Parliamentary Committees and Public Enquiries
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MPs publish report on 2012 accountability hearing with Monitor

Urgent need to clarify roles of Monitor and the Care Quality Commission (CQC), says Health Committee.

The parallel roles of Monitor and CQC were criticized in the Francis Report on the Mid Staffordshire Foundation Trust because they create significant opportunities for confusion. MPs on the Health Committee have today repeated that view and stressed that they need to be addressed urgently to avoid the twin dangers of gaps in regulation and duplication of regulation.

Launching the report of the second annual accountability hearing with Monitor, the Chair of the Health Committee, Stephen Dorrell MP, said:

"Our overall view of Monitor is that believe it is a stable and well-run organisation. We are, however, concerned that the overlapping remits of Monitor and the CQC have caused problems which need to be addressed quickly.

"The urgency of this requirement is illustrated by the serious failings in quality and safety that emerged at the University Hospitals of Morecambe Bay Foundation Trust after an authorization process which did not identify significant issues of care quality and patient safety."

Commenting extensively on Monitor’s new role under the Health and Social Care Act 2012, the report concludes:

  • The proposal to use a combination of transitional powers and licensing provisions (designed to apply to all providers of NHS care) to provide the framework for the long-term regulation of Foundation Trusts is profoundly unsatisfactory. The role anticipated for Monitor changed during the passage of the legislation; this aspect of its powers does not provide an adequate basis for it to meet the expectations of Parliament and public that it will provide effective ongoing oversight of the operation of Foundation Trusts.
  • The role of Monitor in relation to competition in the NHS remains unclear, despite its new primary duty to “protect and promote the interests of people who use health care services”. In particular the respective roles of Monitor and the Competition Commission in the market for health and care services is in urgent need of clarification.
  • Monitor’s positive approach towards the commissioning of integrated care pathways it welcome. The regulator should encourage and facilitate the development and implementation of proposals for the integration of NHS services as well as health and social care services, both as the system regulator and through its oversight of Foundation Trusts.
  • Monitor should use its role in setting the Tariff paid for certain NHS services (alongside the NHS Commissioning Board) to encourage system redesign and the integration of service provision, as well as to discourage “cherry-picking” of the most economically attractive patients.
  • The establishment of a provider failure regime is welcome, but a number of important elements in that regime are not yet fully developed and further progress is needed over the coming months.

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