Poetry plays a large part. As well as the official programme there are popular fringe events such as Ymryson y Beirdd, a daily competition where poets battle to produce poems from scratch. Not only do they have to write on the spot but they also have to stick to an intricate metrical structure — Cynghanedd — which is unique to Welsh poetry. This involves complicated internal rhyming structures and precise matching of consonants between two halves of any line of poetry. The rules seem so convoluted that it is astonishing that anyone can come up with even the occasional banal sentence, yet these poets can craft pieces that are moving, deep, funny and entertaining, and even on the sunniest day, hundreds will cram into an airless tent to relish the daily competition. Of course these rules are not arbitrary, bloody-minded restrictions but have evolved over centuries as a distillation of what was a natural feature of the magic and beauty of poetry. When the rules are followed the language sounds more musical and harmonious to the native speaker's ear, even though we aren't conscious of the technicalities as we listen. What appears to be a denial of choice seems to conjure something that is liberating and more powerful than if it were unrestricted.

Choice, like many of the things we value in life, often has a capricious and frustrating side. Just as limited choice can be something positive, unlimited choice can de detrimental — even with simple pleasures like eating chocolate. Psychologists at Columbia University studied people choosing chocolates from different sized piles. They found that people who chose from the bigger piles were less happy with their choice even though they had identical chocolates. The bigger the choice the more stress they felt about making the decision and afterwards they were dissatisfied by a nagging feeling that they might not have made the best choice from a bigger pile.

The Department of Health is determined to build more choice into the NHS — whether it's wanted or not. They are convinced of its value in modernising services, but don't seem to recognise its occasional inconsistent and unpredictable aspect. Choice can be bewildering for both patients and the health professionals trying to steer them through the maze of decisions and uncertain outcomes. Patients do not seem to rate it as highly as prompt and skilled treatment, and the King's Fund is concerned that increasing choice might lead to greater inequalities, benefiting wealthy, articulate, mobile patients and weakening local services.

These dissenting voices are ignored. Subtlety and uncertainty don't fit in comfortably with their managerial world view. It already seems a long time since we had 24 hours to save the NHS and it's now apparent that salvation is supposed to come through more management rather than vision and investment. If you're convinced that management is fundamental to improving the world then you have to believe that the world is fundamentally manageable. A pure and simple place that runs like clockwork where changes will have easily predictable outcomes. It doesn't take long away from the rarefied atmosphere of discussion documents and brain-storming sessions to realise that it doesn't work like this. Real life is often messy and unpredictable despite our best efforts to organise and structure it, where you may start the day fully equipped with the most up-to-date round holes but then spend all your time dealing with square pegs.