Costain has pulled out of the race for the £3bn Procure 21+ framework, amid growing concerns over the future of healthcare spending

The NHS is refreshing its contractor framework and has been swamped by expressions of interest. But Costain, which is a member of the existing Procure 21 list, has decided not to bid for a place on its replacement, in spite of describing it as a “must win” as recently as June.

Carillion is also understood to have decided against bidding for the framework.

In a poll, 41.8% of people said health would be the public sector area worst hit by cuts.