There was a time when patients expected the NHS to be there on demand, however trivial the complaint. Yet as people became better informed they came to realise the limits of what the tax system can deliver.

Local democracy, already enhanced by the Edinburgh parliament, and assemblies in Cardiff, Belfast, London, Manchester and Newcastle, is becoming further enriched by the use of the Internet to gauge opinion on, for example, hospital closures.

Public organisations expect to enable, facilitate and regulate rather than provide public services. And not-for-profit organisations are the fastest growing sector of the economy - even though questions remain about their accountability.

Increased prosperity has removed much of the traditional opposition to charges for public services; it now seems surprising there should ever have been such a fuss over charges for home visits from the primary care trust or elective surgery.

Scenario two: pay as you go

The haemorrhaging of power to Brussels, Edinburgh, Cardiff and Belfast has now left the mother of parliaments looking old and tired.

Slow to embrace new technology, and achieving only mixed results when they have, the traditional, tax-funded public services have found it difficult to keep up in an information age where people expect 24-hour service and a customised response.

Management costs have risen too - the 1998 health service reforms led to a 10 per cent rise in spending on NHS bureaucracy, and with a proliferation of bodies now policing standards, it is easy to see why some are calling for a stop to it all.

Primary care trusts run by professional co-operatives and commercial companies have underlined the blurring of boundaries between the public and private sector, and both NHS charges and rationing are now widely accepted.