Speciality or generalisation ...

I've just (last Saturday) had my hip resurfaced on the NHS, coming home on the Monday after just less than 48 hours. I wouldn't recommend it as a rest cure - and I will fight off the temptation to post a picture of the huge bruise on my right buttock - but I was genuinely impressed by the care I received. In part this was because the NHS has realised that small general facilities are just less good than large specialist facilties; Mr Quarashi, my consultant, and his team, only do hips and knees, but they do hundreds of them and the success rate is very high indeed. Would I have preferred to have gone to a small cottage hospital where they do a much wider variety of surgery? No way, I wanted somone who really understood hips.

The same is true for children's health. Localism vs centralism is a false debate in these circumstances. If we need to have fewer, larger facilities to deliver specialist children's health, at the cost of having to travel a bit further, with less local provsioin, my vote is solidly on the side of specialism. But there is always an outcry when a small local hospital is to be closed ... this is not the same argument as closing a small local pimary school, but the pubic debate is too often ill-informed.

The same arguments apply to post-16 education, and the worry here is that all the new academies that were previously 11-16 schools will want to open sixth forms. These sixth forms will be small, inefficient, ineffective and offer poor choice. But they will be populated, as the schools have a captive market - literally a captivae market, as I have heard credible horror stories about school staff removing college prospectusses from school libraries. And as 'new' sixth forms open, existing effective and efficient FE colleges and Sixth Form Colleges will be squeezed ... making them less good.

The market will not, by itself, drive effective practice; it needs regulation and management; from banks, to the NHS, to schools, to children's services.