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At last a balanced piece - well done. Of the three areas of concern you can be sure the "technical restrictions" will be enforced to stop unfair advantage - the Procurement Police will see to that. As for the lack of loyalty to the NHS - managers in particular can be forgiven for having precious little loyalty towards a system which says goodbye to 40% of them and before you go please ensure a smooth transition to the new untried clinical leadership cadre . Yes they get paid well but most of these senior figures really care ( I know it sounds corny) about what happens - these are not easy decisions. QIPP is a policital as well as an economic necessity but don't imagine responsibiity for one of the few measurable national targets was easy. As to the increased influence of the private sector in the NHS has anyone spoken to a CCG recently? Many of them are even more opposed to the private sector than Mr Burnham at the end of the last Labour adminstration, - apart of course from innovative primary care GP led providers who live in a mysterious "not the private sector" parallel universe where profit (and an absence of competition) is permitted for their kind but no one else - that is a bigger practical, current and continuing risk than a rampant private sector