Monitor's new powers should be diluted, says NHS forum

13 Jun 11
An independent review of the government's planned shake-up of the NHS has today recommended a series of radical changes, including 'significantly diluting' the proposed role of regulator Monitor.
By Lucy Phillips | 13 June 2011

An independent review of the government’s planned shake-up of the NHS has today recommended a series of radical changes, including ‘significantly diluting’ the proposed role of regulator Monitor.


Steve Field

The NHS Future Forum, chaired by Professor Steve Field, a practising GP and former chair of the Royal College of GPs, was set up in April to lead the government’s ‘listening exercise’ on its controversial Health & Social Care Bill. After an eight-week consultation with health professionals and patients, the forum todaypublished its findings.

Field said while there was ‘a very good place for competition’ in the English NHS, for improving quality and choice, ‘competition should not be used for an end in itself’.   

The forum is therefore recommending removing the primary duty placed on Monitor in the Bill to promote competition. Monitor, currently the independent regulator of foundation trusts, is being turned into a full-blown economic regulator under the government’s plans.  

Field said that Monitor’s role ‘should be significantly diluted’ and it should not act like a utility regulator ‘but be a sector regulator for health, which is very, very different’. Previously, Monitor’s new role had been likened to that of energy price watchdog Ofgem, a model that was felt to be inappropriate for the health care market.

He added that the NHS needed ‘to do all we can to avoid cherry picking by private providers’.

Speaking more widely about the Bill, Field said the consultation had thrown up ‘lots of genuine and deep-seated concern’ from staff, patients and members of the public.

The pace of change proposed by the government must be varied, he said, so that the NHS implemented change only when it was ready to do so. GP consortiums, for example, should ‘move towards being accredited’ but the April 2013 deadline ‘might be too onerous for some’.

Field added: ‘We don’t think people should have a rigid black and white cut off... But the NHS commissioning board should do everything it can do get them approved as quickly as possible.’

Among other recommendations is that all organisations involved in NHS care and spending public money should be subject to the same high standards of public openness and accountability. For example, each GP consortium would need to have a governing body, which met in public, and NHS foundation trusts would be required to hold their board meetings in public.

The forum also called for the role and influence of local authority-led health and wellbeing boards to be strengthened – ‘giving them stronger powers to require commissioners of both local NHS and social care services to account if their commissioning plans are not in line with the joint health and wellbeing strategy’.

The report says: ‘Local government and NHS staff see huge potential in health and wellbeing boards becoming the generators of health and social care integration and in ensuring the needs of local populations and vulnerable people are met.’

Field also revealed that during the consultation they had been ‘alarmed at many meetings about how demoralised managers have been over the past few months’.

He said: ‘They feel marginalised, unloved and many of the good ones are fleeing the NHS or taking early retirement.’

The government will respond to the Future Forum’s report tomorrow. Monitor is also due to publish its response then.

Jennifer Dixon, director of the Nuffield Trust, said: ‘The forum has done a good job of helping to clarify and suggest ways that the best intentions of the original legislation can be built upon.

‘As a set of principles, the recommendations provide a sound basis for consensus.The question is whether the government’s proposed amendments will speak fully to the forum’s recommendations. We urge the government to ensure that they do so that the Bill can be passed without further delay.'

But the Unite union warned that the ‘NHS privatisation programme is still on track’ despite the recommendation for removing Monitor’s key power.

 Unite national officer for health Rachael Maskell said: ‘The problem with Monitor is that it will now promote choice, competition and collaboration – all of which are contradictory aims.

‘The hybrid mess that Monitor will become will do to the NHS what other botched regulatory bodies have done to other public services – from rail to social care.  Unless patient care comes first, then Monitor will fail patients – and our politicians will have failed them too.’

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