Unison, the largest public sector union, led calls to stop the building of any more independent treatment centres for conditions such as cataracts and hip replacements.

For the second time this week at Brighton, unions combined in a show of force to embarrass Tony Blair by committing the Labour conference to an urgent review of private provision.

Bernard Ribeiro, the president of the RCS, said that hospitals could be asset-stripped and destabilised by the plans to contract care out to the private sector. He said that he had no problem with “plurality of care” under the NHS banner, but called the Government’s plans “a vision translated into action with no real evidence that it will provide good results”.

“They are using this [the independent sector treatment centres] to challenge what they feel is a poorly performing NHS. But the risk is that it could destabilise the NHS.”

Mr Ribeiro said that the college had been taking evidence from doctors, managers and academics on the likely impact of the private sector centres on the NHS. He will present the results to Patricia Hewitt, the Health Secretary, next month.

She has said that a maximum of 15 per cent of elective surgery would go to the private sector centres. “But that is still quite a lot,” Mr Ribeiro said.

“About half the time of orthopaedic and general surgeons is spent on emergency cases. If you remove 15 per cent of what’s left, you skew the balance. Things will start to creak and the impact will be on the acute sector. Where is the evidence that these changes are going to be effective?”

Mr Ribeiro, who is a consultant general surgeon at Basildon Hospital, said he believed that the Government was bent on “change, change, change”. Reform of the NHS was not going to be impeded, and the foot was on the accelerator.

Accepting that, it was the college’s job to ensure that the quality of care was not compromised. One problem was the training of new surgeons. Surgery was a craft, and it took time to learn that craft, he said.

One answer was to allow junior doctors to be trained in the private centres, although Mr Ribeiro said that with the first-phase centres this had proved impossible. He saw the second wave as a huge opportunity. “We have got to be clever and create training programmes with periods in independent sector treatment centres,” he said.

The British Medical Association echoed his words yesterday, giving warning that independent sector centres could damage training. Jo Hilborne, the chairman of the BMA’s Junior Doctors’ Committee, said: “It’s not clear whether profit-making companies running treatment centres will provide training to the same standards as the NHS.

“How is a trainee surgeon supposed to learn how to do a hip replacement if their hospital has lost its contract to do them? Little thought seems to have been given to doctors’ training in a market-based NHS.”

Mrs Hewitt told The Times: “There must always be a quality concern when we are talking about our patients and there are sometimes quality concerns within NHS hospitals. Any doctor working for an independent treatment centre — and many come from abroad — has to be qualified to NHS standards and they are subject to exactly the same regulation and inspection as NHS providers.”

Joyce Still, a nurse from Aldershot, said: “It now appears for the first time that we will allow the private sector to run services such as district nurses, health visitors, occupational therapists, cancer screening, asthma and diabetic clinics. Are these companies going to be motivated by patient care?”

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