The week began with a media feeding frenzy around the government’s NHS reforms created by the imminent publication of the health bill. Dire warnings were ten a penny, while the PM adopted a Thatcherite “no alternative” stance.

The BBC’s Nick Robinson declared: “David Cameron made clear his view that ‘choice, competition and diversity drives up standards’. He is counting on groups of GPs - often in partnership with private companies - to drive a harder bargain with hospitals.”

The truth is that increasing private sector involvement in the management of the NHS is very hard

If competition and greater private involvement really is the PM’s goal, then he is likely to find it as difficult to achieve as Tony Blair before him.

The truth is that increasing private sector involvement in the management of the NHS is very hard. Preferred business models collide with a political desire not to scare the horses (BMA, RCN etc) and the financial and organisational imperatives built into the NHS infrastructure.

HSJ’s exclusive that US healthcare giant Humana is leaving these shores after five years is totemic of these difficulties. The company is leaving for “strategic” reasons, but they do so in the belief that the Department of Health’s focus is on finding roles for existing PCT and SHA staff, not developing a market for commissioning support.

KPMG has secured a consortia development contract from NHS London and United Healthcare has done a referral management deal with a consortium in the west of the capital, but – for the reasons above - anyone expecting a rash of such moves is likely to be disappointed/pleased (delete to suit prejudice).

The private sector will grow in influence over NHS service delivery – but that growth will be incremental. The success of the government’s health reforms will depend much more on the efforts of those receiving a NHS pay cheque.

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US health giant Humana to pull out of UK