4 Mar 2011

NHS reform: regulation is ‘slack’

Doctors are worried that NHS reforms do not include enough checks and balances to make sure patients are getting the best service, Channel 4 News understands.

NHS reforms - doctors' worries over 'slack' regulation (Getty)

The British Medical Association Council Chairman Hamish Meldrum told Channel 4 News: “It’s a real concern. We do support the idea of doctors getting more involved but not on an unmonitored basis. We do worry that some of the governance and oversight provisions in the bill are a bit slack.

“We had our issues with Primary Care Trusts [the bodies which currently commission care], but at least they were a local oversight who could step in if there were problems.”

A Channel 4 News investigation on Wednesday revealed that the NHS reforms could see GPs making decisions based on profit rather than the clinical needs of the patient.

The Patients Association told Channel 4 News that the risk of conflict was so high it could “utterly destroy any relationship of trust between doctor and patient.”

The Department of Health stressed that the potential conflict of interests would be managed.

Monitor – already the regulatory body for Foundation Trusts which run some hospitals – will be responsible for regulation nationally along with the NHS Commissioning Board.

NHS reform (Getty)

But Dr Meldrum he said the plans were a concern because of the lack of local control.

“We have not seen the detail of devolved control, but we are not sure the bodies will be able to exert influence if national. We are a public service and we work for a public service, and we would expect to be accountable. Any reasonable doctor would have no problem with that.”

“We worry that some of the governance and oversight provisions in the bill are a bit slack.” BMA Council Chairman Hamish Meldrum

The Department of Health told Channel 4 News there would be clear guidance for doctors.

A spokesperson said: “The NHS Commissioning Board and Monitor will develop clear binding guidance for consortia to ensure decisions are fair, transparent and avoid any perceived or potential conflicts of interest.

“Each consortium must also set out arrangements for managing potential conflicts of interest and publish a constitution that details this.

“The Bill also contains clear duties on the NHS Commissioning Board, and if necessary Monitor, to intervene where there are concerns about the fairness of commissioning decisions.”

In an interview with Channel 4 News on Wednesday, Health Minister Lord Howe told Channel 4 News that Monitor is the solution for those concerned about conflict and competition issues in the new system.

“Monitor will have very very substantial powers to bear down on anti-competitive conduct,” he said.

“And each GP consortium must have an accountable officer – that means that we are clearly intent on having complete transparency over the way that public money is used.”

During the interview, Jon Snow suggested it would “beggar belief” if Monitor’s role included keeping data on every doctor and the financial interests of their friends and family, to ensure that a doctor did not commission a service by which they or someone close to them could gain financially rather than a better or more appropriate service. Lord Howe responded: “It shouldn’t beggar belief. We will have a transparent reporting system.”

A spokesman for Monitor said it supported Lord Howe’s statement, but the detail was not yet clear of whether a database of this type would be involved in its regulatory work.

He said: “Monitor’s role will be to oversee healthcare and to make sure that any markets are operating to protect the interests of people who use health care services. On a day to day basis we would not intervene in how commissioners do their jobs.”

GPs remain concerned that this means that abuses, and mistakes, could slip through the system. But Monitor stressed it will investigate if it receives a complaint, and will also conduct studies of the market to ensure there is no anti-competitive behaviour.

The spokesman said: “If we receive a complaint then we can investigate this and if necessary intervene using our regulatory powers. It is also proposed that we will have powers, like other regulators, to undertake studies of the market to make sure that they are delivering the outcomes that we would expect.”