other regulators and quangos.
Sitting in his new office, just minutes from Westminster, Bundred tells Public Finance he ‘never presumed’ the outcome of the election. In fact, he had judged a Conservative-Liberal Democrat alliance to be particularly unlikely. But he was aware that Monitor would be given a beefed-up role if the Conservatives came to power. The Tories had published a white paper in 2007, NHS autonomy and accountability, which outlined the new powers they would give the body. Bundred calls it ‘the best guide as to what might be in prospect’, although he accepts that the LibDems might have some reservations.
Beyond that, the new chair must wait for further information to unfold in a white paper next month and legislation in the autumn. But he says that this lack of clarity does not bother him. ‘If you found it frustrating not knowing what was going to happen in the future, you would never develop a career in public services. We’re not just waiting for things to happen to us, our [interim] chief executive and his senior colleagues are actively engaged in dialogue with the department, helping it to flesh out the detail.’
According to the 2007 paper, Monitor will have six statutory duties and eight ‘key functions’. The former include securing universal access to health care, promoting competition, ensuring sufficient supply of skilled professionals and supporting safety, quality and efficiency. Among the latter, the regulator will license health care providers, control market entry, apply price controls (including determining the NHS tariff) and promote foundation trust freedoms.
Bundred is unapologetic about perceived conflicts of interest. The current arrangements are already at odds with each other, he says, with the Department of Health both owning the NHS and being responsible for tariff-setting and creating a mixed market. ‘I think most people given a choice between having such conflicts managed by politicians or independent regulators would opt for independent regulators.’
He adds that the new system of GPs commissioning their own services will also, by nature, result in clashing priorities, but ‘with all of these sorts of issues, the way to manage around them is to be conscious that they exist’.
One of the first things that struck Bundred on joining Monitor was ‘how lean and fit’ the regulator is. It has just 100 staff, in stark contrast to the 2,000 employees at the Audit Commission. Despite all its new responsibilities he doesn’t believe Monitor will ever become a large organisation as this would run ‘completely counter’ to its culture and ethos.
Not everyone agrees. John Appleby, chief economist for health policy at the King’s Fund, predicts that the new super-regulator will ‘balloon’ as it sweeps up the functions, powers and staff of a shrinking DoH.
‘It’s quite incredible the range of things they are being asked to do. The powers and responsibilities are right across the board,’ he says. ‘They will have to increase the number of staff they have. If they are going to do a proper job, they will have to have skills and people to do this.’
Appleby’s main concern is the lack of an ‘overarching goal’ for Monitor. ‘An economic regulator can be anything politicians want it to be and can be given whatever functions they want – and that’s what they are doing. [But] when push comes to shove, how does it resolve the trade-off between universal access and providing an efficient health care system?’
He adds that ‘maybe in the end it will just be a case of giving it these powers and seeing what happens’, with the secretary of state picking up the pieces when things prove too contentious.
One area that is already contentious is the proposal for the NHS and its £100bn budget to be run by an independent board. Former LibDem health spokesman Norman Lamb even branded the proposals ‘nonsense’ in the run-up to the election, and questions are still being asked about where the buck would stop if there were a health service crisis.
Bundred suggests he ‘doesn’t have a strong view’ about the rights and wrongs of an NHS board. He asserts that ‘you will never remove political influence completely’, and rightly so, but such a system could remove ministers from day-to-day interference. He points to the higher education model, whereby a national funding council allocates money to universities on the back of an annual letter from the government setting out its spending priorities. ‘I think that is a perfectly viable model in health as well,’ he says.
Just a month into the job, Bundred declares it ‘an exciting period’ to be in the health service, with the latest reforms representing ‘a once in a generation change to the way in which the NHS operates’.
The career shift has certainly made Bundred soften his line on the issue of ring-fencing some departmental budgets at the expense of others – something he previously branded ‘insane’. He now says the protection given to health ‘is relative rather than absolute, because in a system where demand is constantly expanding and population is rising you have to receive extra money annually just to stand still’
Lucy Philips is the senior reporter for Public Finance
10 June 2010
Former Audit Commission chief executive Steve Bundred said he had ‘one more big job left in him’ – and he got it. The new chair of rapidly expanding NHS regulator Monitor talks to Lucy Phillips about working in the fast lane
A shake-up of the NHS on the advent of a new government hardly came as a shock. Quick off the mark, the coalition introduced a new health Bill just two weeks after the Cameron-Clegg partnership began, paving the way for a health service that is freer from central controls. This includes creating an independent board to oversee the allocation of budgets and commissioning of care, and making GPs responsible for their own contracts.
But it is the other major change that is raising the most eyebrows. In a drive ‘to improve efficiency and outcomes’, Monitor, the independent watchdog for NHS foundation trusts, will be made into a full blown economic regulator – managing access, competition and price-setting across the service. The role of the Care Quality Commission will also be ‘strengthened’, although in essence its job will be to inspect care standards and pass on reports to Monitor.
Steve Bundred, who took up the post of chair of Monitor at the beginning of May, has been plunged right into the middle of it all. He caught many people by surprise late last year when he announced his departure from the helm of the Audit Commission, but was clear that, aged 57, he wanted ‘one more big job’. It has now emerged as a particularly canny move given Monitor’s wider remit and the cuts in line for other regulators and quangos.
Sitting in his new office, just minutes from Westminster, Bundred tells Public Finance he ‘never presumed’ the outcome of the election. In fact, he had judged a Conservative-Liberal Democrat alliance to be particularly unlikely. But he was aware that Monitor would be given a beefed-up role if the Conservatives came to power. The Tories had published a white paper in 2007, NHS autonomy and accountability, which outlined the new powers they would give the body. Bundred calls it ‘the best guide as to what might be in prospect’, although he accepts that the LibDems might have some reservations.
Beyond that, the new chair must wait for further information to unfold in a white paper next month and legislation in the autumn. But he says that this lack of clarity does not bother him. ‘If you found it frustrating not knowing what was going to happen in the future, you would never develop a career in public services. We’re not just waiting for things to happen to us, our [interim] chief executive and his senior colleagues are actively engaged in dialogue with the department, helping it to flesh out the detail.’
According to the 2007 paper, Monitor will have six statutory duties and eight ‘key functions’. The former include securing universal access to health care, promoting competition, ensuring sufficient supply of skilled professionals and supporting safety, quality and efficiency. Among the latter, the regulator will license health care providers, control market entry, apply price controls (including determining the NHS tariff) and promote foundation trust freedoms.
Bundred is unapologetic about perceived conflicts of interest. The current arrangements are already at odds with each other, he says, with the Department of Health both owning the NHS and being responsible for tariff-setting and creating a mixed market. ‘I think most people given a choice between having such conflicts managed by politicians or independent regulators would opt for independent regulators.’
He adds that the new system of GPs commissioning their own services will also, by nature, result in clashing priorities, but ‘with all of these sorts of issues, the way to manage around them is to be conscious that they exist’.
One of the first things that struck Bundred on joining Monitor was ‘how lean and fit’ the regulator is. It has just 100 staff, in stark contrast to the 2,000 employees at the Audit Commission. Despite all its new responsibilities he doesn’t believe Monitor will ever become a large organisation as this would run ‘completely counter’ to its culture and ethos.
Not everyone agrees. John Appleby, chief economist for health policy at the King’s Fund, predicts that the new super-regulator will ‘balloon’ as it sweeps up the functions, powers and staff of a shrinking DoH.
‘It’s quite incredible the range of things they are being asked to do. The powers and responsibilities are right across the board,’ he says. ‘They will have to increase the number of staff they have. If they are going to do a proper job, they will have to have skills and people to do this.’
Appleby’s main concern is the lack of an ‘overarching goal’ for Monitor. ‘An economic regulator can be anything politicians want it to be and can be given whatever functions they want – and that’s what they are doing. [But] when push comes to shove, how does it resolve the trade-off between universal access and providing an efficient health care system?’
He adds that ‘maybe in the end it will just be a case of giving it these powers and seeing what happens’, with the secretary of state picking up the pieces when things prove too contentious.
One area that is already contentious is the proposal for the NHS and its £100bn budget to be run by an independent board. Former LibDem health spokesman Norman Lamb even branded the proposals ‘nonsense’ in the run-up to the election, and questions are still being asked about where the buck would stop if there were a health service crisis.
Bundred suggests he ‘doesn’t have a strong view’ about the rights and wrongs of an NHS board. He asserts that ‘you will never remove political influence completely’, and rightly so, but such a system could remove ministers from day-to-day interference. He points to the higher education model, whereby a national funding council allocates money to universities on the back of an annual letter from the government setting out its spending priorities. ‘I think that is a perfectly viable model in health as well,’ he says.
Just a month into the job, Bundred declares it ‘an exciting period’ to be in the health service, with the latest reforms representing ‘a once in a generation change to the way in which the NHS operates’.
The career shift has certainly made Bundred soften his line on the issue of ring-fencing some departmental budgets at the expense of others – something he previously branded ‘insane’. He now says the protection given to health ‘is relative rather than absolute, because in a system where demand is constantly expanding and population is rising you have to receive extra money annually just to stand still’
Lucy Philips is the senior reporter for Public Finance
