Regulators’ roles allow for gaps or duplication in monitoring NHS, say MPs

BMJ 2013; 346 doi: (Published 06 March 2013) Cite this as: BMJ 2013;346:f1490
  1. Adrian O’Dowd
  1. 1London

The parallel roles of the two main regulators of the NHS in England, the Care Quality Commission (CQC) and Monitor, are confusing and could cause gaps in regulation or duplication of work, MPs have warned.

The government should urgently clarify the roles of the regulators to avoid the dangers of confusion that played a part in the failures at Mid Staffordshire NHS Foundation Trust, said MPs on the parliamentary health select committee.

In its report, published on 5 March, the committee said that a review to clarify the roles of Monitor and the CQC was urgently needed before government changes to the NHS that were due to come into effect next month.1

Robert Francis QC’s report on the Mid Staffordshire trust, published last month,2 criticised the parallel roles of Monitor and CQC for creating opportunities for confusion, the committee said in its own report that was based on its recent inquiry into Monitor’s accountability.3

The MPs said that their own concerns of possible overlap still existed and had, in fact, grown, because the changes in the Health and Social Care Act 2012 that were about to come into force gave Monitor a more “complex and demanding remit” than before.

Under these changes Monitor’s remit would grow from being the independent regulator of NHS foundation trusts to a wider one as a “system regulator,” including working with the NHS Commissioning Board to provide independent pricing regulation of NHS services and dealing with anticompetitive behaviour that acted against patients’ interests.

The Health Committee’s chairman, Stephen Dorrell, the Conservative MP for Charnwood, said, “Our overall view of Monitor is that we 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 authorisation process which did not identify significant issues of care quality and patient safety.”4

The committee’s new report also raises specific concerns about Monitor’s expanded role. For example, it said that the proposal to use a combination of so called “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 was “profoundly unsatisfactory” because it was open ended and unclear.

In addition, Monitor’s role in relation to competition in the NHS was still unclear, said the MPs, despite the regulator’s new primary duty to “protect and promote the interests of people who use healthcare services.”

There was also a need to clarify the respective roles of Monitor and the Competition Commission in the market for health and care services.

Under the government’s changes to the NHS Monitor will have a new role, alongside the NHS Commissioning Board, in setting the tariff paid for certain NHS services, and the committee recommended that the regulator should use this power to encourage redesign of the system and more integration of services.


Cite this as: BMJ 2013;346:f1490