Back when the white paper was first published, we had our first flurry of excitement that the new Monitor would get to tinker under the bonnet of private sector providers – all in the interests of fair regulation and ensuring continuity of services.
That excitement was soon dampened with the news Monitor would only get to play Big Brother and limit, for example, a private provider’s indebtedness, if it was deemed “essential”.
The assumption, at that time, was that very few, if any, private providers would pass any sensible person’s definition of “essential”.That is: private providers tend not to run accident and emergency departments or perform emergency or rare procedures.
But the crucial term there was “sensible”, and sensible discussions about which hospital services are “essential” and which are not are hard to come by. Once that dawned on health ministers they passed the buck.
The current version of the bill now has no up-front designation of “essential” services.
Instead, decisions on what gets saved and what gets carried off by the creditors will be made only at the point of financial failure.
As two pieces of fudge are always better than one, ministers also introduced as a sort of half-way house the concept of “commissioner requested services”. These are the services commissioners want Monitor to consider protecting as “essential” in the event of failure.
Clinical commissioning groups are expected to “request” the vast majority of services.
The upshot for Monitor is it will need to grope around under all those bonnets after all – so it knows which are actually essential. For NHS providers the type of scrutiny envisaged will be nothing new. But for private players, Monitor’s first consultation on the regime makes scary reading: restrictions on asset sales and leveraging, limits on debt and lending, and deference to the beloved credit ratings agencies.
And if as a private provider you do not fancy any of that, you can always try arguing with your cash-strapped CCG that you are not “essential” after all.
Sally Gainsbury is a news reporter for the Financial Times.