Dominic Lawson: Dirty hospitals and a crippled Royal Mail add up to a deep malaise in public services

My friend in Athens rang me excitedly to let me know that he now had a fax line installed "after five years' wait." "Why five years?" I asked. "Because I have influence," he replied. Admittedly this conversation took place a few years back, before the Greeks broke up their telecoms monopoly, but those old enough to remember what the telephone service was like in this country before privatisation in the 1980s will get the point of my friend's joke.

Or perhaps they won't: one of the odd things about the British attitude to market liberalisation is that its benefits tend to be discounted while the queuing of the past is sentimentally exalted: there was never a majority of opinion behind the privatisation of the old state monopolies, even though the policy was enthusiastically imitated by other European countries.

This week we are witnessing on two fronts the unpleasant consequences of monopoly provision – Royal Mail and the NHS. The postal service is in fact a sort of monstrous hybrid, enduring competition in some areas, but still enjoying a monopoly in others. It is the latter, however, which gives the workforce the confidence to withdraw their labour – both officially and unofficially – on the grounds that the general public will have nowhere else to take their business. This may be short-sighted of them – and not just because of the growth of email communication. The rail unions might have thought that their repeated strikes during the "good old days" of British Rail would be without long-term disadvantage to them – but the dramatic switch of freight (especially newspapers) from rail to road was a direct consequence.

To the extent that this strike in one of the last state-owned industries is about pay, it must be causing tremors of alarm in a governing political party which had been excluded from power for almost a generation as a result of industrial action over pay in the state sector – the so-called Winter of Discontent. The unions insist that their real concern is about working practices (described rather mysteriously by the management as "Spanish") and pensions – their employers want to increase the retirement age from 60 to 65.

The last report and accounts of Royal Mail show that its liabilities exceed its assets by £3.34bn: it has a pension fund deficit of £5.6bn. Perhaps this might have been because of bad investment, perhaps Gordon Brown might have had a little bit to do with it; whatever the case, there seems little point in the management just waiting for the tax-payer to make up the difference – and I can't believe that any public willingness to do so will be enhanced by making sure that birthday cards don't arrive on time and closing down small businesses.

Still, no-one is going to die because of it – which is not the case whenever there is incompetence in the NHS. The Healthcare Commission's report into the deaths of 90 people through hospital-acquired infections provided by the Maidstone and Tunbridge Wells NHS Trust is a terrifying account of medical mismanagement: "Patients not being fed, call bells not being answered, patients left in soiled bedding, medication not administered, charts not completed, poor hygiene practices and general disregard for privacy and dignity." Those of us who live in that part of the country will be surprised at none of it: the local name for the Kent and East Sussex Hospital has long been "Kent and Snuff It" – and that's not just because there is a disproportionately elderly population in the region.

I know anecdotes are no substitute for statistics, but I was struck by the account of a friend who rushed her husband to the Kent and East Sussex because she suspected he was having another heart attack. She found it very hard to attract the attention of the receptionist to break off from telephoning laboriously long-winded driving instructions to what seemed to be a boyfriend; when finally acknowledged, her husband was left for almost 24 hours without nutrition or attention – fortunately he survived.

The same man had previously received excellent care and attention at an NHS hospital in another part of the country – the Kent and East Sussex is not typical of the NHS as a whole; but the point is that if his local hospital had been a private company in competition with others – rather than a state-financed monopoly provider – it could not have behaved like that to its customers, or not without going out of business, at any rate.

Successive Governments have attempted to introduce competitive disciplines into the NHS, but without great effect. Treasury officials under the Conservatives would describe this sarcastically as "playing shops"– in other words, it bore as much relevance to the real disciplines of the market place as children's shopping games do to actually running a business. The other approach – which the present Government has favoured – is to set up ever more elaborate regulation.

The Healthcare Commission's report unwittingly demonstrates what a colossally expensive farce this is. The Healthcare Commission, which itself replaced the National Care Standards Commission (abandoned in March 2004) and the Commission for Health Improvement (also deceased March 2004) finds that the creation of yet another authority (the Health Protection Authority) "led to some confusion about the role of various bodies in respect of the control of infection in acute trusts". I'll bet.

Then there are the HPUs (Health Protection Units). According to the report, the local Primary Care Trust was at war with the man from the HPU, because it felt that he "was concentrating too much on antibiotics rather than hygiene". When you read almost entirely acronymic passages such as "The HPA has led to confusion about the respective roles of the SHA, PCT and HPA" then you realise that the National Health Service is critically infected by quangos – a government acquired condition for which the extermination of entire layers of bureaucracy is the only appropriate treatment.

Naturally the Healthcare Commission (motto: Inspecting, Informing, Improving) does not suggest such a thing. Instead it takes the hospitals to task for not paying attention to such Government publications as Going Further Faster: Implementing the Saving Lives Delivery Programme and whines that "the serious failure to identify this outbreak was in contravention of Winning Ways and Saving Lives".

Meanwhile, in the scandalously independent private health sector, hospital-acquired infections are almost unheard of (which is why those who can afford it are increasingly deserting the NHS); for example, BUPA hospitals' rate of MRSA infection is 0.0001 per cent. This is partly because BUPA does not run public wards, but also because it's a business in competition with other private medical groups. You see, it's bad for business to kill the customers, unless they have nowhere else to go – in which case it's described as a public service.

d.lawson@independent.co.uk