Labour theory used to be 'private sector bad, public sector good'. Former health secretary Frank Dobson rarely had a good word to say about independent healthcare providers. But keen New Labour types think differently. When companies want to get involved in caring for elderly patients, ministers eager to release scarce hospital beds are right behind them.
Health minister John Denham last week said it would be 'daft' not to follow up proposals from Dr Chai Patel, chief executive of Westminster Healthcare.
Dr Patel, who advises ministers as part of the Department of Health's partnership modernisation team, says care for elderly patients 'can be provided in more than one setting'.
Health secretary Alan Milburn has already said he wants more intermediate care, bridging home and hospital for elderly people.
Earlier this year, in response to the national beds inquiry, he said: 'In many cases we'll have to build more facilities. There will be a new role for private finance here, although of course the care that is provided is free.'
Dr Patel seizes on this statement: 'We don't need to build more hospitals when there is the capacity out there now. We will be able to meet these needs in partnership with the NHS in the independent sector.
We have rehabilitation centres, we have GPs doing regular rounds and nurses and therapists in the community.'
The number of elderly patients stuck in hospital even though they could go home with the right support is certainly a pressing problem.
According to the beds inquiry, pensioners occupy almost two-thirds of the UK's 190,000 general and acute hospital beds. The over-65s 'account for half of the recent growth in emergency admissions', the report says.
Yet the overall number of beds has been falling for decades.
And ministers are keen to make sure that those left are not blocked by patients who do not need high-tech hospital care.
Some managers believe that as long as the beds are freed, what happens next is not their problem. But Paul Forden, finance director at King's Healthcare trust in south London, says: 'We can't just get rid of people.
There is an ethical problem about placing people in the right conditions.' And there are practical reasons for making sure patients are well after they leave: 'Their conditions might worsen and we may have to re-admit.'
Christine Outram, chief executive of Enfield and Haringey health authority, says any development of joint working with the private sector needs to be handled carefully. 'We have used private facilities in the past. . . to deal with particular pressures on beds. But it is always in conjunction with NHS staff.'
The minister's statement could be useful in making policy more 'explicit', she adds. 'It would be helpful to have more intermediate care beds, both in the private sector and in the NHS.'
The issue is most pressing in areas with a large population of retired people. But Ian Carruthers, chief executive of Dorset HA, says there are constraints to using private nursing homes or private care in people's own homes: 'We do have to ensure that we get value for money, that services are appropriate for the patient and that before we invest in the private sector we should test the opportunity to invest in the NHS. Can the NHS recruit the staff and provide better value than the private sector?'
Ray Rowden, professor of nursing at York University, says the government hasn't defined the concept of intermediate care. 'Until the government is clear about what it means, it is difficult to go forward.
There is a world of difference between a robust 70-year-old who needs to recover from a hip replacement and a 70-year-old who needs immediate post-stroke care.'
Ministers 'are not clear what they want in policy terms and are leaping for a quick policy fix'.
GPs form care deal with nursing home A group of GPs in Devon say working with private nursing homes can give patients better care, closer to home - and save the NHS money.
Three practices in Cullompton set up a scheme with a private nursing home in 1993, after failing to secure funding for a local community hospital. It works by preventing hospital admissions, rather than picking up the pieces afterwards. Instead of sending elderly flu or pneumonia victims to hospital in Exeter, GPs supervise the care of chronically ill patients at the Old Vicarage home, on a shared rota. North East Devon health authority pays£60,000 a year, for an average of 80 patients. The HA only pays for the beds actually used and occupancy varies between zero in summer to five in winter.
The nursing home sister contacts social services on the day of admission to start planning for discharge; patients are only referred if they are expected to recover within two weeks. The service is carefully audited twice a year.
The GPs say the scheme has cut admissions to the Royal Devon and Exeter Hospital from Cullompton by 23 per cent - at a time when the overall figures are rising. The average stay of just over 11 days costs£64 a day, compared with£234 a day for an emergency medical hospital admission. Each practice earns 10 per cent of the nursing home fee for providing the medical care.
Dr Michael Dixon, who founded the scheme, says: 'This is a win-win situation. We are only paying for the beds we use, it keeps patients near home, their relatives can visit easily and it is properly organised.'