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• Introduction »
• Development of Foundation Trusts »
• Role of Monitor »
• Points of issue »
The Coalition Government has come to power with an aim to restructure the provision of healthcare in England. It has published an introductory white paper and several subsequent consultation papers. This document offers a précis of the consultation on ‘Regulating healthcare providers’.
This consultation document deals with the development of foundation trusts, as social enterprises, and the remit and role of Monitor as the economic regulator. The outcomes expected from this consultation will provide answers on how NHS Trusts will move to foundation status and how any NHS provider will be regulated by Monitor.
The proposals set out in this consultation align with the Government's overarching intention to free providers so they can focus on improving outcomes, be more responsive to patients and innovate. The Government's belief is that these freedoms should be given alongside a framework which ensures accountability. Its approach centres on the use of regulatory licensing and clinically led contracting as specific control mechanisms for providers to ensure this, rather than hierarchical management. As the health service moves away from a system of top-down performance management, the establishment of an economic regulator will be a necessary component of the system to protect the public interest in the provision of services.
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Development of Foundation Trusts
The Government stated in the main white paper their ambition to create the ‘largest and most vibrant social enterprise sector in the world’. Social enterprises are organisations with a social purpose that use any surpluses in pursuit of their response. Every NHS Trust will become a Foundation trust; it will not be an option for organisations to decide to remain an NHS trust rather than become or be part of a foundation trust. Foundation Trusts are, in essence, social enterprises as any surplus, and any proceeds from the sale of assets, are reinvested in the organisation or used to repay debt to ensure that patients reap the benefit.
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Monitor will license providers of NHS healthcare services and will ensure they are legally constituted and have clear governance arrangements. It will exercise its functions in three areas: regulating prices, promoting competition and supporting service continuity. Its remit will not extend to regulating supply of products or technologies such as equipment or pharmaceuticals. However, Monitor will have powers to enforce competition law and impose sanctions and remedies in relation to providers of health or adult social care services irrespective of whether they are required to hold a license. Monitor will have the power to set general licence conditions for all licensed providers.
When carrying out its functions Monitor will have regard to the following objectives:
- Maintaining the safety of patients and individuals accessing services
- Securing ongoing improvements in quality of care
- Providing equitable access to essential health and adult social care services
- Supporting commissioners in maintaining continuity of essential services
- Promoting appropriate investment and innovation
- Making best use of limited NHS and adult social care resources
How does Monitor work with CQC?
The CQC and Monitor will be jointly responsible for administering an integrated and streamlined registration and licensing regime. CQC will continue to register providers of health and adult social care and Monitor will license providers of NHS healthcare services. It will be a requirement of Monitor’s licence that organisations have gained CQC registration. CQC will continue to ensure that their registered providers meet essential levels of quality and safety.
How does Monitor work with the NHS Commissioning Board?
Monitor will be responsible for setting efficient prices, or maximum prices, for NHS funded services, in order to promote fair competition and drive productivity. Monitor will work closely with the NHS Commissioning Board to determine which NHS funded services should be subject to national tariffs and to develop appropriate currencies for pricing and payment purposes. They will be under an obligation to consult with each other on the services to national tariffs, contract currencies and funding models. The NHS Commissioning Board will be able to appeal to the Competition Commissioner if it opposes Monitor’s methodology for setting tariff prices.
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- It is not clear as to if and when community pharmacies will be required to be licensed and registered with Monitor. Essential services appear to be outside the remit of Monitor but it is not clear where the provision of enhanced services sit.
- The interaction of pharmacies and provision of pharmaceutical services with or within social enterprises needs to be considered
- Views need to be sought on how the mandatory move to Foundation trusts will affect pharmacists working in secondary care
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