Our response to the Fair Playing Field Review

The Fair Playing Field Review, which was published today, will help ensure quality care for patients.


I see this review as part of a much bigger picture in helping provide improved patient care; whether that is delivered in hospitals, in hospices, or out in the community. Its recommendations are one component in a complex set of arrangements which the Department of Health, NHS Commissioning Board (NHS England), Monitor and others are putting in place. We must ensure that all parts of the system and all pieces of the jigsaw reflect the realities of service provision for charities; particularly end of life care charities.  We agree that the best solution is for commissioners to plan and commission services based on a clear understanding of the makeup and needs of their local communities.

Key recommendations

Our response to key recommendations in the Review which impact on charities.


Money set aside for VAT is money taken away from patient care.  We welcome the recommendation to explore how VAT refunds can be extended to charitable sector providers of NHS funded care. If the Exchequer agrees to this measure, for Marie Curie it would mean a saving of nearly half a million a year for our hospices alone; funds which would enable us to provide an additional 2000 nursing hours in each hospice. (This doesn’t take into account VAT savings that would be made by our community nursing service).


A. Bundling of Contracts Issues such as how contracts are ‘bundled’ are crucial if charities are to be able to continue to provide high quality, patient centred services in the reformed NHS.  Any attempt to ‘bundle’ smaller services into huge community services contracts would effectively exclude charities from delivering those services because we can only do things which meet our stated purpose. B. Contract length Longer contracts would enable us to invest more in patient services and encourage innovation.


As the Review notes access to capital is a key issue for many charities. We welcome Monitor’s call for commissioners to limit requests for disproportionate levels of reserves and working capital, which can unfairly and unnecessarily exclude many charities. We believe the Review represents a balanced attempt to ensure all providers are able to deliver services in the reformed NHS. We commend Monitor for the open way it has approached the Review and recognised the unique position charities can bring to the provision of NHS services. We call on those working at a national and local level to think about how they commission so that it doesn’t disadvantage the charitable sector and reduce patient choice.