The RCN remains concerned about fragmentation of care and spiralling transactions costs associated with increasing the number of providers of healthcare to patients across England.
The RCN has previously said that we support the forward looking approach of Monitor in assessing risk and that looking at metrics relating to cash flow makes sense (albeit we look to others to provide financial expertise to know if the precise metrics are appropriate). We did not however agree with the Department of Health to exempt providers who deliver services that are worth less than £10 million. However this decision has already been made by the Department of Health, it is not up to Monitor to decide.
The RCN is also aware that much rests on the performance of Commissioners for monitoring of providers to work well: if a provider delivers less than £10 million worth of NHS services it will only be scrutinised by Monitor where Commissioner(s) designate those services as being essential (technically termed Commissioner Requested Services or CRS). If they don‟t, then scrutiny for the financial health of those providers rests with the Commissioners and shareholders. That may be sufficient if the Commissioner is able to conduct scrutiny: however we are aware that Commissioners have considerable workloads and may be dealing with multiple providers, and there will be variation in their approaches to contract monitoring across the country.
The RCN also wants to ensure sufficient monitoring of both quality and finance (and we see an intrinsic link between the two – just as noted by Monitor themselves). We are therefore interested in how well Monitor and the Care Quality Commission (CQC) are working together to ensure that providers are both delivering high quality compassionate care, and are financially sound.