The duty of the NHS regulator Monitor to promote competition should be removed from the Health and Social Care Bill and the agency should be regarded not as an economic regulator but as a sector regulator for health, the NHS Future Forum has stated.
Competition within the NHS must never be pursued as an end in itself but should be used as a tool for supporting choice, promoting integration and improving quality, the Forum team said yesterday, as they published their report to government following their eight-week public listening exercise on the Bill.
Monitor's role in promoting competition should be replaced with a duty to promote real integration and collaboration between different parts of the NHS, while the enduring values of the Service and the rights of patients and citizens, as set out in the NHS Constitution, should be protected and promoted at all times, says the report, to which the government is expected to make an initial response today.
There is no doubt that the NHS needs to change, said Forum chairman Professor Steve Field, a former chairman of the Royal College of General Practitioners (RCGP), presenting the panel's findings yesterday. While the listening exercise had found strong support for the principles underlying the Bill - devolving control to clinicians, giving patients real choices and control and focusing on outcomes - it had also heard "genuine and deep-seated concerns from NHS staff, patients and the public that must be addressed if the reforms are to be progressed," he added.
Among its 16 key recommendations, the Forum says that the pace of the proposed changes should be varied so that the NHS implements them only where it is ready, and the 2013 deadline for consortia to take over commissioning should be scrapped, allowing consortia to "take on their full range of responsibilities when they can demonstrate that they have the right skills, capacity and capability to do so."
The report also recommends that: - while the NHS should be freed from day-to-day political interference, the Secretary of State for Health should remain ultimately accountable for the Service; - nurses, specialist doctors and other clinicians as well as GPs must be involved in making local decisions about the commissioning of care, although care must be taken to avoid tokenism or the creation of a new bureaucracy; - private providers should not be allowed to "cherry pick" patients; and - the government must not seek to increase the role of the private sector as an end in itself.
The listening exercise and subsequent report generally have been generally welcomed, with NHS Confederation Mike Farrar stating that the Forum had "run an exemplary process" and that its report makes "big strides in the right direction."
The Confederation particularly welcomes the report's recommendations for: - clarity about “who is accountable for what;” - an "intelligent" approach to integration and competition rather than a one-size-fits-all system that risks fragmenting services; - and a "realistic timetable for transition, not a rushed approach that risks some parts of the NHS losing control of finances," he said.
The Royal College of Physicians (RCP) said it was pleased that the Forum has recommended multiprofessional involvement and an increased role for hospital doctors in commissioning, and also called for GPs to sit on the boards of foundation trusts, so that all doctors can work together to lead a health service in the bests interests of patients.
The report’s call for Monitor's role to be altered is also "a step in the right direction," said RCP president Sir Richard Thompson. The Bill "must clearly state that the primary focus of regulation is promoting integration, collaboration and quality, not promoting competition," he said, adding: "the RCP how waits to see how the government will reconcile choice and patient safety through the regulators - Monitor and the Care Quality Commission."
Dr Hamish Meldrum, chairman of council at the British Medical Association (BMA), said that the Forum's recommendations had addressed many of the BMA's key concerns, the listening exercise had been "a refreshing experience," and that it was "vital that this constructive approach is maintained in the following months as the detail is worked on."
If the government does accept the Forum's recommendations, this will produce, at the least, a dramatically different Bill and "one that would get us onto a much better track," said Dr Meldrum.
RCGP chair Dr Claire Gerada also said the College was "reassured that things are moving in the right direction" and "encouraged by the Forum's recommendations for the future role of Monitor in relation to competition," but she added that it still has a number of outstanding concerns.
For example, she said: "we need the government to reassure us that GPs will be given the freedom and autonomy to lead the decision-making and design of future integrated health systems, drawing on the support of other health, social care and third sector services."
"We support clinician-led commissioning but continue to believe that GPs are best placed to lead this process," said Dr Gerarda.
The King's Fund "strongly" welcomes the report, and if the government accepts its recommendations this will significantly improve the Bill, said Professor Chris Ham, the health policy think tank's chief executive.
• During the eight-week listening exercise, the Forum's 45 members had listened to over 6,700 people at more than 200 separate events, received over 25,000 emails, 2,400 comments on its website and 1,500 other electronic responses, "while 175 individuals and organisations have taken the time to post us their thoughts and responses," said Prof Field.