Around the world, governments are caught between the public’s unwillingness to pay more tax and their expectation that government can make a real difference to education, health, crime and employment. Reforms in the 1990s have had some success in making government more efficient but left it less able to tackle big cross-cutting social problems. The author calls for radical reform to make government more holistic, preventive, outcome-oriented and culture-changing. Perri 6 is a writer, lecturer and Demos Associate.