Patient choice

·         The Government will amend the Bill to strengthen and emphasise commissioners' duty to promote choice, in line with the right in the NHS Constitution for patients to make choices about their NHS care and to receive information to support those choices. As recommended by the Future Forum, the Secretary of State's mandate to the NHS Commissioning Board will set clear expectations about offering patients choice: a "choice mandate".

·         Subject to evidence from the current pilots, the mandate to the Board will also make it a priority to extend personal health budgets, including integrated budgets across health and social care.

·         As recommended by the Future Forum's report, HealthWatch England will have the power to establish a citizens' panel, or equivalent arrangement, to look at how choice and competition are working, and inform HealthWatch's annual report to Parliament.

·        The Government  will maintain its commitment to extending patients' choice of "Any Qualified Provider", but the Government will do this in a much more phased way, and will delay starting until April 2012. Choice of Any Qualified Provider will be limited to services covered by national or local tariff pricing, to ensure competition is based on quality. The Government will focus on the services where patients say they want more choice, for example starting with selected community services, rather than seeking blanket coverage. There will be some services, such as A&E and critical care, where Any Qualified Provider will never be practicable or in patients' interests.

·         Following the Future Forum's recommendation, we will carry out further work on the feasibility of a citizens' 'Right to Challenge' poor quality services and lack of choice.

Competition

·         Monitor's core duty will be to protect and promote patients' interests.

·         The Government will remove Monitor's powers to "promote" competition as if it were an end in itself. Monitor will be limited to tackling specific abuses and unjustifiable restrictions that demonstrably act against patients' interests, to ensure a level playing field between providers. Monitor will be required to support the delivery of integrated services for patients where this would improve quality of care for patients or improve efficiency.

·         The NHS Commissioning Board, in consultation with Monitor, will set out guidance on how choice and competition should be applied to particular services, guided by the mandate set by Ministers. This includes guidance on how services should be bundled or integrated.

·         The Government will narrow Monitor's powers over anti-competitive purchasing behaviour so that these are more proportionate and focus on preventing abuses rather than promoting competition.

·         The Government will remove Monitor's powers to open up competition by requiring a provider to allow access to its facilities to another provider.

·         The Government will maintain the existing competition rules for the NHS introduced by the last Government (the Principles and Rules for Co-operation and Competition), and give them a clearer statutory underpinning. The body that applies them, the Co-operation and Competition Panel will transfer to Monitor and retain its distinct identity.

·         The Government will retain our proposals to give Monitor concurrent powers with the Office of Fair Trading, to ensure that competition rules can be applied by a sector-specific regulator with expertise in healthcare. The Future Forum recommended that this was the best safeguard against competition being applied disproportionately. The Bill does not change EU competition law.

Safeguards against privatisation

·         Competition will be on the basis of quality not price. The Government will create additional safeguards against price competition and "cherry picking".

·         So that providers cannot "cherry pick" the profitable, "easy" cases, services will be covered by a system of prices that accurately reflect clinical complexity, except where this is not practical. Commissioners will be required to follow "best value" principles when tendering for non-tariff services, rather than simply choosing the lowest price.

·         The Government will outlaw any policy to increase the market share of any particular sector of provider. This will prevent current or future Ministers, the NHS Commissioning Board or Monitor from having a deliberate policy of encouraging the growth of the private sector over existing state providers - or vice versa. What matters is the quality of care, not the ownership model.

·        The Government will require foundation trusts to produce separate accounts for NHS and private-funded services.

Integration of services

·         In addition to revising Monitor's core duty, the Government will create a new duty for clinical commissioning groups to promote integrated services for patients, both within the NHS and between health, social care and other local services; and the Government will strengthen the existing duty on the NHS Commissioning Board.

·         The NHS Commissioning Board will promote innovative ways of demonstrating how care can be made more integrated for patients: for example, by developing tariffs for integrated pathways of care, and exploring opportunities to move towards single budgets for health and social care. We will work with organisations such as the King's Fund and the Nuffield Trust to develop these ideas further.