Our aim is to improve outcomes for people with mental health needs. We plan to meet this aim by constructively informing central and local government policy that relates to our work, through positive dialogue with policymakers. We also work collectively as a sector in understanding developments in government policy and in discovering how our services might adapt to meet the requirements of policy changes.

Summary of response:

  • Monitor should work positively with the CQC and not duplicate its services.

  • The appeal process should be robust, quick, accessible and transparent.

  • Lower prices may encourage providers to avoid more difficult patients allowing them to fall through the gaps. The price should accurately reflect the cost of delivering an effective service based on a recovery model ie the cost should diminish over time.

  • There must be clear dialogue on identifying cost-effective (not cheap) services.

  • There should a duty to ensure a level playing field placed on Monitor.

  • Mental health patients need guaranteed access to services. They often die earlier than other patients because they do not have access to physical health services.

  • Competition must be fair, open and equitable.

  • Encourage commissioners to take a longer term view of a pathway approach to generate system savings over time.

 

Responses to questions:

Q9. Do you agree with the proposals set out in this document for Monitor’s licensing role?

9.1 Monitor should work positively with the CQC and not duplicate its services. Monitor and the CQC need to sit on a joint board and have joint responsibilities and where possible have shared aims, objectives and protocols.

 

Q10.Under what circumstances should providers have the right to appeal against proposed licence modifications?

10.1 The appeal process should be robust, quick, accessible and transparent. Insufficient appeal processes will lead to immediate litigation as providers will have no other options. There should also be a specific complaints procedure which includes options for appeal to an independent or agreed arbiter.

 

Q11.Do you agree that Monitor should fund its regulatory activities through fees? What if any constraints should be imposed on Monitor’s ability to charge fees?

 

11.1 The process should be equitable for all providers on a per bed basis. The system should be transparent and must involve providers in decisions.

 

Q12.How should Monitor have regard to overall affordability constraints in regulating prices for NHS services?

12.1 This must be balanced against the risk to complex services. Lower prices may encourage providers to avoid more difficult patients allowing them to fall through the gaps. Effective outcomes for higher acuity patients can be associated with costlier inputs to the service. These need to be considered as part of funding and commissioning decisions. This will also create cost shunting from health to other services as people are simply moved around.

 

Q13. Under what circumstances and on what grounds should the NHS Commissioning Board or providers be able to appeal regarding Monitor’s pricing methodology?

13.1 Any system in place should be robust and transparent and be developed with provider involvement.

 

Q14.How should Monitor and the Commissioning Board work together in developing the tariff? How can constructive behaviours be promoted?

14.1 There must be clear dialogue on identifying cost-effective (not cheap) services. This should involve a clear definition of standards and the development of agreed Key Performance Indicators (KPIs) both general and service specific. Decisions should involve the needs of providers and service users. The tariff must reflect the optimum true cost of delivery to ensure quality is not sacrificed to drive down cost,

 

Q16.What more should be done to support a level playing field for providers?

16.1 All processes should be transparent. Costing arrangements should be clear and publicly available. Pension costs should be included in all contract bids as a clearly identifiable cost.

 

Q17. How should we implement these proposals to prevent anti-competitive behaviour by commissioners? Do you agree that additional legislation is needed as a basis for addressing anticompetitive conduct by commissioners and what would such legislation need to cover? What problems could arise? What alternative solutions would you prefer and why?

17.1 There should a duty to ensure a level playing field placed on Monitor. Decisions should be transparent and focused on the services that users want.

 

Q18.Do you agree that Monitor needs powers to impose additional regulation to help commissioners maintain access to essential public services? If so, in what circumstances, and under what criteria, should it be able to exercise such powers?

18.1 Monitor should explore national standards and make sure that commissioners abide by these standards. Mental health patients need guaranteed access to services via GPs and local authorities. They often die earlier than other patients because they do not have access to physical health services.

 

18.2 Some sections of the mental health population present with a wide range of general health care needs that are complex in nature, Monitor should make clear whose responsibility it is

 

 

to give mental health patients access to wider services such as dentistry. Monitor should be enforcing the IAPT programme.

 

Q20.Do you have any further comments or proposals on freeing foundation trusts and introducing a system of economic regulation?

20.1 Competition must be fair, open and equitable. Perverse contractual obligations should be re-examined. There should be complete freedom and parity around tendering for new services.

 

Recommendations:

1. Monitor and the CQC need to sit on a joint board and have joint responsibilities and where possible have shared aims, objectives and protocols.

2. There should be a specific complaints procedure which includes options for appeal to an independent or agreed arbiter.

3. There must be clear dialogue on identifying cost-effective (not cheap) services. This should involve a clear definition of standards and the development of agreed Key Performance Indicators (KPIs) both general and service specific.

4. Monitor should explore national standards and make sure that commissioners abide by these standards. Mental health patients need guaranteed access to services. They often die earlier than other patients because they do not have access to physical health services.

5. Competition must be fair, open and equitable. Perverse contractual obligations should be re-examined. There should be complete freedom around tendering for new services.

 

For more information please contact Mihir Magudia, IMHSA Secretariat, This email address is being protected from spambots. You need JavaScript enabled to view it., 020 7227 1644