The NHS in 2013: the new leaders of healthcare – who are they?

Anthony Rowbottom

Clinical Current

This article is the second instalment in a series of updates from Clinical Current as they look ahead to when the Health and Social Care Act 2012 will transform the healthcare landscape from April 2013 onwards. This particular piece focuses on the people who will be leading the NHS, in particular the sector regulator – Monitor – and the Care Quality Commission (CQC).

(Continued from “The NHS in 2013: a review of 2012 and a look at the year ahead”)

Monitor

Dr David Bennett, Chair &amp, Chief Executive

A lot has been written about David Bennett, most notably his connections to McKinsey. Indeed, critics of the Health &amp, Social Care Act 2012 point towards McKinsey’s close relationship with several of the new NHS’s executive team as proof of plans to privatise the health service in future. A lot less has been written about how David Bennett &amp, Monitor aims to transform healthcare in England from April 2013 onwards.

Monitor is going to be the healthcare sector regulator – regulating all providers of publicly funded healthcare in England. This means it has a statutory duty to look after the interests of the people the NHS cares for: ensuring the healthcare services the NHS provides are efficient, safe, cost effective and constantly strive to improve the quality of care.

“Our job is to try and make the system work. I often say to people that we are there to help others deliver better services. We are clearly not delivering any services ourselves. We are trying to make sure the system is working well.”

David Bennett at the Annual Accountability Hearing with Monitor, October 2012.

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“Monitor is going to be the healthcare sector regulator – regulating all providers of publicly funded healthcare in England.”

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Monitor also has a duty to licence individual service providers across England alongside its role as a Foundation Trust regulator, which means it has to approve of any healthcare provider based on four key areas:

1 Pricing

2 Integrated care

3 Competition

4 Service continuity

Here is a brief video of David Bennett explaining Monitor’s role:

Whether or not Monitor will become a ‘toothless’ regulator is up for debate – it has the potential to become nothing more than an accounting organisation, rubber stamping commissioning decisions made elsewhere or becoming a lender of last resort rather than a proactive organisation influencing the direction of CCGs and the NHS as a whole. This depends, to some extent, on the ability of the NHS Commissioning Board to effectively support commissioning decisions made at the CCG level and also on the ability of CCGs to effectively work with local authorities (via the Health &amp, Wellbeing Board) to execute commissioning plans. If CCGs and the NHS Commissioning Board can effectively work together then Monitor’s role will be somewhat akin to that of OfCom or OfGem: merely regulating disputes. If however, the relationships between CCGs and the NHS Commissioning Board become strained or confrontational then Monitor has a crucial role as mediator and ‘service provider of last result’.

Care Quality Commission (CQC)

Preferred Candidate: David Prior, Chair

David Prior is an ex-Conservative MP for Norwich (1997-2001) and has recently given evidence to the Health Select Committee as part of the process of being nominated the Chair of the CQC. He has a long and varied career including training as a Barrister, working for British Steel and working for Norwich University Hospitals. It will be interesting to see how the CQC develops under his leadership, especially as in 2006 he was involved in a police fraud investigation looking into financial irregularities at Cawston Park Hospital in Norfolk.

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“Whether or not Monitor will become a ‘toothless’ regulator is up for debate…”

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The CQC’s new role will be to ascertain the quality and safety of care provided to patients in a variety of settings – be that home care, care in NHS hospitals, dentists, in ambulances and care homes. These standards are to be enforced nationally across the whole of England.

As of 2009, the CQC had replaced and consolidated several other agencies as an independent regulator of social care for adults in England. The standards it enforces nationally are rather vague but are achieved by 3 types of activity:

1 Using so called Quality &amp, Risk Profiles – a document or a series of documents outlining the risks each healthcare service provider faces and what are the acceptable tolerances of these risks

2 Each healthcare provider is also required to notify the CQC when an incident outside of risk tolerances happens

3 As the CQC also inspects a service provider, said provider may have to produce a Provider Compliance Assessment – a document which outlines details and responses to any evidence gathered by the CQC during an assessment

Using these tools, the CQC ensures each healthcare service provider is “treating patients with dignity &amp, respect, making sure food &amp, drink meet people’s needs, making sure that the environment is clean &amp, safe and staff are managed to adequate levels to ensure decent service levels”.

So far the CQC has been heavily criticised for not fulfilling its duties &amp, roles. Indeed, David Prior himself refers to this during his Pre-Appointment hearing:

“I have to establish myself as a very visible, hands on chairman of the organisation. The organisation needs some stability and strong leadership because it has gone through a troubled time … I would hope that by the end of March [2013] we will have a very clear strategy of where we are going and how we are going to do it.”

David Prior, December 2012.

Although this is a laudable goal, it is troubling that the CQC still doesn’t have a clearly defined strategy for how it is to achieve its objectives – especially given how close we are to April when it formally assumes all its new obligations, duties and responsibilities.

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“…it is troubling that the CQC still doesn’t have a clearly defined strategy for how it is to achieve its objectives…”

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Importantly for the pharmaceutical industry, the CQC sees the role of the patient being increasingly important for the UK’s healthcare system. In particular Healthwatch, the patient champion, is anticipated to play a very important role:

“I think Healthwatch is going to have a very important role to play…There has always been, traditionally, within the NHS, an attitude that when something goes wrong you bring up the drawbridge and close the shutters, and that has got to change. I think that CQC and Healthwatch will have a big impact on making sure that change is really embedded into the system.”

David Prior, December 2012, Pre-Appointment for Chair of the Care Quality Commission.

CCG Update

As of 10th December 2012, 34 out of 211 CCGs have been authorised by the NHS Commissioning Board. Of those now authorised, almost 1 in 4 of were approved without prior conditions. The others share common conditions yet to be authorised, most notable of which appears to be the lack of a credible integrated plan for improving care within a CCG (section 3.1.1B of the Application Guide). The 26 CCGs not authorised without prior conditions mainly have 1-4 outstanding issues. Of particular note however, are Bedfordshire, Reading and Wokingham CCGs who have 9, 14 and 8 outstanding conditions respectively to address.

There remains 177 CCGs to be authorised before April. If everything is to run according to plan for the new NHS then it will be important that a high proportion of these organisations have done the necessary preparatory work and can be authorised with little further work on their part.

The next article in this series will be published in early March.

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About the author:

Anthony is Head of Health &amp, Engagement at Clinical Current, a specialist health consultancy and technology business based in London.

Anthony joined Clinical Current at an early stage and helped launch the community, having a long history in healthcare: starting his working life at a small healthcare market research agency in Oxfordshire, then moving to London and finally joining Insight Research Group. Anthony has worked with numerous blue-chip pharmaceutical companies over the years and has previously been involved in successfully launching healthcare professional technology platforms.

Anthony is a keen cyclist and Germanophile – combining both, he is aiming to cycle from London to Berlin in 2013 and further afield in the near future. Anthony is also a lover of politics, both domestic and international … check out his Twitter feed in &amp, around BBC Question Time for some interesting debates!

Who will be 2013’s new leaders of healthcare, in your opinion?

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