Why are they doomed to fail?

We are now used to the idea that despite spending enormous sums of extra money on our public services, improvements are small or non-existent. There may be some improvement in health, but education seems to be going backwards and we are slipping down the league tables.

Is there a reason? Yes, more than one!

Our supply is centralised and monolithic. Everything is top down, with London setting targets and trying to fine tune by diktat and finance. The NHS is one of the largest organisations in the world. To try to run this from the centre is bound to result in confusion and inefficiency. The decision makers at the top lack knowledge of what is happening at the bottom, despite the vast arrays of statistics collected, the people at the bottom are demoralised by targets, instructions from distant bosses, and a belittling of their roles. They will avoid whatever they can of what they resent, take whatever they can from the system and avoid hassle as far as possible. The result is the kind of inefficiency that we used to see in Soviet Socialism. There is little discretion and initiative locally and little incentive to work hard or save resources. When inspectors come there is attempt at cover up, apparent compliance, but once they depart.....

The supply is monopolistic (ignoring the private education and health for the relative few), little chance for customers to vote with their feet if things are not satisfactory. The enterprises are producer dominated, rather than consumer orientated.

The enterprises are ultimately ideologically and politically oriented. Politicians see them as serving some political purpose. If the results seem to show something challenging for the political masters, "spin" them away. If failures are exposed, find sacrificial victims - hospital executives, school heads, to carry the can, - politicians will always try to save their own necks.

Is this all inevitable? Yes, if we continue to try to run a centralised, monopolistic, ideological service, rather than one that is ultimately decentralised, where local suppliers are closer to local needs, competitive and above political considerations.

The Labour Government has paid lip service to competition, by talking about choice - although it doesn't really want the complications that real choice would give to a centralised system. In talking about foundation hospitals with some autonomy, they seem to appreciate the need to decentralise, but there are too many among them who want to control things from the centre.

A year or two more of President Blair could perhaps have made choice and autonomy more real, but we now have a prime minister who seems even more of a centraliser. It could take some considerable events to move to a more efficient consumer-orientated service