Health commissioning blog


September 30, 2014 1:59 PM | Posted by Elsegood, Simon | Permalink

Earlier this month Monitor published its guidelines for providers of NHS-funded services on how Monitor will apply the patient choice and competition rules. These can be found here. Monitor has also published some helpful hypothetical scenarios showing how it applies this guidance, which can be found here. The scenarios cover market sharing, price fixing, bid rigging, other types of anti-competitive agreements, abuse of dominance and integrated care.

In summary, arrangements between providers (and possibly commissioners) that are on the face of it anti-competitive may nonetheless be permitted if they improve the provision of healthcare services, are necessary for that improvement and do allow the elimination of competition for the provision of those services. In other words, they will be allowed if they are necessary for the provision of better services to patients. Monitor and the Competition & Markets Authority (the CMA) enforce competition law in the healthcare sector. In particular Monitor advises the CMA on patient benefits. Therefore it is important for providers to understand this guidance. Also a provider’s NHS provider licence requires that it complies with the principles of the law prohibiting anti-competitive agreements, and compliance with this licence is regulated by Monitor.

September 30, 2014 10:53 AM | Posted by Richards, Tania | Permalink

Any of you taking a peek at the draft new UK Public Procurement Regulations for implementing the new EU Public Procurement Directive, which were published for consultation by the Cabinet Office on Friday 19 September will note there’s some extra breathing space for NHS commissioners in the form of a delayed effective date.

The light touch regime under the new Public Contract Regulations 2015 will not apply to the procurement of contracts for NHS health care services falling within the scope of the NHS (Procurement, Patient Choice and Competition) (No 2) Regulations 2013 (PPCCR) until the later date of 18 April 2016.

The light touch regime replaces the current Part B Services regime that applies alongside the PCCR 2013.

In short, CCGs and NHS England will continue to follow the existing Part B Services regime and the PPCCR until 18 April 2016. Thereafter, the light touch regime for health and social services under the new Directive will replace the existing Part B services regime and will apply in addition to the continued application of the PPCCR.

We understand that practical guidance on the light touch regime will be published shortly.
Anyone wishing to respond to the Cabinet Office consultation has a relatively short period of time in which to do so as the consultation ends on 17 October 2014. These can be found on the gov.uk website.

September 26, 2014 11:23 AM | Posted by Grey, Philip | Permalink

There will be very few readers who don't have some involvement in reconfigurations and the necessary consultation exercises. There has been a run of court cases in recent years, in healthcare and other sectors, where the fairness and lawfulness of consultations have been challenged. We have already commented on many of these. Even those cases that don't involve the NHS provide valuable lessons for how to protect your own processes from legal challenge.

The latest judgment concerns the reorganisation of criminal legal aid by the Ministry of Justice ("MoJ"). In the case of London Criminal Law Solicitors Association and Criminal Law Solicitors Association -v- The Lord Chancellor, the High Court has ruled that an MoJ consultation was unfair and quashed the resulting decisions.

A couple of statistics serve to illustrate the controversial nature of the proposed changes:

• an immediate fee cut of 8.75% followed by a further 8.75% cut next year;
• a proposal to offer 525 contracts for legal aid work, when currently 1600 firms provide such work.

The announcement of these changes followed a consultation process, in which the criminal solicitors profession was asked to respond to a wide range of questions. The profession's representative bodies had commissioned independent research into issues relating to capability and capacity within the legal aid market. They argued that solicitors responding to the consultation would be doing so "in the dark" without the benefit of the research and asked for a delay in the process for that research to be completed. The MoJ refused this request. As well as this, the professions did not have available to them (and were not even made aware of) a report from KPMG, which was completed after the conclusion of the consultation and largely informed the MoJ's decisions. Having seen that report, the claimants argued that the assumptions made in it were flawed, or at least open to challenge. They argued that the opportunity should have been given to consultees to see and comment on this report.

The Court agreed with those submissions, but considered with some care the degree of unfairness required before it should interfere and rule a consultation unlawful. The judge was greatly influenced by the enormous impact that the changes would have on many firms and individuals, stating: "The impact of a decision is a material factor in deciding what fairness demands or requires in any particular case." He approved an earlier judgment which stated: "Sufficient information to enable an intelligent response requires the consultee to know not just what the proposal is in whatever detail is necessary, but also the factors likely to be of substantial importance to the decision, or the basis on which the decision is likely to be taken."

The lesson of the case is this: commissioners need to consider with care the level of background detail they are required to disclose as part of any consultation exercise. You do not have to automatically disclose all of the reports and analysis you obtain, but you should carefully consider if not doing so could be considered unfair. This is a judgment that needs to be made on a case by case basis and, if finely balanced, you should seek advice.

September 19, 2014 3:17 PM | Posted by Fawlk, Catherine | Permalink

The Legislative Reform (Clinical Commissioning Groups) Order 2014 amends the NHS Act 2006 (2006 Act) so that from 1 October 2014:

(a) two or more Clinical Commissioning Groups (CCGs) will be able to form joint committees to exercise any of their commissioning functions jointly; and

(b) one or more CCGs and NHS England will be able to form joint committees to exercise the functions of a CCG.

CCGs being able to form joint committees

Currently although the 2006 Act allows CCGs to exercise their commissioning functions jointly, there is no provision in the 2006 Act to enable CCGs to exercise functions jointly by means of a joint committee. This means that CCGs are unable to set up a binding joint decision making body. CCGs who want to exercise their functions jointly have been creating “committees in common” to exercise their functions jointly. But as such committees do not have the authority to make decisions, CCG representatives sitting on them need to go back to the CCG appointing them for separate ratifications of matters discussed at the committee.

The inability of CCGs to form joint committees has created practical problems for CCGs when working together when jointly commissioning services and in areas such as continuing healthcare.

CCG/(s) and NHS England forming joint committees to jointly exercise functions of a CCG/(s)

Currently under the 2006 Act, NHS England may, at the request of a CCG/CCGs, exercise any of the CCG/(s) functions where requested by the CCG/(s).

The 2006 Act does not currently provide for a CCG/(s) and NHS England to create a joint committee to carry out CCG functions jointly. Paradoxically the 2006 Act does allow NHS England to form a joint committee with a range of other bodies (including CCGs) for the exercise of its functions.

Joint committees between CCGs and NHS England for the exercise of CCGs’ functions could be used to assist in joint decision making when there is a need to reconfigure services that cut across both NHS England and CCG commissioned services.

Allowing CCGs to create a joint decision making body either with other CCGs or NHS England will remove administrative burdens, allow CCGs greater flexibility in their commissioning arrangements, in discharging their functions and allow them to operate more efficiently and effectively in the future.

September 15, 2014 3:39 PM | Posted by Richard, Tania | Permalink

A National Audit Office (NAO) report, Funding healthcare: Making allocations to local areas looks at how the Department of Health (DH) and NHS England (NHSE) allocate funds to local commissioners of healthcare. Since the reforms to the health system in 2013 the three groups of commissioners (clinical commissioning groups (CCGs), NHS England area teams and local authorities) receive separate funding allocations to commission services for their local populations.

The audit finds a ‘wide variation’ in the allocation of £79 billion in central funding to local commissioners which in 2014-15 terms is equivalent to £1,400 per person.

According to the report the distribution of resources to local commissioners differs from their target funding allocations which are based on relative need. In 2014-15 over three-quarters of the local authorities and nearly two-fifths of CCGs are more than five percentage points above or below their fair share of funding per person. As an example, funding for CCGs ranges from £137 per person below target to £361 per person above target.

The report says that whilst the approach to resource allocation is ‘generally sound’ the challenging financial environment has made it difficult for the DH and NHSE to achieve a balance of fairness and financial stability in allocating funding.

Commenting on the report Amyas Morse, head of the National Audit Office says:

“Funding allocations have reflected, among other factors, a desire not to upset local health economies by taking funding away or even by increasing it by less than inflation. This has significantly slowed progress towards a fair distribution where funding fully reflects need across the country. The Department and NHS England need to consider carefully whether this approach is fast-moving enough to sustain hard-pressed local areas in the next few years.”

August 19, 2014 3:41 PM | Posted by Shah, Surbhi | Permalink
The Court of Appeal has given judgment in the case of Hainsworth v Ministry of Defence . While not an NHS specific case, it provides helpful clarification regarding the limits of the law on reasonable adjustments.
Mrs Hainsworth was a civilian employee of the British armed forces, based in Germany. She was not disabled, but her daughter has Down's syndrome. Mrs Hainsworth requested a transfer to the UK so that her daughter could attend specialist education and training facilities. Her request was refused. She brought a claim alleging that this refusal amounted to a breach of her employer’s duty to make reasonable adjustments.
The question for consideration was whether the duty to make reasonable adjustments extended to disabled persons associated with the employee. The court rejected Mrs Hainsworth’s appeal. They found that the wording of the Equality Act 2010 and Article 5 Equal Treatment Framework Directive  (© European Union, http://eurlex.europa.eu/1998-2014 ) is clear in that their provisions only apply to reasonable adjustments for the assistance
of disabled employees or prospective employees. The court said that any attempt to stretch this to cover a disabled person associated with an employee is "doomed to failure".
August 14, 2014 7:42 PM | Posted by Richards, Tania | Permalink

What does Rose v Thanet Clinical Commissioning Group tell us about the status of NICE guidelines in priority setting? Healthcare lawyer Jane Williams looks at Rose where the Administrative Court considered whether a CCG had acted unlawfully in failing to implement National Institute for Health and Care Excellence guidance even though it was under no statutory obligation to do so.  Read Jane’s briefing.

If your CCG has any queries on priority setting, policies or individual funding requests please do not hesitate to contact Jane Williams.

August 8, 2014 9:58 AM | Posted by Elsegood, Simon | Permalink

This week the final stage of the procurement process for the Lead Provider Framework for quality assessing providers of CSS was launched. NHS England has announced the 16 bidders who have made it through to the final assessment stage for a place on the Framework to offer end-to-end commissioning support services.

Due to launch in January 2015, the Lead Provider Framework will provide clinical commissioning groups with a small number of NHS- accredited firms they can use to run their commissioning process.

Nine of the successful bidders for end-to-end support services were commissioning support units (CSUs) and seven were non-NHS organisations that include a mixture of local authorities and private firms.

August 8, 2014 9:56 AM | Posted by Richards, Tania | Permalink

NHS bodies face escalating demand for services, increasing scrutiny of quality and flatline funding. From reviews of acute, community and mental health services to proposals to relocate or close a single service, clinical commissioning groups, trusts and foundation trusts are making daily decisions about which services to continue, which to commission and which to stop. 

Regulatory healthcare lawyer Philip Grey offers some practical tips for an effective, lawful consultation process in his National Health Executive article: Think before you speak: How to involve the public effectively when reconfiguring NHS services.  You can view Philip’s piece on the National Health Executive’s website.

Mills & Reeve has extensive experience of providing service reconfiguration advice. We can advise NHS bodies on: when they must consult the public, how they go about doing it and how they can protect themselves from legal challenge.  

If you have any questions on reconfiguring NHS services please do not hesitate to contact Philip Grey.

August 8, 2014 9:53 AM | Posted by Richards, Tania | Permalink

A current hot topic is the statutory duty of candour which requires providers of health or social care to voluntarily “open up” about mistakes and failures. The duty will be introduced in October 2014. It will place a formal requirement on providers of health or social care to be open with their patients when they suffer harm related to care or treatment . Read our two-page briefing on the Government's proposals.  If you have any queries on the duty of candour please do not hesitate to contact Duncan Astill or Jill Mason.

July 24, 2014 2:30 PM | Posted by Fawlk, Catherine | Permalink

On 15th July 2014, the Ministry of Justice announced that the Information Commissioner’s Office (“ICO”) is to be given new powers by the end of the year to carry out compulsory data protection audits of public NHS bodies.

The ICO can already carry out consensual audits of NHS bodies, but has long argued that simply relying on organisations to agree to an audit is not sufficient to address the significant compliance problems within the NHS.

At present even after compulsory audits have been initiated by the ICO serving “an assessment notice” data controllers can still agree to consensual audits. According to the Ministry of Justice, no assessment notices have yet been served because all those who fall within the scope of the existing compulsory audit powers have agreed to an audit when asked to do so by the ICO.  This means that the mere existence of the power of compulsory audit has been enough to secure compliance.

This is also the way in which the ICO envisages using the new powers when introduced. Compulsory audits will only be carried out when a data controller has failed to respond to a request for a consensual audit or has refused consent without adequate reason. In addition, NHS bodies will be audited by the ICO when identified on a risk assessment basis.

What is the aim of compulsory audits?

Compulsory audit of NHS bodies is intended to allow the ICO to review their processes, policies and procedures to ensure compliance with the data protection principles.  The proposed power is not intended to be used for the investigation of individual breaches of the DPA.

What will it mean for NHS bodies?

The power would require NHS bodies to allow the ICO to enter their premises, direct the ICO to documents of a specified description, assist the ICO to view information using equipment on the premises and permit the ICO to observe the processing of any personal data which takes places on the premises.

The ICO have said that visits would not be unannounced and that it would conduct as much of the audit as possible off site in order that time on site would be limited to a maximum of three days.

The ICO would try to conduct a consensual audit in the first instance. 

More work for NHS bodies?

The ICO has responded to concerns that compulsory audits would place additional burdens on an already heavily regulated sector by stating that it is working closely with the Health and Social Care Information Centre in the development of the IG Toolkit to ensure that there is minimal duplication. The ICO has also stated that it is aware of the CQC Essential Standards and will continue to review its own procedures to ensure that they are consistent.

Who will the new power apply to?

The new power, when it is introduced, will extend to all those NHS bodies that are currently subject to the freedom of information legislation:  namely, public sector providers of NHS services such as NHS Foundation Trusts, GP practices, Clinical Commissioning Groups and the Health and Social Care Information Centre.  It will not initially extend to cover private and third sector providers of NHS services, although this will be kept under review.

It is hard to see private and third sector providers should be treated differently, when they operate in the same market, handle sensitive personal data that has the potential to cause real damage and harm if not processed in accordance with the DPA, and are also already required to comply with the DPA.

The new power - a good thing?

The new power seems to be a new tool in the ICO’s toolkit to encourage NHS bodies to ensure that their processes, policies and procedures comply with the data protection principles rather than a means of unearthing and enforcing breaches of the DPA.  As  a backstop for encouraging NHS bodies to get their DPA house in order, this must be a good thing. But surely a good thing that should apply to all providers of NHS services not just NHS bodies.

The Ministry of Justice consultation outcome:  Extension of the Information Commissioner’s powers under the Data Protection Act 1998

https://www.gov.uk/government/consultations/extension-of-the-information-commissioner-s-powers-under-the-data-protection-act-1998

July 24, 2014 2:30 PM | Posted by Fawlk, Catherine | Permalink

On 15th July 2014, the Ministry of Justice announced that the Information Commissioner’s Office (“ICO”) is to be given new powers by the end of the year to carry out compulsory data protection audits of public NHS bodies.

The ICO can already carry out consensual audits of NHS bodies, but has long argued that simply relying on organisations to agree to an audit is not sufficient to address the significant compliance problems within the NHS.

At present even after compulsory audits have been initiated by the ICO serving “an assessment notice” data controllers can still agree to consensual audits. According to the Ministry of Justice, no assessment notices have yet been served because all those who fall within the scope of the existing compulsory audit powers have agreed to an audit when asked to do so by the ICO.  This means that the mere existence of the power of compulsory audit has been enough to secure compliance.

This is also the way in which the ICO envisages using the new powers when introduced. Compulsory audits will only be carried out when a data controller has failed to respond to a request for a consensual audit or has refused consent without adequate reason. In addition, NHS bodies will be audited by the ICO when identified on a risk assessment basis.

What is the aim of compulsory audits?

Compulsory audit of NHS bodies is intended to allow the ICO to review their processes, policies and procedures to ensure compliance with the data protection principles.  The proposed power is not intended to be used for the investigation of individual breaches of the DPA.

What will it mean for NHS bodies?

The power would require NHS bodies to allow the ICO to enter their premises, direct the ICO to documents of a specified description, assist the ICO to view information using equipment on the premises and permit the ICO to observe the processing of any personal data which takes places on the premises.

The ICO have said that visits would not be unannounced and that it would conduct as much of the audit as possible off site in order that time on site would be limited to a maximum of three days.

The ICO would try to conduct a consensual audit in the first instance. 

More work for NHS bodies?

The ICO has responded to concerns that compulsory audits would place additional burdens on an already heavily regulated sector by stating that it is working closely with the Health and Social Care Information Centre in the development of the IG Toolkit to ensure that there is minimal duplication. The ICO has also stated that it is aware of the CQC Essential Standards and will continue to review its own procedures to ensure that they are consistent.

Who will the new power apply to?

The new power, when it is introduced, will extend to all those NHS bodies that are currently subject to the freedom of information legislation:  namely, public sector providers of NHS services such as NHS Foundation Trusts, GP practices, Clinical Commissioning Groups and the Health and Social Care Information Centre.  It will not initially extend to cover private and third sector providers of NHS services, although this will be kept under review.

It is hard to see private and third sector providers should be treated differently, when they operate in the same market, handle sensitive personal data that has the potential to cause real damage and harm if not processed in accordance with the DPA, and are also already required to comply with the DPA.

The new power - a good thing?

The new power seems to be a new tool in the ICO’s toolkit to encourage NHS bodies to ensure that their processes, policies and procedures comply with the data protection principles rather than a means of unearthing and enforcing breaches of the DPA.  As  a backstop for encouraging NHS bodies to get their DPA house in order, this must be a good thing. But surely a good thing that should apply to all providers of NHS services not just NHS bodies.

The Ministry of Justice consultation outcome:  Extension of the Information Commissioner’s powers under the Data Protection Act 1998

https://www.gov.uk/government/consultations/extension-of-the-information-commissioner-s-powers-under-the-data-protection-act-1998

July 17, 2014 9:51 AM | Posted by Shah, Surbhi | Permalink

The Information Commissioner's Office (ICO) has published new guidance on what employers need to do to comply with the Data Protection Act 1998 (DPA) when disclosing personal information about their employees under TUPE.

The guidance aims to help employers understand their obligations and also provides a list of good practice tips.

TUPE requires that the new employer is provided with specific information about transferring employees by the old employer before a transfer takes place. The DPA permits these disclosures because they are required by law.

The guidance states that, wherever possible, personal information should be anonymised. At the very least, obvious identifiers such as names should be removed. This extra information should only be disclosed with the employee’s consent, or if appropriate safeguards have been put in place.

The guidance provides that employee’s employment records can be given to the new employer without the employee’s consent, provided they are necessary for the purpose of the transfer and the business needs of both parties. Any unnecessary information should be deleted or destroyed securely before the files are given to the new employer.

The former employer can keep some personal information about former employees, as long as there is a justifiable need to do so and it is only kept for as long as necessary. Any information the former employer does not need to keep should be deleted or destroyed securely.

The guidance also provides a list of good practice tips. These include:

  • Thinking about data protection early in the TUPE process
  • Agreeing what information is to be transferred well before the transfer takes place
  • Telling employees that information concerning them is being passed to the new employer
July 11, 2014 10:51 AM | Posted by Elsegood, Simon | Permalink
NHS England has updated the model terms and conditions for CCGs to use for commissioning support services following a Francis Report recommendation that the NHS Constitution should be explicitly included. An additional principle at clause 2.1.11 now includes: “The Parties must abide by and promote awareness of the NHS Constitution, including the rights and pledges set out in it. The Provider must ensure that all Sub-Contractors and all Staff abide by the NHS Constitution.” The model terms can be found from NHS England’s 3 July bulletin for CCGs here: [http://www.england.nhs.uk/2014/07/03/bulletin-for-ccgs-issue-62-03-july-2014/#ccg7 ]



Even though this clause is for the model terms and conditions, which are not compulsory for CCGs to use, in the light of the Francis Report it is sensible for a similar clause to be included in any terms that CCGs have with CSUs and any other provider. If the terms are already signed, this clause can usually be incorporated into the terms by a simple letter of variation signed by both parties.
July 8, 2014 12:29 PM | Posted by Durham, Chris | Permalink

The Health Service Journal reports that there appears to have been a good response to NHS England’s request for submissions of expressions of interest for taking on enhanced powers and responsibilities to co-commission primary care (as reported by Phil Grey in his blog on 9 May 2014). It suggests up to 180 of the 211 CCGs invited to respond have expressed an interest (although these are not confirmed figures).

Despite the seeming popularity amongst CCGs, the plans appear to have generated mixed reviews among the wider health sector. The HSJ notes opposition from the BMA and other senior health leaders.

The most obvious issue raised by NHS England’s proposal is that of the potential for conflicts of interests with GPs involved in both the commissioning and delivery of primary care services.  

We know from experience that conflicts of interest are an aspect of commissioning that have caused concerns for a number of our CCG clients. However, conflicts of interest can be managed and there is guidance issued by NHS England to assist commissioners together with a code of conduct designed to deal specifically with scenarios where GPs could be potential providers of services commissioned by a CCG.

It will be interesting to see the detail of NHS England’s proposals for how it plans to implement co-commissioning and whether any additional updates to this guidance will be required to help CCGs avoid conflicts in this situation.    

--------------------------

Links to guidance:

http://www.england.nhs.uk/wp-content/uploads/2013/04/ccg-conflict-int-guide.pdf

http://www.england.nhs.uk/wp-content/uploads/2012/09/c-of-c-conflicts-of-interest.pdf

June 26, 2014 1:36 PM | Posted by Richards, Tania | Permalink

The latest CCG bulletin from NHS England includes a guide to Ethical Procurement for GPs and Clinical Commissioning Groups published by the British Medical Association (BMA) in collaboration with the Royal College of General Practitioners (RCGP). It aims to encourage commissioners to consider the wider impact of procurement decisions beyond their local populations.

Currently CCGs have to demonstrate a commitment to sustainability as part of the authorisation process. NHS England’s guide to Clinical Commissioning Group Authorisation: Guide for applicants includes a self certification process to demonstrate commitment to sustainability. The ethical agenda would appear to fit well with a CCGs’ sustainability duty.

The BMA’s guidance suggests ways in which CCGs can introduce ethical and sustainable criteria into commissioning and procurement policies.
CCGs may wish to consider :

  • Achieving a formal consensus at board level to support ethical procurement. This has been done by the City and Hackney CCG, London.
  • Giving a member of the CCG responsibility for ethical procurement.
  • Asking providers during the tendering process to show what they are doing to ensure labour standards in the supply chain of their goods.

For more information on ethical procurement in medical supply chains, please go to the BMA’s web page.

June 12, 2014 2:31 PM | Posted by Richards, Tania | Permalink

In a new piece, Gayle Curry partner, commercial health considers how health commissioners can deliver change in a difficult financial environment and avoid legal challenge.  She highlights seven areas for commissioners to focus on – from compliant public consultations to choosing the best procurement process.  Read Gayle’s piece in our conference bulletin for NHS Confed 2014

If you require further information, please contact Gayle Curry.

June 12, 2014 10:44 AM | Posted by Richards, Tania | Permalink

It is over a year since CCGs became responsible for purchasing the majority of care provided to local populations.  Many are now planning to commission in a radically different way in order to deliver outcomes-focused care for the population and to meet financial challenges.  But how do you achieve the best results and avoid the legal pitfalls ?

Primary Care Commissioning and Mills & Reeve have designed a workshop: Managing Commissioning Risk to look at both corporate and individual accountability of CCGs.  It will help you to understand your responsibilities, put them in context within the healthcare environment and know what that means on the ground when making commissioning decisions.

To find out more information about this workshop please go to PCC’s events webpage.

June 12, 2014 10:40 AM | Posted by Elsegood, Simon | Permalink
At the recent NHS Confederation conference in Liverpool, Simon Stevens, CEO of NHS England said new local models for care delivery could see GPs, hospitals and social services form new joint provider groups. But Mr Stevens is not proposing another round of wholesale reform of the NHS. Instead he emphasises that this proposals are very much "horses for courses".

In a wide ranging speech, one of the questions Mr Stevens asked was "And what if in a few parts of the country – rather than perpetuate the increasingly arbitrary boundary between GP and community-based care on the one hand, and hospital-based outpatient, diagnostic and even some inpatient care on the other – these health professionals and perhaps even social services wanted to form new multispecialty provider groups? Perhaps taking delegated multiyear budgets to manage defined populations, while committing to use the dividend from more efficient team working to put the local NHS on a sustainable financial trajectory?"

The full text of Mr Stevens's speech can be found here: http://www.england.nhs.uk/2014/06/04/simon-stevens-speech-confed/
June 5, 2014 2:27 PM | Posted by Paterson, Melissa | Permalink

Monitor’s latest guidance on integrated care looks at how healthcare providers and commissioners can enable better integration of care so services are less fragmented and easier for patients to access.

Monitor as the health sector regulator has a legal duty to consider how it can enable integrated care where this improves the quality, outcomes or efficiency of services or reduces inequalities of access or outcomes. The regulator has various powers that help it to:

  • remove barriers
  • consider how to enable integrated care provision including stopping things that block it
  • actively support the sector

But what about competition and integration - Monitor’s view is that “competition and integration are not mutually exclusive and that competition does not and should not have to come at the expense of beneficial co-ordination.”

In collaboration with national partners, Monitor aims to support and create the conditions for person–centred, co-ordinated care.  That said, it will be for commissioners working with local healthcare providers to develop and fund better integrated care patterns for their local populations. 

As for healthcare providers, Monitor’s NHS provider licence includes an Integrated Care Condition which enables the regulator to take action if integrated care is not being delivered.  The condition provides that NHS provider licence holders should not do anything that might be “detrimental” to enabling integrated care.   

In short, Monitor’s guidance sets a clear direction on integrated care and sends a strong message to commissioners and providers of healthcare that integrated care and support is an important issue and will remain so.

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