Breakfast seminar

Monitor’s primary duty was to protect – and promote the interests of – people who used healthcare services, Toby Lambert told delegates. Since the Health and Social Care Act 2012, however, it had moved from ‘a very institutional focus to very much a consumer focus’, he said.

 

The organisation’s role covered foundation trust governance, pricing, choice and competition, integrated care and continuity of essential services, he said. It had recently issued enforcement guidance and a risk assessment framework, while its new provider licence obligations included provisions for pricing, integrated care, continuity of service and governance, as well as a range of general conditions.

 

The licensing process “should take a matter of days or weeks”, he said. “A slight complication is that it has to be done jointly with the CQC [Care Quality Commission], so with a new provider that wasn’t CQC-registered it could take longer. The application process won’t be particularly complex – the process is more that we’ll give you a licence and then come down on you if you don’t fulfill the terms of it.”

 

Once an organisation found itself in a position where it was unable – or unlikely to be able – to pay its debts, “as a private or charitable provider you would go into ‘health special administration’, the priority of which is to maintain essential services,” he told the seminar. “If special administration is considered likely, we send in a contingency planning team to work with local commissioners to identify the services that need to be protected, and how best to achieve it.”

 

The team “essentially looks at what would happen to those essential services if the provider went bust”, he said. “It’s a consideration of whether there are things we can realistically do to ensure ongoing financial responsibility. If not, we have powers to direct you to do certain things to preserve financial viability.”

 

In terms of the duty on integrated care, and how the provisions of the Health and Social Care Act and the Care and Support Bill would work together, there would be “some good clinical commissioning groups that will get on top of it”, he said. “In other places, it will be a game of catch-up. It comes down to a question of capacity and capability. Legislation can’t make it happen.”

 

There was an ongoing debate about whether closer scrutiny minimised risk, he continued, with some people stating that it could discourage innovation and therefore increase risk. On the question of competition, meanwhile, there were various agencies with an interest, he said. “Where mergers are concerned, Monitor has no formal role. Foundations and NHS trusts are classed as enterprises, so in terms of mergers between foundation trusts we don’t have a formal competition capability. But we do still have a duty to judge whether there will be a risk to the continuity of services depending on that merger – we have a financial risk role in that, and we can comment to the Office of Fair Trading about the likely implications in terms of patients.”

 

On the question of what ‘success’ looked like to Monitor, he told delegates that “ultimately, our main duty is to protect people who use healthcare services. It’s not something where we can sit there at the end of the year and say ‘here’s where we made a difference’ – it takes longer than that, and part of it is looking at things like whether we’re running efficient case reviews on the monitoring side.”

 

The organisation’s responsibilities and duties clearly overlapped with those of the CQC, he said. “Philosophically, where we’d like to be is to put the CQC in the lead in terms of guaranteeing essential services, but given their current position it can be quite hard to maintain that line, and we get drawn into overseeing quality. It will depend on how the CQC develops over the next couple of years.”