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英国首相布莱尔01系列演讲之Prime Minister's speech on the NHS - 6 December

2006-05-30 14:52

  We have called this press conference to set out our agenda for investment and reform of the NHS. The NHS is back in the news in the last few days but everything we are doing today is a continuation of the programme of investment and reform that we have been pursuing for the last few years.

  Our case is that only by taking the decisions now to increase investment in the NHS, and only by being radical about how we provide NHS care, will we deliver for patients in the years to come.

  I know our NHS divides opinions in this country into two camps.

  There will be those who have been left waiting for months, often in pain, for an operation who are likely to feel let down.

  And there will be those who have every reason to thank the NHS - and who may owe their lives to the astonishing skill and dedication of its doctors and nurses.

  I suspect there will be many more people with a good experience of the NHS than a bad one. But I also know there are far too many people who rightly believe the NHS can do better.

  Our job is to make sure that excellence that happens in one part of the country happens in every part of the country. Every time I speak to doctors, nurses, managers, and consultants I am struck by what can be achieved.

  * We are the first country to introduce the Meningitis C vaccine and we have dramatically reduced cases of the disease.

  * Our cancer strategy is beginning to cut waiting dramatically

  * Rapid access chest pain clinics to speed up diagnosis

  * Thousands already benefiting from booked appointments

  * NHS Walk In Centres on the high street

  * NHS Direct the most popular telephone and internet advice and information service in the world.

  These successes are a tribute to the innovation of frontline staff. They are a reminder of the strengths of the NHS but should not be used as a hiding place for its failings. The NHS does have problems. And we know what they are. At their root are under-investment and lack of responsiveness to patients.

  Decades of under-investment requires money to put it right. Lack of responsiveness requires reform to put it right. Both are essential. Sometimes those who make the case for the money shout less loudly for the reform. But the public demand both for they know without reform their money can be wasted.

  In 1997 we took a political risk: to get the economy back on a sound footing before we spent extra money on the health service. That was the right thing to do for the country's long term future and for the long term future of the health service. That success on the economy - with mortgages the lowest for more than 35 years - has given us the chance to put money into the health service not patchily, as in the past, but in a sustained way.

  NHS funding is now growing at more than 6% in real terms a year - double the average achieved in the NHS over the last 20 years. We are increasing health spending faster than any other major country in Europe.

  The debate we have begun is how you sustain those rates. How we ensure that the NHS continues to get the money that it needs to recruit more doctors and more nurses, build new hospitals and buy the most modern equipment and treatments.

  Some have already responded to this debate in a dishonest way. They put forward a magic alternative model - social insurance or private insurance where you don't have to pay. This myth should be put to rest now. There is no free lunch.

  People are right to say healthcare in France has a lot going for it. But those who sing its praises fail to distinguish between the impact of extra resources and the mechanism for raising the cash.

  They don't tell you that working families in France spend on average 20 per cent of their gross income on health, including insurance contributions.

  Or that the French government had to levy a new tax in 1996 to make up for the deficits in the social insurance funds.

  So let those who want to change to the French system also remind people that it is a system that loads all the extra costs on businesses and employees.

  The German system is similarly expensive. And as for private models they have even greater draw backs. First millions cannot afford it - one in six in America. Second it would cost a British family between ??130 and ??240 a month to insure themselves. Third, for one-off operations it can cost up to ??13,000.

  I would draw your attention to the short paper we have put together which sets out some of the facts about the systems of France, Germany and the US. It makes clear that, which ever way you cut it, you have to pay for it. That is the blunt truth.

  So let's learn the right lessons from France and other European countries.

  The reason they have more doctors or beds or shorter waiting lists is that irrespective of their system they spend more public money than we do.

  So we may be traditional in our view of the best way of financing the NHS; through taxation. But let no one doubt our radicalism on how we wish to provide NHS care. There must be a decisive break with the way the NHS has worked in the past. I see the NHS as founded on a set of values and not a set of rigid structures.

  The NHS ten-year Plan sets out those changes; how we intend to redesign the NHS around the needs of the patient.

  Those who work in the NHS will tell you, that, whatever problems remain, the Plan has already unleashed an extraordinary amount of energy and initiative. For the first time the NHS has an independent inspectorate looking into the performance of every hospital and publishing the findings.

  For the first time an independent body makes clinical judgements about the best treatments and drugs. For the first time we have a modernisation agency working with hospitals to spread best practice to cut delays.

  In primary care we are trusting frontline staff to provide new services for local communities with 75 per cent of the NHS budget devolved to them.

  The NHS Plan stated: "The time has come for the NHS to engage more constructively with the private sector." This week we marked another landmark in that engagement with further plans for dealing with the private sector to provide NHS patients with quicker operations.

  Today we show how we will extend choice further. Again our intention was made clear in the NHS Plan where we said in terms: "Patient choice will be strengthened." So we intend to offer heart surgery patients who have been waiting 6 months the chance to go elsewhere for their NHS funded operation - whether to a public or private hospital. This will begin July from next year. To those who say this is a step too far, I say the NHS was set up to relieve pain and suffering not to prolong it. I will not let ideology or dogma prevent this government from doing what it knows to be right for patients.

  But reform does not stop there. With more investment must come more reform. In the coming months we will be stepping up the effort to break down the barriers between staff so nurses can do more.

  We are negotiating new contracts for GPs and consultants. Requiring more flexible working in return for greater rewards.

  We will be using the new powers to intervene where hospitals given time to improve have failed to do so.

  We will be setting up more and more treatment centres for operations, including some through more deals with the private sector.

  All controversial reforms. All with a single purpose: an NHS providing better care for patients.

  My commitment to finding the money for the NHS is absolute. My commitment to reform is just as strong.

  I want a full debate about the NHS. I challenge those who claim to have an alternative plan to spell out how they will raise the money needed, provide quality healthcare to all not just a few, and deliver value for money.

  Let's be clear what we don't want. We don't want a system that benefits the rich at the expense of the poor. That is good at doing one-off operations, but bad at treating ongoing long term illness. That is good for those in the prime of their lives but breaks down when people get older and in more need of health care.

  I refuse to join the band of cynics who have it in for the NHS.

  I am optimistic about the health service

  I have confidence in the NHS Plan

  I have faith in NHS staff

  I have confidence in the arguments we are putting forward.

  I believe we can find the resources the NHS needs even if it requires some tough decisions.

  I believe we can reform the NHS but only if we learn from the experience of patients and listen to the expertise of staff.

  In the coming months the NHS will come under fire. I promise this government and this Prime Minister will be there to defend and improve it.

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