Feature / New ways to regulate

With the NHS looking to develop new ways of working to meet changing patient needs and demand, regulation will need to change too. Monitor’s David Bennett explains


Over the next six or seven years, the NHS will have to answer some difficult questions. As people live longer and more of us have longer-term and multiple conditions, and as new technologies and new treatments enable healthcare providers to provide ever better care, the NHS will have to use the money it gets in different ways. In short, it needs to innovate to continue to provide the best care and as much of it as possible.

Care must be tailored to differing patient needs in different ways, area by area. There is wide agreement that change is needed – and the pace and scale must be greater than ever. Change will mean breaking away from old ways of doing things and taking measured risks.

As a regulator of the health sector, this poses a challenge for Monitor. We have to let the health sector evolve without getting in its way, but we have to balance this with the need to ensure patients receive quality care, and as much of it as possible, for taxpayer money. This means managing the risks of change.

So we are changing our approach to regulation (see Monitor’s annual plan for 2014/15). We will encourage providers to develop ideas for new and better ways of working and allow them to take sensible and calculated risks if needed. We are going to look at the way we work with provider organisations to make sure we are encouraging and not preventing innovation.

As an arm’s-length body working for the interests of patients, we will of course balance this by paying close attention to any effects on patient care. But if we can build the encouragement of innovation into the way we regulate, we can help make change happen.

Setting the direction

An important part of providing care to patients is making sure it is easily accessible. Nobody likes having to go to hospital, particularly if it’s to get help for something that could be treated in a more convenient setting. This is especially true for older or more vulnerable patients.

Like others, we believe there are significant opportunities to promote the interests of patients through the integration of care and the delivery of community-based services. Last year, we asked leading health professionals to come up with ideas to change healthcare. One idea was to use a community-based doctor, who would be fully in charge of their high-risk patients, providing tailored ‘care plans’ and bringing together all the different services they need in one location convenient for the patient. 

But approaches this radical will take time to achieve and we have much to learn from examples in this country and elsewhere.

And there are differing views as to whether this change would bring about the kinds of results needed to improve the patient experience while saving costs. To gather evidence on this and other ideas, we will carry out research this year, with partners including NHS England, on the challenges and potential benefits of new models of local healthcare. Armed with our findings we will be able to better support healthcare providers to plan and develop approaches to community-based care.

Pioneering change

While we can help healthcare providers to change, the delivery and success of any improvement rests with their leadership. Nevertheless, a central part of our role is to ensure NHS foundation trusts are well led, and we have worked on this in two stages.

First, working with NHS England and the NHS Trust Development Authority, we have set a benchmark by identifying what good leadership looks like and, second, we have looked at how we can support leaders to achieve this benchmark.

Bringing more clinicians into leadership roles is crucial to ensuring the day-to-day needs of patients are taken into account when important decisions are made about a hospital. We have talked to medical directors to find out what help they need to improve their leadership skills. Using these and other findings, we will develop training and tools for foundation trust leaders to help them do more for patients.

We are also looking at future leaders, and will work with the NHS Leadership Academy to identify talent and find ways to encourage people to apply for leadership positions. Our actions to support healthcare providers should help give them the confidence, the evidence, the leadership and the freedom to make improvements felt on the ground by patients.

Ultimately, at the heart of everything we do, we ask ourselves ‘what is best for patients’ and this is driving our new plan for this year. With renewed pressure in recent years to improve quality, now is the time for healthcare providers to show they can break with the past.

Targeted action must begin to reinvent healthcare for patients, and at Monitor we will be there challenging and helping healthcare providers to do just that.