Two huge democratic deficits are about to collide: what the general public feel about the NHS and the action of governments, and also the government of Scotland.

The Health and Social Care Act (2012) did not have a single clause on patient safety. It did not speak to Mid Staffs.

Remember when David Cameron promised ‘no top down reorganisation’?

It did, however, contain a very nifty clause, distinct from the legislation which had preceded it, providing a massive legal threat to those NHS contracts which did not go out to competitive tender in section 76(7).

It was clear that this legal threat was not innocent at all, as previous experience from the Netherlands had been very costly.

I reviewed back in January 2013 that in the Netherlands, a year previously, competition law authorities fined the national GP association £6.4 million for trying to prevent the same situation as has been allowed to develop in Sweden, rural areas unserved by primary care services (reported in the British Medical Journal).

This legal pincer grip continues to have sharp teeth. Earlier this year, it was reported that a complaint by private healthcare operators had been upheld against Blackpool CCG on the basis of ‘insufficient choice’.

A lot of damage has done in the English health policy in the name of competition and choice. The idea was that competition would drive up quality and drive down costs. Because of the nature of the oligopolistic market, as would be predicted, this has not happened.

This competition policy has been aggressively pimped in the academic journals as a ‘success’ for New Labour’s health policy between 1997-2010, and together with the public private initiative and TTIP formed an unholy mess.

The privatisation of social care in England is well known to have been a disaster, an explosive mixture of austerity, outsourcing and privatisation opportunities and poor employment bargaining.

In England yesterday, the current Prime Minister framed low taxes as ‘a moral decision’. Low taxes means, however, theoretically less money you contribute to the running of public services such as the NHS, and more you can spend elsewhere for example on private health insurance.

And it has all being elegantly through: the ability to take your pension as a lump sum encourages the free movement of capital into private industry too.

The SNP have now got a clear lead in the polls, and the tendency has been for this to be under-reported in England, emphasising instead that the Conservatives and Labour are ‘neck and neck’.

Whatever the claim and counterclaim, Scotland made a clear departure from the English pro-privatisation legislation back in 2011, and is set to complete the current phase of devolution with a Scotland Bill to be presented to parliament later this year.

As a Guardian newspaper report in 2011 revealed,

“The rhetoric may be strident, but Scottish Government ministers at least practice what they preach. Across a whole range of areas, public versus private sector, telehealth, pooling health and social care and streamlining management, the devolved government has adopted a markedly different approach for the NHS in Scotland. And although that health service had long been administered separately from that in England, it was the creation of the Scottish Parliament in 1999 that made this increasing divergence politically possible.”

So a critical question becomes would the SNP be willing to vote on non-Scottish issues such as the NHS?

The answer, as of January 2015, appears to be “yes”.

Sturgeon explains:

“On health, for example, we are signalling that we would be prepared to vote on matters of English health because that has a direct impact potential on Scotland’s budget. So, if there was a vote in the House of Commons to repeal the privatisation of the health service that has been seen in England, we would vote for that because that would help to protect Scotland’s budget.”

In exchange, the SNP viewed in public during the referendum campaign that Scottish independence as producing a sustainable financial budget for the NHS, hence the smirks from Sturgeon when Nigel Farage claimed that Scotland gets a relatively good deal from “the Barnet Formula”.

Labour’s policy is for the NHS to be the “preferred provider”, but only in January 2015 the English NHS achieved its “biggest-ever privatisation of its services in a deal worth up to £780m intended to help hospitals tackle the growing backlogs of patients waiting for surgery and tests.”

But this policy does not go as far as the SNP one. For a start, the Labour policy still retains the failed quasi-market and purchaser-provider split.

The anti-austerity arguments run that if you ease off the rate of austerity then you can encourage consumer-led growth, increasing tax revenues, and encouraging a recovering economy.

The direct parallel of this is the austerity-induced ‘efficiency savings‘ in the NHS, an austerity narrative which has seen some English NHS hospitals running unsafe staffing  in the aim of balancing budgets, because neoliberal parties do not wish to entertain funding the NHS properly.

The freeze on pay in nurses, therefore, looks ideologically driven, as opposed to using pay to incentivise performance of staff as in any other industry. Also, national policy appears to give the impression that nurses are immune from any recovery in the economy due to this imposed austerity, which is a crying shame.

Of course, the trade off for a more public NHS in England might be Scottish independence, but some feel the most pertinent moral argument is here that Westminster should not be governing over Scotland anyway if has few or no MPs.

Unbelievably, two democratic deficits have collided: one to do with the NHS and one to do with Scotland.