2013 accountability hearing with Monitor - Health Committee Contents

1  Introduction

1. The Department of Health provides the following summary of Monitor's role and functions:

    Monitor is the sector regulator for health services in England. Its job is to protect and promote the interests of patients by ensuring that the whole sector works for their benefit.Monitor exercises a range of powers granted by Parliament which include setting and enforcing a framework of rules for providers and commissioners - implemented in part through licences it issues to NHS-funded providers.

    Monitor was originally established in 2004 but the regulatory landscape has changed significantly in the last twelve months and the Health and Social Care Act 2012 expanded the regulator's role considerably.From 1st April 2013 it has been Monitor's overarching responsibility to protect and promote the interests of patients by ensuring that the whole sector works for their benefit.In fulfilling its role Monitor is responsible for ensuring that:

    a.  public sector providers are well led and provide high quality care to their patients;

    b.  essential NHS services continue if a provider gets into difficulty;

    c.  the NHS payment system rewards quality and efficiency; and

    d.  choice and competition operate in the best interests of patients.[2]

2. In the Department of Health's view, Monitor is managing the transition to its new functions well:

    Over the last year, Monitor has undergone significant change to its role following the Health and Social Care Act 2012. Monitor has adapted well to this change, making good progress in authorising new FTs, ensuring the continuity of services in under-performing FTs, and by ensuring that its organisational capacity is stronger. The Department believes that Monitor is well placed to go from strength to strength as an effective regulator in the health and social care system.[3]

3. The Foundation Trust Network (FTN), the membership body for NHS acute hospitals, and community, mental health and ambulance services that treat NHS patients, states that "Monitor has made considerable progress in adapting to its new sector regulatory role, including successful introduction for FTs of the new licensing regime."[4]

4. However, as the Committee argued in its report of last year's accountability hearing, Monitor's role remains complex and demanding[5]; the British Medical Association (BMA) have echoed this warning, describing Monitor's role as "exceptionally challenging".[6]

5. Against this background, the Committee held its annual accountability hearing with Monitor on 26th November 2013. This is the third such accountability hearing the Committee has held with Monitor in this Parliament. The Committee took oral evidence from Dr David Bennett, at the time Monitor's Chair and Chief Executive; Stephen Hay, Managing Director of Provider Regulation; and Adrian Masters, Managing Director of Sector Development. The Committee received nine submissions of written evidence. In addition, this inquiry has been informed by some of the oral and written evidence submitted to the Committee's other recent inquiries, including its inquiries into the Implementation of the Health and Social Care Act 2012 and into Public Expenditure; and its annual accountability hearing with the Care Quality Commission (CQC).

6. One of the Committee's roles is to hold pre-appointment hearings in connection with appointments to the Chairs of relevant non-departmental public bodies. On 10th October 2013, the Secretary of State informed the Committee that the Government's preferred candidate for the post of Chair of Monitor was Dominic Dodd, and the Committee held a pre-appointment hearing on 15th October 2013. The Committee did not endorse Mr Dodd's appointment, and Mr Dodd subsequently withdrew from the selection process. Baroness Hanham has now been appointed as Interim Chair of Monitor, and the Secretary of State has informed the Committee that the Department will advertise for a new Chair by the autumn. The Committee will hold a pre-appointment hearing once a preferred candidate has been selected.

2   Department of Health (AMO 0002), paras 3 - 4  Back

3   Department of Health (AMO 0002), para 36 Back

4   Foundation Trust Network (AMO 0007), Summary Back

5   Health Committee, Tenth Report of Session 2012-13, 2012 Accountability Hearing with Monitor, para 5 Back

6   British Medical Association (AMO 0003),para 1 Back

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Prepared 26 March 2014