An end seemed in sight to the era of big, centrally negotiated contracts between private healthproviders and the government yesterday when Patricia Hewitt said patients, primary care trusts and family doctors would decide the extent of private sector involvement in the National Health Service.

In a speech in London to the Institute of Public Policy Research, the think-tank, the health secretary risked the wrath of trades unionists and Labour left-wingers by declaring that the government would set no curbs on the extent of private sector provision of NHS care.