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英国首相布莱尔02系列演讲之Public Services speech - 25 January

2006-05-30 18:38

  I said back in June when we were re-elected that the battle over the economy and public services would dominate this Parliament. This isn't and can't be a matter of one individual case, no matter how hotly contested.

  As I said yesterday, let us make this deal: the Government should not pretend that public services are all perfect; and our opponents should not pretend they're all rubbish. Let's celebrate the good and tackle the bad. And let all of us praise the dedication of our public servants.

  But underneath, there is a very serious debate taking shape.

  The choice is this:

  Do we believe as a nation that the problem in our public services is years of underinvestment and that the solution is sustained investment matched with reform?

  Or do we believe the problem is that the Thatcherite revolution was never completed and that the solution is the cut back on investment, cut taxes and then get people to purchase their own services?

  Obviously, I favour the first analysis and in a moment I will say why. But for those who favour the second, it is time they stepped out and made their argument openly.

  At present, they confine themselves to denigrating everything about the public services - running them down, saying the services are lousy - so that people feel it's all hopeless, nothing works, that any investment is just wasted money. Each individual case of actual or perceived service failure, accepted or disputed, true or false, is luridly headlined in order to demoralize us all.

  It is denigration for a purpose: to argue that the public services aren't worth saving.

  Now it is out in the open, let me be clear.

  To the papers, a real life NHS story is today's frenzy and tomorrow's fish and chip wrapper.

  To the nurse and doctor it is their reputation, their integrity, their life, today, tomorrow, the next day.

  Public service is not some vague notion. It is real. It is good. It is what binds our country together.

  It is the millions of hours in unpaid overtime.

  It is the doctor willing to get out of bed in the middle of the night to see a young child.

  It is the teacher who in his spare time runs the school football team.

  It is the policewoman with the guts to take on a group of anti-social kids yelling abuse on the street corner.

  It is the head teacher who stands up for his staff when they are confronted by abusive parents.

  These are talented people. Many of them could earn more elsewhere.

  But they choose public service and they deserve our respect.

  They should have it.

  Because I say to those who are undermining our public services: if you're on the side of the people who use public services, you should be on the side of the people who work in public services as they make the reforms vital to those services.

  If you're on the side of the pupil, you should be on the side of the teacher.

  If you're on the side of the citizen, you should be on the side of the police.

  If you're on the side of the patient, you should be on the side of the nurse, the doctor, the hospital staff.

  While there are indeed huge challenges for our services to overcome, do not let us underestimate the very significant progress Britain has already made, precisely through investment and reform.

  Yes, there are cases of poor treatment inside the NHS, and some wait unacceptably long, but the vast majority get excellent care. The average waiting time is now below three months. We are increasing public spending on health faster than any major country in Europe, and as a result already have 27,000 extra nurses and 6,700 more doctors since 1997. Two weeks ago, the Modernisation Board of the NHS, peopled by professionals in the NHS, said clearly: there were big problems, but the NHS is definitely improving.

  We are driving the longest sustained period of investment in education for a generation, and by 2003/04 we will be spending a third more on it in real terms than in 1997. There are now more teachers in maintained schools in England than at any time in nearly 20 years. Our education service, as the most authoritative international survey recently found, is amongst the best in the world, ranked above France and Germany for children of 15.

  Crime is down on 1997, though still too high. But over this year and the next two, policing will get a cash boost of 20 per cent. Last year saw the largest number of police recruits for 20 years, and by spring this year there will be more police officers in England and Wales than ever before.

  Transport, for the reasons we know, needs fundamental restructuring after Hatfield exposed the true state of the rail infrastructure - and it urgently needs investment. That is the goal of our ten-year transport plan and of our programme of investment.

  The reason I argue that the problem is underinvestment and the solution is to invest in reform of public services is very simple. The underinvestment in education, the NHS and transport is there for all to see. The biggest constraint in the NHS is capacity. There is a huge programme of capital works in schools still being carried out. There is a vast need in all services for modern buildings, technology and equipment. And to attract more staff we need to reward them properly.

  For reasons of equity and fairness too, I favour building up public services rather than pushing people to go private. If we cut investment and let people pay, then the top ten percent may be able to afford it. But the other 90 per cent will just be left with sink public services in a perpetual state of decline. And let no-one pretend that there is, on the one hand, a public service which we pay for in taxes, and on the other a private service that somehow comes free.

  The opportunity now is to use the prospect of investment to lever in reform. Because as we all know, it is not just about money. The services urgently need change, redesigning them around the needs of the consumer, making them fit for the new age of high expectations in which we live.

  So I approach this debate with relish. Let us take on those who would cut back the investment our public services need. And let us take on the diehards who refuse reform.

  Let me put the public service debate in a wider context too. New Labour did not and does not believe in reversing all the Thatcherite changes of the 1980's. But we do believe we inherited key weaknesses - in the economy, in public services, in social inequality and in international isolation. These challenges held our country back and deprived millions of our people of the opportunities they need to do well and prosper.

  Our first task was to stabilize the economy and get inflation, interest rates and the costs of unemployment down. We have.

  Then we said education was our number one priority. It was.

  Then on the basis of sound public finances, we began our plans for investment and change in all public services. At the same time, with the New Deal for the unemployed, the Working Families Tax Credit, extra help for pensioners, and huge increases in child benefit, we started the process of building a more just society.

  And throughout our time we have repositioned Britain as a strong player on the world stage and a constructive partner in Europe.

  Of course it all takes time. Remember that even in January 1984 the Thatcher government had still not passed its major trade union legislation or done its first big privatisation or had the miners' strike. Similarly many of our changes and challenges lie ahead. But in each public service area, there is a clear plan, money earmarked for investment, and a programme of radical reform.

  Reform means redesigning public services around the consumer, giving people the services they today expect- services that put them first, that are prompt, convenient, responsive and of the highest quality. For example, they want hospital appointments booked to suit the patient, not the hospital.

  Our progress towards this goal is guided by four key principles:

  First, high national standards and full accountability.

  Second, empowering front-line staff to encourage diversity and local creativity.

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

  And fourth, the promotion of alternative providers and greater choice for consumers.

  These principles add up to a fundamental shift away from the oldpublic sector ethos to a new public serviceethos.

  Today I want to focus on the staff who hold the whole system of public services together, and on whom all our plans depend. And in particular I want to set out how better leadership and flexibility will help them achieve ever-higher standards.

  Leadership

  It will first of all take leadership.

  Nothing is more important in raising the standard of public services than the quality of their leadership - not just at national level, but on the front line of each service. You can feel the difference that effective leadership makes as soon as you walk into a well-led school or police station; I felt it visited the A&E of North Tyneside Hospital and saw the effective, high quality service that Sue Page runs there. It is headteachers, police chief superintendents, ward sisters, leaders of the new Primary Care Trusts and their management teams who will make the difference locally.

  So they need to be properly paid and trained, strongly incentivised, and given the authority they need - subject to full accountability and delivering high standards - to get on with the job. And if, for example, that means paying a good Primary Care Trust chief executive at around the same level as a senior consultant, then so be it.

  We need systematic training for leadership. That is the goal of the National College for School Leadership, training our best headteachers to take on the toughest school challenges. Similarly the Police Leadership Development Board will bring on effective police commanders. And the Public Service Leaders Scheme, a joint venture between the Civil Service, the NHS, local government and the police, is supporting future leaders across the public sector.

  It is a shift that will turn front-line leaders like head teachers, hospital medical directors, and police superintendents into Britain's new social entrepreneurs. This is the decade when we will look to public service professionals as the new byword for can-do innovation and dynamism. For shaking things up and getting things done.

  Better pay/conditions

  They will achieve this with a staff reinvigorated through more attractive and flexible pay and conditions. For the first time in nearly a decade, public sector pay is now rising faster than private sector pay.

  Effective teachers who want to stay in the classroom can now earn more than a quarter more than the maximum that they could have without additional responsibilities in 1997. And some primary school head teachers can now make up to ??60,000.

  Meanwhile since 1997, pay for newly qualified nurses is up by nearly a third. And new nurse consultant posts give nurses the potential to earn over ??45,000.

  Working conditions are improving too. By this March we will have funded repairs to 17,000 schools. We're updating IT systems. We're cutting red tape and form filling, with a unit at the heart of government dedicated to saving teachers', GPs' and police officers' time spent on unnecessary bureaucracy. I know that we still need to do better on these kind of issues. But we are making progress.

  Devolving decision making

  Yet the new public service ethos goes far beyond pay and conditions. More fundamentally, flexibility will mean the opportunity to work more effectively, to sweep away the bureaucracy and structures that get in the way of innovation and initiative.

  I want staff to be excited with the possibility of new ways of doing things - not just because that will be more efficient, but because successful reform depends on government learning from the innovators on the front line.

  Your customers are all different. They have different needs that can't be second-guessed by central government. That is why we are empowering front-line staff with the freedom to decide what's best.

  For example, Primary Care Trusts will control 75 per cent of the NHS budget. Under Personal Medical Services contracts now being piloted, it is GPs and their practices who decide how to spend money on services and staff. Jo Davidson, nurse lead at a practice in Tipton, in the West Midlands, says: "It allows us to use the same amount of money in a more creative way."

  In hospitals, ward sisters and charge nurses are being given control of staffing budgets. That puts them in a better position to manage rosters and shift patterns, and decide the mix of grades, skills and jobs on their ward, so that they maximise nurses' hours at the patients' bedside.

  Or take the commander of a police Basic Command Unit - policing an area like a large town. They will have a key role in decisions about use of local crime reduction or anti-drugs money, and responsibility for coordinating the mix of police and non-police staff on their patch.

  And school headteachers and their governors now have almost complete control of their budgets - including up to ??82,000 in new direct payments to spend on their schools' priorities.

  Flexibility

  To create and sustain such power at the point of delivery, every public service will need greater flexibility in its staff's pay and working conditions.

  For example, pay structures need to be flexible enough to reflect the cost of living in different areas. Increased allowances for police and nurses in London reflect that. So too does the new recruitment and retention funding for schools in high-cost areas. It is essential that front-line managers use this extra funding flexibly. If the key shortage is in good maths teachers or IT technicians, incentive packages need to reflect this. And those who strive for excellence know too that in many cases performance-related pay can be important.

  Flexibility in working hours will help us deliver services when and how people want them. Take NHS Direct, praised just today in a report by the National Audit Office - a modern, always accessible service that meets the needs of today's health service consumers.

  And flexibility will help staff plan their career development and work-life balance better too.

  For example, Thomas Telford School, one of the highest achieving and most innovative secondary schools in the country. All staff teach a four day week, with the fifth day for preparation and development. Or Prince Albert School in Birmingham, an innovative primary school that has developed a scheme for collaborative planning that means that all its teachers are now given a minimum of a quarter day a week for professional development.

  Or take the Royal College of Midwives' Partnership on Progress in Maternity Services aims to help midwifery managers and RCM stewards work together to improve retention and returner rates for midwives through childcare, work-life balance, and cultural change initiatives.

  Indeed the NHS is already a market leader in flexible working, through strategies such as childcare provision, job sharing and annualised hours. King's College Hospital won the Lloyds TSB employer of the year award in 2000. This kind of approach now has to happen where possible across all public services.

  A new public service professionalism

  Flexibility also means abolishing outdated professional demarcations.

  In the NHS, GPs and properly trained nurses and other professionals can take on wider roles to the benefit of patients and of health professionals across the board. For example, nurses at Harlow NHS Walk-in Centre are now referring patients directly to certain hospital wards and departments including radiology, paediatrics, gynaecology and mental health. This is reducing patient waiting times - before, they had to go to A&E and wait for admission.

  Meanwhile in Bradford South and West Primary Care Trust, patients can get specialist treatment from GPs, nurses, therapists, opticians and pharmacists, where this offers a quicker alternative than visiting local hospital outpatient departments. Waiting times for some tests have been cut from five months to two weeks.

  In schools, a revolution is taking place in the use of teaching assistants and support staff. It needs to advance further and faster to enable schools to focus better on pupil needs and to free teachers to teach. It will make their job simpler and more enjoyable; it will help them be more effective at it; and it willraise the status of the teaching profession.

  Take Winston Churchill School in Woking, which reviewed the non-teaching tasks taking up teachers' time and identified 24 tasks where teachers could benefit from support or transferring tasks to others. As a result, they have made significant gains in their time.

  In the police service, officers spend far too much time on paperwork like preparing statements, charges and reports which could be done by administrative staff. One recent study found that police officers were spending almost as much time in the station as on the street. Neither the police nor the public want that. So the reforms proposed in the Police Reform Bill foresee a greater role for civilians such as detention staff and case managers, and for the wider "policy family" including community support officers and special constables.

  For example in Portsmouth, Camden and dozens of other places, neighbourhood wardens are already working successfully in liaison with police. Elsewhere, one local police commander appointed a civilian to monitor investigation of domestic violence cases and liaise with victims. Victims have proved more willing to speak to someone who is not a police officer - and it of course has freed up officers' time.

  Such innovations and flexibility are not an attack on professionalism. On the contrary: they go hand in hand with astrengthening of professional standards through new national standards for excellence and organisations to ensure accountability, such as of the General Teaching Council, the Police Standards Unit, and the Commission for Health Improvement.

  It adds up to a new public service professionalism. Professionalism has always been defined by pride, integrity and commitment. But modern public service professionalism also demands flexibility to achieve ever-higher standards.

  Forward-looking trade unions understand this new professionalism. They know that the future is about partnership rather than confrontation.

  They are leading the way in a number of projects. For example in Wolverhampton, Unison are working with Wolverhampton Health Trust to develop a new management style and increase staff involvement. They plan to extend and disseminate best practice across the NHS with the support of the NHS and other unions.

  And teacher unions have been in the forefront of policies to boost training and professional development.

  Such professionalism will help all those in the public service advance their careers - backed by improved career development and training. A new approach to training is emerging across the public services, backed by new institutions such as the new NHS University and the Central Police Training and Development Authority.

  Change in Whitehall is fundamental too - to make the Civil Service more outward-looking and entrepreneurial, and to bring much greater individual accountability and rewards for success. This is already happening. For example, the new Senior Civil Service pay and performance management system offers significant bonuses for the best performers. We have brought in people with skills we need on secondment from many outside organisations, and the number of senior Civil Service posts filled by open competition has almost doubled in the last two years.

  The new public service professionalism once again comes back to the public service ethos and to the challenge of serving today's consumer. Fulfilling consumers' expectations is different now for doctors whose patients have discussed their symptoms in internet chatrooms or called NHS Direct. It's different for teachers, talking to parents who have researched local schools' exam results on the web. And the revolution in public services will enable all staff to be able to meet those consumers' high expectations.

  Conclusion

  So to anyone working in the public services or considering a career in them, I say: this is an exciting time.

  But for both staff and the public they serve to enjoy the full advantages of what we are proposing, we must seize the opportunity of change - not shrink from it.

  Effective pursuit of excellence does mean a tough line on failure. To enjoy public confidence, the public services must meet the standards that we have agreed.

  Yes, there is a long way still to go. But we have real excellence to build on - our public services in many areas are stunningly successful. Every day their staffs' achievements are huge - schools educating over nine million children every day. A health service treating a million people every 36 hours.

  All the ingredients are there for excellence in our public services - committed staff, investment, and a clear plan for reform. That is our goal. The choice is now clear.

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