Monitor’s guidance is an important step in establishing more transparency in the system of intra-NHS funding transfers, but it would be helpful if other implied objectives were made more explicit.
Responding to Monitor’s consultation on guidance for commissioners, some of the questions we ask around the objectives include: is the aim to expose more providers to genuine risk of failure and therefore exit (i.e. those not designated as essential), thereby stimulating improvement?
Is a secondary objective of the policy to stimulate the market in local health economies or is the process better understood as an opportunity for commissioners to complete a thorough review of the quality and configuration of every service provided in a local area?
Without making the underlying objectives of the draft guidance more explicit, there is a risk that Monitor’s role could be perceived as distracting managerial and clinical effort from more pressing concerns
Our response argues that making the underlying objectives of the draft guidance more explicit (or at least clarifying whether or not they are relevant) would go a long way to strengthening the legitimacy of these measures as they are implemented and the role of Monitor as a sector regulator more generally.
Without this, there is a risk that Monitor’s role could be perceived as distracting managerial and clinical effort from the more pressing concerns of guaranteeing both the quality of, and access to, NHS services in a time of financial austerity.
We conclude by asking whether the process of designation could, or should, be reframed as an opportunity to improve the range and quality of services more generally (which is indeed hinted at in the document, for example in relation to understanding the link between volume and quality).
Nuffield Trust (2012) Continuity of services and designating commissioner requested services. Briefing.