'A fair playing field for the benefit of NHS patients' review

On 21 May 2012, the Secretary of State, Andrew Lansley, wrote to Monitor asking the organisation to carry out an independent review into the issues that limit the participation of different providers of NHS services.

The review was published on 26 March 2013. Monitor found that there were three potential distortions to the provider playing field that might affect patients.

Participation distortions 

Some providers were directly or indirectly excluded from offering their services to NHS patients. Monitor found that some commissioners were failing to consider alternative providers and/or were running unnecessarily complex procurement processes.

Cost distortions

Some types of providers faced externally imposed costs that were not universally applied across all providers. Private and charitable providers were disadvantaged compared to public sector providers regarding rebates for VAT and the cost of raising capital funding.

Flexibility distortions

Public sector providers faced different obligations to voluntary or private sector providers. For example, mandatory service obligations, rigidities in public sector workforce and the possibility of direct government intervention.


A fair playing field for the benefit of NHS patients.
Monitor; 2013.