Monitor, the current foundation trust regulator and, under the government’s NHS plans, soon to be the health service’s new economic regulator as well, has scrapped, at least for now, its plan to appoint a new chief executive.
The move demonstrates the profound uncertainty that still haunts Andrew Lansley’s reforms, despite the end of the famous “pause”.
Shirley Williams, the Lib Dem peer, has made clear that her party in the Lord still intends to try to amend the bill, whatever deal has been done in the Commons. The large medical mafia in the Lords and Labour will doubtless seek to do the same.
The halting of the appointment process, however, may also be because, as currently constructed, the job of chief executive of the new Monitor looks distinctly undo-able.
It will have three tasks. Continuing to regulate foundation trusts. Helping set prices for treatments. And regulating competition between the public, private and voluntary sectors, including foundation trusts.
There is an obvious conflict of interest between at least two and arguably all three of these tasks. The prices set will affect foundation trust finances. Yet Monitor will be responsible for overseeing their financial viability. A competition ruling, equally, could affect FT’s viability, and so on.
So Monitor will have to have at least one, possibly two, Chinese walls, and the chief executive will be able to have little direct oversight over at least one, and possibly two, of these remits. Not a terribly clear, nor perhaps a terribly satisfying job – being a boss part of whose empire has to be run by someone else.
Monitor said today that despite some strong applicants, “none had quite the right mix of skills and experience for the role as currently set out.” Given the above, that is hardly surprising.
And anyway, Monitor added, it has decided to “wait for Parliament’s view to become clearer” before it re-starts recruitment. Which is code for “wait to see how badly the Lords messes the bill up”.
The one thing their Lordships could do, of course, is provide for the foundation trust regulator to be a separate quango from the economic regulator. Which would be a) good policy, despite the government’s desparate desire to create no new quangos, and b) make it much easier to find a chief executive for the two bodies.
Jim Pickard
Kiran Stacey