'Concerns will be increased by the fact that the second wave of ITCs will not, as previously indicated, be risk-free to commissioners.'

The independent treatment centre programme has had a difficult childhood, as even its parents will not dispute. However, our analysis this week shows just what a struggle it has been (news analysis, page 12).

The Department of Health argues our figure is unfair because undercapacity in the early days could be made up later along in the life of the contract. This is, in theory, true - but difficult to achieve and will not happen of its own accord. And how will capacity that is underused now because of GP referral patterns shift so markedly in the future? Referral rates do not just have to rise, but in many cases to accelerate hugely.

It is also a claim that local managers, and not the DoH, will have to make good. Concerns will be increased by the fact that the second wave of ITCs will not, as previously indicated, be risk-free to commissioners - so called 'tapered' contracts will mean that independent providers will still have some form of income guarantee.

Our snapshot survey of chief executives shows that most still believe there is too much capacity introduced in the wrong way and in the wrong places.

Although it will clearly be a major health theme at next week's Labour Party conference, the question is not whether the independent sector has an important role to play. The health secretary made clear on Tuesday that there will be no artificial and unsustainable cap on the proportion of NHS work it carries out.

But what our analysis shows is that the NHS has to get much better at planning the way extra capacity is introduced - and even more importantly, adapting behaviour to that plan. Otherwise the stated DoH target to get to almost 200,000 procedures in 2006-07 looks unrealistic.