'The suspicion will be that the people who shaped the market will profit from its creation'

If the industrial action in response to the NHS Logistics deal has not provided enough fuel for the 'privatisation' debate at next week's Labour Party conference, the news of McKinsey's bid for primary care trust commissioning contracts will be seen by the unions as further proof that the NHS is being served up on a plate.

What makes McKinsey's presence as a potential private sector provider controversial is that the consultants designed the fitness for purpose programme for PCTs and the accompanying commissioning diagnostic tool. The suspicion will be that the people who shaped the market will profit from its creation.

It would surely be odd if the Department of Health was getting advice on a service from people who were not well placed to provide it. What counts is the robustness of the process. Can Whitehall demonstrate that it can carry out competitive tendering properly (it remains to be seen whether the NHS Logistics deal will stand up to scrutiny, for instance)?

The unions' argument is one they applied to the appointment of former prime ministerial health adviser Simon Stevens to UnitedHealth Europe. Indeed, pretty much the same claims and complaints were made during the major outsourcing of council services in the 1990s.

But the McKinsey news still has the shock of the new and will be difficult to manage politically in the short term. The emotional impact of what some see as the spectre of an archetype of US capitalism taking over the NHS is a powerful one. There will be more to come.

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