The Health and Social Care Act (2012) sets out an explicit focus on the importance of integrated care. Monitor will be required to support the delivery of integrated services for patients where this would improve quality of care or improve efficiency.
More consistent, co-ordinated and comprehensive care is especially important for groups such as the elderly, who may need continuous care or have long-term conditions and need to be in contact with a range of health and social care professionals. It is also important for those using specialist services – for example, cardiac and cancer care, and for those with long-term conditions like diabetes or asthma. In any of these areas, care will currently often be delivered by multiple providers. This creates a real risk that the care will be fragmented and that one provider will not always know what another provider has done. The consequence is that a patient, at a time of considerable personal stress, will have to work out how and when to deal with different providers for different elements of their care. On top of the damaging impact on the patient, this can also lead to wasted time and money for the health service.
Monitor will have a duty to consider how it can enable or facilitate integrated care. While it will be for commissioners, working with local providers, to develop and fund better and more integrated patterns of care, Monitor’s role as the sector regulator will be to work with others, particularly commissioners, to remove any barriers and consider how to enable integrated care provision where this is in the interests of patients.
Monitor has always been clear that we support better integration of health services where this is of benefit to patients. We believe that there are significant opportunities to promote the interests of patients through the integration of care and are fully supportive of any changes to the reforms that make this clear and help us to make this happen. It is our view that competition and co-operation are not mutually exclusive and that competition does not and should not have to come at the expense of beneficial co-operation.
One area of the Bill which received a significant amount of attention during its passage through Parliament is competition. There were concerns that Monitor would pursue competition as an end in itself. It was never Monitor’s intention to do this and the Government amended the Bill during its passage through Parliament, to provide reassurance on this point, a move which we welcome.
While the Bill initially proposed that Monitor should have a role in promoting competition in healthcare, under the Act Monitor’s role will focus on making sure that competition is fair and that it operates in the interests of patients. To carry this out, we will have the power to impose licence conditions to prevent anti-competitive behaviour. However, it is also important that the patient’s ability to choose must be protected wherever this is appropriate and Monitor will have a key role in making sure that the players within the sector work together to give patients choices about their health care. This means that we will look to tackle specific abuses and restrictions that act against patients' interests, ensuring, amongst other things, that there is a level playing field for all providers. The amendments made to the Bill make it clearer that competition is a means to an end and not an end in itself and aim to ensure that sector specific knowledge is used when considering cases in healthcare.
If you have any questions about the above areas of Monitor's new role, please contact Jessica Dahlstrom at Monitor.