Herceptin, despite its expense and modest usefulness, has become universally available, courtesy of a successful media campaign—regardless, given budget constraints, of the adverse consequences to patients with more serious conditions competing for the same scare pounds.1 The average inoculation rates using MMR (measles, mumps, and rubella) vaccine are 81% in England,2 after the media interest in Dr Andrew Wakefield's now disproved claims of a link with autism; the optimal rate is 95%.3 And Dr Richard Taylor, the independent MP for Kidderminster, was re-elected solely on his opposition to the private finance initiative and the scaling back of the local hospital4—notwithstanding the wider tangible improvements to health delivery that the reorganisation might bring.

Some readers will agree with the campaigners on some of these issues—I had and have considerable reservations about the private finance initiative—but I doubt that there is anybody who will agree that the campaigners are right on all three. And more importantly, nobody can argue that the debate around them even begins to approach a semblance of rationality. Health issues in Britain are attended by levels of emotionality and near hysteria that are increasing by the year. The attempt to construct a National Health Service in which there is a coherent system of prioritising resources and of internal organisation is proving ever more elusive.

For the past 18 months my own organisation, the Work Foundation, has been trying to develop the concept of public value as a response to this problem (detailed in our report “Deliberative Democracy and the role of public managers”), which is apparent not just in the health service but …