Private providers have called on the new health secretary to clarify his commitment to independent sector expansion amid fears it will slip down the political agenda.

In the week that patients in England are given the right to choose orthopaedic treatment at any independent sector centre on the national list, private providers have urged Alan Johnson to continue the reform programme.

Graham Kendall, acting general manager of NHS Partners, the NHS Confederation's independent sector network, said private providers were greeting the health secretary's appointment with 'caution'.

'When Alan Johnson was running for deputy leader, he said the important thing was delivering good quality patient care and he avoided saying whether he was pro- or anti-independent sector,' he said. 'We'd like an early indication of his commitment.'

The private sector has a long list of priorities for Mr Johnson, including delivering the second wave of independent sector treatment centres on time.

Netcare director of corporate affairs Julia Eadie said she was hoping for confirmation that the independent sector still has a role in partnering with the NHS. 'We would like a clear ministerial statement that would give our equity partners confidence,' she said.

Private sector drop-off

But Institute for Public Policy Research senior researcher Joe Farrington-Douglas predicted a 'quietening-down' of private-sector expansion. 'It's not a big change of direction, but a change of emphasis,' he said. 'I don't see any large-scale going back. However, the more extreme, Blairite thinking might be slowed down.'

Private sector services would probably not take over end-to-end commissioning on any large scale, he added, and mistakes made in past programmes make it unlikely there will be huge new waves of ISTC capacity.

However, the appointment of Greg Beales as prime minister Gordon Brown's adviser on health, who is understood to be a strong supporter of practice-based commissioning and the 18-week target, 'suggests that the reform doesn't stop'. 'Competition and choice will continue to apply but it might not be so high up the agenda,' Mr Farrington-Douglas said.

Sally Taber, director of the independent healthcare sector's umbrella organisation Independent Healthcare Advisory Services, admitted to feeling apprehensive.

She said: 'We welcome Mr Johnson's appointment but would want to make sure that we continue to be represented on all the major stakeholder pieces of work that need to be taken forward and that the agenda to create a level playing field continues.'

Policy on the internal market in England is likely to increasingly diverge from that in Scotland and Wales. Both the Welsh Assembly and the Scottish Executive have issued statements rejecting the use of the private sector.

The One Wales agreement signed on 27 June by Labour and Plaid Cymru commits the Welsh Assembly to ending the internal market and eliminating use of private hospitals by 2011.