SPEECH BY THE PRIME MINISTER THE RIGHT HONOURABLE TONY BLAIR MP
AT THE GUARDIAN PUBLIC SERVICES SUMMIT RICKMANSWORTH THURSDAY 29 JANUARY 2004
In respect of university finance, I am delighted that the proposals can now proceed. They are a vital reform to put our university sector on a secure footing for the future. It is true the majority was narrow. It is true that there are lessons to be learnt. The lesson the Labour Party in Government should not learn is to shy away from radical reform. A future fair for all. That is our mission. Cease to meet the challenge of the future – the reason for the reforms in education, health and crime – and we cease to have a purpose in Government. My purpose in politics is governed not by doing the job, but by what the job can do. It’s the only basis worth being Prime Minister. When our further reforms, to which I will turn in a moment are published in June, and taken to party conference in October, they will not be a retreat from reform but a quickening of its pace.
Some of my colleagues have said to me after the vote this week, “never again”.
I cannot promise it will be “never again” in the sense of asking MPs or the Labour Party to make a tough and important choice. To do so would not just be an absence of leadership, more importantly it would be a dereliction of responsibility towards those who will benefit from the opportunity and better public services brought about by reform.
But that said there is a lesson that should be learnt about the way I have conducted the debate on reform. We have made a mistake in allowing the changes we are making to be portrayed as being contrary to our values. In fact the opposite is true. It would be easy to talk about values like opportunity and ignore the fact that for too many people, that’s all it would be – talk. In their real lives, too often the reality is opportunity and choice are for someone else.
Public services have a crucial role to play in our society. They extend opportunity by caring for the sick, by giving people an education, by leading the fight against crime and disorder.
I know I have been fortunate in my own life. I have had chances and opportunities that I know many others do not. I don’t pretend everyone can exercise exactly the same choices in life whatever their background. But I do say this – the purpose and principle behind the changes I am fighting for is to extend to others the kinds of opportunities currently enjoyed by the few.
It is a progressive aim and one that is at the core of our beliefs as a centre left party.
Furthermore, policy first and explanation later is not the way to do things, and this was the problem with the way the debate on university finance happened. Some MPs felt the university finance measures were sprung on them with too little explanation and too sparse a tilling of the ground of debate and argument about the nature of the problem. Hence we had the bizarre situation of some MPs who voted against the Government telling me that they agreed with 90 per cent of the proposals but were too far exposed in their public position to climb back.
Precisely for this reason, we started the Big Conversation – the party discussion with the public – to elucidate and describe the future challenges Britain faces. And what is more through Government, there is now a detailed process of discussion that allows full and informed debate including with backbench MPs.
Partly, it is through the process of dialogue and discussion that some of the myths about reform can be examined and demolished.
I would not be in politics, New Labour would not exist, if we accepted the idea that the modern world has somehow made futile the pursuit of our progressive values. That all we can do is cling on to fragments of the post-war settlement while we let the tide of individualistic modernity wash around us. The aim of reform is modern social justice – to ensure that the values of public service – equity, universality, public accountability – not only survive but thrive in a world of rapid change, of increasingly complex needs and of ever more demanding people.
So: lessons to be learnt, bridges to be rebuilt, but no wavering in our political purpose. A new progressive settlement; solidarity and justice for a modern world.
THE NEXT STAGE ON THE JOURNEY OF REFORM
In recent times there have been lively debates among public service commentators between the virtues of centralism and localism, between those who see the public as consumers those who prefer the idea of citizens. But the approach I lay out today seeks to move beyond these debates. I want to show how at the centre, in local government and at the front line we can work together with a shared point of reference; putting the public at the heart of public services. For it is only by truly transferring power to the public through choice, through personalising services, through enhanced accountability, that we can create the drivers for continuous improvement in all our services.
But first I want to explain how over the last six and half years we have got to this crucial moment on the path of reform. New Labour inherited fundamental weaknesses in Britain from the Tory years – economy instability, social inequality, international isolation – perhaps worst of all the state of our public services. These challenges held our country back and deprived millions of our people of the opportunities they needed to do well and prosper.
Our first task was to stabilise the economy taking tough decisions to get inflation, interest rates and the costs of unemployment down. It is our commitment to meet the need for sustained investment while maintaining sound finances that mean we are the only developed world Government which last year, this year and next is increasing the proportion of national wealth going to health and education and fighting crime.
So it was on the basis of sound public finances, providing the stability that is essential to the generation of wealth, that we began to expand investment in our public services. Recruiting hundreds of thousands of new workers, embarking on the biggest programme of capital investment the country has ever seen.
To ensure the money counted, we also made sure the basics were in place across each of the public services. Gathering and publishing performance information, establishing national frameworks and targets, tackling outdated practices and underperforming institutions. Getting the foundations right in each public service.
Now our aim is radical reform, re-designing public services around the individual pupil and patient, working with public service managers – like all of you – to give people the services they today expect – services that are prompt, convenient, responsive, and of the highest quality.
Each of these stages on our journey is connected. Our economic management and investment, our commitment to social justice and public service provides an unprecedented opportunity, a different world from the years of social division and the run down of the public realm. But the authors of the failed neo-conservative experiment have not given up. It is still their absolute priority to show that public provision is inherently inefficient, unresponsive and second rate. We will only win and keep winning the argument for public investment if we can show that every penny we spend is spent in the interests of the public, offering to the public a standard of service that matches and surpasses the best in the world.
COMMUNICATING SUCCESS: THE STORIES BEHIND THE STATISTICS
And you are succeeding; services are improving. The best ever school results, waiting lists falling, crime levels down, council performance improving. The facts ought to speak for themselves. But polling evidence on public perception of the services we offer reveals a paradox. While people’s own experiences are generally positive and improving, this is not reflected in their perceptions of services as a whole.
The disconnect between first hand satisfaction and second hand scepticism is both fuelled, and exploited, by those – never far away – who are hostile to the very idea of universal public services.
This gap between reality and perception also inhibits informed public debate. Effective public accountability means ministers being answerable when things are seen to go wrong but also responding when they are going right. Building on success is as important an imperative for public policy as addressing failure.
So we need to find new and better ways of communicating our shared successes in public services improvement, connecting people’s experiences to our programme of investment and reform. We need to tell the stories that lie behind the statistics. Let me tell you just two:
The facts tell us there are:
- 55,000 more nurses
- 14,000 more doctors
- 213 more consultant cardiologists
- 24 major new hospitals
- waiting lists at their lowest level for a decade
- heart disease deaths down by 23%
Behind these facts lies a transformation in the patient experience. In 1997, a person arriving in his GP surgery complaining of chest pains faced a bleak prognosis. A wait of several days to see his doctor, more for a series of diagnostic tests and an initial outpatient appointment with a hospital consultant. When we came to power, it was not uncommon for patients to wait up to two years for a heart operation.
Today, someone is the same position has a choice of ways to access rapid help and support. For instant advice, he can call a qualified nurse at NHS Direct. This service did not exist when we came to power and now gets over 6 million calls a year. He could then either get a rapid appointment with his GP – 9 out of 10 patients are now seen within 2 days compared to 5 in 10 in 1997 – or choose to attend one of the national network of Rapid Access Chest Pain clinics we have created. He might have been prescribed cholesterol-lowering statins to reduce his risk of a heart attack – now going to 1.5 million patients. He would have benefited from the eighty nine new Cardiac Catheter Laboratories being installed around the country and the increase in consultant cardiologist and cardiothoracic surgeon numbers. If he needed surgery, he would be guaranteed it within six months or given the option of going anywhere in the country or abroad – NHS or private – that could provide surgery more quickly, or even travelling abroad for treatment. Now no one waits over nine months for heart surgery and we are confident that, by March 2005, if not sooner, no one will have to wait longer than three months.
The facts tell us the UK has one of the highest rates of employment and lowest rates of unemployment in the developed world, that we have virtually eradicated youth long term unemployment; that we have helped over 225,000 lone parents move off benefit and into work through the New Deal. But behind the facts is the story of a service completely rebuilt around the needs of the user.
In 1997 a lone parent on Income Support would have made a claim for benefit in local benefits office – in some inner city areas those offices would have had queues hours long, screens separating advisor from client, a depressing unwelcoming environment, no facilities for children, no help with finding a job or help with tackling the barriers to work. Today, a lone parent going into one of our new Job Centre Plus offices – now numbering 350 – would be faced by a transformed environment – open plan offices, screens done away with, comfortable chairs, many with facilities for children. Instead of feeling like a second-class citizen everyone is welcomed at the entrance by a dedicated floor manager and directed to the best source of help. Every client has an interview with a Personal Advisor whose role is both to process the benefit claim and provide a work-focused advice. The Personal Advisor can draw on a range of private and voluntary sector providers to develop a flexible package to meet the client’s needs or direct the client to Job Point – the internet Job bank – where at the touch of a button you can find information about jobs in your local area, broken down into types of jobs, hours available, skills required. The new Advisor Discretion Fund provides the Personal Advisor with the freedom to pay for a new bus pass, to settle a debt, to buy a work suit – practical help to enable their client to take a job.
CONTINUOUS IMPROVEMENT BY PUTTING THE PUBLIC AT THE HEART OF PUBLIC SERVICES
So, over the last six and a half years we have substantially enhanced the offer that public services make to users. But an entitlement is only meaningful if people know about it and use it. Since the creation of the modern welfare state politicians and mangers have tended to see their job as damping down public expectation, minimising the scope for complaint or redress, suppressing dissatisfaction. We are starting to change this culture, to understand that service users with high expectations and the power to choose and to be heard are the best drivers of further improvement. By arming the public with greater choice and by strengthening their individual and collective voice we are making them partners in service improvement.
This might seem like common sense but we need to understand the legacy of professional domination of service provision. The sixties and seventies were a period of unprecedented expansion in public services. Government provided the funds for services but allowed the professionals and their managers at the local level – whether housing mangers, consultants or teachers – to define not just the way services were delivered but also the standards to which they were delivered. And this too often meant services where standards were too low, an unacceptable variability in delivery which entrenched inequality and service users – parents, patients and tenants – who were disempowered and demoralised.
In recent decades governments across the developed world have sought to address underperformance. Separating the role of purchaser of public services from that of provider has been possible to break up some of the old monolithic public service bureaucracies. The use of explicit contracts has raised standards of performance. And regulation and inspection, together with the publication of an increasingly wide range of performance indicators, have increased the accountability of public service professionals. These new approaches have significantly raised standards.
But change driven from the centre has its limits. It is vital that service reform is to be driven from the bottom, as well as enabled by the centre. That is why the priority for reform – the principle tying together the different elements of change – is to put the public at the heart of public services, making ‘Power to the people’ the guiding principle of public sector improvement and reform.
What are the key elements if we are really to put the public at the heart of public services? First, it means a continuous drive to increase the scope and scale of choice available to public service users. Whenever the expansion of choice has been proposed in the public sector there have been the doomsayers arguing that such freedoms would be exploited by the assertive few at the expense of everyone else. Each time these predictions have been wrong. Go to any secondary school on the day prospective parents come in to look around, you will see parents of all backgrounds each wanting to know more, to engage more, to get the best for their children. The evidence on school choice has now clearly disproved the argument that it would drive social polarization. We heard the same arguments when we began bringing choice into the NHS. But early evaluation of the London Patient Choice Pilot suggest that over two thirds of patients offered the choice in London have taken up the offer to be treated more quickly at an alternative hospital. We are still at the early stages but the path of reform is clear. In the NHS as we move towards electronic patient records, we will give each patient greater knowledge, greater control and greater choice, not just over elective surgery but over primary care provider.
Putting the public at the heart of public services also means services that fit the individual needs and preferences of each service user. From the best practice in individual social care commissioning to the package of training and support offered a jobseeker, a commitment to personalised services is beginning to reverse the decades old assumption that the task of public service delivery was to fit the user to the service. Diversity and contestability in public service provision, both between public service providers, and bringing in the private and voluntary sector adds to the choices available and creates strong incentives for more personalized services. Again, there is much further to go. In secondary education, future reform must have as a core objective a flexible curriculum providing a distinct and personal offer to every child.
Through choice and personalization our aim is ambitious and progressive; ‘services fair for all, personal to each’. Public services that harness the drive of competition, and the power of choice to the public sector ethic of altruism and equity.
Along with choice we must also provide the public with a louder and clearer voice. This means direct user engagement whether in school governing bodies, Foundation Trust Boards, tenants forums. In the bodies we have set up since 1997 like Sure Start and New Deal for Communities we have built in user engagement from the start. These new forms of engagement are not an attempt to supplant local government, but to enhance it. Both in central and local government we are exploring how to increase turnout in elections, but as we do this we need to recognise that voting is a blunt tool for the expression of complex opinions and detailed preferences. Now we need to explore how we can provide a stronger voice for the public in new areas. For example, David Blunkett is consulting over models of greater police accountability. As part of the Big Conversation exercise we are asking how we can decentralize decision making in areas like public order and local liveability to community level. Indeed, many local authorities have already experimented successfully with forms of community governance.
Enhancing both choice and voice also means providing robust and trusted performance information. Some commentators assert a false dichotomy between national standards and local decentralization. In reality, a strong framework of national standards backed up by enforceable entitlements are important levers for users and citizens to drive local improvement. For example, our national programmes for literacy and numeracy have provided parents with the information and confidence to want to know more about how their children are progressing.
There are those who believe that the very idea of choice, of diversity and competition, of giving people a greater say in the services they receive must drive inequality of provision and outcome. But this is wrong on three counts. First, it ignores the fact that the old monopolistic, paternalist model of public services failed to address inequalities, indeed in some cases worsened them. The privileged have always had choices. Second, it is a view that patronises poorer people, says for example that they are not capable of choosing to invest in their own higher education, or aspire to the best school for their children – the evidence shows that this is simply wrong. Third, it fails to see that by tackling exclusion, by supporting people through the system we can make choice and personalisation work for everyone. It is no accident that at the heart of many of our reforms – Job Centres, the Connexions service to name two – is the development of the personal adviser role, a trained professional understanding the full needs of service users and helping them get the most of the system. We are exploring how we can apply the model of personal adviser to enhance the choices and rights we are providing to NHS patients.
So, our strategy for continuous improvement through giving power to people involves greater choice, greater voice and more personalised services. But there is one more element. As you all know, public services are a partnership. Parents are key partners in the education of their children. The cooperation of local communities is vital to tackling crime and anti-social behaviour. Employers are key to finding the right jobs for the right people. We can only make real strides in improving the nation’s health if citizens themselves lead healthier lifestyles.
These are issues that can be discussed in the context of the Big Conversation and the Government debates. In examining them, I want to answer one crucial question that somewhat unnerves part of the progressive left about this agenda. This is the idea that the reform programme comes with a hidden agenda of “marketising” services; that if we create diversity, for example between universities, we create inequality; that we make some parts of the services different or better than others. I remember being told during the Foundation Hospital debate by some MPs that Foundation Hospitals were a bad thing because staff would want to work in them and that therefore they would gain an unfair advantage over the hospitals that weren’t foundation ones.
The truth is that diversity in quality and type of public services is not a reform; it is a reality. Students don’t think all universities are the same. Parents don’t think all schools are. Patients know darn well some hospitals and doctors are better than others.
The question is: how do you drive up standards across the board? And the answer is partly money; partly accountability; partly the spread of best practice; partly Government initiative. But it is also the knowledge that the consumer can go elsewhere. That is not to create “a market” in the sense that whether they can go elsewhere, depends on their wealth – the private sector market solution. It is choice and contestability based not on wealth but on one’s equal status as a citizen. And it is wholly healthy. Because our approach to public services must never be about levelling down but levelling up.
IMPLICATIONS FOR THE CENTRE AND THE FRONT LINE
This strategy has major implications for central Government. It has been said that it is no longer the man in Whitehall who knows best, now it is the mother in the nursery or the patient in the surgery. When central Government becomes too big it sucks up resources that should be at the front line. It runs the risk that Ministers and officials try to intervene even when there is little value they can add. We must create a centre that is streamlined and focussed; developing the strategic policy framework; for example, the thinking the Home Office is doing on how different kinds of criminality – organised crimes, repeat offending, anti-social behaviour require different organisational and policy responses. A centre that acts as a resource for best practise, that sets and monitors minimum standards, that intervenes in the front line rarely but in the case of failure doing so swiftly and effectively. Over the coming months I will be asking all our major Whitehall service departments to examine how they can enhance their strategic capacity while cutting away at unnecessary functions and activities. Already the Department of Health is well advanced on a programme of reducing head office staff by 38%.
What does the ambition for freedom and innovation at the front-line driven by customer power means for your services – and for you as managers?
Firstly, greater freedom will demand stronger leadership at all levels. The aspirations that you have for your services will have to be rooted in the needs and desires of the users of your services. And it is not always easy, responding to individual choices while meeting the collective priorities, meeting the expectations of the centre while responding to the specific needs of local communities; the answers can’t be found in text books nor even taught on management courses. It requires you to be what has been called street-level entrepreneurs, meeting needs but also making the trade offs, engaging citizens in the choices you have to make.
Secondly, at the core of high performing public services is a clear and unambiguous sense of mission – to serve the public. In many ways, this is an obvious point. Once you make clear that health services must be patient-focussed then every member of the health team – from pharmacist to physiotherapist, from theatre nurse to orthopaedic surgeon – can understand the role they play in transforming services. That buy-in is a critical success factor – but too often we allow a proliferation of priorities, objectives and targets to obscure the core purpose of our services.
This is linked to the third point – it is staff who make the difference. The school secretary, the social worker, the housing clerk are not merely front-line workers – they are the public face of public services and there is a significant pay-off when they gain new skills. But this emphasis on supporting staff to provide higher quality, more flexible services must be matched by an equal focus on bearing down on failures within the system. Over recent years there has been a substantial increase in spending on public services – and a significant proportion of that has been used to improve public sector wages which had fallen behind. There is, however, a matching need to focus on increasing productivity in public services. New ways of working will lead to greater job satisfaction for staff, higher quality services for users and increased support for the public sector overall.
Finally, we know from the best of our schools, surgeries and councils that there are many examples of innovation. When that best practice is shared with others then the benefits of service improvement are felt more widely. Every public sector organisation needs to be a learning organisation. The quid pro quo for less top down direction must be better learning across the public sector, providing opportunities for best practice to spread more quickly, enabling those who have succeeded to guide others, using their leadership to drive change in areas and institutions where progress has stalled.
CONCLUSION: OUR AMBITION OF PUBLIC SERVICE
For some people this week’s debate about tuition fees was about abandoning my party’s progressive values, undermining core principles of public service.
That is not true as I think we comprehensively demonstrated this week. Our reforms of higher education funding are about extending opportunity to all and investing in our universities to secure prosperity for the country. We have secured those objectives with a truly progressive package of proposals.
And let me be absolutely clear, despite the ill founded speculation of various commentators, there is no secret plan for us to abandon the principle of free universal public services where they now exist. Of course, as we face the future and look at creating new opportunities and providing new services – for example expanding provision in the vital early years – there will have to be a debate about the right balance of funding. That will be a debate we have in the party and in the country at large – is it a key part of our Big Conversation about how we create a future fair for all.
A future fair for all; that is the goal. In its pursuit, the question my Government and my party faces is the same you face every day. Do we see that change is tough and back away, do we prefer the certainty of hitting an easy target to the risk of missing a higher one. Or do we hold fast to our ambitions, do we remember and rekindle that determination to tackle injustice and wasted opportunity that made us first commit to public service. You know my answer, I think I know yours. We have an opportunity to achieve an irreversible shift in the quality of our public services, an irreversible opening up of opportunity for all – let’s make sure we take it.