All of us can tell our own story about the ethos and tradition of public service in Britain. We think of our teachers and their extraordinary power to make a difference to our lives.
We know nurses, doctors and health service staff who everyday can make the difference between life and death. Social workers and care staff who can transform hopelessness into hope. Home helps and care assistants who, for the frailest and the weakest, make public service the mark of civility. Street orderlies and ancillaries who show, by their commitment, why public service is about improving the quality of life. And if you’ve ever been involved in an emergency you remember the calm, unflappable skill, the professionalism, and self-sacrifice of all our public services.
Each time good is done it sends out a message that duty, obligation and service are at the heart of our country’s sense of itself. The very character of our country, as a community with shared needs and linked destinies, is shaped by acts of selfless dedication, inspired by higher ideals.
So many of our opportunities – schooling, healthcare, university – are owed to the decisions to create a welfare state that took the shame out of need, a National Health Service free to all and decent public services. We reaffirmed those principles when we put public services first in last year’s election and we won a mandate for more ambitious goals to build the best modern transport, health, education and housing our country can afford.
As we worked to put the NHS on a sustainable footing for the long term, it was not enough merely to assert that the health of each of us depends upon a contribution by all of us. The question for Britain was whether the 50-year consensus on a tax funded NHS should be renewed.
We examined other systems like private insurance where, in the case of the US, family premiums average around £100 a week and are set to rise next year on average by £13 a week, and insure only some of the people for some of their care. Under the French social insurance system, for example, the typical employer pays £60 a week per employee. In systems with charges for clinical services the patients face rising bills for treatment and the sick pay more for being sick.
When the NHS was founded there was no chemotherapy, cardiac surgery was in its infancy, intensive care barely existed and hip or knee replacements were almost unknown. Scientific advance and today’s higher standards mean some treatments can cost £100,000. The costs of treatment are higher than ever, the risks to family finances are greater than ever, and so the need for a comprehensive NHS, free at the point of need, is stronger than ever.
Far from being a hangover from a distant age, the NHS is demonstrably the modern rational choice. Not just for low-income families, but for the vast majority of families in Britain. Not just for today, but for tomorrow, too. But after decades of under-investment, we need new investment to make the NHS what it should be – the best insurance policy in the world.
The foundation for better public services is an economic stability that can sustain increases in public investment. We have taken tough decisions to deliver economic stability, with Bank of England independence and borrowing cut to bring the public finances under control. Unemployment and debt have been cut to release new resources for investment, conditions have been set to match new resources to better results, and we have developed a modern and long-term framework for better public services.
Just as we took tough decisions on the economy, we must now have the strength to take equally tough decisions on the funding of our public services and do what needs to be done for the health service. This is why we have decided that, from April next year, all employers and employees will pay an additional one percent in National Insurance Contributions.
But we must reform and modernise to ensure investment delivers results. Four clear principles have been set for this year’s spending review.
First, we are setting national standards with proper accountability – working with hospitals, schools, police forces and local government to agree tough targets, and to see performance independently monitored so people can see how their local services compare.
The second modernisation is putting the frontline first, with devolution to get money down to the local level. In the old days the man in Whitehall thought he knew best. Nowadays, central government has to learn to let go and give successful frontline professionals the freedom to deliver.
Third, we must allow the flexibility necessary to achieve results. We will remove the artificial barriers that prevent staff delivering improvements.
And the fourth modernisation is extending choice, as citizens increasingly want to be able to choose the service which best fits their requirements.
Based on this foundation of reform and modernisation, current public spending is rising from £390 billion this year to £471 billion in 2005-6. Low levels of public investment are being reversed at the same time. NHS spending will rise on average by 7.4 percent in real terms each year – an annual cash rise of ten percent for five years. UK health spending will grow from £65.4 billion this year to £105.6 billion in 2007-8. Health service investment will have doubled since 1997 in real terms.
Last year we invested £2,370 for the average household on the NHS. By 2007-8 we will be investing £4,060 per household – a 48 percent increase after inflation. This new investment will deliver 35,000 more nurses, 15,000 more doctors, 40 new hospitals and 500 primary care centres.
More than that, it will uphold and improve the NHS, not just as an institution that is part of our history and our shared values, but because, reformed and renewed, it can be the most efficient and equitable guarantee of healthcare for millions. The NHS can provide the better choices and service the British people need and become the best insurance policy in the world.
Let us be clear about the choice the country faces. It is between Labour reforming the NHS and the Tories breaking it up. Between Labour investing and modernising and the Tories cutting and privatising. We are engaged in a battle for nothing less than the future of the National Health Service. A battle to show that we can build public services for the 21st century.
So let us reaffirm that our public services represent the best ideals of Britain and let us join together in this crusade for renewing the National Health Service and our public services.