Health sector regulator Monitor has launched a review of possible barriers to "a fair playing field" among current and potential NHS providers.
The regulator says the move is "an independent review of matters that may be affecting the ability of current and future providers of NHS serves to participate fully in improving patient care." The aim is “to identify barriers to a fair playing field, and possible solutions which would protect and promote the interests of patients," it adds.
Matters that have already been raised as areas which might prevent some providers from operating on an equal footing with others include: - corporation and value-added tax (VAT); - NHS staff contracts and pensions; - payment systems; - barriers to exit; - teaching and training for clinical staff; - incumbency advantages; - costs of capital; - access to capital; - information and IT; - insurance; and - tendering and commissioning behaviours.
This list has been drawn up from the Department of Health's previous work on the fair playing field issue and from academic sources, but the review will start with a very broad scope, Monitor's chairman and interim chief executive, David Bennett, has told Health Secretary Andrew Lansley, who requested the review.
It "will be open to looking at any problem raised and cover all types and different sizes of providers, including NHS trusts, foundation trusts, social enterprises, voluntary and community sector providers and for-profit providers," Mr Bennett adds.
He also agrees with Mr Lansley on the need to proceed speedily with the review, given the requirement for the Health Secretary to lay a report before Parliament by March 27, 2013, as required under the Health and Social Care Act. "This requirement reflects the House of Lords' agreement to proposals from Lord Patel of Bradford regarding the urgent need for such a review," Mr Lansley notes, in his original request to Monitor to undertake the review.
Last November, in the first setback to the Act during its passage through Parliament, the Lords backed an amendment put forward by Lord Patel establishing "equality of provision" for charities supplying NHS services, which currently have to pay VAT on supplies while NHS bodies do not.
On March 19, Parliament widened this amendment to require a government review of the barriers affecting the involvement of a variety of health providers, and for the Health Secretary to report in a year's time on all matters affecting charities' ability to provide NHS services.
In his request to Monitor to conduct the independent review, Mr Lansley noted that "of particular importance will be the need to engage with charities, hospices, mutuals, palliative care organisations, co-operatives and social enterprises, as Lord Patel and others have emphasised. These organisations have always made valuable contributions to the NHS and will play a vital role in helping the NHS to provide better services and in improving health outcomes for the future," he says.
Mr Bennett has also told Mr Lansley that the need to undertake the review at speed will mean that "our recommendations to you are likely to be preliminary, to be supported by further work after the publication of the review as necessary."
He adds: "as our report will be independent of government, we expect you will want to produce your own statutory report on the fair playing field. To ensure you are able to produce this in good time, we will share drafts of the final report with [Monitor's Steering Group, which is chaired by Ian Dodge at the Department of Health] as they become available."
The deadline for initial submissions to the review is July 6.