Monitor duty to support integration of care

Prime minister David Cameron announced the plan on Tuesday, which could give the economic regulator in the new NHS landscape a more passive role.

He said Monitor “will now have a new duty to support the integration of services – whether that’s between primary and secondary care, mental and physical care, or health and social care”.

The original wording of the Health Bill included a duty for Monitor as the economic regulator of the NHS to promote competition. Mr Cameron said this “could be misinterpreted and we don’t want any doubt in anyone’s mind”.

He stressed that Monitor would “protect and promote the interests of people who use health care services” and create a “genuine level playing field”.

HSJ understands the duty will act as a counterbalance to the regulator’s duty to promote competition. This will mean Monitor is more likely to allow organisations to merge or remain large, having a duty to consider the benefits of integration as well as the downsides of monopolies of provision.

The importance of integration will also have to be considered when Monitor works with the NHS Commissioning Board when to set pricing for NHS treatments. This could make tariffs for whole pathways of care more likely.

King’s Fund director of policy Anna Dixon said the move signalled “a more nuanced approach to the application of competition”. She said: “There’s still a sense of a strong belief in the benefit of competition and of transparency and choice. But [the government] has come to realise that it isn’t the answer for all types of care and there is great value in having better integration.”

Ms Dixon said it meant the regulator would be less likely to “go out breaking up monopolies”.

She said in cases where Monitor has to apply competition law to organisations providing integrated care it would have to consider the potential downsides of fragmentation, as well as its benefits.