Four flawed beliefs have dominated the actions of UK governments on healthcare over the past 25 years: personal responsibility for health supersedes government responsibility; markets drive efficiency; universal healthcare is ultimately unaffordable; and it is entirely legitimate to view healthcare as a business.

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But infants and children cannot exercise personal responsibility – nor have the greatest health gains come from personal choices, but rather from public measures: clean water, clean air, immunisations, affordable good food and housing, and environments that facilitate healthy lifestyles. Good health also comes from the security of a strong social safety net.

Government understands its responsibility to protect citizens from lawlessness and terrorism, but failing to invest in safeguarding the health and social care of children will ultimately prove even more damaging to the national wellbeing.

More and more, we hear voices claiming the NHS is somehow unaffordable through taxation, and that we need to look at different funding models, such as insurance. Hospital trust chair Christopher Smallwood has made that case. But there are better options.

Margaret Thatcher’s government introduced the internal market in 1990, creating a split between purchasers and providers. New Labour expanded the private finance initiative, further opening the door to commercialisation. The Conservative-Lib Dem coalition reneged on a major election promise, introducing the biggest ever restructuring with the 2012 Health and Social Care Act. This reduced the NHS in England to a logo and a funding stream channelled through a new commissioning board, hastily renamed NHS England.

With the act, the health secretary’s responsibility to “provide or secure” healthcare – in place since the founding of the NHS in 1948 – was lost; universal provision was replaced with commissioning for registered patients; healthcare was thrown open to “any willing” – hastily changed to “any qualified” provider; and a crippling financial straitjacket was imposed.

Although discredited – in 2010 a Health Select Committee called it “20 years of costly failure” – the internal market was retained, paving the way for a growing external market in healthcare.

Currently 853 independent organisations contribute to NHS care – commissioned by more than 400 local authorities, 209 clinical commissioning groups, and NHS England. Into this chaotic mix has come further fragmentation with the devolution of acute, public and social care commissioning to large urban conurbations. The opportunity for improved healthcare through strong national coordination is being lost.

The balance of evidence is that for-profit healthcare is poorer quality at greater cost. Following a damning report from the Care Quality Commission, Circle is reported to have pulled out of a £1bn 10-year hospital contract. And after data falsification and a culture of intimidation was exposed, Serco withdrew from a GP out-of-hours contract.

Private firms operate under the NHS logo, so the public is likely to be unaware when treatment is being provided by a for-profit company. The private sector is said to have received 70% of contracts awarded over 2013-14, estimated at £20bn of the total NHS budget of £113bn.

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Virgin Care – awarded some of the biggest contracts, including £140m for children’s services in Devon – admits a profit intention of at least 8% – is this use of taxpayers’ money defensible while the health budget is being squeezed?

PFI repayments haemorrhage around £10bn each year; providers and commissioners, ill-prepared for the burgeoning complexity of a devolved health service, spend £640m each year on management consultants. Expenditure on private health insurance and products currently runs to £20bn; incompetence in dealing with the pharmaceutical industry has led, for example, to a sharp rise in the annual cost of a widely used epilepsy medication from £2m to a breathtaking £47m.

Addressing this appalling waste and doing away with the internal market, which is estimated to cost between £4.5bn and £10bn to administer, should surely be the focus of a government committed to fiscal prudence. Instead there has been a 30% increase in advertisements inviting bids from non-NHS organisations, and a growing proportion of the healthcare budget is in the pockets of private enterprise – at a time when the NHS is being starved of resources and required to find £20bn in “efficiency savings”.

UK health expenditure at 7-8% of GDP is about half that of the United States, and less than our European neighbours – though the public has indicated time and again that it would willingly support a greater contribution through general taxation to strengthen the NHS.

The 2014 Commonwealth Fund report on 11 wealthy countries shows that the UK spends least but ranks first in healthcare performance; the US spends most but ranks bottom. In the US, one in six citizens has no health cover and inability to pay healthcare bills is the primary cause for personal bankruptcies, yet we are witnessing extraordinary, deliberate moves towards a failed US-style healthcare model.

Why have successive governments behaved so irresponsibly and illogically? The only possible explanations are ideological conviction, ignorance of the evidence, or personal self-interest.

Universal healthcare, free at the point of need and funded through general taxation, is cost-effective, increasingly justified by evidence, and morally right. The formation of the NHS was ahead of its time in recognising health as a leveller (any one of us might break a leg, contract pneumonia or have a child develop leukaemia), and enshrining in law a government responsibility. Healthcare in a civilised 21st century nation is a human right, a public service, not a business.

The public may not be fully aware of the extent to which the health service has moved away from its founding principles. The NHS is not unaffordable, but marketisation and commercialisation have led to escalating costs, inefficiencies and a widening of health inequities.

Re-establishing the secretary of state’s legal duty to the NHS in England, and protecting the NHS from competition law and increasing marketisation would be a good opportunity to redress past mistakes and strengthen a magnificent service that, though not perfect, has been a global beacon of equality and efficiency.