The private sector may play a key role in the new generation of 'fasttrack' treatment centres, with private finance initiative-style contracts to provide management and clinical staffing considered as one option for the 26 elective units approved by the government.

A Department of Health spokesperson told HSJ: 'I do not think we rule anything in or out.

The key thing is we will be providing NHS care. We want to invest in the NHS and in fast-track centres.

There is not necessarily any presumption against the private sector. We do want to be pragmatic. '

NHS Confederation policy director Nigel Edwards said he 'accepted the private sector could have a role' and that 'this particular genie is out of the bottle'.

Changes to ways of working, including 'challenging existing demarcation lines', could be implemented more quickly with private sector involvement, he added.

Any issues were practical rather than ones of principle, he stressed. 'They are about our capacity to specify and run what are very complex contracts. The issue of principle was given away some time ago. The private sector does run mental health services, for example. '

Earmarked in the hospital building programme, the elective centres will be modelled on the successful and politically favoured Central Middlesex Ambulatory Care and Diagnostic Centre in north-west London. Once up and running, it is predicted they could eventually account for half of all hospital activity.

Management consultant Andy Black, who carried out the concept planning for the Central Middlesex unit, said: 'We would love to run those centres. We could do it at 80 per cent of the cost and 200 times better. '

Unison and the Hospital Consultants and Specialists Association are strongly opposed to any move to introduce PFI arrangements for clinical services.

But Mr Black argued that staff would be better off. 'There is an enormous amount of junior talent - including anaesthetists, pharmacists and managers - not reaching its full potential. '

National officer for Unison Steven Weeks, although supportive of the idea of fast-track centres in principle, said his union had 'made it clear to the government that we are opposed to private sector involvement in the delivery of their services'.

'Where is the evidence that privatisation would provide a better service to the public? In America there are all sorts of issues around accountability, cost and quality. '

President of the Hospital Consultants and Specialists Association Winston Peters said extending PFI contracts into clinical services was 'inherently wrong and the first step in destroying the NHS as we know it'.

Labour think-tank the Institute for Public Policy Research publishes the results of its examination of the future of public-private partnerships, including PFI, at the end of May. Last July, a report for the IPPR by healthcare strategists RKW said private sector contractors working with the NHS should be allowed to 'help deliver on health outcomes'.