Monitor needs more clarity or risks failure – King’s Fund
pharmafile | November 10, 2011 | News story | Sales and Marketing | Monitor, NHS reform, king's fund
The watchdog that will oversee competition and co-operation within the NHS needs to have a clearer remit or could face failure, a think tank has warned.
Monitor is set to take on the role of “economic regulator” for the NHS and private healthcare providers, as part of the new reforms of the health service.
The organisation currently regulates NHS foundation trusts, but will take on a much bigger role in the new system, and one that has no precedent in the NHS.
Anna Dixon, director of policy at leading healthcare think tank King’s Fund and the lead author of a new report says the current plans for the regulator are too vague.
“Monitor has been set a formidable task with little precedent and supporting analysis, so the risks of failure are considerable,” said Dixon.
“Unless economic regulation is designed and executed well, it may end up imposing more costs than the benefits it delivers.”
The organisation will have a budget of £82 million and around 500 staff, and be responsible for price-setting, competition, licensing providers, ‘managing failure’ (when hospitals get into debt) and providing oversight of foundation trusts.
Removing political interference
The King’s Fund said Monitor’s primary task must be to establish clear roles and relationships with current NHS bodies, including NICE, the NHS Commissioning Board and the Care Quality Commission.
The think-tank said these relationships needed to be clear otherwise the regulator would need to defer to government to resolve major issues, defeating the purpose of having an independent body.
The King’s Fund also said that the health secretary’s role also needed greater clarification.
The King’s Fund says that in principle the health secretary is not permitted to intervene in Monitor’s remit, but warns that politicians will be under pressure to intervene in hospital closures and debt problems.
The think tank says regulation may bring benefits by creating a system of fair competition and prevent monopolies, but there is also a risk that Monitor could stifle innovation.
The current proposals imply that Monitor will police offences, stepping in and potentially punishing anti-competitive behaviour in the system.
Because of this there is a risk that providers, not wanting to fall foul of the regulator, fail to innovate, or alter current service configurations or establish models of integrated care, the think-tank said.
Further Health Bill amendments
The Fund said the Health and Social Care Bill, which is currently at the committee stage of the House of Lords, may need to be further amended to clarify Monitor’s remit and how it interacts with other key NHS bodies.
The King’s Fund report concluded that experience of ‘economic regulators’ in deregulated markets, such as OFWAT and water companies has shown that producing improved standards and increased efficiency is far from guaranteed.
“As the Health and Social Care Bill proceeds through the House of Lords, we hope that ministers will look again at the lessons to be learned from other regulators and make the changes needed to enable Monitor to succeed in its new role,” she concluded.
Ben Adams
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