2006-12-17 The Large State Indicted

The other reviewers have done justice to the very disturbing contents of this comprehensive survey, and this is a book that everyone interested in politics - and the process of government - needs to read.

However, there is a huge item of government waste which seems to have been missed: the Private Finance Initiative.

The Conservative Party has recently claimed that hospital projects which would have cost the public sector £8 billion, will in fact cost £53 billion over the 30-year lifetime of the PFIs concerned.

Worse, the private sector gets paid in full even if the hospital closes, or is merged with another one. This, of course, is not the fault of the private sector but it IS an example of government waste.

Then there is waste caused by the injection of bogus competition into the NHS.

The example of the impact of the new Horton Capio ISTC (Independent Sector Treatment Centre) on the Nuffield Orthopaedic Centre in Oxfordshire illustrates the problem.

The Nuffield Centre is locked into a 30-year PFI contract, but is losing income to the ISTC which only undertakes "easier" procedures. So the Nuffield's debts will mount, and it faces merger into another hospital trust.

Even if it closed, the PFI debt will remain.

Having missed one spectacular example of "waste" - a deliberate ruse by Gordon Brown to massage the PSBR - the book goes on to attack the spending of £400 million on anti-depressants.

This is an excellent example of "tabloid" journalism: an attack on a soft target, probably made without detailed evidence, since some people who need anti-depressants are thereby enabled to continue working. Depression is an illness, not a crime.

More than 400 people have been killed by `mentally ill' patients released into the community in the past eight years, largely due to the fact that - thanks to this kind of prejudice - spending on "mental health" services have been cut, and cut again since 1979.

The policy of "Care in the community" - in plain English "dumped on the street" - might usefully be investigated on the basis of "penny wise and pound foolish".

A few months ago a Lancashire man set fire to a shop in St Anne's-on-Sea, and was subsequently imprisoned for three years for arson.

A few hours before he caused the fire he had been turned out of his local psychiatric unit and left to fend for himself. He was abandoned by both the unit, and by social services, both of whom will almost certainly have had larger caseloads than they could be expected to deal with relative to the massive needs of their clients.

The shop suffered £75k of damage, and then there is the cost of three years in gaol. He will probably be released early into the care of the same inadequate services, and the whole sorry saga may well be repeated.

The waste is not only financial, which leads to the bigger issue.

This government tries to do everything, and does all of it badly.

Bureaucracies are inherently wasteful. All this is agreed.

However, there are some jobs the private sector is unlikely to want to take on, and the more problematic procedures undertaken by the Nuffield Centre - such as Lady Tebbitt benefited from - are but one example.

The proper care for the mentally ill is another.

There is an even bigger issue: do we as a society any longer believe that those of us who are fit and well - and not in need of state support - should contribute to the welfare of those less fortunate?

Or are the less fortunate simply "scroungers" to be punished?