In the new health system we work closely together because we can do a better job for people that way. The needs of patients and communities are more important than the boundaries between our organisations.
We will all put patients first. We will work hard to give people the information they need to make choices about their own care if they want to, and to help doctors and nurses to deliver the best results for them.
We will all use hard evidence to make the best possible decisions in patients' interests – decisions which drive improved quality and safety while making the best use of valuable public money so that it can stretch even further.
In line with the principles and values set out in the NHS Constitution, together we will make sure that the people who use NHS services, the organisations which provide them and the commissioners who buy them are able to focus on the quality, safety and viability of the services people depend on in times of need.
The Care Quality Commission (CQC) is responsible for safeguarding appropriate standards of quality and safety within health and social care in England.
The CQC registers, and therefore licences, all adult health and social care providers, including NHS foundation trusts, and monitors providers’ compliance with their registration requirements on an ongoing basis. If concerns are raised as to how a care provider is operating, there are a range of actions the CQC can take.
Monitor is also concerned about quality, but our role is different in that we focus specifically on ensuring that the boards of NHS foundation trusts are doing their jobs properly, on quality as well as finance.
Monitor and the CQC
Monitor and the CQC work closely together and have distinct but complementary roles. When we look at the leadership of an NHS foundation trust, we look particularly at whether it is meeting the required quality standards, as judged by the CQC, as well as looking at the foundation trust’s financial strength.
If the CQC has a concern about the quality of care being delivered at an NHS foundation trust, they will inform Monitor so we can work together to ensure that appropriate and joined-up regulatory action is taken. Likewise, if Monitor is made aware of any issues regarding the provision of healthcare by a foundation trust which we feel would help the CQC in its regulatory capacity, we will communicate this to them.
In the case of an NHS foundation trust failing to meet its CQC registration requirements, the CQC will liaise with Monitor and, taking account of our respective powers, we will work together to ensure these requirements are met.
The CQC and Monitor will also inform each other of any potential concerns regarding NHS trusts that are being assessed for NHS foundation trust status.
Together, Monitor and the CQC are committed to identifying where improvement is needed, and to ensuring that our approach is coordinated in order to deliver real benefits for patients, while not duplicating regulatory activity.
The Memorandum of Understanding between Monitor and the CQC describes in detail how the two organisations work together. We will shortly be updating this document to reflect the commencement of new powers given to us under the Health and Social Care Act 2012.
NHS England will set guidelines for local commissioners to ensure that a choice of NHS services is available to people where possible. Monitor will ensure that providers of NHS services give people the information they need to make their own choices about which service to use. Where Commissioners decide to make use of competition to increase quality and choice, Monitor will ensure that it operates fairly and in patients' interests.
Monitor and NHS England will also work together to ensure that the prices paid to providers of NHS services are designed in a way which drives improvements in quality and encourages them to deliver integrated services where that’s best for patients.
Close working between the two organisations will ensure that prices for services are fair and transparent, rewarding efficient providers.
The NHS Trust Development Authority will drive improvements in the quality and efficiency of NHS trusts, using rules which are consistent with Monitor’s rules for foundation trusts and other providers.
Trusts which reach the required standards can then apply to Monitor for foundation trust status, which gives them greater freedoms in how they run their business to achieve the best possible care for patients.
NICE will produce national guidance, standards and information to help health and social care professionals deliver the best possible care using the best available evidence. NHS England will use NICE standards and other evidence to ensure that the £85 billion that it and Clinical Commissioning Groups spend on health services is producing the best results for patients.
Monitor's ground rules for providers will ensure they use the resources for healthcare as effectively and efficiently as possible. NICE’s guidance and advice will also help commissioners and providers to do this by providing an evidence base for investment and disinvestment.
The National Quality Board is a multi-stakeholder board established to champion quality and ensure alignment in quality throughout the NHS. We are an active partner and are fully committed to the board's goals of driving forward the national quality agenda.
In January 2013 the National Quality Board published:
Past work with the National Quality Board
Our other work with the board has included active contributions to developing quality accounts, the implementation of better reporting on quality performance, the quality information strategy, the publication of Quality Governance in the NHS - a guide for provider boards, based on our Quality Governance Framework, the Review of Early Warning Systems and update Maintaining and improving quality during the transition: safety, effectiveness, experience (Part One ‐2011‐12) following the failings at Mid Staffordshire NHS Foundation Trust.
The Co-operation and Competition Panel (CCP) is currently an advisory panel to the Department of Health and Monitor. From April 2013 the CCP will be an integral part of Monitor.
The rules that currently govern co-operation and competition in the commissioning and provision of NHS services in England are set out in the Principles and Rules for Co-operation and Competition. While the substance of those rules will remain, from April 2013 the rules will be given a firmer statutory footing through the conditions of the provider licence and through secondary legislation imposing requirements on commissioners as to procurement, patient choice and competition. Monitor will have powers to enforce licence conditions and this secondary legislation imposing requirements on commissioners.
To enable Monitor to carry out our role relating to safeguarding choice and preventing anti-competitive behaviour which is against patients’ interests, we will have a co-operation and competition directorate. The Executive Director of Co-operation and Competition will be Catherine Davies, who is currently Director of the CCP. The CCP’s Panel members, Lord Carter of Coles (Chairman), Guy Beringer QC, Laura Carstensen, Dame Janet Husband, Peter Smith, John Swift QC and John Wotton will continue to provide independent advice to Monitor.
Currently where cases relate to NHS foundation trusts, the Panel will make an independent recommendation to Monitor (to the Department of Health in relation to other NHS providers and commissioners). Monitor’s Board will then decide what action it will take.
Monitor can also refer non-specific competition issues to the CCP for examination. Details of previous non-specific referrals are provided below.
Operation of 'any willing provider' for the provision of routine elective care under 'free choice'
Monitor and the Department of Health jointly asked the CCP to conduct a study into the operation of the ‘any willing provider’ model of choice in acute elective NHS-funded healthcare services in the context of the Principles and Rules for Cooperation and Competition (PRCC).
We asked the Panel to review the commissioning and contracting practices used by PCTs in regard to patients who are entitled to be offered a choice of provider for their first outpatient appointment. This followed concerns about alleged behaviour that is believed to be inconsistent with national policy on free choice of elective care and the PRCC.
The study has now been completed and the CCP published a final report in July 2011.
Report on NHS consultants' non-contracted hours restrictions
In 2008, Monitor and the Department of Health asked the CCP to carry out a study which examined restrictions on NHS consultants’ ability to work for alternative providers of NHS-funded services during their non-contracted hours. This followed concerns raised with both Monitor and the Department around whether these restrictions are preventing providers from offering new services, which could potentially have an adverse effect on patient choice and competition.
The CCP report finds that, in most cases, restrictions can be expected to have an adverse effect of patients and taxpayers. The CCP has set out two specific scenarios in which patient choice and competition would not be negatively impacted by restrictions being imposed: these relate to protecting patient safety and where consultants have a strategic role in a competing organisation.
The report offers clear guidance about the CCP’s views on compliance with the PRCC. NHS organisations, including foundation trusts should consider this guidance to inform their view on any restrictions they currently have in place.