The Government declared: 'The NHS cannot remain a monolithic, centrally-run monopoly provider. Ideological or institutional boundaries should not stand in the way of better care for NHS patients.'

In order to change the nature and increase the volume of services, it is now an explicit policy to achieve a greater plurality of providers. The Government has said plainly that it wants this to be a permanent development. 'Working with providers from the independent sector and from overseas is not a temporary measure. They will become a permanent feature of the new NHS landscape and will provide NHS services. Different healthcare providers will work to a common ethos, common standards and a common system of inspection.'

By 2008 the Government envisages that the independent sector will provide up to 15 per cent of operations and an increasing number of diagnostic procedures to NHS patients. It particularly wants to transform diagnostic services, and has commissioned 80,000 extra MRI scans a year through a mobile service run by the independent sector - a 10 per cent addition to NHS capacity. All independent sector providers must guarantee high standards of care and good value for money.

In addition, the Government is offering help to PCTs to commission services from 'a diverse set of suppliers for communities that have previously been poorly served', according to the White Paper, Our health, our care, our say (466Kb PDF). The Government had earlier said (in Creating a Patient-led NHS) that it wanted to introduce 'some radically different types of provision' that would 'involve freeing up the entrepreneurialism within primary care and developing new types of provider organisations'. It predicted these would include 'providers who are currently part of the NHS; established independent suppliers such as GPs and their teams, pharmacies and independent hospitals; other parts of the statutory sector; the voluntary sector; and new entrants from the independent, statutory or voluntary sectors'.

Nevertheless, the Secretary of State has said that, 'In the overall scale of the NHS, the independent sector is small beer' - estimating its contribution at 'about 10 per cent of electives and around one per cent of the total NHS budget', adding that, 'this does not herald the end of NHS provision, or the NHS becoming purely a funder and commissioner of services... In primary and community health services, as in acute hospitals, NHS providers will continue to flourish.'