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英国首相布莱尔01系列演讲之Reform of Public Service - 16 July

2006-05-30 16:13

  My argument is this. Without investment Britain will never get the modern public services it needs. But investment is not enough. Public services need reform if they are to deliver the uniformly high standards and consumer focus that people expect in the 21st century. The best people to make that reform are those who believe in the values, the ethos, and the potential embodied in our public services. This government wants to work in partnership with public servants on the frontline to make the often difficult changes that will deliver more opportunity and more security to the vast majority of people who rely on our education, health, police and public transport systems.

  In the 1980s the business entrepreneurs who turned their ideas into successful companies were celebrated. In this early part of the 21st century, we need to celebrate the social entrepreneurs who turn their ideas into successful schools, universities, better healthcare, crime prevention and detection, better public transport, more responsive and effective government.

  On June 7th the political landscape shifted.

  Investment was put before tax cuts.

  Strong public services were put at the centre of political debate.

  And more than both those things politics made another decisive shift away from selfish individualism and towards a society based on community and shared values.

  Our public services symbolise that spirit of community. Universal public services are right today just as they were right more than 50 years ago. Collective provision, not the market, is the best way of ensuring that the majority get the opportunity and security that the few at the top take for granted.

  Our public servants symbolise that community too. Ask a teacher, a doctor, a nurse, a police officer why they do their job and almost always it's about giving to others not taking for themselves. It is rarely for the money, it is almost always for the satisfaction and pride that comes from seeing someone else succeed - the child learning to read, the patient returning to good health, the victim of crime knowing the criminal that attacked them is behind bars.

  In our first term, we laid the solid economic foundations and began to put in the investment public services desperately need.

  In our second term, as the global economy goes through a period of uncertainty, we must do nothing to put at risk that basic economic stability. But we must also accelerate the pace of change in our public services.

  And all with one aim in mind: to re-design our public services around the individuals they serve.

  So because for most people education is their route to opportunity and fulfilment, we put the pupil first.

  Because most people will always want and need to rely on the National Health Service, we put the patient first.

  In communities where people want us to be tough on crime and tough on the causes of crime we put the victim and law abiding citizens first.

  Not everything will be done overnight. Not every problem will be solved in 3,4 or 5 years time.

  What is more, there is a huge amount that is good in our public services. For example:

  In education, Britain has one of the highest university graduation rates in Europe, together with one of the lowest student drop-out rates and a formidable reputation in scientific and other research.

  In health, recent years have seen dramatic improvement in death rates from children's cancers and breast cancer.

  In law and order, London's murder rate is below the average not only for major US cities, but also for EU capitals. It is significantly below that for Amsterdam, Berlin and Copenhagen.

  Nor is it the case that the rest of Europe is without its problems.

  Winter pressures hit health care systems across Europe two years ago.

  In France, reform of the school and university systems is a cause of deep controversy.

  Reform of the German health insurance system is equally difficult, with street protests by doctors opposed to change.

  Reform of the Italian state pension system is a key challenge for the new government as it strives to keep the budget deficit under control.

  But we know our services here in Britain should be and can be much better; and I believe we can make measurable progress in them.

  So what are the yardsticks by which we wished to be judged at the end of this Parliament?

  In education, in addition to continuing progress in primary schools we need a step change in performance in secondary schools. We have set a target of three-quarters of 14 year olds to achieve the standard expected of their age in maths, English and science. We will increase the number of excellent secondary schools in every community. We will make significant progress in improving adult skills, progress too towards our target of 50% of young people going to university. We must not just recruit 10,000 more teachers but further raise the status and standing of the profession.

  In health, we can make real progress on inpatient waiting times reducing them from an 18 month maximum down to a historic low of 6 months, with average waiting times down to 7 weeks. There should be significant improvements in primary care services. We will be able not just to recruit the 20,000 extra nurses and 10,000 more doctors but agree new modern contracts for consultants, doctors and nurses to give professionals and patients a better deal. We will improve cancer and heart disease treatment. And we will also make sure the patient experience in hospitals - cleaner wards, better food, better equipment - gets better in all parts of the country.

  We want to reduce crime further including reducing violent crime. We want more persistent offenders arrested and brought to justice. And in partnership with communities we want to tackle the anti-social behaviour that in some inner city estates has made life a misery for too many people.

  On transport the test is clear: improved safety, reliability, punctuality, and comfort on our railways and London Underground.

  Let me start with an analysis of why our public services need radical improvement.

  First expectations have risen enormously yet public services designed for a previous age find it difficult to respond. Unlike 1945, people don't put up with the basics. In a consumer age, they expect quality, choice and standards and too often don't experience them.

  Secondly, the demands on the systems have risen: more people live longer; more diseases are treatable; more go to nursery and to university; more people use public transport.

  Thirdly, there has been chronic under-investment that has run down the essential infrastructure, buildings, equipment, track and trains in transport.

  Fourth, staff recruitment is so much harder with employment at record levels and the spectrum of private sector jobs, many with higher pay, is so much greater; and where in many key public service jobs, there is real and growing stress.

  Yet the irony is that for all the talk of collective provision being old-fashioned the need for public services is greater than ever.

  Without good state education only a minority of the population can afford private education; the rest will see their potential squandered.

  Without a good NHS, people will live in fear of illness or accidents.

  Without good transport people spend their lives stuck in traffic.

  Without an effective police force, people live in fear for their safety.

  So ours is a task as great as any that has faced a post-war government.

  Investment is now happening.

  On education we are spending 5 per cent more per year in real terms for the next 3 years. And today I reaffirm our commitment that the share of national income going on education will increase during this Parliament.

  On health we are increasing spending by an average of 6.3 per cent in real terms each year for the next 3.

  We are increasing spending on the police by an average of 3.8 per cent a year in real terms through to 2003.

  Transport spending is up by 20% for the next 3 years on our way to a ??180bn public and private partnership over the next 10 years.

  It is a far cry from 1979 when the Thatcher government declared in line one of their first public spending white papers that: "Public expenditure is at the heart of Britain's present economic difficulties." We continue to this day to pay the price for the under-investment of the period that followed.

  But in the end investment only works if it levers in change. Without the change, money is simply wasted on outdated practices.

  When consultants, by their own admission, waste as much as 40% of their time, because of the way their clinics are run, it's time for reform.

  When in one out of every seven secondary schools, under a quarter of pupils get 5 A-C at GCSEs, it's time for reform.

  When doctors and teachers still do most of their paperwork by hand, it's time for reform.

  When nurses cannot discharge a patient for 3 hours because they have to wait for the doctor, it's time for reform.

  Where out of date hierarchies hold back the promotion of talent, it's time for reform.

  When one hospital can cut waiting times dramatically whilst in another in the same area they are going up, it's time to spread reform throughout the health service.

  When only 1 in 30 crimes results in a conviction, it is time for reform.

  If we fail to face up to change and, by way of justification, say that we are protecting public services, we are in fact condemning those services to decline.

  If we do that, people will either give up on public services if they can; or those that can't, will suffer a second class service.

  That would mean inequality, disadvantage, and opportunities denied.

  So there can be no greater crusade for a modern centre-left government than to invest in and reform our public services. We should embrace it with every bit as much zeal and commitment as the Attlee government built the welfare state. Go back to the central message of our election campaign: that we want everyone not just a few to be able to make the most of themselves. The reform agenda is about doing just that. A good education goes so much further than simply a rise in benefits. A good NHS there when you need it is better than a short term tax cut that you simply pay for in another way.

  Of course, there will be opposition to change. Change is seldom popular. Every reason, good or bad, for resisting it, will be given: safety, practicality, unfairness to the workforce; the spectre of rail privatisation will be mentioned every time a proposal for reform is made, so that people are too scared to consider on its merits the change being asked.

  But I give a commitment and a warning. My commitment is that I will not flinch from the decisions and changes to deliver better public services, no matter how much opposition. If the changes are right, they will be done.

  My warning is equally clear. If we who believe in public services don't change them for the better, there is an alternative political party and position that will seize on our weakness and use it to dismantle the very notion of public services as we know them. It is reform or bust.

  Across all services there are three pillars to reform.

  First, the role of the centre will be to set a framework of national priorities and then a system of accountability, inspection, and intervention to maintain basic standards across the country.

  That is why, for example, we have literacy and numeracy strategies in primary schools; fundamental reforms of the criminal justice system under way and national service frameworks within the NHS for key diseases.

  It is why we now have not just Ofsted for school inspection but a Commission for Health Improvement for the NHS, a stronger police Inspectorate and a Strategic Rail Authority for the transport system.

  Secondly, however, within those national priorities, the essential structural change will be to give the devolve power to the frontline professionals and set them free to innovate and develop the services needed.

  In our first term, when we were often acting to stop the rot and introduce basic rules, there was heavy intervention from the centre. Now we have a national framework in place, power can and should be released to the front line and targets cut back to the essential.

  So Primary Care Trusts will give family doctors and nurses the chance to come together to provide local health services tailored to the needs of the local population. Schools and universities will be given greater freedoms to innovate to create their own centres of excellence. We also need a system of contestability so that when a service is under-performing, other providers can be brought in to do it.

  Third, because front line staff will have more power, their terms and conditions of employment should be geared to proper recognition for the work they do, real incentives for better performance, higher morale and greater fulfilment. We want to recruit more staff - 20,000 nurses, 10,000 doctors, 10,000 teachers, 6,000 police recruits. But we need them to work better and smarter. We must break down the artificial and often damaging barriers and demarcations between staff and allow those who do well, to be rewarded well, and allow staff to rise as far and as fast as their talents will take them.

  Nurses could do more work currently done by doctors. With proper support, GPs could provide services presently done by consultants.

  Classroom assistants and ICT specialists have a major role in classrooms, alongside traditional teaching.

  So our strategy for public service reforms is: national standards, local innovation and more and better rewarded staff.

  In specific terms this means:

  In education our first term focused on primary schools, where we saw substantial progress. Now there must be the same relentless focus on secondary schools and the same step change in standards to liberate the potential of all our children.

  That means:

  * Greater diversity in secondary schools with more specialist schools and different types of schools including city academies and more church schools; fully inclusive in their intake, but far more flexibly designed around the needs of the pupil;

  * greater flexibility to shape the curriculum around the needs and aspirations of pupils;

  * accelerated GCSEs for the able, catch up classes for those who need them;

  * tougher rules on school discipline;

  * New vocational pathways after 14;

  * More funding directly to headteachers;

  * greater flexibility in pay and incentives for teachers and Head Teachers.

  In health we believe in the principle that the NHS should provide care to all regardless of ability to pay. An NHS free at the point of use is its key principle. We must build on the new national standards we have put in place, the new hospitals, the modern A and E, and stronger primary care.

  That means

  * Devolving 75% of NHS budgets to local primary care trusts

  * Reforming appointment systems so hospital appointments are booked for the convenience of patients

  * Publishing performance information on quality, efficiency and responsiveness to patients of every hospital.

  * Building new free standing surgical units to do routine operations, so as to cut waiting times.

  * Allowing successful NHS hospitals to take over failing ones

  * A university for the NHS to give all NHS staff the chance to improve their new skills.

  * Changing doctors, nurses and consultants contracts so as to open up better career development, allow more flexible working and an end to unnecessary demarcation in working practices.

  Crime is falling but we need to do more to tackle violent crime and anti-social behaviour.

  That means

  * overhauling the criminal courts system following publication of the Auld report - new IT, evening and weekend courts in high crime areas

  * New rules of evidence to help juries form a clear judgement of guilt and innocence

  * New sentencing framework with tougher sentences for repeat offenders and more supervision of prisoners after release

  * A new criminal assets recovery agency to seize the assets of drug dealers and those involved in organised crime;

  * A reform of the police service in line with the consultations now underway.

  On transport we need to restore the very basis of confidence in the railways.

  That means:

  * greater control over the strategic direction and enhancement of the railway infrastructure;

  * re-franchising the train operating companies; and gearing franchises more strictly to performance;

  * massive new investment from public and private sectors in the Tube;

  * a new ??60 billion investment in the roads programme;

  * a new effective and independent safety regime following the Cullen report.

  Where it makes sense to use private or voluntary sectors better to deliver public services, we will. This is nothing new to local government; nothing new in the provision of government services like the New Deal, essentially done in partnership with the private sector.

  There is a lot of nonsense often written and spoken about the role of the private sector. Nobody suggests it is a panacea or that it can transform on its own public services. It is simply one part of our reform programme but because it has provoked so much discussion, much ill-informed, I should deal with it in detail.

  There is an ethos of service and duty in public services that many business chief executives I have spoken to envy. Good companies have tried for years to create the trusting relationships with their consumers that teachers, doctors, police have in many cases built up over generations in the public sector.

  But in turn there are some things that the public sector can learn from the private sector. Private companies can in many cases be more responsive to the immediate needs of demanding consumers. If they don't they go out of business. They know that poor service, lack of courtesy, massive delays, destroys their image and their success. It would be surprising if the public sector could not learn something from that responsiveness to consumers. The best parts already do.

  And we should never forget the public are not ideologues they are realists. If you are knocked down in the street and you are taken to a brand new PFI built hospital, rather than a run down Victorian hospital built, incidentally, entirely by the private sector, then you are probably relieved rather than angry.

  A pensioner waiting for a hip operation on the NHS is not going to refuse to be treated more quickly where there is spare capacity that the NHS can use.

  A mother who is shown round the new suite of computers at her child's secondary school is not going to berate the headteacher who tells her that it came about through an enterprising deal with a computer company.

  So in the NHS: we are using spare capacity in private sector hospitals to perform operations on NHS patients where it makes sense to do so. Second, we will get private sector management to run some of the new stand-alone surgery centres where they offer the best service. Third, we will extend PFI beyond the hospital sector into primary care, social services and the provision of imaging and laboratory equipment. Fourth, we will use private sector management expertise such as in the running of NHS buildings and IT systems.

  In these areas there is a commitment to forge a new relationship between the NHS and the private sector. It is, as Alan Milburn has said, a partnership, not a take-over. The key distinction is between privatising a part of the NHS and by contrast, working with the private sector to deliver a better NHS service for patients.

  And in schools I believe the private sector can help us to build new schools and improve old ones. In some cases the private sector can provide management expertise for failing schools or LEAs. Other voluntary sector involvement in City Academies and other schools can create "not for profit" schools funded on a contract basis with the government.

  The benefits of engagement with the private and voluntary sectors are not hypothetical: they are real and immediate. Consider Glasgow's 'Project 2002' scheme to transform its secondary schools. Over the course of three years, the project will provide 29 excellent quality schools - 12 of them completely new build, the others significantly extended and refurbished. The contractor is building schools of quality - built to last, because the contractor is responsible for them if they don't - with first-rate modern teaching and learning facilities of which teachers and pupils are proud.

  The result? A new, state-of-the-art secondary school infrastructure for Glasgow in three years, when conventional public sector procurement would have taken 25 years.

  In all areas, what counts is what provides a better public service for the consumer.

  With the 10 year crime plan under way, once the Auld Report into criminal justice is published, there will be comprehensive public service reform plans in existence for each major public service. In addition, the Civil Service and government itself is carrying out its own extensive programme of change: new structures in Government, new ways of delivering services, changes in career and incentives systems for civil servants.

  All of this change amounts to the biggest reform programme in public services for half a century. All of it driven not by out-dated or even new-fangled ideology but by a sense of mission: to renew our public services for the 21st century consumer age in which we live.

  Two concluding points should be made.

  First I want to be honest too about what is not going to happen this Parliament.

  We are going to make significant improvements in the health service; we are not going to complete its renewal. It will as we said, be a ten-year process.

  We are not going to stop all trains being late or cancelled. Our job is to make sure it's as few as possible.

  We are not going to stop children failing exams or eliminate all poor schools. But education results and the numbers of good schools will be measurably better and greater.

  Crime will still happen. We will not perfect human nature in this or any other Parliament. Criminals will commit crimes. Our job is to catch more of them, punish more of them, deter more of them, rehabilitate more of them and try to reduce the conditions in which crime breeds.

  So it is significant progress we will achieve not completed transformation.

  Secondly, we offer our public servants a genuine partnership in achieving these reforms. There will and should be discussion and dialogue about how they are best achieved. Many unions and trade unionists are working constructively with us, as the recent MSF statement shows. Where policy is shown to be in need of adapting or changing, we will do so. But it is a partnership for change; not a veto over it. Vested interests are not the public service ethos. A commitment to better public services is and no vested interests can have a veto on reform.

  This is a great progressive cause. A great cause for any centre-left government. A great cause for the people of Britain. The means we use today are, of course, different but the aim endures - to liberate the potential of all our citizens.

  When Attlee looked back at the 1945 government he said: "Unless there had been a government with a clear policy and a resolute will we might have slipped back to the evil conditions of the past. No doubt there were many mistakes, but there has been in many directions a remarkable advance."

  Our task surely is to try and emulate that sense of resolve. We will, of course, make mistakes too. But our challenge is to be able to look back in years to come and say that Britain made another "remarkable advance" in delivering better services to the public.

  Our first term mission was to sort out the economy and begin the process of investment and reform of public services. Our second term mission is to make real and lasting improvements in our public services. It can be done. It will be done.

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