A nursing union has hit out at government plans to include more private firms in the health service.
Fourteen companies, including big health insurers in the US as well as UK specialists like Bupa and the consultants KPMG, have been approved to help NHS trusts commission services for patients.
The Department of Health claims it will make it easier for PCTs to buy private help and specialist expertise in areas such as population analysis.
But Mike Jackson, senior national officer for Unison, said: "Unison does not believe that the private sector has the necessary skills and expertise to commission healthcare for such a wide range of people, especially vulnerable groups.
"We have yet to see proof of the track record of these companies in commissioning on such a broad scale. We fear that patients may be the ones who suffer as a result of this lack of experience.
"The commissioning skills already exist within the NHS and we know they can deliver, so it is disappointing that the private sector is making further inroads into the NHS.
"Unfortunately Unison was not involved in the evaluation of these companies and we see no cost benefit attached to this move.
"We will be monitoring this development and seeking feedback from the Department of Health about its progress."
"I believe this is the UK goverment's secret attempt to give private health insurance companies unrestricted access to local NHS trusts runing and decision making, thus giving them the chance to decide which NHS trusts are financialy viable and lucrative to privatise in the future - Vladimir Tutko, HCA, Cambridge