NHS Future Forum: Monitor's role must be changed and clarified

The role of Monitor must be changed and greater clarity given on the use of the competition, the NHS Future Forum has said.

In its summary report on proposed changes to the NHS, the NHS Future Forum has described choice and competition as ‘the most controversial area’ of its work. 

It has made recommendations for changes to the role of Monitor and calls for much greater clarity on where competition should be applied. 

The secretary of state should give a ‘choice mandate’ to the NHS Commissioning Board setting out the parameters for choice and competition in all parts of the service, The Choice and Competition group of the NHS Future Forum said.

 ‘All players in the system should then be held to account for delivering this offer,’ the report said.

According to the report, ‘choice must be more than just choice of provider,’ and it must ‘support better quality and more integration between health and social care.’

The group has called for ‘much greater clarity’ on where competition would be applied in the NHS.

‘Competition already exists in the health service, and the forum is convinced that it has a place in enabling choice and improving quality. But, it will not be appropriate everywhere. The current policy is not clear enough about this,’ the report said.

The group have called for changes to the current plans ‘to put stronger safeguards in place against the misuse of competition.’

The Health Bill should be changed to be very clear that Monitor’s primary duty is not to promote competition, but to ensure the best care for patients, the report said.

The report also recommended that the institutional duty on Monitor to 'promote' competition should be replaced with a new right for patients – ‘the right to challenge commissioners at local level where they feel that choice does not exist and where they feel that services are not good enough.’

The group recognised fears that policies such as ‘Any Qualified Provider’ would allow the private sector to get involved in large parts of the NHS.

‘The forum is very clear that the NHS should not be "privatised"’, the report said.

The report said that more needs to be done to ensure that cherry picking does not undermine the quality of services that patients have access to locally.

The NHS Future Forum’s report on choice and competition concluded that if competition is used effectively and properly regulated, ‘we do not believe it threatens the fundamental principle of an NHS that is universal and free at point of delivery.’

‘The reverse may well be true; that it helps protect that into the future,’ the report said. 

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