The NHS will be forced to abandon its founding principle of providing a comprehensive service 'free at the point of delivery' by 2015, a leading private sector provider has predicted.

The NHS will be forced to abandon its founding principle of providing a comprehensive service 'free at the point of delivery' by 2015, a leading private sector provider has predicted.

Patients will have to pay for a range of services including fertility treatment, some specialist drugs and weight-loss surgery, according to a director of Netcare, which holds NHS contracts as part of the independent treatment centre programme.

Julia Eadie, Netcare's director of corporate affairs and a former senior Department of Health official, who most recently headed its policy on overseas teams, told an HSJconference last week that financial constraints would force the NHS to restrict itself to a core service.

She said that with financial growth forecast to be no more than 3 per cent from 2008, compared to the figure of nearly 7 per cent the NHS has seen over the last five years, the state would no longer pay for treatments including weight-loss surgery, infertility treatment, laser eye surgery, treatment for sports injuries, varicose vein surgery and many specialist drugs.

Decisions on such treatments are currently taken locally, with controversy over primary care trusts that have introduced restrictions which go further than guidance from the National Institute for Health and Clinical Excellence.

She said that in future, patients seeking such treatments would need to use independent companies such as Netcare - which will have spare capacity once the NHS has met its overarching target of a maximum 18 weeks from GP consultation to treatment, she said.

Ms Eadie was explicit about the potential benefits for the private sector as the increase in state funding shrinks.

'There will be a major funding gap post-2008, and we see this as an opportunity ñ ´¨e NHS will still be doing some services but it will also draw a line. Four years ago you would never have seen the NHS talking about &Quot;markets&Quot; or &Quot;demand management&Quot;. People are already opting to self-pay for cosmetic surgery and things like Botox.'

Before joining Netcare, Ms Eadie led and implemented the overseas teams and treatment policy at the DoH.

NHS Confederation policy director Nigel Edwards said he did not agree with Ms Eadie's logic. But he said constraints on financial growth highlighted the need for a more overt discussion about what the NHS should and should not pay for.

'I don't think the NHS should be funding things like IVF or sports injuries ñ ·¥ don't do much cosmetic or laser anyway. But we should be having a discussion with the public about whether to fund things that are not cost effective.

'We have needed a debate about priority-setting and rationing for ages. People all nod their heads sagely and say yes, but we never do. Perhaps as patient and public involvement advances we should be taking up that baton.'

British Medical Association consultants and specialists committee chair Dr Jonathan Fielden said Ms Eadie's statements were 'simply wishful thinking on Netcare's behalf to safeguard its future'.

'The NHS is raising its game, waiting lists are falling and if we are allowed to work on a level playing field there will be a lot less work for aggressive organisations like Netcare. The NHS doesn't do a lot of things that Ms Eadie mentions but it does where there is a genuine medical need.

'The NHS needs to stand by its principle of being a universal and comprehensive set of core services, but that is not to say we don't need a wider debate about what we should not be doing.'

Mark Gould