Are you sure that's not a piss take? That can't be real....

Final bids will be evaluated in May. The contract will be awarded to "the most economically advantageous" bid, according to criteria listed for it on the European commission website, where any European public tenders are required by competition law to be published.

Perhaps most importantly, the compulsory licensing of medical professionals should be abolished. Anyone should be at liberty to practice as a doctor or nurse, with patients relying on brand names or competing voluntary associations to ensure quality. Ending current restrictive practices is essential to enable private firms to increase productivity in the sector.

The drip-feed of pro-competition arguments from economists Julian Le Grand and Zack Cooper at the London School of Economics raises serious questions about the independence and academic rigour of research by academics seeking to reassure government of the benefits of market competition in healthcare.

Last July, Cooper and several colleagues released an unpublished paper to coincide with the prime minister's announcement that he was setting up a forum in response to concerns about his health bill. The authors were sufficiently persuasive for David Cameron to declare "Put simply: competition is one way we can make things work better for patients. This isn't ideological theory. A study published by the London School of Economics found hospitals in areas with more choice had lower death rates."

The study in question claimed that competition in the NHS saved lives. The authors claimed that if heart attack mortality rates were used as an indicator of quality, mortality rates fell more quickly and therefore quality improved for patients after competition between hospitals was introduced to the NHS in their area. But if you examine the evidence it is clear that competition had nothing to do with it. The intervention that the authors claimed reduced deaths from heart attacks was patient choice – a proxy for competition. In 2006, patients were given choices of hospitals, including private providers, for some selected treatments, mainly non-emergency surgery. Yet there is no biological mechanism to explain why having a choice of providers for cataract, hip and knee operations could affect the overall survival rate from heart attacks. These are emergencies where patients do not exercise choice over where they are treated and are usually treated in the NHS.

As the government's own cardiac tsar Roger Boyle explains. "Patients can't chose where to have their heart attack or where to be treated. It is bizarre to choose a condition where choice by consumer can have virtually no effect. Patients suffering severe pain in emergencies clouded by strong analgesia don't make choices. It's the ambulance driver who follows the protocol and drives to the nearest heart attack centre."

So among the numerous problems with this study the authors have made the cardinal error of confusing minor statistical associations with causation. Deaths from acute heart attacks are not a measure of the quality of hospital care as a whole, as they claim, but rather a measure of access to and quality of cardiology care. Gwyn Bevan, professor of management science at the London School of Economics, who carried out a review of patient choice and competition in the BMJ commented on the paper's shortcomings. He subsequently went on to say that he was "perplexed" by Andrew Lansley's emphasis on the role of choice and competition because "the evidence is very weak and contested".

"In fact, I would argue that we don't have any strong evidence of that effect. To my mind, the jury is at best still out on whether choice and competition will improve quality of care in the NHS."

Serco are incredible. You could put anything out to tender and they'd turn up. "Transferable" skills?

Illustrative Scenario6

A seven year old girl has autism and attention deficit hyperactivity disorder. She lives with her single mother and three siblings in a high rise flat in a deprived area. Her mother is depressed and struggling to cope.

The school are concerned because she regularly has bruises on her arms and arrives hungry and late. The bruising may result from reasonable restraint by her mother and her hunger may be indicative of her challenging behaviour as autistic children can be difficult to feed.

She needs an urgent combined health and social care assessment to determine whether she is being abused and/or neglected. She requires an appropriate school that can cope with her complex needs, and regular review by community paediatricians, a child development team and child and adolescent mental health professionals working together to coordinate services around the child. A high level of cooperation is essential to ensure the child’s safety.

The notion of choice has no relevance to this family. It is unlikely that this girl’s mother will be able to adequately articulate her needs and have the skill and resources to navigate a complex environment of healthcare, social care and education services.

Some of the services this family need, such as parenting skills for her mother, may be regarded as low priority by the CCG. Services for this family will fall under the responsibility of the CCG, the NHS Commissioning Board, the local authority public health department, the local authority children’s social care and with the new Police Commissioner. Ensuring that fragmented health services can fully integrate with social care and education services will be a significant challenge.

In a competitive market there is no incentive for providers to collaborate to provide integrated pathways of care. Indeed, such collaboration may be seen as anti-competitive and incur substantial financial penalties

Leading private health firms hoping to benefit from the government's controversial NHS reforms have set up corporate structures that allow the avoidance of tax on millions of pounds' worth of profit, it can be revealed.

An investigation into the accounts of five of the biggest corporate names who lobbied in favour of health secretary Andrew Lansley's reforms has found widespread use of tax havens.