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As economic regulator of the health sector, Monitor, will have three main tasks, firstly setting the price at which NHS funded services will be reimbursed, secondly, tackling anti competitive behaviour  and  thirdly , dealing with financial failure and insolvency. Our recent report on economic regulation argued that although Monitor’s primary duty, to protect the interests of patients, is now clearer than it was in the original draft Health and Social Care Bill, there are still far too many other objectives.

The experience of other regulators in other markets outside of health suggests that objectives will need to be updated, so they should be put into secondary regulations or something similar to the mandate for the NHS Commissioning Board. We suggest their objectives be updated once every parliament, similar to other regulators.

Monitor will remain independent in order to avoid political interference by government. However  accountability to parliament has not been really effective to date, partly due to confusion about what the regulator is being held account for. The health select committee has recently undertaken hearing into the performance of the regulators. The Public Accounts Committee has also taken an interest in assessing regulators such as the CQC. Parliament is  becoming more active in their monitoring of regulators, however, for this to be effective there needs to be clear objectives set by  the Department of Health and agreed by parliament against which they can be measured. To be effective the regulator needs clarity of purpose and the appropriate resources.

There is a strong clinical case for changes to the configuration of services. It is important that clinically led reconfigurations take place rather than waiting for organisations to fail and Monitor to step in. We need a pro –active approach where commissioners and providers work together to agree on planned changes to  services in order to achieve high quality care for the patient. Currently these processes are lengthy. Further changes are needed to remove the politics from reconfiguration and to ensure the system of decision making is streamlined.

 

Economic regulation in health care: what can we learn from other regulators?

Written by Anna Dixon
Tuesday, 15 November 2011 14:02

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David Wathey, Head of Sustainable Procurement, Department of Health

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  2. 8 × SELECT * FROM jos_categories
  3. 6 × select * from jos_content
  4. 6 × select (a.username)username,(a.email)email,(b.firstname)firstname,(b.lastname)lastname,(b.cb_org)cb_org,(b.cb_title)cb_title,(b.cb_jobtitle)cb_jobtitle,(b.avatar)avatar from jos_users as a,jos_comprofiler as b
  5. 5 × select * from jos_comprofiler
  6. 4 × SELECT extension_id AS "id", element AS "option", params, enabled FROM jos_extensions
  7. 2 × SELECT a.id as id,a.type as type,a.name as name,a.clickurl as clickurl,a.cid as cid,a.params as params,a.custombannercode as custombannercode,a.track_impressions as track_impressions,cl.track_impressions as client_track_impressions FROM jos_banners as a LEFT JOIN jos_banner_clients AS cl ON cl.id = a.cid LEFT JOIN jos_categories as cat ON a.catid = cat.id
  8. 2 × select id,title,catid,introtext,created_by from jos_content
  9. 1 × select * from jos_web_media
  10. 1 × SELECT m.id, m.title, m.module, m.position, m.content, m.showtitle, m.params, mm.menuid FROM jos_modules AS m LEFT JOIN jos_modules_menu AS mm ON mm.moduleid = m.id LEFT JOIN jos_extensions AS e ON e.element = m.module AND e.client_id = m.client_id
  11. 1 × SELECT * FROM jos_banners
  12. 1 × select * from jos_jcomments
  13. 1 × select * from jos_tag_term
  14. 1 × select * from jos_event_web as a inner join jos_web as b on b.id = a.webid
  15. 1 × SELECT id FROM jos_menu
  16. 1 × select (a.catid)catid,(b.level)level from jos_content as a, jos_categories as b
  17. 1 × select * from jos_web
  18. 1 × SELECT id, home, template, s.params FROM jos_template_styles as s LEFT JOIN jos_extensions as e ON e.element=s.template AND e.type='template' AND e.client_id=s.client_id
  19. 1 × SELECT * FROM jos_jcomments_setting
  20. 1 × SELECT m.id, m.menutype, m.title, m.alias, m.path AS route, m.link, m.type, m.level, m.language,m.browserNav, m.access, m.params, m.home, m.img, m.template_style_id, m.component_id, m.parent_id,e.element as component FROM jos_menu AS m LEFT JOIN jos_extensions AS e ON m.component_id = e.extension_id
  21. 1 × SELECT folder AS type, element AS name, params FROM jos_extensions
  22. 1 × SELECT * FROM jos_languages
  23. 1 × SELECT b.rules FROM jos_assets AS a LEFT JOIN jos_assets AS b ON b.lft <= a.lft AND b.rgt >= a.rgt
  24. 1 × SELECT * FROM `jos_jcomments_objects`
  25. 1 × SELECT count(*) FROM jos_jcomments AS c
  26. 1 × select * from jos_tag_term_content as a, jos_tag_term as b
  27. 1 × SELECT c.*,CASE WHEN CHAR_LENGTH(c.alias) THEN CONCAT_WS(":", c.id, c.alias) ELSE c.id END as slug FROM jos_categories as c LEFT JOIN jos_categories AS s ON (s.lft <= c.lft AND s.rgt >= c.rgt) OR (s.lft > c.lft AND s.rgt < c.rgt) LEFT JOIN (SELECT cat.id as id FROM jos_categories AS cat JOIN jos_categories AS parent ON cat.lft BETWEEN parent.lft AND parent.rgt
  28. 1 × SELECT a.id, a.asset_id, a.title, a.alias, a.title_alias, a.introtext, a.fulltext, CASE WHEN badcats.id is null THEN a.state ELSE 0 END AS state, a.mask, a.catid, a.created, a.created_by, a.created_by_alias, a.modified, a.modified_by, a.checked_out, a.checked_out_time, a.publish_up, a.publish_down, a.images, a.urls, a.attribs, a.version, a.parentid, a.ordering, a.metakey, a.metadesc, a.access, a.hits, a.metadata, a.featured, a.language, a.xreference,c.title AS category_title, c.alias AS category_alias, c.access AS category_access,u.name AS author,contact.id as contactid,parent.title as parent_title, parent.id as parent_id, parent.path as parent_route, parent.alias as parent_alias,ROUND( v.rating_sum / v.rating_count ) AS rating, v.rating_count as rating_count FROM jos_content AS a LEFT JOIN jos_categories AS c on c.id = a.catid LEFT JOIN jos_users AS u on u.id = a.created_by LEFT JOIN jos_contact_details AS contact on contact.user_id = a.created_by LEFT JOIN jos_categories as parent ON parent.id = c.parent_id LEFT JOIN jos_content_rating AS v ON a.id = v.content_id LEFT OUTER JOIN (SELECT cat.id as id FROM jos_categories AS cat JOIN jos_categories AS parent ON cat.lft BETWEEN parent.lft AND parent.rgt
  29. 1 × SELECT `data` FROM `jos_session`
OTHER Tables:
  1. 3 × UPDATE jos_banners SET impmade = (impmade + 1)
  2. 1 × UPDATE `jos_session` SET `data` = '__default|a:7:{s:15:\"session.counter\";i:41;s:19:\"session.timer.start\";i:1330907045;s:18:\"session.timer.last\";i:1330913602;s:17:\"session.timer.now\";i:1330913611;s:22:\"session.client.browser\";s:89:\"Mozilla/5.0 (compatible; archive.org_bot +http://www.archive.org/details/archive.org_bot)\";s:8:\"registry\";O:9:\"JRegistry\":1:{s:7:\"\0*\0data\";O:8:\"stdClass\":0:{}}s:4:\"user\";O:5:\"JUser\":23:{s:9:\"\0*\0isRoot\";b:0;s:2:\"id\";i:0;s:4:\"name\";N;s:8:\"username\";N;s:5:\"email\";N;s:8:\"password\";N;s:14:\"password_clear\";s:0:\"\";s:8:\"usertype\";N;s:5:\"block\";N;s:9:\"sendEmail\";i:0;s:12:\"registerDate\";N;s:13:\"lastvisitDate\";N;s:10:\"activation\";N;s:6:\"params\";N;s:6:\"groups\";a:0:{}s:5:\"guest\";i:1;s:10:\"\0*\0_params\";O:9:\"JRegistry\":1:{s:7:\"\0*\0data\";O:8:\"stdClass\":0:{}}s:14:\"\0*\0_authGroups\";a:1:{i:0;i:1;}s:14:\"\0*\0_authLevels\";a:2:{i:0;i:1;i:1;i:1;}s:15:\"\0*\0_authActions\";N;s:12:\"\0*\0_errorMsg\";N;s:10:\"\0*\0_errors\";a:0:{}s:3:\"aid\";i:0;}}', `time` = 1330913612
  3. 1 × UPDATE jos_content SET hits = hits + 1
  4. 1 × DELETE FROM `jos_session`