The NHS lurches its way through funding crises and organisational dilemmas. It faces the challenge of antibiotic resistance and it must ponder the deeply conflicted question of the uses and abuses of new technology. Its short-term horizon is so thronged with urgent problems that it would be a surprise if anyone had the spare capacity to consider how things could look by the end of the century.

A new social enterprise, Kaleidoscope Health & Care, however, decided it would be useful to try to raise the collective medical gaze into the very long term. Last year it organised a science fiction short story competition and invited writers to consider healthcare in 2100. The winners are announced on Thursday.

The stories (I was a lay judge) raised some fundamental questions about how the explosion of innovation in genetics and biotechnology would reshape our sense of being human. Most writers were anxious about how to preserve equality of access to healthcare; one of my favourite stories explored the scope for understanding better what we already know about the human biome and its relationship with the natural world. No one considered what seems to me likely to be the existential threat to the NHS, its reluctance to convert itself from a sickness to a health service. But if that particular problem isn’t resolved by 2100 it will probably be too late.

The most persistent anxiety was about the ownership and exploitation of genetic data. Not surprising: only consider the fog that shrouds the subject now, where knowledge and expertise is all on one side. Merely contemplating the mix of big data analysts and, different but related, artificial intelligence developers on the one hand, and the vast resource of the NHS’s 70 years of records of the nation’s health on the other makes me feel a bit like King Logenbula faced with Cecil Rhodes, slavering over his goldfields. You know there’s only going to be one outcome.

In the 21st-century dystopia of some of the entries for the Kaleidoscope prize, big data becomes big business, captures the secret of life, or at least of postponing death, and then exploits human vulnerability – the desire for perfection, the urge to protect – to enslave us all. It feels horribly plausible. It convinces me that something needs to be done, now.

The relationship between the use of NHS data, its huge potential to unlock understanding and at the same time the enticing prospect of building a world-beating life sciences industry by exploiting it – the sort of thing envisaged in the government’s recent life sciences industrial strategy – is something that ought to be keeping us all awake at night. Instead, most of us park it in the too complicated file, and if asked about data sharing tick the box saying no.

But that’s a mistake too. NHS data is an astonishing resource. It has the capacity to transform our understanding of care and drugs and environmental and occupational impacts. There may be arguments for saying it’s best left undisturbed; but already, cash-starved NHS managers are plotting ways of monetising it. So, instead of leaving it to them we should demand that it becomes a much more open and public process that sets out to inform and engage, instead of walling off knowledge behind a barricade of techspeak.

Parliament, since government may not see what’s in it for them, should consider, say, the experience of the Human Fertilisation and Embryology Authority as a model for how a complex scientific and ethical subject can be handled so that it builds support from both the medical and scientific community and the public.

The mission statement of the NHS Data Commission would be similar: to build popular confidence by bringing expert scrutiny to the way the life sciences industry wants to use information gained from patients with the power to dictate the terms. Along with scientists and ethicists, it would include intellectual property and privacy lawyers who understand the implications of developments. Its meetings would be public and its reports published, with a particular remit to be accessible. It would be a proper basis for a new industry.

The purpose of good science fiction writing is, at least partly, to reflect on the present. That’s what the Kaleidoscope prize does. It would be foolish not to listen.