Half the waiting lists are day cases and cheaply treated.
After a hiatus, suddenly there is a spasm of action, and no one quite knows why. These managers can’t shave without a consultation process resolving clinical governance with the legal issues, so how are they going to ask for several million pounds by Wednesday?Let’s leave that aside for the moment. Mr Milburn looks as if he is going to implement the idea in the NHS plan This is astonishing in itself It’s late but it’s great After five years, we have the Third Way in action Private firms on a public-service mission. It’s a government-funded market in action, the application of resources ordered by supply and demand It is bold, brilliant and entirely commendable It will work It should work It might just work.

So why won’t it work?You might feel this is an unnecessarily pessimistic question.Cataracts Let’s look at cataracts. There are 100,000 people waiting for their cataracts to be done. British private medicine charges between £3,000 and £1,500 for this simple, 20-minute operation Foreign teams are offering it for £600. Currently, our private eye surgeons get paid more than that for the operation, even before all the other staff and theatre charges. Our surgeons come in one morning a week and do 10 private operations for a fee of £800 a pop (an income approaching half a million a year for one morning a week).So they aren’t going to like this, not one little bit. And if the consultants and the surgeons won’t like it, the managers won’t like it.

Private hospitals that house foreign teams offering operations at one-fifth the going rate will rapidly destroy the pleasant relationship they’ve had with local surgeons.Vested interests are powerful and mysterious Consultants and surgeons will resist Maybe they are already. The latest results show surgeons are treating 20 per cent fewer patients than they were seven years ago.So Milburn has a fight, probably an asymmetric fight, on his hands The bureaucrats have a secret agenda It is the hardest secret agenda to discern. It is to do nothing.Meanwhile, people going blind are crying out for treatment; foreign surgical teams are crying out to treat them. What could possibly go wrong? Old habits die hard but a boom ends quicklyGwyneth Dunwoody chairs the Transport Select Committee. Last year, the Government tried to depose her, but met a backbench rebellion She was left in post. Now we see why it tried to get rid of her.Her committee’s report on the 10-year transport plan is a tremendous argument in favour of independent select committees.

John Prescott’s daft 10-year transport plan is characterised by “exaggerated claims and incomprehensible policies”. Lord Birt, the Prime Minister’s special transport adviser, is called “a casual enthusiast”. And as for the private funding the whole plan is based on: “No one shares the department’s confidence about the ease of producing” it.Actually, the money will be forthcoming, but the terms on which it is provided – that’s the important thing – will crucify the Government. The Oster Doctrine (from Neil Oster of Marathon Asset Management) states: “Anything involving trust with the Government has to be priced again.”In other words, we’ll find the money to be more expensive, and the risk transferred to the private sector to be negligible. Maybe that’s what Ms Dunwoody’s committee will monitor for us in the next five years.Occasionally it’s worth rehearsing the New Zealand experience at the beginning of the 1990s. Fiscal austerity and a deregulated labour market produced a period of sensational economic growth Unprecedented surpluses accumulated Then old political habits reasserted themselves.