Future Forum proposes to hand competition powers to Nicholson's commissioning board

The Future Forum’s choice and competition report, published this afternoon, proposes that the commissioning board be given a “choice mandate” which would “set the parameters for choice and competition in all parts of the service, for example promoting more integration and a focus on outcomes”.

The suggested changes would limit the role of Monitor to supporting “choice, competition and integrated care within the model of choice and competition set out by the NHS Commissioning Board”.

The forum also proposes to remove from the Health and Social Care Bill Monitor’s primary duty to “promote competition” and all descriptions of the organisation as an “economic regulator”. It says that its primary duty is to “protect and promote interests of the patient”.

“We… feel that the language of ‘economic regulator’ is misleading, suggesting an organisation like a utilities regulator – a model that is unhelpful and inaccurate,” it states.

However, it insists that the controversial provisions of the bill which give Monitor concurrent enforcement powers with the Office of Fair Trading to prevent “anti-competitive behaviour” should be retained. The forum states its view that “should a court ever decide that aspects of EU competition law were applicable to some NHS services, it is important for these decisions to be made by an organisation that has a real understanding of the unique nature of healthcare and the NHS…

“The existence of a sector specific regulator could provide as strong defence against other bodies, both in the UK and EU, becoming involved in the event of any challenges.”

To address other concerns about the involvement of the private sector in the NHS, the report recommends that “Monitor, working with the NHS Commissioning Board, should be tasked with preventing cherry-picking from undermining the quality of NHS services or distorting the market”.

It suggests that this would include “further work to ensure that the [NHS] tariff reflects a fair price for the service they have provided and the case mix of patients treated and a requirement on commissioners to act on cases of possible cherry-picking at a local level”.

But the overall tone of the report favours competition and the introduction of a wider range of providers in the NHS. Sir Stephen Bubb, chair of the choice and competition group of the Future Forum, writes: “I have concluded that it is an error to suppose effective and properly regulated competition threatens the fundamental principle of an NHS that is universal and free at point of delivery. The reverse may be true; that it helps protect the NHS into the future.”

It argues that a “diverse range of providers is a good way of stimulating innovation – whether this is from within the NHS, from the third sector or independent organisations”.

It suggests the commissioning board and Monitor should work together to ensure there is a level playing field “that enables people with new ideas to enter the market”. This, it says, should include consideration of the potential for stronger support for social enterprise, “for example examining the role of the existing Social Enterprise Investment Fund and how that could be expanded”. Sir Stephen is also chair of The Social Investment Business, which part manages the SEIF.

Other recommendations in the choice and competition report include:

• Offering all patients who would benefit from a personal health budget should be offered one within five years.
• A Citizens’ Panel should be set up to hold the system to account by publishing an assessment to Parliament of how well the choice mandate has been acted upon.
• The Right to Challenge, proposed in the government’s Localism Bill, should be extended to the NHS to allow patients to hold their health service to account on choice and quality.