Adam Smith Institute

State-run prisons suffer from the familiar problems of other public-sector institutions that face no competition: inadequate supply, poor quality and high cost. All too often, prisons are schools for crime. Many of them suffer from serious problems associated with over-crowding, poor sanitation, violence, drugs and sexual assault. Prison warders have become a powerful vested interest, exerting undue influence over prison policy.
 

Amongst the events that predictably lead to demands for government action are business failures and corporate scandals. Demands for government action to improve corporate governance are, however, based on a dual mistake. They wrongly presuppose that the problems have been caused by a lack of sufficient regulation, and they erroneously assume that government regulation can make things better.
 

Big bureaucracies are notoriously difficult to reform. They have their own ways of working, and even though these might be 50 years out of date, the time and cost of moving to new ones can be seen as prohibitive by all who work in them. State bureaucracies have it harder than most, because they do not face direct pressure from customers, and do not see their finances ebbing away when they provide a poor service, since most users have no real alternative.
 

The NHS is the dominant provider of healthcare services, but it is the dominant funder of services too. Nominally, the financing function of the NHS is a national health-insurance system: but it is a highly dysfunctional one.
 

Note of a workshop in the House of Commons, Monday 10th July 2000

1. 'I see no reason why patients should have to be referred to and from hospital for services which could be provided in their local GP surgery. This is a win-win situation for everyone. GPs are keen to broaden the range of services they can offer, patients want quicker access and less hassle in getting the care they need while hospital clinics and consultants want to reduce waiting times for their specialist services.' (Alan Milburn, 23 June 2000)

What do waiting lists measure?

The newspaper headlines which tell us there are now a million people on NHS waiting lists are rightly shocking. The figure means that one in sixty of us are now waiting for medical treatment. And by no means all of us are even ill. Of those who actually need the NHS to do something for them, it is more like one in six who are condemned to wait.
 

Could medical savings accounts provide the escape from runaway healthcare costs?

Many countries with private health insurance schemes -- the US, Singapore, even South Africa -- have developed the medical savings account idea as an escape from runaway healthcare costs. The idea is to allow insurance, public or private, to concentrate on providing against the big, unpredictable and costly healthcare needs, but to ensure that everyone has access to savings that can be used to provide for the smaller, routine, more everyday healthcare costs.
 

1. The current consensus

Who, what, and why?

A recent note from the House of Commons Library suggests that there is really no argument about the need for affordable housing. It states: "The provision of affordable housing is viewed as a fundamental component of sustainable development."
 

In her first 2,000 days Margaret Thatcher changed the world. She privatized state industries, lowered taxes, deregulated the economy, and tamed the unions. The miners were conquered at home, the Falklands liberated abroad. By late 1984, after decades of decline, Britain was back and booming.
 

When the Conservatives took office in 1979 we had an instruction from Prime Minister Thatcher that we, at the Department of Education, as it was then known, should issue no more that one Circular (to educational establishments) per year. I was the Special Advisor to the Secretary of State, having formulated much of the education policy of the previous years in Opposition. We pursued such policies as the Assisted Places Scheme, Local Management of Schools, and latterly, Grant Maintained Schools.