Summary: Monitor's investigation and findings, and next steps
Updated 20 March 2015
Applies to England
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Monitor has now completed its investigation into a complaint brought by Spire Healthcare Limited (Spire).
The investigation found that Blackpool Clinical Commissioning Group and Fylde and Wyre Clinical Commissioning Group (the CCGs) had not ensured that patients were being offered choice and that patient choice was being publicised and promoted.
What Monitor has published
This document provides a summary of the complaint, Monitor’s investigation and findings, and next steps.
The final report sets out in detail Monitor’s findings on the matters raised in the complaint.
A remedies document seeks your views on the actions Monitor should take to address the problems identified.
1. The complaint
The core of Spire’s complaint was that the number of patients being referred to its Fylde Coast Hospital had fallen, and that this was a result of actions by the CCGs which had the effect of directing patients away from Spire’s hospital and towards Blackpool Teaching Hospitals NHS Foundation Trust.
Spire submitted evidence in the form of patient referral data, which it said showed a significant and sustained decline in referrals to its hospital from November 2012 onwards. Spire said that this drop in referrals could not be explained by legitimate factors.
Spire pointed to a number of actions by the clinical commissioning groups which it said had caused this fall in referrals; these included a change in the CCGs’ joint approach to commissioning services from Blackpool Teaching Hospitals NHS Foundation Trust. Spire also raised concerns regarding both the arrangements the CCGs had in place to protect and promote patient choice for first outpatient appointment, and also the ability of patients to change provider where they were waiting longer than 18 weeks to begin treatment.
Spire complained that these actions were in breach of a number of the rules governing commissioner conduct and were having a negative impact on patients.
2. The investigation and findings
Monitor analysed patient referral data for the relevant period and sought information about the CCGs’ approach to commissioning services from Blackpool Teaching Hospitals NHS Foundation Trust. The analysis did not support the complaint that patients had been directed away from Spire Fylde Coast Hospital and towards Blackpool Teaching Hospitals NHS Foundation Trust.
Monitor also investigated Spire Healthcare Limited’s concerns regarding the operation of patient choice, both at first outpatient appointment and also where a patient would wait longer than 18 weeks to begin treatment.
Commissioners are required to take proactive steps to ensure that GPs and other referrers offer patients a choice of provider for their first outpatient appointment and that the availability of this choice is publicised and promoted. However, it was found that:
- both CCGs did not ensure that patients were offered a choice of provider when they were referred for a first outpatient appointment with a consultant or consultant-led team
- both CCGs did not ensure that the availability of choice of provider for first outpatient appointment with a consultant or consultant-led team was publicised and promoted
Commissioners are also required to take all reasonable steps to ensure that a person requesting an alternative provider (where they will wait longer than 18 weeks for treatment) is offered an appointment with a suitable alternative provider. If there is more than 1 suitable provider, the person referred must also be offered a choice of at least 2 suitable available providers.
Monitor found that the CCGs were not in breach of these requirements. However, Monitor is concerned that very few patients appear to have requested an alternative provider, despite a substantial number waiting longer than 18 weeks to begin treatment at Blackpool Teaching Hospitals NHS Foundation Trust. Monitor will work with commissioners and local providers to ensure that patients are aware of their rights and able to exercise them effectively.
3. Next steps
To ensure that the clinical commissioning groups meet their responsibilities in relation to patient choice for first outpatient appointments, Monitor has published a remedies document, which:
- summarises the problems Monitor identified with the protection and promotion of patient choice
- sets out the actions each CCG has taken to date to improve the operation and promotion of patient choice
- explores the options available to Monitor to address ongoing concerns
The remedies document is a consultation – Monitor invites views from the CCGs, stakeholders and interested parties, including patients in the local area. Monitor would like to know, for each CCG, whether a specific remedy is required. It will then decide what further action to take.
Send Monitor your views
Please send your views to coopandcompcases@monitor.gov.uk. The deadline for responses is 5.30pm on Friday, 17 October 2014.