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Evidence is emerging that some health managers are rebelling against plans to create greater competition in the NHS.

The ����ý has learnt that many English trusts are introducing steps that make it harder for patients to opt to have NHS care done by private hospitals.

Health firms said it was a sign of bias, while ministers said there was no justification for the restrictions.

The behaviour of nearly half of local NHS management bodies is now being looked at by a government inquiry.

NHS patients needing non-emergency operations, such as hip and knee replacements, are already able to be treated by private hospitals that have agreements in place to carry out the care at NHS cost.

At the moment, only 3.5% of operations are done this way, but under the government's shake-up of the health service the number is set to increase.

Curb competition

However, in recent months managers working for primary care trusts have started trying to impose restrictions that channel patients away from private hospitals.

These include reductions in the range of treatments that private hospitals can offer NHS patients, caps on the number of people they can treat and promising NHS hospitals set numbers of patients.

Another tactic is to introduce minimum waiting times, which has the effect of slowing the flow of patients and cancels out one of the key benefits of being seen by the private sector - quicker treatment.

The issue is being looked into by the Co-operation and Competition Panel on behalf of the Department of Health. Its interim findings suggested as many as 70 of the 151 PCTs are employing such tactics.

They refused to give the ����ý the details of the complaints, but a source close to the inquiry said trusts seemed to be motivated by a desire to protect their local hospitals in the tight financial situation - in some cases specialist regional NHS centres outside trust areas were being hit by the restrictions - and a desire to curb competition in the health service.

Circle is one of the health firms that has complained. It has highlighted the behaviour of two PCTs - Wiltshire and Bath and North East Somerset, which cover the areas surrounding its Bath hospital.

Documents seen by the ����ý show that the PCTs have proposed introducing a range of restrictions, including cutting the number of areas of treatment Circle - and any other private sector provider - can offer to NHS patients from 11 to five. Part of the reasoning is that it is needed to protect the local NHS hospitals.

The PCTs refused to comment about the plans, which were to be introduced in April but have now been postponed while the government inquiry is carried out.

Ali Parsa, head of Circle, said there needed to be a "change in mindset" in the NHS. "There is too much focus on who is delivering the care. It is quality that matters."

David Worskett, director of the NHS Partners Network, which represents those private firms which see NHS patients, said the tendency within the NHS at the moment was one of "retreat" away from choice and competition.

"It is absolutely the case that in this period of transition that independent sectors are facing significant difficulties. The practices seem to be bias against the independent sector."

Health minister Lord Howe said: "There is no justification, either financial or clinical, for PCTs to restrict patient choice and think that they know better than patients or their doctors where patients should be treated.

"Any barriers to patient choice must be removed. In the future, Monitor [the regulator] will have legal powers to address restrictions on patient choice."

But David Stout, of the PCT Network, rejected the suggestion there was an anti-private sector culture in the NHS.

"It is not necessarily against the rules. These things can be justified because of the financial situation or because of valid clinical reasons. For example, it may be right to protect the local hospital to keep essential services going.

"I am sure many members of the public would be sympathetic to that. The important things is that it must be done in a transparent way and be able to be justified."