With the exception of Edward Heath who understood the need for such a union, all our prime ministers have been a catastrophe, wanting to be top bulldog and to disable the edifice at the same time, built so painstakingly by continental Europeans after the two bloody wars. Imagine what would happen if during the 2012 Olympics, the Germans or Senegalese or Pakistanis ran amok in Trafalgar Square? No such caveats would be proffered. There is one rule for British tribes and another for the rest.
Immigrants are often blamed for this social collapse, but I don’t think cunning criminal-asylum seekers whited up to make hell in Stuttgart These relentless bad boys are a product of our past. Yobs may have no GCSEs, but they sure carry in their noses the smell of colonial entitlement and supremacy.

How is it that a country which ruled the waves and sought to “civilise” millions fails now to civilise its own?

When hideous England fans swept into Stuttgart, like Mongols, only without purpose, broadcasters produced a run of excuses – it was too hot, this was only a minority, the police didn’t know how to manage English temperaments. Patient empowerment and incentivisation are the key to the reforms – unlovely expressions, but no more so than privatisation, and a great deal more accurate. The writer is Richard Titmuss Professor of Health Policy at the LSE and a former Downing Street health policy adviser. However, the recent dramatic increases in doctors’ pay should help soften that blow. And the new quasi-market will offer greater freedoms than the old, target- driven regime; a change that medical professionals, demoralised and demotivated by continually being told what to do by minister and civil servants, should welcome.The real motive behind the Government’s reforms is not to privatise the NHS, but to give it greater freedom to innovate and – importantly – to provide it with the incentives to do so.

Nobody likes being subject to competition – especially when, as with some consultants, it threatens not only their traditional ways of doing things, but also a highly lucrative private practice. In York, faced with competition from a local independent treatment centre, the local trust has re-organised its facilities to minimise staff and patient movements, and sharply increased its rate of theatre utilisation.Of course, much of the doctors’ unhappiness is understandable. In the West Country, local Trusts have begun to replicate some of their independent sector competitors’ methods, improving rehabilitation, providing better discharge planning and using more day-case surgery and local anaesthetics. Staff at the independent treatment centres are 60 per cent more productive than similar staff in NHS trusts.

Theatre utilisation in the centres is up to one-third higher than in comparable NHS acute trusts. The average surgical duration for a knee replacement across a number of centres was 24 per cent shorter than the typical NHS time.These improvements are beginning to spread into the NHS. Is the best way to compel people to go to their local hospital, regardless of the time of appointment or the standard of treatment? Or is it to give them a choice, with the money following the choice, so that if the local hospital is providing a poor service, it has a strong incentive to improve?In fact, there is some evidence that the incentive pressure from choice is beginning to work. Patient satisfaction (at 97 per cent) is higher than for NHS trusts as a whole (91 per cent), re-admission rates for the treatment centres are lower, they have not reported a single case of hospital-acquired MRSA infection.It is true that, when patients are asked if they want choice or a good local service, they will opt for the local service But that is a nonsensical question. Anyone asked if they would prefer a perfect television set or a choice of television sets would prefer the perfect television The real issue is how to get a good local service. There is no evidence whatsoever that the new treatment centres are providing care of a lower quality than other NHS hospitals Indeed, such evidence as exists shows quite the reverse.