Thames Valley Strategic Health Authority has proposed procuring “the provision of management services to the Oxfordshire PCT(s)… Bids would be welcome from NHS teams, the voluntary and private sector” (www.tvsha.nhs.uk/board-papers-12th-october-2005/Board_paper_62-05_CPLNHS.pdf). This, the authority says, will increase the culture of “choice and plurality in the NHS.” But this is not just a matter of NHS policy: there are also serious questions concerning patients' rights.

Private companies' fundamental duty is not to serve the public interest

Until now, the commissioning function of the NHS has been done by public health authorities, currently primary care trusts. Public authorities are governed by judicial review, which regulates public bodies in the performance of their statutory activities. The values of such bodies are based on public service and were stated in the first report of the “Nolan” Committee on Standards in Public Life as selflessness, integrity, objectivity, accountability, openness, honesty, and leadership (HMSO, Cm 2850).

Does this framework apply to private commissioners? Private sector companies are different from public authorities. They are not created by statute. Their fundamental duty is not to serve …