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Lib Dem leader says Monitor must not become an ‘economic regulator’ while National Audit Office condemns latest delay in NHS patient database Nick Clegg has singled out the role of Monitor, the NHS regulator, as the area of the embattled NHS bill that needs the “most substantial changes” and has said that all references to the body being an economic regulator “should be removed”. In a presentation by the deputy prime minister to the weekly meeting of his parliamentary party and leaked to the Guardian, Clegg circulated a page-long document in which he set out how he believes the regulator should be reconceived. “Instead of having a duty to promote competition, Monitor’s main duty should be explicitly to protect and promote the interests of patients,” Clegg wrote, saying the NHS cannot be regulated as if it was just a utility “like electricity or telephones”. A new role for Monitor has long been a running sore in the health secretary’s plans. Last week Steve Field, the man appointed by David Cameron to oversee the “pause” in the health legislation, said he also thought the proposed new role for Monitor should be scrapped. Instead, it should promote co-operation and collaboration and the integration of health services. It is known that the Lib Dems dislike health secretary Andrew Lansley’s proposal that Monitor become an “economic regulator”, but this is the first time a full critique has emerged with detailed alternative proposals. Clegg said: “We cannot treat the NHS as if it were a utility, and the decision to establish Monitor as an ‘economic regulator’ was clearly a misjudgment, failing to recognise all the unique characteristics of a public health service, and opening us up to accusations that we are trying to subject the NHS to the full rigours of UK and EU competition law. “I have come to the conclusion that we must not make this change. We must remove from the bill changes to establish Monitor as a competition authority. Monitor should be empowered to encourage informed patient choice and act against anti-competitive practices but only when this is in the interest of patients, individually and collectively, and in the interest of equality of access.” The Lib Dem document shows it wants to maintain the principles of collaboration and competition overseen by the NHS collaboration and competition panel – protocols which are understood to have insulated the NHS from the office of fair trading exercising the full force of competition act powers. Clegg writes: “The CCP should become an advisory body to Monitor. We should agree a memorandum of understanding between Monitor and the Office of Fair Trading on this basis. We will also need to retain Monitor’s role in relationship to foundation trusts to be clear they are not “undertakings’ within the terms of EU law. “Together these changes should mean we can be clear that we are making no substantive changes to the way in which competition law operates in relation to the NHS. “Instead of having a duty to promote competition, Monitor’s main duty should be explicitly to protect and promote the interests of patients, including recognising the ways in which those interests are met by integrated care. Monitor should be empowered to encourage informed patient choice and act against anti-competitive practices but only when this is in the interest of patients, individually and collectively, and in the interest of equality of access.” The party also calls for Monitor to have a role in ensuring there is no cherry-picking by providers of the most expensive treatments. The government is coming under increasing pressure, meanwhile, to abandon plans for a new NHS patient record system after the official spending watchdog warned that it was very likely to waste another £4.3bn in the next four years. The original aim of the £11.4bn NHS IT programme, to install a patient record database accessible from any point in the NHS in England by 2015, will fail, the National Audit Office warns. The £2.7bn spent so far on the system has not been value for money, it says, and the watchdog has no confidence the remaining £4.3bn will be any better spent. The nine-year-old project – the biggest civilian IT scheme attempted – has been in disarray since it missed its first deadlines in 2007. While its ambitions have been downgraded in recent years, the bill from the suppliers has remained largely unchanged, the report says. MPs appealed for the remaining contracts to be abandoned to prevent the £4.3bn going to waste. It amounts to more than a fifth of the £20bn efficiencies the NHS is attempting to achieve. Doctors warned against abandoning the project altogether, saying the modernisation of the paper-based patient record system should still be a priority. The NAO says the new patient records have been implemented in a tiny minority of trusts while other IT systems, such as the digitisation of x-ray images, have been achieved. But the original target to start introducing a database of medical records by 2007 was missed and, according to the current projections, it will not be achieved by the new 2014-15 deadline. The plans for one comprehensive system of patient records have been reduced to a patchwork of different systems across the country that threaten to clock up a new £220m bill to make them compatible with each other, the NAO says. Two of the four contractors have already pulled out, and the prime minister revealed last week that the government was considering terminating a third contractor, CSC, which has been put under review. That would most likely leave the contracts concentrated in the hands of BT, but even its work is under question by the NAO. Amyas Morse, head of the NAO, said: “The original vision for the national programme for IT in the NHS will not be realised. “The NHS is now getting far fewer systems than planned despite the department paying contractors almost the same amount of money. This is yet another example of a department fundamentally underestimating the scale and complexity of a major IT-enabled change programme. “The Department of Health needs to admit that it is now in damage-limitation mode. I hope that my report, together with the forthcoming review by the Cabinet Office and Treasury, announced by the prime minister, will help to prevent further loss of public value from future expenditure on the programme.” Richard Bacon, the Conservative MP for South Norfolk, who has campaigned to highlight the problems, said: “It is perfectly clear that throwing more money at the problem will not work. “This turkey will never fly and it is time the Department of Health faced reality and channelled the remaining funds into something useful that will actually benefit patients. The largest civilian IT project in the world has failed.” Officials will be called before the Commons public accounts committee to justify the continuation of the programme. Margaret Hodge, Labour chair of the committee, said: “It is deeply worrying to hear the NAO ‘has no grounds for confidence’ that the remaining planned spending of £4.3bn on care records systems will provide value for money.” Simon Burns, the health minister, said: “In the north, the Midlands and the east, only 4% of hospital records systems have been installed. “A decade on and £6.4bn down, all Labour managed to deliver was a patchy IT system that experts now confirm has failed its core objectives. This has been an expensive farce from the beginning.” Dr Chaand Nagpaul, a GP member of the British Medical Association’s working party on NHS IT, said: “We cannot turn the clock back, but this report provides useful lessons on how best to use resources in the future. Patient care needs to be supported by reliable information systems, and IT should continue to be a priority for the NHS.” NHS ‘needs managers’ The coalition’s plan to cut the number of NHS managers is not based on evidence and will damage the service just at the time it needs high-calibre bosses, according to the King’s Fund thinktank. Health secretary Andrew Lansley’s proposals to cut the number of managers by 45% and administration costs by 33% are “simply arbitrary” and should be rethought, it says in a report. The report also accuses ministers of “denigrating” NHS managers by referring to them as “pen-pushers” and warns that that will damage staff morale, deter skilled people from joining and discourage doctors from switching to management roles. David Cameron celebrated the recent rise in the number of doctors and fall in managers in a major speech on health on Monday. The government’s NHS shakeup is being undermined by the steady loss of quality managers, the influential thinktank also states. “Many experienced leaders have already been lost and this puts at risk delivery of the government’s plans”, says its study of NHS leadership and management. Lansley, meanwhile, will reveal more of his thinking about potential changes to the health and social care bill – including the politically charged issues of choice and competition – when he addresses a King’s Fund conference on Wednesday. Denis Campbell Health policy Health NHS Nick Clegg Liberal Democrats Polly Curtis Allegra Stratton guardian.co.uk