Monitor faces a “considerable” risk of failing in its role as an economic regulator and is too vulnerable to interference by ministers, the King’s Fund has warned.

A paper published today by the think tank looks at Monitor’s future role in regulating prices, enabling integration, protecting against anti-competitive behaviour and supporting service continuity.

It concludes: “Monitor has been set a formidable task with little precedent and supporting analysis, so the risk of failure is considerable.”

Economic Regulation in Health Care: what can we learn from other regulators? also found a need for greater clarity about whether Monitor was meant to act as an independent economic regulator with limited ministerial guidance, or pursue government policy objectives.

There is a risk Monitor’s independence “will not be sufficient to protect it from ministerial interference, given the political interest in decisions about reconfiguration and failure”, it says.

The report also raises concerns that the right of the health secretary to veto plans for continuing access to services if a provider became unsustainable could block service changes that were in the interests of patients and taxpayers.

In addition, the lack of clarity over whether commissioners or Monitor would ultimately shape the health market remained “an inherent tension in the government’s reforms”, the paper says. The government “must clarify which of these scenarios it anticipates”, it adds.

The report claims Monitor’s influence  would partly depend on the balance between the services required to be open to any qualified provider and those that commissioners chose to award through a tendering process. Although Monitor’s foremost duty will be to protect the interests of patients, it will have some “latitude” to decide how interventionist it is in the market, the report says.

However, it was important the regulator sent out “clear, early signals about the approach it intends to take, particularly with regard to the arrangements for developing more integrated models of care”.