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英国首相布莱尔01系列演讲之Prime Minister's speech on Public Service Reform - 16 October

2006-05-30 15:25

  At the moment, the focus of public concern is rightly on the consequences of the terrible acts of 11 September in the USA. These consequences will be far-reaching, probably defining or redefining international relations and politics of the next generation.

  Also, unlike the war in Kosovo, the events of 11 September impact very directly here in Britain. The international terrorists behind the atrocities target Europe as well as the US. Already the economic effect of 11 September has spread round the world, and thousands of jobs in airline and related industries have been lost or put at risk. There is the link between Afghanistan and the drugs trade in the UK and elsewhere. Tackling this evil, eradicating the terror network of Al Quaida and associated groups is, therefore, in a very real sense, part of achieving domestic stability and prosperity in Britain.

  However, none of this should cause us to lose our focus on the more normal areas of public policy that will, in the end, determine our strength and success as a nation as much as any international crisis: the economy, living standards, crime, the welfare state and the public services - schools, the NHS, and transport. It is these bread and butter issues on which the Government will rightly be judged.

  Today, I want to explain our mission to change and reform public services: to describe why, despite current events, we continue to focus rigorously on this agenda; to say why investment alone is not enough in public services; and to defend our decision to proceed with that agenda of change, and allow no dogma or vested interests to stand in its way.

  This will be the toughest challenge of this Parliament. The legislative programme is dominated by it: major bills on school reform, the NHS, criminal justice and asylum and the railways. And I accept that the public, and many of those who work in public services, are sceptical about it. They wonder can it really be done? My answer is: in time and with reform, it can.

  I am passionate about this programme. When I visited the Department of Health yesterday and met civil servants and people working in the NHS, I was struck once again by two things: the dedication and commitment of our public servants, some doing brilliant work, many with very little proper recognition. And the vital need to reconfigure the system within which they work. I believe that very often public servants are working flat out but in a system that shrieks out for fundamental change. Go to an A&E department and the problem may not in reality be trolley waitsper se; but the bed-blocking as a result of insufficient care outside the hospital, which then feeds its way down from the ward to the A&E. Or police officers, struggling with street crime that is in fact about truancy. Or schools, that may not really need more teachers but more ICT specialists or classroom assistants.

  If we don't get the systems and structures right, we will never grip the roots of the problem only prune its visible branches. And we do this against the background of sharply rising public expectations. People demand more than the basics. They expect quality and expect it now. Managing those expectations is a challenge for all of us. But in the end, we have to meet them.

  The key to reform is re-designing the system round the user - the patient, the pupil, the passenger, the victim of crime. This is the orientation behind our programme. I do believe, incidentally, that people can be persuaded that they have to pay for good public services. I don't believe the public is any longer fooled by the notion of short-term tax cuts at the expense of long-term investment.

  But the issue is: how do they pay? Do they buy the services themselves; or do they pay collectively through taxation? For reasons of equity and efficiency - never forget the NHS is renowned world-wide as immensely cost-effective, if under-funded - I prefer the latter route. The vast majority in any event can't afford private schools or healthcare.

  But for this route to be taken, we must let the systems change and develop. The old monolithic structures won't do. We can't engineer change and improvement through bureaucratic edict. Hence the reform programme.

  Before I come to it in detail, let me set it in a broader context.

  People sometimes say: why can't we act with the same decisiveness on the domestic agenda as on the military conflicts? But since 1997 we have already undertaken a huge programme of change.

  We have reformed totally the system of economic management. Bank of England independence and new fiscal rules were huge changes.

  Long-term and youth unemployment required immediate attention. We launched the New Deal. It was also critical to make work pay and to tackle benefit dependency, which is why we introduced the minimum wage, the Working Families Tax Credit and welfare reforms. These have given us big welfare savings.

  We also faced a raft of difficult constitutional issues. The refusal of the last government to countenance a devolved Scottish Parliament and Welsh Assembly generated a crisis in the working of the United Kingdom which had to be resolved immediately we came to office for the good of the entire Union. We resolved it. With devolution and other major constitutional reforms, we have put the UK's system of government on a sound and more stable footing to tackle the challenges of government.

  But it was the fundamental weaknesses in the public finances which took longest to resolve. Until they were resolved, public service reform could not be tackled properly. There was a simple reason for this. The biggest problem in our public services was and is under-investment. Yet until we had put the public finances in order, there could be no new strategy for long-term public sector investment.

  We did a great deal to improve the public services in the first term. We started to put right many of the basics in health and education - literacy and numeracy in primary schools; infant class sizes; failing schools; the immediate crisis in the health service and the absence of proper systems of accountability; and the issue of student finance, where whatever future changes we make, the principle of a fair student contribution to the cost, which has enabled us to increase student numbers and university funding, will continue.

  But until the economic position and the public finances had been stabilised, we could not properly address the legacy of long-term under-investment.

  Now we are able to do so. Health investment is rising at nearly 6% a year over the current three-year spending settlement - more than twice the rate under the last government. Education is rising at more than 5%, also twice the previous rate. And there will be ??180 billion of investment in transport under the ten-year plan.

  Our new investment programme is enabling us to tackle big backlogs in infrastructure investment. There will be more than 600 new or completely refurbished schools over the next three years, and the largest hospital building programme ever.

  We will stick to these investment commitments. Our fiscal position remains strong; our tax rates remain highly competitive by European standards; and according to the latest IMF forecasts the UK is set to be the fastest growing G7 economy this year and next.

  It is not our tax and fiscal positions which are holding us back as a nation. It is productivity and the state of our public services.

  I have stressed investment as a key constraint holding our public services back. But two other points are crucial to understanding the position we are now in.

  First, it is not remotely the case that everything in our public services is weak or sub-standard. There are many beacons of excellence. The best of our schools, hospitals and universities are a match for any in the world. In the NHS, the new Modernisation Agency has brought about dramatic cuts in waiting times for cancer and heart treatment. In education, test results for primary school pupils have sharply improved. In higher education, we have one of the highest graduation rates and lowest drop-out rates in the world.

  This British Library is amongst the finest anywhere.

  The weakness of our public services has not been their inability to achieve excellence, but the fact that it is too thinly spread, with opportunities and high quality provision too often restricted to a minority.

  My second point is less positive. It is not just investment that has held back reform. We have also been held back by ideological clashes, going back decades, which have distracted from the real challenge of improving our public services:

  * The education battle of selection versus comprehensive, when for 25 years the real challenge has been to make all-ability schools successful in providing for all abilities and aptitudes;

  * 'Tough on crime' versus 'tough on the causes of crime' - when the two should and must go together;

  * And throughout the public services, the battle of public versus private, when the best public services in Europe have long moved beyond this to harness all first-rate providers - including those in the voluntary and private sectors - to support and improve state-funded services.

  It is therefore on the basis of sustained investment, a frank appraisal of the good and the bad in our public services, and a non-ideological approach to reform, that we are embarking on the most ambitious programme of change since the 1940s.

  We are backing investment with reform around four key principles:

  * First, high national standards and full accountability

  * Second, devolution to the front-line to encourage diversity and local creativity

  * Third, flexibility of employment so that staff are better able to deliver modern public services

  * Fourth, the promotion of alternative providers and greater choice.

  All four principles have one goal - to put the consumer first. We are making the public services user-led; not producer or bureaucracy led, allowing far greater freedom and incentives for services to develop as users want.

  So consumers should know that they will get certain minimum standards wherever they live. Staff should be able to work in new ways and be employed on a more flexible basis to meet the interests of pupil, patient or victim of crime. And wherever possible, the consumer should not be left with only one choice of provider.

  Therefore national standards and systems of accountability now apply, or are being established, across the public services.

  In education, there are national tests in the basics for all 7, 11 and 14 year-olds; regular inspection of schools; and national strategies including the literacy and numeracy hours to ensure basic minimum standards of teaching and learning school by school. These have been immensely successful, thanks to the dedication of primary school teachers school by school.

  In health, there is now independent inspection of hospitals and publication of the results - the first national star ratings for each hospital in the country published two weeks ago - and a National Institute for Clinical Excellence to set standards for best treatments across the NHS.

  In the police, we are driving up the performance of the weakest forces so that they match the performance of the best. David Blunkett is setting up a strong Police Standards Unit to spread best practice rapidly across the country, and he will have powers of intervention where forces are failing. The forthcoming Police Reform Bill will ensure the highest national standards and the means to enforce them.

  Radical structural change is also required in our criminal justice system. Last week we published Lord Justice Auld's report proposing a radical modernisation of the criminal court and trial system, including the creation of a unified criminal court in place of today's Byzantine structure. We will put forward proposals early next year to carry this through, together with reforms to sentencing, so that offenders are brought to justice more rapidly and effectively and the criminal justice agencies can do their job within a modern structure.

  With these systems in place, we propose to give much greater freedom to front line managers and their staff.

  More than 85 per cent of local education funding now goes directly into school budgets, for headteachers and governors to allocate as they decide. The forthcoming Education Bill will guarantee maximum delegation of funding to schools and sweep away legal restrictions which prevent schools from providing childcare and other community facilities. It will give schools greater freedom over their own governance arrangements, and empower successful schools to assist failing schools.

  Secondary schools, our key education priority for the second term, can't meet the aspirations of all their pupils without a far better structure for vocational education, which is why we intend to overhaul the curriculum beyond the age of 14 to promote far better vocational pathways.

  Specialist schools - schools which build a real centre of excellence in one area while continuing to teach the whole curriculum - also represent significant change. Schools achieving highly in one respect tend to perform better across the board - GCSE results in specialist schools are nearly 10 percentage points higher than in non-specialist comprehensives with a similar intake. Our programme of diversity in secondary education is therefore vital to the future, which is why we have set a target of at least 1,500 specialist schools by 2005 as a staging post to specialist status for all secondary schools ready for it.

  In health, over ??40 billion of the NHS budget is to be allocated direct to local Primary Care Trusts, who will be able to establish new services and commission from the most cost-effective providers in the public, voluntary and private sectors. The forthcoming Health Bill will further devolve power to the PCTs. Two-thirds of health authorities will be abolished in April, as power and resources pass down to PCTs. The best performing hospitals are being given greater freedom, including the chance to take over running of poorly performing trusts. A ??500 million NHS 'performance fund' will incentivise best practice, with the best hospitals having total freedom over how they use their share of the money.

  In policing, we are looking to devolve more power down to the Basic Command Units.

  In transport, we also need major change. The financial situation of Railtrack made Administration unavoidable. But this is an opportunity to rebuild properly; to put in place a new network operator, and regulatory structure, resolutely focused on service improvement, creating a unified sense of purpose in the rail industry; and an end to the blame culture with over-burdensome regulation while services deteriorated. Instead, we need a concentration across the industry on reliability, punctuality, and a better service to the travelling public.

  But devolution to the frontline has to be accompanied by extra recruitment, better retention and far greater flexibility of employment. Since 1997 we have recruited 11,000 extra teachers, 44,000 extra classroom assistants, 17,000 extra nurses and 7,000 extra doctors - 1,300 extra police recruits in the last year, turning the tide on police numbers - with pledges to increase staffing substantially further over the next four years. One reason there are extra vacancies is there are extra staff being recruited.

  There are new training salaries for new post-graduate teacher trainees, a performance bonus of ??2,000 to nearly 200,000 classroom teachers, shorter hours for junior doctors, 'golden hellos' of up to ??10,000 for new GPS, and the best recruitment and salary packages ever for nurses. None of this is enough but it is a start which is why numbers in training are rising.

  In education we have established the new National College for School Leadership. The new NHS University we are launching today will have the capacity for up to a million students, offering courses and training for every nurse, doctor, therapist and cleaner.

  To improve support and flexibility of staffing, schools have taken advantage of their increased budgets and autonomy to employ more teaching assistants and administrative staff, freeing teachers to teach. We will be coming forward with new proposals to tackle teacher workload which build on this.

  In the NHS we are investing in more childcare to help staff balance work and family and are breaking down unnecessary barriers between nurses and doctors, between doctors and consultants, and between doctors and others including physiotherapists. The negotiations over new contracts for doctors and consultants will take this further.

  In the police service we are promoting wider use of civilian expertise and seeking to modernise employment terms and conditions so that frontline officers and managers are better incentivised.

  The fourth of our reform principles is the provision of far greater choice to the consumer - not just formal choice, but the ability to make that choice effective.

  In education this means not only a wider variety of schools, but also expansion of successful schools and encouragement of the very successful to take over schools or set up new schools, so that more parents are able to secure their first preference school for their child. I am delighted, for example, to see Thomas Telford, one of the best state schools in the country, setting up an entirely new City Academy in Walsall.

  Patients, similarly, need an ability to choose their GP, and successful GP practices to should be encouraged to expand.

  In developing greater choice of provider, the private and voluntary sectors can play a role. Contrary to myth, no-one has ever suggested they are the answer. Or that they should replace public services. But where use of them can improve public services, nothing should stand in the way of their use. In any event, round the world, the barriers between public, private and voluntary are coming down. Neither need this be solely driven from Government. I say: if PCTs or regional health directors want to use spare private sector capacity or do innovative deals with private or voluntary sectors to help patients, they should be free to do so. Or if schools want a new relationship with business in their community, as many do, let them. Or police who want to use support staff in new ways. What I'm saying is let the system breathe; develop; expand; let the innovation and creative ideas of public servants be given a chance to flourish. Sure, there are risks. It won't always work. But taking risks is part of change leading to improvement.

  Indeed, much of this is happening now from PFI in hospital and school building, to the NHS Concordat with the private sector, to private help with prisons and the Probation Service. And the voluntary sector and private sector has been vital to the New Deal.

  The point, very simply, is this: the user comes first; if the service they are offered is failing, they should be able to change provider; and if partnership with other sectors can improve a service, the public sector should be able to do it. There is in the best of public service a real spirit of entrepreneurship. Constantly, I meet public servants whom I find truly inspiring; people who are change makers and social entrepreneurs every bit as capable and creative as the best private sector entrepreneurs. We need to encourage them, to let diversity break down the old monoliths.

  The programme I have set out today will take time to deliver - it can't be done overnight, and we have been careful not to promise more than we can realistically achieve. We have pledged that:

  * within four years patients will be able to choose the time and date of their hospital operation, as we move to the booking of 100% of outpatient appointments and planned hospital admissions;

  * there will be a near doubling in the number of cancer and cardiac specialists by 2005;

  * we will cut maximum waiting times by two-thirds, from 18 to 6 months, over four years;

  * three-quarters of 14 year olds are to be up to standard in the basics of English, maths and ICT by 2005;

  * we want to see 50% of young people progressing to higher education by 2010;

  * we are pledged to cut vehicle crime by 30 per cent, burglary by 25 per cent and to increase police numbers to their highest ever.

  Yesterday, I started visits direct to each of the main delivery departments to hear at first hand how they propose to meet them, and in particular how they propose to empower professionals on the front line - the teachers, doctors, nurses, and police officers who must embrace public service reform as a true partnership if we are to succeed. I am holding a series of meetings with senior civil servants to see how Civil Service reform, already well under way under Sir Richard Wilson's leadership, can be taken forward. In the Civil Service also, I find enormous talent and ability often held back by outdated practices and systems of working.

  After the election, I established the Delivery Unit under Lord Macdonald and Michael Barber. The Unit has been working with Ministers and civil servants in the Home Office, DTLR, Education and Health to ensure that for each of my key priorities across those four departments effective strategy for implementing policy is being put in place. In addition, the structures of Government and their reform is being reviewed by Wendy Thomson.

  Finally, none of this can happen without the help and commitment of public servants. I know we are putting you under great pressure. I know, too, that the more we talk about public services, the more the public expect of them. There is also a real tension between the centre's desire to get targets met and the local leaders' desire to get on with their job. And we have both learnt from the experience of the past few years. I believe that now, around these four principles of reform, we can really make a difference.

  Without hesitation, I pay tribute to the superb work you do. But also without hesitation, we both know the systems have to change. The investment and reform must go together.

  All of it is for a reason. Without high quality education for all, children never achieve their potential and the prosperity of the nation, dependent on skill, suffers. Without healthcare that is accessible inside the NHS, people are forced to pay or to live in pain. Without a properly-functioniong criminal justice system, the society we live in is less stable, less secure, and less fair. Without quality public transport, there is no alternative to ever-greater congestion on the roads.

  We all believe in this. We have to find the money and make the changes and for that we need to have the political will. Not just in government, but also in the public services themselves. To this end, we offer a genuine partnership for change. It won't be easy. But it is worth it.

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