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Had we not already heard about measures to crack down on antisocial behaviour? Were on-the-spot fines not already operating? Tougher sentences for sex offenders – surely that has all been done? Even the announcing of plans to obliterate such cherished freedoms as double jeopardy sounded curiously familiar, as did the plan to give juries the right to know your previous convictions before they reach a verdict.

How could this be? Would Her Majesty suddenly remember mid-speech that she had had this conversation before? Alas, no. The reason we think we've heard it all before is because we have; not from the Queen but from the government itself. Almost every one of these measures has been trailed in consultation documents, white papers, draft bills or leaks of one kind or another.

Predictable this speech may have been, but it was also significant in marking the next step in the New Labour project. This was marked by the proposal to create "foundation hospitals" – a modest proposal covering perhaps a dozen institutions that will be given new freedoms and a novel set of governance arrangements. Its significance lies first in the fact that ministers see this as the model for the future of the NHS and indeed the possible shape of things to come elsewhere in the public sector.

In health and education, the government has decided to move from its first phase of reform – centrally determined targets, national standards, tough inspections – to the second phase: choice for users and a range of organisations providing services.

These will include private, voluntary and what we shall now call "ambiguous" bodies like foundation hospitals – it seems they will be a cross between public and voluntary sector outfits. And with choice for parents and patients it means all these organisations will, to some degree at least, be expected to compete with one another for customers.

The second phase of the government reform programme will not displace the first, but there is the prospect of a very different landscape in both education and health.

The Queen’s Speech sounded very familiar. How could this be? Would Her Majesty suddenly remember mid-speech that she had had this conversation before? Alas, no

In the new order there will be a variety of different types of schools, hospital and health organisations providing free care and education – they would not necessarily be state-run or even state-owned. Foundation status would be roughly akin to a halfway house: public interest institutions held accountable locally through a stakeholder council dominated by users of the service.

Housing associations are probably the nearest thing we have to foundation-style institutions. They have a clear social purpose and most guard their independence jealously in spite of their guardianship of large sums of public money and, in some cases, assets that were once in the public sector.

It is ironic then that, just as the NHS is developing similar forms of governance to free hospitals from Whitehall control, there are concerns in the housing association movement that their autonomy could be compromised by the new inspection arrangements. The fact that the Audit Commission as the new inspector is so firmly in the public sector and is perceived to oversee public sector rather than independent or voluntary bodies has understandably made some feel nervous.

The price of freedom, to coin a phrase, is eternal vigilance. If foundation hospitals, specialist schools and the like do take off, they will usher in a new era of diversity in the provision of public services. There will be a range of different public interest companies and similar organisations in every locality.