24 January 2007
Tony Blair spoke to business leaders about ensuring that investment in public services is matched by continued reform.
Read the transcript
Prime Minister:
Thank you very much indeed. Thank you Kevin. I must get you to introduce me more often, but thank you for also reminding me what I said in 2005 and I did think that, but for reasons I will give in a moment I actually think over the past 18 months we have probably gone further and faster on public service reform than we have ever done as a government, and maybe that has been part of my learning curve in government too, and what I am going to do is I am going to speak to you for 10 or 15 minutes and then answer questions. This will be my second question time of the day and I hope you are more polite than the first audience, but who knows!
Anyway the first thing I would like to say is this is that I think that one of the most frustrating things for me is in the discussion of public services there is a danger we get a completely unbalanced picture. We now have a set of polling results that is quite remarkable in this sense that if you ask people what their personal experience of public services is, that personal experience is getting better. If you ask them what the overall state of the service is, they say it is getting worse and there is a huge dichotomy that has now grown up between people’s personal experience and their view of the collective. Far be it from me to suggest that might be something to do with the reporting but I think there is a sense, if we are not careful, that we get this completely out of kilter.
For example I don’t think there is any independent body that would say that the National Health Service hasn’t improved and indeed significantly over the past decade. Likewise if you look at the school results whether it is GCSEs or literacy and numeracy aged 11, yes it is true you can say we are a couple of percentage points off your target but actually there are vastly more kids passing the requisite results at age 11 in literacy and numeracy than there were 10 years ago. Interestingly, too, within those statistics, for the number of children that are not just getting Level 4 which is what they are required to get, but are actually getting Level 5 which is one above what they are required to get, those numbers in fact have more than doubled in the past 10 years. So there are some interesting things happening there. If you look for example - I was, for the purposes of Prime Minister’s Questions today, looking at the median waiting time within the Health Service - it has come down, this is just over the last 4 years because there weren’t really figures kept it on it properly before 2002-2003, the median waiting time has come down from something like 11 weeks to 6 and a bit weeks.
Now none of that is to say in a Health Service that treats a million people every 36 hours there aren’t horror stories. There are huge challenges: MRSA and issues to do with the reconfigurations at the moment and so on, of course there are, and any health care system in the world has big challenges, but if you look for example at productivity in the Health Service and factor in the amount of time people wait and the quality of service, again it isn’t true that productivity has not risen in the past few years. It has actually risen and it has risen quite significantly in many cases. People used to wait 2 years for cataract operations, they now get them - well actually the worst waiting time is around about 3 months, the average is far less than that.
Now even dare I say it this is a pretty bold statement to make in the light of the publicity of the last few months, if you take the Home Office as an institution and you may say well, no you can keep it, but if you take the Home Office as an institution it is interesting that if you were to ask people has it actually got worse in the last 10 years people would say yes but in fact if you ask people who are working from within the system, have there been no improvements in the last
10 years they would say well actually there have been and I think the real issue is the gap between what people now expect from the system and what they are seeing, so for example if you take immigration and asylum, as a result of the reforms that have been made, we used to only remove one in five failed asylum claimants. We now for the last year, 2006, for the first time in the Immigration Department’s history have got a tipping point where we are removing more people than we are taking in, in unfounded claims.
Or, for example, it happens to be the fact that crime, both recorded crime and on the British Crime Survey is down. That’s no consolation if you are victim of crime, but it is actually true. So there are times when sometimes the facts that we get about public services are rather worse than reality. The reality is more balanced. And the reality also, and this is very important in the light of what Kevin was saying earlier. The other thing that I think that is sometimes said is you know this is my public service reform programme and it is obviously it is closely associated with me and the time that I have been Prime Minister, but if you look round the world today public services are subject in our types of country basically to the same pressures and though the prescriptions are different in each case, in fact it is remarkable how similar the basic principles of those prescriptions are. And they really fall, I think, into 4 categories and these are the basic elements of public service reform nowadays.
One, you need a strong performance management from the centre. That is the role of the centre. Earlier in this week, and I make no particular party political point about this because there are people in my own party who would strongly agree with this, the Conservative Party said we should get rid of targets. I cannot imagine any private sector organisation putting the amount of money - in fact I can’t imagine them putting in the amount of money full stop - that we have put into the public services over the few years, but putting that amount of money and not demanding certain outputs at the end of it. And if you were to, for example, and it is a very good example of what I was talking about earlier, if you look at the BMA report on Accident and Emergency that was published last week, the headlines were all highly critical, but tucked away in the report was the sentence that in the last 10 years Accident and Emergency departments had been transformed. Now some of you here may have had doubtful experiences in Accident and Emergency, I don’t know. But others may well have found, and I think this is the general finding, that actually over the past few years the experience is significantly better.
It would never have happened without the target being set for people being treated within a certain time. If you look at the waiting times when I first came to office there were thousands of people that waited over 18 months, hundreds of thousands of people who waited over 6 months. There are barely any people now. However, we still have a huge problem with people waiting too long, for example, for diagnostic tests to be carried out in certain areas. But my point is very simple, without strong performance management from the centre, including targets and standards for output, there is no way that we could justify the amount of money that we are putting in. And incidentally I also totally agree with what Kevin was saying in this respect, part of the minimum standards are the proper minimum standards of the workplace, and we as a government have introduced things like the minimum wage and so on and protection for part-time workers, but once you have done that I don’t think there should be any prejudice that the public sector necessarily treats its employees better than the private sector.
But performance management is one thing. The second thing is greater consumer choice. Now again in the fall in waiting lists over the past few years, which is roughly about 400,000 from 1997 here is the fact, and this is what I would say to people who are opposed to our reforms, is that until we introduced some element of contestability and choice we did not get the fall that we needed. I can’t tell you how many occasions you would go to an area and they would say to you well you know we don’t have enough money, even with the money that you are putting in.
We’ve got these long waiting lists. There is nothing we can do about it. And we would say well all right we will set up an independent treatment centre and they can take the strain for you and remarkably, over quite a short period of time, somehow what was previously impossible became a bit more possible and then actually was done. And the truth of the matter is public services, like anything else, if people believe that it is a monopoly service that you have absolutely no option but to use then some of the pressure for change and for paying attention to the consumer and the user of the service just isn’t there. So, within the Health Service we have introduced choice and we are going to roll that out across the whole of the system and that of course is combined with payment by results and what I want to get to a situation where when a patient goes and sees their GP as a result of the changes that we are making they have a range of choices available to them, they can exercise those choices and when they do, the money follows them and goes to the place that is then offering the service that the user wants.
I also think, and this leads me to my third principle, that as well as strong performance management greater emphasis on user choice, and indeed voice, the third thing is the issue of contestability and breaking down the barriers between public, private and voluntary sector. This to me is nothing to do with ideology anymore and I think and maybe I am being too optimistic about this, but believe me in my job you have got to be an optimist, I think that whatever happens in the future in the world of politics I believe this concept of breaking down the barriers between public, private and voluntary is here to stay. Now some people may push it a little bit further, some people may push it a little bit less far but it just makes complete sense.
We would never have got the largest hospital building programme underway without PFI. And I used to have these debates with people when I would say to them look, in the old days before we entered into this partnership with the private sector, the hospitals weren’t built by civil servants. You still had private contractors that came in to do the work. Actually what PFI does is it allows us to demand certain performance from the private sector over a certain number of years but in fact allows us to get these hospitals completed on time and to budget. If you take for example the independent treatment centres, again if you don’t open up some possibility for the private sector to come in then you are left with a situation where you have no option but to carry on using the same service, whatever the standard. I see no reason why in time to come if for example GP services are not being provided properly in a particular area, you can’t have the independent sector come in and bid for those services. In the end if what comes first is the user and the consumer of the service then it should be who provides the best service that is allowed to provide it.
In the voluntary sector I think there is still a massive amount that we could do to open up services to the voluntary sector. For example you take school exclusions, we have now introduced a power for schools to come together and decide they won’t use the local government service for school exclusions. They could use the voluntary sector. Some of the most difficult and disturbed kids, actually some of the charities and the voluntary sector do a better job. We have now introduced the provision in relation to the National Offender Management Service where we are going to allow the voluntary sector to bid for work in relation to the rehabilitation of offenders. Sometimes in relation for example to long-time drug abusers the voluntary sector does it better. They do it better than either frankly central or local government or the private sector.
So there are ways we can use the expertise here. City Academies have brought the independent sector and entrepreneurs into the running of schools, they have greater freedom. Trust Schools will also allow greater partnerships with the independent sector. My attitude to this is look at any other walk of life, take the private sector, services are more customised, they are more built around the preferences of the individual. In exactly the same way that mass production is not really where modern industry is, monolithic services, monolithically provided, isn’t really where public services should be in today’s world either, and all it requires is a proper strategic framework to be set and then open up services to greater contestability and diversity of supply. And I think that part of the creativity and energy that you would find is precisely in people having new ideas, but being able to put those new ideas into practice because the system allows them to come in and provide the service.
And the final and fourth element, so you have got performance management, you have got user and consumer choice and voice, you have got contestability and diversity of supply opening up the system; and the final thing is work force reform. And here again I think there is more that we can do, but there is a lot that we have done. Nurses for example do far today than they ever used to do in the National Health Service. They could do more still. You get GPs, the primary care services can provide some of the work that used to be done by consultants, they can provide it closer to the patient, more easy to do, some of them build up expertise in particular areas - why shouldn’t they use it?
If you look for example at the schools today, City Academies, the Trust Schools, will be able to do the same. Sometimes yes, a school may decide they want to hire an extra teacher, but sometimes they may decide to hire someone different. They may want an IT specialist or if you take the Home Office and the policing services for example I think, there are a whole range of things, new job opportunities that can be opened up if we broke down some of the barriers between different types of discipline and profession coming in and providing services. Sometimes today in the Health Service for example it would be professional therapists of one sort or another. Physiotherapists for example may be able to do better in treating back complaints than someone waiting months and then going to see a consultant who probably in the end will refer them back to the physiotherapist. So there is a whole set of issues there to do with work force reform that are very important.
Now, how do we sum all this up? I think that over the past 10 years there has been a significant amount of change and the interesting thing is I think in the last 18 months in relation to Trust Schools and City Academies, NHS reform, Payment by Results, the National Offender Management Service and so on, some of the changes that we are making in the way services are delivered, I think actually we have probably come faster and further than I would have anticipated possible back then. However there is still a significant distance to go.
And my own view, and my advice to those that come after me, as it were, is take this agenda and push it further, because it should be pushed further, and recognise that in today’s world it is not about artificial barriers between public, private and voluntary sector. It is about recognising that in the world in which we live today the thing that matters is what provides the best service for the user of that service. Now the user of that service yes wants a well-motivated and well-paid workforce, but they also want to know that the service is run for them, not the service run for itself, so it is a cultural change, if you like, that we are bringing about through structural change. And I think it is all part of a changing world in which the state and government increasingly adopts a strategic and enabling role, commissioning services but recognising that the traditional monolithic forms of provision are not the best, that we should break up those monoliths, and allow a far greater sense of diversity, contestability, competition, allowing people in who will release as I say that tremendous creative energy that is there in many local communities.
Final, final point it shouldn’t be a matter of political ideology, this. It really shouldn’t. In the end, as I say, look round the world. Similar types of public service reform programme are being pursued by governments on the centre left and governments on the centre right. It is an agenda that is actually less to do with ideology and more to do with modernity. The early 21st century is not 1945. The values and principles of public service may remain the same but it is high time we understood that their implementation, like everything else in the world in which we live, has to move with the times.
Thank you very much.
Chairman:
Thank you very much indeed Prime Minister. Before we go on to some polite but challenging questions I would just like to ask Brendan and Tom for a comment. I made the point at the beginning that we have leaders from business, politics and the trade unions and from front line staff. Just very quickly really an immediate reaction and I guess your sense of the direction of travel of public service reform in the future.
Brendan Barber:
Thanks Kevin and thank you very much for the invitation to take part this afternoon. I feel a little bit like I am playing an away fixture, but it is always good to get these invitations. Just first to say from my perspective, just first to emphasise I hope people don’t regard in a sense my contribution to this debate as coming from the perspective of a narrow producer interest. We represent millions of trade union members who are absolutely users of the services, who along with the rest of the public want to see those services improving, see them as vital to their quality of life and the investment that we have seen over recent years has been hugely welcome and as, Tony, you were saying, there have been some real improvements beginning to come through that we should all be celebrating. But one of the dilemmas that I think we have got in the current state of the debate is the degree of emphasis that Tony and other colleagues in the government put on the mantra about further reform always seems to be sending a message that actually the services are still somehow failing, still grossly inadequate, and I tell you that I get a very strong impression that that does enormous damage in terms of the morale of a lot of staff who are delivering those services from the front line.
A second key concern that comes to me continuously is about the pace of change and about the extent to which change is really tested and evaluated and the solidity of the evidence base for change before things are rolled out right across public services. I could refer to some of the particular services where there is a sense that the evidence base just isn’t there. And without getting into a great ideological debate certainly the degree of fragmentation of services and the privatisation thrust that we see coming from government causes huge insecurities. If you take for example the most recent big privatisation in the National Health Service, the Logistics Service which moves the vital equipment around all the parts of the NHS and the staff affected by that privatisation were given all the reassurances about their own terms and conditions going forward but actually what hurt them most was this sense that they were being taken out of the NHS, an organisation that they were hugely proud to be a part of and to work for. So that issue of fragmentation and privatisation.
And just a final point perhaps at this stage. You made the point Tony that there is this gulf between people’s personal experience of the use of many of our public services and the reaction they give and the wider reaction that people give about their impression about the extent to which services are improving. As individuals they think that things have got better but in the wider community there isn’t that sense that things have improved. Some of the work that we have looked at within the Public Services Forum has shown actually that the staff of our public services are themselves amongst the most vital ambassadors for the services that they work for and help to deliver. And if there is that destructive impact on morale of some of the changes that are coming through, that doesn’t half have a damaging effect upon the wider perception about the degree of progress being made within the services, so that challenge of managing change that really does bring staff with you, that challenge is a hugely important one I think in terms of the politics of the reform process across our public services as well as the internal industrial relations within the services themselves.
Chairman:
Brendan, thanks. If I can take that as a perspective. I would just like to get Tom’s perspective as a front line service provider and then perhaps Tony as we get into questions you could perhaps pick up one or two of those points from there.
Tom Coffey GP:
Thank you I feel very privileged to be with you today amongst very august company. I am a very simple, lowly paid GP from Tooting. [Laughter]. I got a bus here as you can imagine. I will give you a very narrow perspective, I’m afraid. I’m from Tooting, I was born in Tooting, I went to school in Tooting, I work in Tooting, I live in Tooting, I take my holidays in Tooting, and believe me I am going to die in Tooting. I will give you the Tooting perspective. I sometimes go and see Chelsea play, but then I rush back. As a GP I must say I have seen an enormous transformation in the NHS. One area I will focus on is for me cancer services. 10 years ago - as a GP in Tooting - I would refer a patient into a bit of an abyss and see what happened and maybe 6 months later a patient may get an appointment. Now I am 100% confident that my patient will be seen within 2 weeks and that is an amazing improvement and an amazing transformation.
Secondly the question about where could the Prime Minister have been a bit braver and I would say it is around patient choice. The targets have been very effective in many areas, but patient choice for me locally has produced a paradigm shift in how hospitals and GPs provide their services. The example that I have got is bone scanning. We had a 17-month wait for bone scans and then we didn’t know what to do, we worked for years with the local hospital, and then we said OK we are going actually maybe put it somewhere else. Within 4 weeks the waiting list went down to 17 days because they realised that if they didn’t change they would lose their business and there was a transformation without a target.
Future work, as a GP I know how easy it is to get to see me, you can ring up any time of the day and you can see me. My receptionists are so polite, lovely, warm, friendly and giving - in Tooting of course - and I believe that maybe the area where we need a bit more choice is in general practice services. I feel that we have been a bit protected, understandably because GP services are seen still as very popular, but access to GPs is poor and I think we know that and I would feel that an extra bit of competition for myself and my colleagues may make us raise our game. That’s my perspective. Thank you.
Chairman:
Thank you very much. Never has the Tooting Popular Front had such strong leadership!
Questions, ladies and gentlemen. I’m sure there are going to be lots, so let’s take three at a time, as tried and tested in the session this morning. Let’s start over here. If you could give us your name and organisation and either address your question directly to a panel member or more generally if you prefer.
Question:
Prime Minister, it is a pleasure speaking to you once again. You may recall the last time we spoke, at the annual CBI Interactive Conference in November 2006. And now in 2007 it is good to see you are still here. I found your views on the future of service delivery in the public sector very interesting and inspiring. I myself worked for 6 years in the public sector working for Solihull Council and now Birmingham City Council for 3 days a week. Prime Minister you have answered many questions in your speech today, but could you please reiterate and let me know what your views on the subject are. Do you accept that the actions of the Labour Government under your leadership to improve local public services over the past 10 years have been a success, bearing in mind that in order to improve public services it is important and essential for a successful, democratic society that there is honesty, trust and credibility in government and in your view as Prime Minister, do you think that public-private partnerships work more effectively when the elected government has control both nationally and locally? What evidence is there to suggest that government controlled partnerships are more effective than those controlled by local government?
Prime Minister:
I remember the Conference now! [LAUGHTER] Actually I think the issue really is not so much to do with whether it is central or local but whether you do manage to break down the barriers between public and private and whether there is this ability of people to come into the system and offer a better service. That is where I totally agree with what Tom was saying earlier about the GP service in the future. You see all of it, whether it is locally or centrally done, the concept of the public-private partnership is to open the system up. And you can open it up by having a partnership as you do in PFI but you can also open it up in saying we are not going to have a preconception that this service, presently delivered in this way has always to be delivered in this way, and I think when people talk about the dynamism and entrepreneurship in the private sector I actually think, and Tom is an example of this, there are dynamic, entrepreneurial people in the public sector, but often they are constrained. Now sometimes you will hear people say well they are constrained because of government targets and this and that, and we have got to be careful of that, and I can come onto the targets issue in a moment, but in fact one of the ways of releasing that dynamism and entrepreneurship is to allow people to come in and develop the service in the way that they want. That is why City Academies and Trust Schools will be able to hire their staff in a different way, will be able to run their schools in a different way and as a result of that, because they have got more power in their hands, then they are better able to develop the service in the way they want.
I think localism is not just about central government pushing it down to local government, it is also about coming down to the local community and to the people within that local community and having the power they need to deliver the service. And increasingly what I think, and I have said this before but I will say it again, when I first came into government and I had this kind of mantra about the Conservative Government at the time which is that it is standards which matter not structures and truthfully what I have learned over - well I’ve learned a lot of things over the 10 years - but one of the things I have learned is that actually it was a good thing to say because in the end the structures can lead to the standards being raised and the job of central government is to put the structural framework in place that allows the local dynamism to come forth. If you simply say, we will hand it over to the local people but there is no contestability, there is no diversity of supply, there is no ability for people to go elsewhere, actually all you are doing is in fact just handing it over to the producer interest and saying do whatever you want. But if you have greater power in local hands within a structure that allows other people to come forward and provide that service, then I think you are getting the balance more correct, and that is what I would say I have learned very strongly from our experience.
Question:
Representing private, voluntary and (INAUDIBLE) sector child care providers, Prime Minister, at the moment the government seems to have a huge appetite in investing and creating new entrepreneurs. If the media coverage is anything to go by this morning (INAUDIBLE)… What I really would like to know is there seems to be a distinct lack of appetite when it comes to supporting existing businesses. I’m talking about small and medium-sized private businesses and voluntary sector organisations and that is all due to the lack of a level playing field and lack of investment in building their capacity to be able to deliver public services equally along with everybody else.
Question:
Prime Minister, I think you are right that the argument for greater diversity in public services is now won. The evidence from a greater diversity is there. The issue is simply the pace of reform. And if you are looking for a monolithic, state-run service that is in need of radical reform, can I suggest employment and training services - Job Centre Plus. The evidence from Australia where the reforms of that service now mean that third sector organisations and private sector organisations provide between them about 50% of the service where the outcome has been more people placed in jobs, choice in service and lower costs. That could happen here. Shall we do it?
Question:
Prime Minister I just wanted to know if you had a blank sheet of paper and obviously as we know this is your final year in your current job, just interested to know if you could write your own legacy in terms of delivery of public services, and maybe other things as well but certainly as far as public services, what would it be?
Prime Minister:
On the level playing field I would have to know more about the individual circumstances but let me say to you I think there is a risk that we as it were say that we are opening everything up and then you find that the playing field isn’t level. Now I do understand that, and one of the things that we have got to watch as political leaders, because the system is not always that keen on opening up to be absolutely frank about it, is that we are making sure that what we are saying rhetorically is delivered. I mean actually of course in relation to day nurses, and indeed child-minding and so on, there is a huge private and voluntary sector out there and it is important that we mobilise the energy and assets of those people. But I will, if you like, come back to you specifically if you give me a note of what the individual problems are on level playing field for your type of organisation I will be very happy to look into it. It is an issue that the CBI has raised with us in another context and on which we have managed to take some action so we should be able to do that in your area too.
Stephen, I think that welfare reform is a very good area to explore further the possibilities of work with the voluntary sector, in particular people finding jobs and again, you know, the truth is for some people, particularly those that are hard to place, people who maybe have got multiple disadvantages or difficulties in finding work, the voluntary sector can often do better and I think you will find in the Welfare Reform paper that we publish in the next couple of months that takes forward that whole area of potential reform because I think it is important to do and the truth is, again Brendan was absolutely right in saying you have got to have an evidence base, but actually there is a lot of evidence base in relation to these people now and I think for a lot of the people who work in the Service as well they would like to have greater freedom to use different ways of helping place people in work and of course workforce management and workforce opportunity is something that both the private and the voluntary sector have a great deal of experience in, so I think you will find when we publish this in the next few weeks that your call has been answered.
To the gentleman from the Radio Taxi Group, if I could write my own legacy on public services, I doubt if I would be able to actually. I have got a few people who want to write my legacy for me. But I think that the most important thing that we have done, provided we keep the investment under reform, is create the circumstances in which the public will carry on supporting taxpayer-funded services. In my view the reason why I think the reformers are the true supporters of public services is that the public will not support their taxes going to fund public services unless they think they are responsive to them as consumers and taxpayers in today’s world. I was delighted to hear what Tom was saying about the availability of himself as a GP - in Tooting!
But the fact of the matter is in every other walk of life, and this is again why I say this is an issue of change and modernity not an issue of ideology, in every other walk of life, people expect a service to be responsive to them. For the people that you represent they certainly do. As public services change and we get the investment up to the requisite level, if the service doesn’t improve in the way it treats the user of the service, well people will say well OK let’s try a different system then. And the tragedy is for the Health Service in particular, and I can assure you I have looked at this very carefully, there are basically three models. There is the private insurance model which is the American system which has all the problems associated with it. I’m not saying that there isn’t good health care delivered for many people, but the fact is there are around 40-50 million people without health insurance who have real problems and actually if you were to talk to any of the leading politicians in America they would tell you that health care is now slap bang in the middle of the domestic agenda there. There is a social insurance system, but you talk to German and French employers about their costs for a social insurance system and they will tell you it is a major problem and it has been a huge issue in both French and German politics recently and our taxpayer- funded service I think is certainly as a concept is as good as the other two concepts, in my view better.
But it is only if we are prepared then to recognise that we have got to make it a service that is responsive to people that we will keep that support for it, and in this connection one of the things that I think is really important to say and I know people often don’t like me saying it or misunderstand what I am saying, a public service is not a private company. That is absolutely true. But you can end up in an absurd situation here if you take that conclusion too literally. Lots of what a public service does is exactly the same as what a private sector company has to do. You have to procure the best value with all the money you spend on goods and services. When you are a hospital managing the flow of patients, you know we caused a certain amount of outrage by teaming up foundation trusts with private sector companies used to managing the flow on a production line and everyone said you are saying that patients are just as if they are on a production line.
Well you are not, but some of the same techniques are applicable actually in how you manage the system properly, and so when we say a public service is not a private service, of course that is true in the sense that it is not run for profit, but actually some of the lessons from private sector change are absolutely applicable to public services in the same way, incidentally, that some of the trust that the public services have with their consumers offers some lessons for the private sector as well and that as I say just underlines the point again that I think the best legacy for me would be that we made a substantial investment in our public services but at the same time put in place a process of reform that will lead to people supporting taxpayer-funded public services in the future.
Chairman:
(Beginning inaudible) ….given the skills are not exclusively the remit of teachers given the skills that these days that somebody needs to run a school is not the same as in the classroom, so it will be interesting to see how that develops I think for all of us.
I will take 2 final questions and then we have unfortunately to say goodbye to the Prime Minister.
Question:
I just wanted to come back to Brendan Barber. He commented that the Prime Minister’s comment on the continuing need for reforms suggested that there was something wrong with the public services today and that people were not providing good service. It seems to me that unfortunately it is an inescapable fact that if we are to continue to raise living standards and quality of life for everybody in society, continuous improvement is just a fundamental for everybody in the private sector and the public sector, and I wonder what advice he could give those of us trying to enable change in the public sector about how we can work better with front line staff to actually engage them in the process and have them contribute to it in a creative and positive way rather than sometimes make mistakes and cause them to resist.
Question:
I am trying to work out why I am fascinated by you Prime Minister, why I like you. I can see why you have been Prime Minister for 10 years but in the back of my mind I can see a dichotomy between what you are saying and the consequences of what you are saying in the lives of people who work in private industry. For instance somebody in my ward, a young man, sweeps the streets of Norwich. He gets paid the minimum wage. He has to live with his parents with his wife and small child because he can’t afford a house. We have 2,000 homeless people in North Norfolk. For a Labour Party Prime Minister, even New Labour, you are looking at one side of the coin, and I don’t see you looking too much at the other side of the coin. The hospital service in my view the cleanliness in hospitals is a direct result of private cleaning and lack of supervision of that private cleaning. In the North Norfolk Hospital private enterprise had a windfall of many millions of pounds and refused to give any of it back as a moral basis. I don’t buy this private enterprise being the godliness of everything. I think there are very good reasons why we should have private enterprise but I think I would like to see you, in your last few months, doing something to redress the balance for the way private enterprise affects ordinary individuals.
Brendan Barber:
Just specifically on the first question, and I have some sympathy with the points made by my colleague actually in the last question as you might expect, but on the first question, how to do it well is absolutely the right question I think and it is something that we have very much been working on through the Public Services Forum that was established on the initiative of the Prime Minister 2 or 3 years ago, where together with the leading public service employers we have actually developed a tool kit on best practice for managing change and really ensuring that the staff feel involved in developing change and are a part of that.
And we have looked at projects in local government, in the Health Service, in other areas too to produce that very practical advice. And it is not rocket science, it is about open communications, it is about building genuine trust, it is about giving staff a real feeling that their contribution is valued, they are able to make a contribution and help shape the change so that their real commitment and wish to see the positive outcomes in terms of service improvements, that is captured in a genuinely positive way. And through the Public Services Forum the unions involved on our side are promoting that work through our structures to trade unionists at every level and the major public service employers we hope are doing the same through their structures too. And we want to see more change managed in that kind of positive way.
Chairman:
And the final question, Prime Minister. Is the 10 percent of public services that is currently done outside the public sector too far, or far enough?
Prime Minister:
Well I think what I would say is it depends who provides the best service and you shouldn’t set an arbitrary limit but if I can address the question very quickly. First of all, the second question. I am well aware that there is another side of the coin in terms of people who are trying to get proper homes and trying to get better-paid jobs. We did actually introduce the minimum wage and also introduced many protections for people in the workplace but one of the things I used to think when I first got the job was that at some point the job was done, but actually the job is never done and now you have got a new problem which is with house prices high and young couples finding it difficult to get their feet on the first rung of the housing ladder, we have got to take fresh measures and we should do that.
And on a thing like cleanliness in hospitals, I think it is a point that people often make to me and I am not really in a position to judge whether it is the issue of the private or public service in relation to cleanliness in hospitals. But I also think it is one of these things that again I think one of the things we have got to do in this new system that we are introducing in the Health Service is to say to local hospitals and the local management well you are responsible for this. I had a meeting not so long ago with some of the local health service people who said to me that we have a real problem with the cleanliness in one of our local hospitals, what are you going to do about it and I said well actually what are you going to do about it and I think we do need to have to face people up with their own responsibility to deal with these issues since I cannot believe myself that cleanliness in hospital is rocket science. I think it should be possible to do and indeed one can go to hospitals in which they have achieved far greater standards in things like cleanliness and things like the quality of food and the quality of service. But at the risk of making you obviously revert to your original view of not liking me I should say it is a difficult situation but I am not saying - the whole point about it is to get away from private sector good, public sector bad or the opposite but to get to a situation where we accept things have changed so that you can move across these old demarcations.
And that leads me just to the final point I wanted to make which is to the question from the gentleman from Deloittes. This is what I have learned about this issue with reform and change because what Brendan says is right to this extent that I think when you are putting through reform you are inevitably saying the service has to change and therefore you are inevitably saying it has shortcomings. If you are not careful that then becomes translated into well the service is rubbish, which is not necessarily true and I think the real position is this, and I think you put your finger on it when you talked about continuous improvement, and this is a very difficult thing for political leaders to say to people because it is an uncomfortable message. The truth is whether it is in the private sector or the public sector we have no option but to carry on changing constantly. The truth about this is that there isn’t a reform programme that is going to come to a halt and then everything is going to go into a steady state and will remain like that for decades to come. That’s not the world in which we live.
The world in which we live is one in which technology is changing things constantly, expectations are constantly changing, communities are changing, the demography of society is changing and the treatments and cures in the Health Service are changing the whole time. Chronic disease management, for example, where conditions will exist over a long period of time, not necessarily terminal but conditions like say diabetes, or heart disease or so on, you will find I bet in 10 or 15 years time a completely different way of managing those diseases and a different interaction between primary and secondary care in doing that and the truth is, if we are honest with people there is no way I can say to you, once this reform process is through, then nothing else is ever going to change and one of the things I say to people about the Health Service is you have got an organisation with 1.3 million people that does treat 1 million people every 36 hours. It would be bizarre if in this world in which everything else changes this institution remained in aspic, never changing.
So it is not going to happen, but what I do find is that when you are putting through reform people will tell you that it is the end of the world. That is what they say. I mean I have never put through a reform where anyone has said that sounds like a good idea, let’s go and do it. It’s not the way it happens. I remember there was a very early time when we put through the changes in the Labour Party. We were never going to win an election as a result of it.
When we first said in relation to specialist schools, which were the forerunners of Trust Schools and City Academies, this would be the end of secondary education and the principles of equal education as we knew it. When we first introduced choice in the Health Service it was a terrible thing that only middle class people wanted which is of course nonsense. But whilst it is happening, everyone resists it. When it happens, provided it is the right reform and obviously there is a debate about that, but when it does happen you find a couple of years later no-one can remember what the fight was about and therefore what I have learned in the end, and uncomfortable though it is, and difficult though it is, is you might as well face up to the fact of continuous improvements, put the reforms in place, take them through even though it is difficult and maybe unpopular whilst you are doing it because in the end that is the only way to provide leadership rather than simply managing a static situation and in the end I think the leadership route - this is my final reflection on 10 years - is better than the alternative, which is the absence of it.
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