Back Street's Back

Thanks to the unelected political donors, washed-up ex-backbenchers and celebrity stunt appointees in the House of Lords, the NHS as a legal entity has now been abolished.

The government - Tories who promised 'no top-down reorganisations' and the Lib Dems who… well, it doesn't matter what they said, does it - has turned the National Health Service from an aspiration into a brand, under cover of which the profitable bits will be sold to corporations and the grotty bits (mental health, geriatrics) will moulder away and die.

Doctors will be forced to contract out to cherry-picking companies: some doctors will take the cheapskate options because they get to keep the change, others will make cosy deals with private providers. Either way, the interest of the patient will be less important than now.

Meanwhile, the public good is to be abolished. Like education, the Conservatives see health as a private good, rather than a public one. In reality, your health is important to me. If you're free of contagious disease, so am I. If you quit the cigarettes or start wearing your seatbelt, less of my tax will be spent on reinflating your blackened lungs or scraping your remaining brains back into your skull.

The NHS died today for many reasons, many of them obscure and legalistic. But here's one: the  Secretary of State for Health is no longer legally required to maintain a National Health Service. There are two immediate effects. Firstly, local health bodies can decide for themselves what the health priorities are. This may have some positive effects, but I can just as easily see some localities deciding that sexual health, or vaccinations aren't important. Diseases associated with poverty will be ignored, while the sexy ailments which make the front page of the Daily Mail will get priority funding. It's a return to the back streets, especially if your local authority decides that sexual health and terminations are morally unacceptable.

Secondly, if the 'NHS' fails in future, there's no democratic way to get answers, or to make heads roll. You'll pay for it, but your MP won't be able to ask the Secretary of State for Health to answer your questions. 'It's not my responsibility', he'll say. It's up to your local provider - and good luck with that, as they'll probably be exempt from Freedom of Information requests (just like the 'free schools' that we're now paying for).

I liked the NHS. My parents are doctors and many of my friends and family have been nurses or - more often - patients. It's been underfunded, kicked and abused. Some areas of provision are shockingly bad. But I've always understood that they're ultimately working for, and answerable to, us.

No longer.