The health regulator Monitor could fail to meet its responsibilities to regulate health care unless the Health and Social Care Bill is amended, The King’s Fund has warned.
The health charity’s latest report Economic regulation in health care: What can we learn from other regulators? points out that the Bill’s proposals to greatly increase Monitor’s powers may cause confusion, and risk diluting the focus of its work.
The regulator would have to dramatically increase in both size and budget to undertake the new responsibilities imposed by the Bill – including setting prices for NHS-funded services, tackling anti-competitive behaviour, and maintaining essential services if providers become financially unsustainable – which it may struggle to manage, argue the report’s authors.
They criticise the lack of clarity over how Monitor will work with the rest of the NHS, such as the NHS Commissioning Board and the Care Quality Commission, which they say risks creating tension and making disputes harder to resolve.
They also warn that ministerial interference in decisions about reconfiguring services and provider failure might be strong enough to overcome the regulator’s supposed independence.
The authors, including The King’s Fund’s director of policy Anna Dixon (pictured), say that lessons should be learned form other regulators, such as those in telecoms and utilities. They point out that although having a regulator specifically for health care has certain advantages, Monitor may struggle to recruit sufficiently skilled and experienced staff to meet new challenges such as setting prices for a wide range of services.
They suggest that:
- the Health and Social Care Bill should be amended to clarify Monitor’s objectives and how it will work with other key NHS bodies
- other regulators’ experience shows that objectives will need to change over time, so a clear process is needed for managing this and protecting it from political whim
- Healthwatch, the new body formed to represent the views of patients in the health system, needs to be a powerful consumer champion for patients and taxpayers and act as a counter-balance to provider interests.
Anna Dixon said: “Monitor has been set a formidable task with little precedent and supporting analysis, so the risks of failure are considerable. Unless economic regulation is designed and executed well, it may end up imposing more costs than the benefits it delivers.
“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.”