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Every age has its fads and foibles. In recent times it has been private enterprise. Its mere presence has become an indictment of the inefficiency, waste and bureaucracy of the state.

Health and welfare were recreated in its image, with logos, targets, mission statements and performance indicators. Sharp-suited consultants, who had rarely run a corner shop, let alone a big business, were recruited in droves to teach public sector workers to "reconceive need" and heed the bottom line. Globalisation meant that multi-nationals provided care home places by the thousand and private hospitals could promise accommodation and itemised accounts.


But suddenly we're being told something else. It's all been a terrible mistake. The market economy isn't working. World-class brands are in trouble. There are serious problems of "corporate governance". Big business successes like Enron and Worldcom were scams. Profits have been invented to boost share values. The conventional wisdom was that manufacturing was old fashioned, fit only for the "third world". Now the bright new hopes of financial services, electronics, communications and e-commerce are imploding.

Be afraid, for where economics hiccup, public health and welfare can expect to catch pneumonia. Already we are seeing occupational pensions in chaos. Unless the patient recovers, next will come cuts in collective provision. The limits of people's capacity to make personal provision for life's difficulties now become clear.

There may be little for us to take comfort in, but the market economy seems to have found its saviour - the public sector. As all the market's principles of competitiveness, efficiency and entrepreneurship come crashing around it, its nurturing of a new domain for exploitation over the past 25 years - public services - now seems to be paying off handsomely. Here at least is one area where for minimal risk and investment it can make massive profits and capital gain.


Here also to be found is the real "dependency culture". This is not the Daily Mail's and Sun's "benefit scrounger", ripping off small sums a week, but companies treating public provision as a milch cow to be sucked dry by the multi-million.

Sadly, so far the market's performance in the public sector appears no more effective than elsewhere - except that there seem to be even fewer checks and balances. Surely it's time for health and welfare to put new confidence in old ideas of public service.