What is it?
To coin a phrase, Ofhealth – the independent regulator of providers of NHS-funded services in England.
What is the rationale behind it?
Like Ofcom which regulates the UK communications industries, Ofsted (education) and Ofgem (gas and electricity industries) and a host of other bodies overseeing sectors where the state was previously the main provider, Monitor has become necessary as provision of NHS care has diversified.
A vibrant, diverse provider sector was part of the vision behind the current wave of NHS reforms set out in the 2010 White Paper ‘Equity and excellence: liberating the NHS’ and as originally envisaged, Monitor´s controversial job would have have been to actively ‘promote’ competition in the NHS. This one word coupled with the suggestion that Monitor would operate both minimum and national tariffs accounted for much of the outcry over the reforms when they were announced by the new coalition government.
The wording of this part of Monitor´s role has now been watered down as set out in its five key areas of responsibility: licensing providers, regulating prices, enabling services to be provided in an integrated way, safeguarding choice and competition and supporting commissioners so that they can ensure essential health services continue to run if a provider gets into financial difficulties.
Exactly where ‘safeguarding choice’ and ‘promoting competition’ diverge remains to be seen. But there is no doubt that competition will remain at the centre of Monitor´s concerns: it will incorporate the current Principles and Rules for Co-operation and Competition into its regulatory framework and the Co-operation and Competition Panel will become part of Monitor.
Where is it in terms of development?
Before the political firestorm that accompanied announcement of its new role, Monitor already quietly oversaw NHS Foundation Trusts, a role which it will continue to fulfill. In 2009, Monitor parachuted a management team in to run the failing Mid Staffordshire NHS Foundation Trust.
Monitor has a board and an executive team led by chief executive David Bennett – a former senior partner in the secretive consultancy firm McKinsey & Company, policy adviser to Tony Blair as Prime Minister and head of the policy directorate at 10 Downing Street.
During 2013, Monitor will introduce a licence for providers of NHS care which it will use to hold providers to account. From 2014 onwards Monitor will work with the NHS Commissioning Board on another controversial area – the pricing of NHS-funded services or setting the national tariff.
What are going to be the tricky bits to digest/get agreement on?
The House of Commons Select Committee – which has an annual accountability hearing with Monitor – is concerned about its ability as an organisation to ‘scale-up’ to take on its new responsibilities and is keeping a close eye on this.
It is also concerned about the fact that widespread provider competition in the NHS is largely untested. This is another area where Monitor’s future workload is somewhat unpredictable. The select committee said Monitor will need to plan for a range of contingencies, and the Government will need to adapt its support as appropriate.
MPs are also worried about the overlap between Monitor and the Care Quality Commission: ‘We are concerned about the scale of the challenges facing Monitor and the CQC, both of which are going through complicated transition periods, coupled with continuing uncertainty and financial risk in the healthcare landscape.’ They are keeping the long-term question of whether the two bodies should merge under review.
Alisdair Stirling is a freelance journalist