The health bill is capable of destroying the NHS. I wish this was hyperbole. It’s not.

I am in Scotland, where things are a bit more sensible. Markets were tried, with Independent Sector Treatment Sectors, but because our hospitals tend to be geographically distant, it’s not really feasible to have a competitive market based system of any quality. Even then, markets don’t work for healthcare; you can’t be mid-heart attack and shop around for the best interventional cardiologist in the country. Markets have been proven not to work, too; there is ample work showing harm with competition. Healthcare is  not like  a market because patients are not shoppers. People with severe mental illness or learning disability or dementia should be able to get good care whether or not they are finding and comparing services data. People who have expensive-to -treat cancers should not be reduced to finding a doctor prepared to take them on. Markets in healthcare just don’t work. Politicians are very slow to catch on.

The USA, with  rafts of unproven tests and overboard investigations in the rich, and lack of healthcare for the poor, is not a model to be chasing. Probably the most developed medical market in the UK is for cosmetic surgery. Here we see the uprising of ‘practitioners’ with varying qualifications, advertising in magazines to teenagers, and celebrities going on to approve or try the wares. Doctors can make a lot of money out of this market. Whether you think that the results – procedures of risk in people who looked fine to start with and who tend to have  more psychological problems than average – is a good thing, is another matter. I don’t think this lucrative market is good for patients or society more broadly.

The Guardian are reporting that independent legal advice suggests that the health bill will contain a ‘hands-off’ clause which will absolve the government of responsibility when it comes to commissioning healthcare. This means that the private companies or GP companies who will be bidding will be effectively unaccountable. We already have the problem with Atos, contracted to do all the DWP health assessments; if you ask the DWP for information relating to the minutia of their assessments you are told no, because it is a private company. They are allowed to be private, although they are contracted by the taxpayer. This feels wrong to me; it means that the care of the most vulnerable people in our society is determined in a non transparent way.

If the NHS is franchised out to a thousand competing companies, what then? I predict: the easiest to set up and most lucrative healthcare interventions will be advertised and creamed off. The most difficult disorders will be unpopular, underdeveloped, and if you are unfortunate enough to need care from several different places at once, all will place caps on what they are willing to do (what they are paid for) and what they won’t (where their contract stops. )

The NHS, for all it’s faults, is fuelled by people who care about their work and who will add extra in. These are the people who chase things up, will stay a bit late to help, who will take a phone call when offduty because it’s something they know about and can fix well. Numb us down to the level of contract salespeople, and we will all suffer. But some people, the sickest, you can bet will suffer far more than others.