The very public NHS privatisation debate
It has been one of the talking points of the week and one of the most hotly debated subjects on social media - is the NHS in England being privatised by the back door?
Labour has tried to push the issue, arguing that privatisation is being forced through. And one estimate put the number of contracts being advertised at nearly £6bn.
More heat is generated on this issue than almost any other area in public policy.
Some believe passionately that the very fabric of the health service is threatened by the tendering of contracts for patient care. They argue that organisations with a profit motive are by definition unsuitable to be awarded such contracts. The need to make a profit, critics argue, will result in costs and service quality being cut.
Others point out that private sector operators are widely involved in social care, so why not health services? Ever since the creation of the NHS, one key part of healthcare, general practice, has been operating at arms length and run in effect as small businesses.
Examples of contract talks which are currently underway include cancer and end of life care for Staffordshire and Stoke-on-Trent and elderly care in Cambridgeshire.
It has been made clear the deals could involve NHS groups, voluntary organisations and private companies.
Labour's Shadow Health Secretary Andy Burnham has argued that the government's controversial Health and Social Care Act had greatly accelerated the momentum behind private provision.
He claimed the legislation required those who commission health services to seek tenders from a range of providers.
Mr Burnham has called for all talks on new contracts to be halted until the general election when, as he put it, the electorate could give their verdict on the process.
But the government was quick to point out that Mr Burnham himself, when he was health secretary, had widened the involvement of private providers in the NHS, for example private hospitals doing hip replacements.
Whitehall sources argued that the proportion of clinical spending in England accounted for by the private sector had increased by 1.7% to 6.6% since the election, whereas under the last four years of the Labour government it had gone up by 2.1 percentage points.
The organisation of health procurement in England under the coalition has changed radically and much of the privatisation debate focuses on that.
Clinical commissioning groups in each area, run largely by GPs, decide where to spend money on behalf of patients.
Ministers argue that if these groups want to sign contracts with private organisations because they believe patients will benefit then politicians should not interfere.
The key question is whether these groups feel obliged to put services out to tender.
The Department of Health says the reform legislation enshrines the right of commissioners to procure from the NHS if they feel satisfactory alternatives are not available.
Competition, according to ministers, can never be allowed to over-ride the need to ensure integrated services.
Labour disagrees and claims commissioning groups feel under pressure to widen the range of providers.
So what do commissioning groups have to say about it?
The NHSCC is their representative organisation. Its co-chair Dr Steve Kell said there was no privatisation agenda and that competition should only be used if it was in the best interest of patients.
Interestingly, though, he added that members were regularly faced with difficult decisions on the need to tender and there was a need for further clarity on the legal framework.
There is no doubting that the volume of services provided by non NHS organisations is increasing.
The management consultancy Bain has estimated that about £5.8bn of NHS work is currently being advertised to the private sector, up 14% on last year.
Christian Mazzi, head of health at Bain, the management talked of a "growing comfort" with outsourcing across Britain.
Some are far from comfortable about the growth of outsourcing in healthcare.
Others argue it's a sensible process if services are improved and that patients are hardly likely to worry if they are happy with their care.
One thing they can agree on is that the debate will remain live through to the election and beyond.