Written evidence from UNISON (MON 05)|
1.1 UNISON is the largest public sector union
with over 1.4 million members working across a range of public
services that help and care for the most vulnerable in our society.
In the health service, UNISON has 450,000 members employed across
the NHS. We are pleased to have the opportunity to make a submission
to the Health Committee in relation to its scrutiny of Monitor.
1.2 As a leading voice for health and social
care staff, UNISON is instrumental in influencing policy at regional,
national and international level. We work collaboratively with
Government and other UK and international unions on health and
social care issues, including areas of practice and care. UNISON
also works closely with each of the health regulators to establish
standards and policies in education and patient care. UNISON is
a diverse organisation, enabling us to have a broad perspective
of health and social care services. We are a key stakeholder and
value the opportunity to participate in any attempts to improve
patient care and public protection.
1.3 We hope that the Health Committee will take
into account the weight of UNISON's views. We have sought to include
information which we believe the committee will find helpful.
2. UNISON COMMENT
2.1 UNISON has serious concerns over the potential
conflict of interest between the roles of Monitor and the Care
Quality Commission (CQC). We believe there to be an inherent contradiction
between the business model of Monitor and the quality care model
of the CQC.
2.2 With the increased powers for Monitor proposed
in the Health and Social Care Bill we believe this contradiction
will increase further. In promoting competition and price driving
service provision rather than quality we see that situations will
arise where CQC and Monitor are in conflict with each other.
2.3 For example how would Monitor deal with a
situation where a Trust's business plan was either just breaking
even or in need of some remedial action based on the performance
indicators set by Monitor yet the CQC's assessment identifies
a need for investment to improve quality standards. Any further
investment by the Trust could worsen the performance indicators
set by Monitor and potentially warrant increased intervention
yet by such investment could get a clean bill of health from CQC.
How would Monitor resolve such conflicts?
2.4 Arguing that the market can provide solutions
we believe does not hold water as evidenced by the introduction
of competition and private contractors in the 1980's into cleaning
in the NHS with price being the driving factor and the resultant
reduction in quality and increase in hospital infection.
2.5 David Bennett, Chair of Monitor, has likened
the NHS to utility companies and argued that it was ripe for dismemberment
following the lead of the privatised utilities and railways. UNISON
has real concerns over the "level playing field" that
lays ahead for NHS Trusts when Mr Bennett clearly sees plurality
of provider and competition as the means of providing NHS services.
How does this sit with the provision of quality care?
2.6 We would argue that this view is further
compounded by Mr Bennett quoted in the Times
as saying: "I think over time an amount of price competition
will be appropriate,"
"The question for us is,
would we seek to force a degree of price competition? And we would
have to be very careful about doing that because there is a risk
2.7 So risk to quality is clearly an issue and
as stated earlier allowing competition and price to be the driving
factors for services leads to reduced quality of service and increased
risk to patient safety.
2.8 As a regulator what guarantees can Monitor
provide to ensure that quality will take precedence over cost
when its overall aim is focused on a business model and competition?
How will Monitor use regulation to enforce quality over cost within
2.9 We believe using a business model, competition
and price as the driving force for determining the provision of
NHS services is too great a risk to quality care and patient safety.
Light touch regulation further increases those risks. Evidence
such as Mid-Staffs shows that organisations focusing on achieving
their business plan and seeking to achieve Foundation status lose
sight of quality and results in compromised care and patient safety.
2.10 Even with Monitor taking on board the recommendations
of the Mid-Staffs enquiry earlier intervention still poses significant
risks when competition and price is the prime driver for NHS services
and quality secondary.
2.11 Since the Health Select Committee commenced
the evidence session, the Future Forum reports have been published
and on Monday the Department of Health (England) published the
government response to this. However whilst the language has changed
in relation to the role of Monitor we do not believe the over
riding policy has changed and therefore remain concerned about
the role of Monitor and its interface with the CQC.
2.12 We believe also there may be further valuable
lessons to be gained from Robert Francis once the Mid Staffordshire
inquiry has concluded. In particular the conflict of external
regulation, and the implication of managing differing priorities
relating to these reporting structures. Robert Francis said in
his earlier report "if there is one lesson to be learnt,
I suggest it is that people must always come before numbers"
30 In need of a spoonful of competition to revitalise
NHS-The Times 25 February 2011. Back
Independent Inquiry into care provided by Mid Staffordshire NHS
Foundation Trust January 2005 to March 2009 Volume 1, Robert Francis
QC, London:The Stationery Office, February 2010. Back