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Future Forum recommends rewrite of controversial competition rules in health bill

By Nigel Praities

The health bill should be amended to remove Monitor's duty to promote competition and instead include a new 'choice mandate' to allow patients to challenge the NHS about a lack of quality services in their area, Government experts have recommended.

In a major rewrite of the competition rules contained in the health bill, the NHS Future Forum recommends in a report published yesterday that the NHS Commissioning Board should be given a mandate to expand choice in the NHS, but only if it improves outcomes and lowers costs.

The forum - tasked by the Government to lead the 'listening exercise' on the health bill and led by former RCGP chair Professor Steve Field - says the health bill had 'insufficient safeguards' against private firms cherry-picking services and needs revisions to protect patients.

The duty of Monitor to promote competition was one of the most controversial aspects of the health reforms, but Professor Field and his team's recommendations have been received a cautious welcome from GP leaders.

The report also recommends consortia should be required to set up ‘multi?specialty clinical senates' so that other doctors and nurses can advise on cany changes they make, but it stops short of insisting that GP consortia are required to include hospital consultants on their boards.

It also formally recommends the deadline for the handover in April 2013 should only be for GP consortia that are ready, as announced by Prime Minister David Cameron last week, and says that the NHS Commissioning Board should commission services in areas where GPs are not able to take over from PCTs.

Professor Field said: 'Competition should be used as a tool for supporting choice, promoting integration and improving quality and must never be pursued as an end in itself,' he said.

'Monitor's role in relation to competition should be significantly diluted in the bill. Its primary duty to "promote" competition should be removed and the bill should be amended to require Monitor to support choice, collaboration and integration.'

The NHS Commissioning Board's new 'choice mandate' will be closely monitored, with the boards required to report on its progress and measure results in terms of health outcomes and effective use of resources. It will also be held to account by a new Citizens Panel, part of Healthwatch England, which will publish an annual assessment for Parliament on how well organisations have done in delivering the mandate. The public will also have a new ‘right to challenge' if they are not getting the choice they desire.

Dr Hamish Meldrum, BMA chair said the report addressed many of their key concerns.

'Obviously, the critical factor is now how the Government responds, as well as ensuring that the detail of the changes matches up to expectations. But if the Government does accept the recommendations we have heard today we will be seeing, at the least, a dramatically different Health and Social Care Bill and one that would get us onto a much better track,' he said.

Dr Clare Gerada, RCGP chair said she was 'reassured' about the direction of the proposals, but still had some concerns.

'We need the Government to reassure us that GPs will be given the freedom and autonomy to lead the decision-making and design of future integrated health systems drawing on the support of other health, social care and third sector services. We support clinician-led commissioning but continue to believe that GPs are best placed to lead this process.'

Other key recommendations in the report include:

  • The Secretary of State must remain ‘ultimately accountable' for a national health service.
  • Consortia should have a governing body that holds meetings in public and publishes details of their contracts with providers.
  • All commissioners and significant providers of NHS?funded services, including NHS Foundation Trusts, should be required, as a minimum, to publish board papers and minutes and hold their board meetings in public.
  • Any successor organisation to SHA deaneries must remain part of the NHS.
  • Commissioning should remain under the 'any qualified provider model'.

Follow the latest developments

To see minute-by-minute coverage of the press conference launching the NHS Future Forum report,
click here.

For the latest developments on the health bill over the next few days - including the Government's response to the Future Forum report tomorrow - check out Pulse's
health bill relaunch live blog.

More on the NHS Future Forum report of the listening exercise

Read more on the NHS Future Forum report here:

Future Forum calls for April 2013 deadline to be lifted
Consortia should have to set up 'clinical senates'
Choice mandate 'to increase integration of services'
Commissioning under 'any qualifying provider' to remain
Deaneries 'should remain part of the NHS'

Professor Steve Field headed up the NHS Future Forum panel Professor Steve Field headed up the NHS Future Forum panel