It is not only the Treasury that has questions about the proposed deal with private hospitals: NHS campaigners will also have many big questions over how the deal would work. Here are ten to get started.

Will the government publish details of the contracts with the private hospitals and allow Parliament to scrutinse them? Commercial confidentially is traditionally cited to keep these deals out of the public view but in March the government also suspended the normal requirement to advertise and award contracts through open competition, so even a partial view has been obscured.

Will the government ensure that a plan to raise NHS capacity runs in parallel with any deal, so that the NHS can take over all work as quickly as possible? NHS beds numbers have been cut in recent years despite rising demand. There is a £6bn backlog in building repairs and a shortfall of at least 100,000 staff and yet there is no credible plan to fund an expansion of services.

How long will this arrangement stand? The Cameron government over saw a vast experiment with private sector involvement in the NHS. Seven years later NHS England called for a new law to remove the compulsory tendering of NHS contracts, but no change has happened. NHS expenditure on the private sector still grows and with some concern that without controls the government could exploit this opportunity to expand the role of the private sector.

Will the private sector receive the NHS rate in payment and how will the government prevent the waste that has happened in the past? The NHS tariff sets out the price at which NHS hospitals receive payment, the private sector should not receive more.

There is a precedent for badly made large-scale deals between the NHS and private hospitals – the contracts for the Independent Sector Treatment Centres (ISTC), which were begun with the aim of reducing the waiting lists back in 2003 to 2007 were later found to have wasted taxpayer money to the tune of almost £500 million including a series of ‘needless’ payments written into contracts that were virtually risk-free for the private companies involved.

How will safety measures in the NHS be applied and checked across private sector sites? A report in 2018 by Centre for Health and the Public Interest identifies what they believe is a systemic patient safety risk within private hospitals.

They identify that post-operative care in most private hospitals is carried out by an inexperienced junior doctor, most units lack intensive care facilities and the consultant who carries out the surgery is permitted to be off-site, in some cases 45 minutes away CHPI also contends that the data on patient safety incidents in private hospitals is poor and private hospitals are not required to notify patient safety incidents in the same way as the NHS.

Will the cost of staff training, normally borne by the NHS be reflected in the terms of agreement? The BMA says the NHS Standard Contract should include a clause requiring independent sector providers to contribute towards the education and training of the NHS workforce. In UK the private sector makes use of staff who have been trained in the public sector but makes a negligible contribution to training costs.

How will the government make sure the financial viability of NHS is not affected? NHS hospitals rely on the income from treating patients to sustain their activities. It is therefore essential for their sustainability for the arrangement with the private sector to be time limited.

Who will control the allocations and ensure the best clinical decisions? In the past contracted companies have falsified performance data and there have been accusations that caseloads are manipulated to reduce their costs and operations carried out needlessly

What happens to patients on the waiting lists in areas where this extra capacity is not available? Additional capacity will not always be where the longest waits exist. There is already inequity in provision, how will this be managed?

Can the government guarantee transparency over the operation of this deal? How will the contracts be monitored and information published given the lack of resources traditionally spent on this aspect and the fact that the Freedom of Information Act does not apply to private providers?

Despite the situation the NHS finds itself in, there should be no reason that any deal with the private sector should not be fully scrutinised.

Without adequate scrutiny of the deal, the NHS could simply end up bailing out an ailing private sector – to the tune of billions of pounds.

The evidence so far of the use of the private sector over the past three months shows that the private sector’s help for the NHS has been limited, but in exchange it has received millions to pay its debts and operating costs.

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