In our response to Monitor’s consultation on the draft licence for providers of NHS services, we offer overall comments and answers to some specific questions posed by the consultation document.
Through the licence, the Health and Social Care Act 2012 allows Monitor to enforce behaviour such as making trusts and commissioners provide good quality data on pricing and costs, discourage anti-competitive behavior, and support patient choice, continuity of service and integrated care, as appropriate.
The creation of Monitor as an economic sector regulator is central to achieving the Government’s vision of a ‘liberated’ NHS.
According to this vision, the quality and efficiency of services will be shaped by clinically-led local commissioners, supported by enhanced patient choice and competition and more robust pricing mechanisms, alongside traditional tools, such as quality regulation and inspection, centrally-provided guidance on clinical standards and support for improvement.
Assessing the scope and content of the licence is hampered by the still incomplete level of detail about how, precisely, Monitor will function in relation to many of its duties
In those areas where detail is emerging, for instance in the draft guidance on commissioner-requested services and the failure regime, Monitor’s scope is potentially large and its ability to intervene and shape local services is extensive.
Assessing the scope and content of the licence is hampered however by the still incomplete level of detail about how, precisely, Monitor will function in relation to many of its other duties – for example in relation to patient choice.
We are concerned about the relative weight being placed on developing sector regulation licensing (carried out by Monitor and other organisations) relative to developing and improving quality regulation, carried out by the Care Quality Commission for providers and NHS England (formally the NHS Commissioning Board) for commissioners. Indeed, the precise regulatory role of Monitor with respect to quality of care is unclear.
It will be critical for the Department of Health/Secretary of State to regularly review how the roles of Monitor, NHS England (formally the NHS Commissioning Board) and the Care Quality Commission are developing individually, and more importantly together, in order to develop high quality and efficient care for all.
The roles of these bodies are intertwined, and more effective collaboration than in the past will be critical as the NHS faces the very tough next decade given funding constraints.
Nuffield Trust (2012) The new NHS provider licence: our response to the Monitor consultation. Briefing.