The NHS is to more than double its use of the private sector to operate on patients on waiting lists in England, the health secretary Patricia Hewitt will reveal today, in a speech signalling unremitting health service reform.
She will announce new contracts for private healthcare corporations worth more than £3bn over five years. They will secure about 2m extra operations a year, helping the government to achieve its target of cutting the maximum wait for treatment to 18 weeks by 2008.
But the contracts are due to extend well beyond that deadline, confirming fears among public sector unions that the government is committed to establishing a marketplace in healthcare in which NHS and private hospitals are locked in permanent competition.
Ms Hewitt will tell NHS personnel managers in Birmingham that the new wave of private contracts signals her "determination to continue both the direction and pace of reform".
But her decision to announce the move so early in Labour's third term - and without a pause for consultation - prompted dismay from Unison, the union representing half the NHS workforce.
Karen Jennings, Unison's head of health, said: "There was a glimmer of hope that this new administration would listen a bit. This privatising agenda will undermine the good work that is taking place in the NHS."
The new plans include a second wave of independent sector treatment centres to operate on patients needing orthopaedic or general surgery, treatment for ear, nose and throat problems and urological conditions.
The government will organise the bulk purchase of a further 250,000 operations a year from independent providers, worth about £2.5bn over five years. This will be in addition to the 215,000 operations a year contracted in the first wave of the programme by Ms Hewitt's predecessor, John Reid.
The deals agreed by Mr Reid were due to provide 3.9% of NHS capacity for non-emergency "elective" surgery, but many were signed only recently and the full impact has not yet been felt by the NHS.
The second wave will run concurrently, increasing the independent sector's contribution to 8.5%. And Ms Hewitt is due to announce a second initiative today raising that share to 11%.
This will go along way toward the limit on private sector involvement forecast by Mr Reid when he forecast that the maximum private share of NHS work would be no more than 15% "in my lifetime".
Ms Hewitt's second initiative will be to provide a facility worth up to £1bn over five years to allow NHS hospitals to send patients for a wide range of operations in private hospitals.
Unlike the treatment centres, it will not be limited to a few common procedures.
Her aim is to get more advantageous terms by bulk buying private hospital places instead of allowing NHS trusts to pay higher prices in the spot purchase market.
The new approach will be called the "extended choice network". It was described by the Department of Health last night as a system of "pre-negotiated call-off contracts for activity as and when needed". Between 150,000 and 200,000 patients a year are expected to use this facility.
Under all these initiatives NHS patients will continue to be treated free of charge. From the end of this year they will be given increasing choice about where to go for an operation.
By signing the contracts -due to be advertised in the EU official journal over the next few days - Ms Hewitt may be taking a commercial risk on behalf of the government. If it pays off, the risk may be transferred to NHS hospitals that are unable to attract enough patients to remain viable.
Ms Hewitt is expected to say: "I want to make clear my determination to continue both the direction and pace of reform set out by the prime minister and my predecessors to deliver the patient-led NHS for which the government has a mandate."
Ms Jennings said: "We believe there is a role for the private sector, particularly where there are long waiting lists, while the public sector increases its capacity. But the private sector will cherry-pick the easiest clients, making it more difficult for the NHS."
