Consultation outcome

Summary of consultation responses

Updated 27 March 2015

Applies to England

1. Background

The NHS provider licence is Monitor’s main tool for regulating providers of NHS services. It includes a condition requiring licence holders not to act in a way that would be detrimental to enabling integrated care. This applies to all licensed providers of NHS-funded services in England and NHS trusts are expected to meet equivalent obligations.

We have produced guidance to help licensees and NHS trusts understand what is expected of them in relation to the integrated care licence condition and where we may take action.

On 14 January 2015 we launched a 4-week public consultation on the draft guidance. This document summarises the responses and the changes we have made to reflect them. Thank you to everyone who took the time to respond to this consultation.

Read Monitor’s published guidance on the integrated care licence condition.

2. The consultation

We consulted on draft guidance for the integrated care licence condition between January and February 2015.

We received 21 formal written responses from a range of stakeholders including NHS foundation trusts, individuals, Royal Colleges and national bodies. In a number of cases the responses included the collective views of their members.

As part of the consultation process, we also held a webinar to seek views on the guidance, which was viewed by 53 people. We took the questions raised by attendees into account when we revised the guidance.

A small number of organisations also contacted us informally to share their views on the draft guidance.

3. Summary of responses and updates to the guidance

The draft guidance was positively welcomed by the majority of respondents to the consultation. Support was particularly strong for the enabling principles.

We have updated the guidance as a result of comments received but taking these into account we have not needed to make substantive changes. We have summarised the responses under the following themes.

4. Remit of the guidance

A number of respondents questioned who the guidance applies to, including how it relates to social care.

Our response:

We explicitly address this point in the new executive summary to the guidance and a new discrete section on who should read the guidance. It now clearly sets out that the guidance is written mainly for licensed providers of NHS-funded services and NHS trusts to help them understand what is expected of them in relation to the integrated care licence condition, rather than being more general guidance on integrated care.

We also highlight that the guidance may be of interest to those who are working with providers to deliver care that is better integrated or who want to understand more about providers’ obligations under the integrated care licence condition.

5. Monitor’s role in integrated care

A few respondents were uncertain about our role in relation to integrated care and questioned how this guidance aligns with ongoing national initiatives around integrating care.

Our response:

These points have been addressed in the new executive summary which highlights that this guidance is part of our wide-ranging programme of work on integrated care. We have also acknowledged related work at a national level.

See our guidance for further details about integrated care and our role.

6. Information-sharing

A number of respondents noted that information-sharing is a particularly challenging area and the rules and regulations around health and social care data sharing are complex. It was suggested that this had not been sufficiently reflected. There was also a recommendation that Monitor should endorse the use of summary care records in the guidance.

Our response:

We acknowledge that there are challenges around information- sharing and have reflected this point in the guidance, but it is an important part of ensuring that care is delivered in an integrated way. We have included links to recent guidance on how providers can navigate their information-sharing concerns.

We have also included reference to summary care records in the example behaviours about sharing information effectively.

7. Interaction with Monitor’s competition requirements

Some respondents suggested that the guidance should go further in setting out how the integrated care and competition licence conditions in the NHS provider licence interact.

Our response:

We acknowledge that there is a perception that the delivery of person-centred, better co-ordinated care is at odds with competition. Our view is this is not the case. We have revised the guidance to emphasise this point.

As the focus of this guidance is on the integrated care licence condition, and ways in which providers may breach that condition, the section on choice and competition does not form an extensive part of the guidance. However, we have signposted where further information can be found, and how it relates to the delivery of integrated care. We also plan to publish more case studies about this.

8. Enforcement

A small number of respondents felt that they did not have sufficient information on what action we could take if a licensee is found in breach. It was also suggested that our information on how to make a complaint should include a separate section on reporting potential breaches of the integrated care licence.

Our response:

We set out full details of the types of action we may take if a licensee is found in breach in our enforcement guidance. We have made some minor changes to the guidance to make sure that the enforcement section sets out relevant information clearly but does not replicate the enforcement guidance.

We have also updated our website to include a separate page on how interested parties can ask a question or make a complaint under the integrated care licence condition.

9. Language and tone

A small number of respondents noted that, in parts, the language in the guidance was over-complicated and could be simplified. There were also questions about whether it would be more effective if the requirements were positively constructed, rather than a requirement not to do anything negative.

Our response:

We have reviewed the language and simplified it where possible. However, the requirements cannot be positively constructed as the licence condition itself is written as a negative prohibition. This is why the examples of behaviours that may breach the licence condition reflect that.

10. Scope of the licence condition

Some respondents suggested that the licence condition itself should be changed from a negative to a positive prohibition.

Our response:

We consulted on the drafting when we developed the licence conditions for the NHS provider licence and at the time most respondents supported the inclusion of a negative prohibition. We are not proposing to make changes to the licence now as it is outside the scope of this consultation. If we decide to revise the NHS provider licence at a later date we will take these comments into consideration.

11. Additional examples

Some respondents suggested that there should be additional examples related to the important role of independent providers and charitable organisations in supporting the delivery of care in an integrated way. Respondents also suggested a few extra examples or updates to existing examples that could be included in the sections on the principles and behaviours.

Our response:

We reviewed these suggested additions and where we consider they are provider specific and not already covered by the existing examples, we have added them. This includes an extra reference to independent providers and charitable organisations, a comment on “producing a statement of shared commitments or objectives to maintain a constructive dialogue with partners” and 2 consolidated examples of effective information-sharing.