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the private sector expects to win £20 billion of business from the NHS, according to the corporate finance adviser Catalyst

a few gluttonous companies—Virgin Care, Serco, Care UK—have secured dominant positions in the market

The biggest privatisations are taking place in community health services.

Local NHS bodies have already been instructed to outsource 39 types of service. Dubbed the “39 steps to privatisation,” this covers everything from autism care to wheelchair provision.

privatisation favours a few big winners over the co-ops, charities and social enterprises

Many Hospital Trusts are being pushed to the financial brink by the disastrous legacy of the Private Finance Initiative (PFI)

In a first for the private sector, in February 2012 Circle took over an entire general hospital at Hinchingbrooke in Cambridgeshire. The hospital has since fallen 19 places in the patient satisfaction rankings and its finances have worsened, forcing Circle to ask for a bailout after just six months. Despite being prepared to make a potential 20 percent cut to the hospital’s workforce, and while mostly owned by investment funds operating out of tax-havens like the Caymen Islands, Circle nevertheless vaunts its friendly-sounding business model under which doctors and nurses are given part-ownership of the company.

another controversial aspect of the Health and Social Care Act—the ability for NHS hospitals to earn half their income from private patients

revealed a tragic case where a consultant left half way through a dangerous birth to carry out a private caesarean section. The baby later died.

many of the dominant players in the new market are owned by ruthless private equity firms

the collapse of the Southern Cross care-home company

All of this comes before the most high-profile part of the Health and Social Care Act has even been fully implemented—the replacement of PCTs with Clinical Commissioning Groups (CCGs)

largely unaccountable new groups, who will in turn outsource the work to privatised “commissioning support units”

Although outsourcing has grown steadily since the 1990s, expectations of an austerity-induced boom have so far disappointed, with some local authorities even deciding to insource services to address concerns that privatisation was not proving the best value for taxpayers’ money.

Cumbria council has recently agreed to repatriate 300 staff outsourced to Amey after its seven-year contract to provide highways maintenance comes to an end in April, while Rotherham and Ealing councils both insourced highways services last year.

Last year, Edinburgh council also decided against privatising the city’s bin collection and street cleaning services.

The SNP government has ruled out any privatisation of the National Health Service, but local authorities are free to consider outsourcing if they believed that would improve delivery of services, added the SNP government

According to the Open Public Services white paper published last year, at least 40 per cent of local authority spending goes on contracts to the private and voluntary sectors; almost half of all councils have outsourced refuse collection while 55 per cent of social housing is provided by housing associations.

When Serco made its bid to run NHS community-health services in Suffolk – district nursing, physiotherapy, OT, end-of-life palliative care, wheelchair services – it reckoned it could do it for £140m over three years – £16m less than the existing NHS "provider" had managed, which would eventually allow for their standard profit margin of around 6% a year. When it started to become clear that Serco was the frontrunner, there was some opposition, but perhaps not nearly enough.

We are meant to be known by the 5,000 not the five billion.

"There's also the inability of the public sector to monitor effectively,

The strangest thing, though, is the gap between Serco's size and how little the public knows about it. Not for nothing does so much coverage of its work include the sentence "the biggest company you've never heard of".

We've still got the same number of patients," she says, "so the workload has massively increased." As a result, she and her colleagues are having to cut people out of their previous entitlement to treatment at home. "That completely goes against our ethics," she says, "but that's what we're having to do.

The NHS is a relatively new area of controversy for Serco, but concerns about their practices run across many other areas

Serco was officially awarded the contract in October 2012, which meant that hundreds of staff would leave the NHS, and become company employees. Within weeks, the company proposed a huge reorganisation, which involved getting rid of one in six jobs. This has since come down to one in seven, two thirds of which will apparently go via natural wastage. In terms of their pay and conditions, the hundreds of people who have been transferred from the NHS to Serco are protected by provisions laid down by the last government, but it is already becoming clear that many new staff are on inferior contracts: as one local source puts it, "they've got less annual leave, less sick pay … it's significantly worse."

great wall of commercial confidentiality

they're good at winning contracts, but too often, they're bad at running services."

The National Audit Office is doing work around the development of quasi-monopoly private providers, which is the world we're moving into. We don't really understand the size of their empires.

Along with the health unions, the doctors' British Medical Association, the Royal College of Nurses and the Royal College of Midwives are now all demanding the bill be scrapped.

Cameron and Lansley insist they don't plan to privatise the NHS, of course. But that's exactly what's happening on the ground even before the bill hits the statute book. The first private company to take over an NHS hospital, the Tory-linked Circle Health, won the contract to run Hinchingbrooke hospital in Cambridgeshire in November, even as it admitted it may not be able to "provide a consistent level of service to its patients".

And the government has been in talks with international health corporations about taking over 20 more, while private companies are already running local doctors' services and preparing to administer the clinical commissioning groups of GPs

Add to that ministers' announcement last month that they would raise the cap on the proportion of income English hospitals can raise from private work from about 2% to 49%

whereas the existing law allows private provision, the coalition bill will require it

it also opens the way for the privatisation of funding, the introduction of charging and top-up payments for services that are currently free, and the cherry-picking of patients by commissioning groups

In Britain the coalition has mimicked this approach. Circle, backed by private equity firms, runs Hinchingbrooke hospital in Cambridge.

Since 2010 private companies have had the right to set up large GP-style services

Corporates have set up 200 healthcare centres in two years, although critics point out that the majority have been in wealthier urban areas.

The Social Democrats, the main Swedish opposition party, have given up the idea of renationalising the health service and instead argue that profits should be capped and quality of care more tightly regulated.

more than 500 beds are being removed from the country's best known health centre, the Karolinska University hospital, and the services are being moved into the community to be run by private companies

a business-backed research institute, the Centre for Business and Policy Studies, looked at the privatisation of public services in Sweden and concluded that the policy had made no difference to the services' productivity. The academic author of the report, who stood by the findings, resigned after a public row.

Last year Stockholm county council, which controls healthcare for a fifth of the Swedish population, withdrew contracts from a private company after staff in a hospital were allegedly told to weigh elderly patients' incontinence pants to see if they were full or could be used for longer.

Swedish tax authorities are, however, taking some companies to court because pay in private equity groups is often linked to the profits made on deals and has been incorrectly taxed for years, it is said, at rates lower than that required for income in Sweden.

la politique libérale sur la vieillesse présentée en mai 2012 ne répond pas aux enjeux réels. Avec seulement quelques centaines de nouvelles places en CHSLD, des investissements minimes dans les services à domicile et la poursuite en douce de la politique de privatisation des services qui, par définition, conduit à une dégradation de la qualité des services pour les moins nantis, nous sommes loin du compte ».  

Bien que l’ancien gouvernement libéral ait annoncé des investissements additionnels de 71,6 millions de dollars dans les services à domicile, l’analyse permet aux chercheurs de constater que « le budget additionnel pour les entreprises d’économie sociale en aide domestique (EESAD) au terme de ce plan de cinq ans n’aurait été, dans la réalité, que de 20 millions $ », ont conclu les chercheurs.

Lansley’s long term links and dialogue with private health care lobbyists and providers was barely mentioned (see Spinwatch

this is a large step towards privatisation. Bupa, currently flooding the UK with advertising, knows this. So do Virgin, Sainsbury’s, United Healthcare, Circle, and Care UK.

£20 billion of ‘efficiency savings’ are really £20 billion of ‘cuts

Former NHS hospitals, free to generate half their income from private patients, will dedicate their staff and facilities to that end, making it impossible to monitor what is public and what people are paying for.

Billing, invoicing, marketing and advertising will add between 30% and 50% to costs compared with 6% in the former NHS bureaucracy.

some of HCA's American hospitals are under investigation for refusing care and performing unnecessary investigations and treatment, including cardiac surgery. A decade ago it paid the federal government $1.7bn to settle fraud charges, while former chief executive Rick Scott – now the Republican governor of Florida – managed to avoid prosecution.

Unitedhealth, which is currently providing services to the NHS, paid hundreds of millions of dollars in settlement of mischarging allegations in the US; Medtronic paid $23.5m for paying illegal kickbacks to physicians to induce them to implant the company's pacemakers and defibrillators; GlaxoSmithKline and Abbott paid $4.5bn in fines relating to improper marketing and coercion of physicians to prescribe antidepressants and antidementia drugs respectively. Novartis, AstraZeneca, Pfizer and Eli Lilly have all paid large fines for regulatory breaches.