Monitor’s accountability as the proposed NHS economic regulator is unclear and its requirements to involve the public appear to be “minimal”, the NHS Confederation has warned.

In written evidence submitted to the Health and Social Care Bill committee, the confederation has identified “significant risks, worrying uncertainties and unexploited opportunities” regarding the reforms.

In particular, it has urged MPs to seek clarity on Monitor’s new role.

The evidence states: “The committee should seek further clarity on how Monitor will be accountable, other than to the secretary of state. We note that the public consultation and patient and public involvement requirements on Monitor appear to be minimal at present.”

It also calls for further consideration of whether the bill ensures Monitor will take taxpayers’ interests into account or is statutorily obliged to consult with local Healthwatch groups, beyond decisions relating to designated essential services.

For example, Healthwatch is also likely to take an interest in licensing conditions and enforcement actions issued to trusts.

The confederation is also concerned that Monitor’s duties around quality and safety could duplicate those of the Care Quality Commission.

A Monitor spokesman said the regulator would remain accountable to Parliament, and would also be accountable to central government for its use of resources.

He added: “We will be under a specific duty to ensure that our regulatory activities are transparent, proportionate, consistent, targeted only at cases where action is needed and not in conflict with our remaining role over foundation trusts.”