Commissioners will only be able to force Monitor to reconsider its approach to price setting for an NHS service if more than half of them object, under latest Department of Health proposals.
The government’s NHS reforms will pass responsibility for setting NHS “tariff” prices to the healthcare sector regulator Monitor from 2014 onwards.
The 2012 Health Act also makes provisions allowing NHS commissioners or providers to object to the way Monitor sets prices for a service. If more than a certain proportion object, the regulator must either redraft the tariff or refer the issue to the Competition Commission.
However, the legislation does not define what proportion of objectors will be necessary to trigger a response from the regulator.
A new DH consultation proposes that Monitor would need to redraft or seek Competition Commission approval for its tariff if it received objections from 51 per cent or more of all NHS commissioners, or 51 per cent or more of all providers of NHS tariff services.
Providers would also be able to trigger action if the tariff income of those objecting accounted for a “share of supply” of 51 per cent or more. To calculate this, providers’ objections would be “weighted” according to the total tariff income reported in their previous year’s accounts.
The consultation paper said the proportion of objections that could trigger a Competition Commission reference needed to be set at a level that would “capture widespread concerns from a range” of providers or commissioners, but which would minimise “the risk of triggering re-consideration simply because some providers were finding it difficult to make improvements”.
The commission will be able to direct Monitor to make changes to the tariff if it determines that the regulator’s proposals are not based on the best available data, are wrong in law, or have not been made with proper regard for its legally defined duties.
If it determines that Monitor is in the wrong it can order the regulator to pay its costs, and the costs of objectors. However, if it determines that Monitor is in the right, the commissioners and providers that had objected to the tariff could be directed to pay the regulator’s costs.
The deadline for consultation responses is 21 December.