This is coupled with the awareness that as a result of varied government initiatives there is the danger that through a series of incremental moves one could end up in a situation that few Government MPs expect or endorse.

These fears were recently expressed in a letter to parliamentarians by John Pugh Co-Chair of the Lib Dem Parliamentary Health Committee in a letter to colleagues and echoed in the many responses he received.and articulated in the article below.

HOW TO ENFEEBLE THE STATE – The End of Public Provision

The Conservative element of the coalition is wedded to the Feeble State idea.

In this the state like an aging, elderly relative is reduced in capacity and ability- able no more to do things on its own behalf- but doomed only to influence events through purchasing and light touch regulation.

A crucial part of this project is to reduce the activities and capacities of the state and its agencies- to terminate public services as we know them. This ‘reform’ programme shelters under the title of “opening up public services”.

The first step is to make all or nearly all public services contestable – following through on the Compulsory Competitive Tendering and Best Value Principles of previous government-but enshrining the right of other organisations to provide the services public bodies do.

Other organisations might mean mutuals, charities, ‘social enterprises’ or private firms but will principally be the latter.

The second step is to convert the public bodies who previously delivered public services into stand-alone mutuals, social enterprises, trusts etc., but with a clear migration path to becoming private enterprises or acting like private enterprises.

The third step is to remove the state’s role in employment through abolishing national pay, terms and conditions and residual TUPE arrangements.

Then one arrives at the goal where the state – either in the form of local or central government- runs nothing and buys (commissions) nearly everything.

The residual public services will be those (police and army) strictly needed to protect the Market.

Any failure of public services during this journey will provoke a call for and action towards increased private sector involvement in public services.

Bit by bit, stage by stage the enfeebled state loses it capacity to act directly.

Much of this can usefully be represented as ‘extending choice’ or ‘increasing diversity’ – irrespective of whether these elements have in every case practical utility or increased efficiency.