- The Observer,
- Sunday May 4 2003
Remember the claims that the national minimum wage would cost a million jobs. We took on the argument and won it. The minimum wage is now part of our national fabric. The controversy is over. The change endures.
Remember the fierce opposition to the literacy hour in primary schools. The controversy was real. It has gone but the change endures. So does the improvement in reading and writing.
The PFI initiative remains a source of real controversy. But as the public benefits from the largest hospital building programme in the history of the NHS, what will people remember - the arcane debate over funding or the new hospitals? It's just one of the ways our health service has improved over the last six years. Every indicator is going in the right direction as a result of the investment and reform we are putting in place.
The New Deal was fiercely opposed on the Right, welfare reform on the Left. The changes have endured and Britain is closer to full employment than for many decades.
On Wednesday, the Commons will debate the Health and Social Care Bill. It's a vital part of our reform programme for our public services and another important step in safeguarding, strengthening and improving our National Health Service.
'Schools and hospitals first' was the slogan on which we fought the last campaign. The success we achieve in making this promise real will decide whether we deserve a third term. But this is about more than electoral politics. It's about whether we are to achieve Labour's goals of a fairer country where everyone shares in increased opportunity and prosperity.
Good state schools and the NHS embody our party's enduring values. It's why we are putting record, sustained investment into health and education to correct the chronic underfunding of the last decades. But part of the bargain with the public who are providing this money is that we make sure it delivers the improved services they want to see. And that means reform is every bit as important as extra money.
The latest political controversy and argument we have to win concerns NHS foundation hospitals. They are an important part of the legislation being debated on Wednesday which also strengthens primary care and dental services and establishes new inspectorates to guarantee high standards in hospitals and care homes.
I believe that when these foundation hospitals are up and running, people will look back again and wonder what the controversy was about. Centre-Left colleagues in Germany and Holland, where they have long had not-for-profit hospital foundations, are astonished to learn that central government here tries to control hospitals so closely from our Health Ministry.
Indeed, I am sure Nye Bevan himself, who memorably said he wanted the sound of a dropped bedpan to echo through his department, would be amazed to learn his words are still taken literally in a much expanded and more complex health service and in a world radically different to the one in which his brilliant creation was born.
One of the strangest aspects of this argument is that the Government is being attacked for putting front-line health staff and local communities in the driving seat in the NHS. On most issues and for most governments, this would be a pretty odd line of attack. But when the criticism comes from many who, for the last six years, have accused this government of control-freakery or worse, then it is stranger still.
Devolution of power has long been identified as one of the key principles of our public-service reform agenda. But we have to do more than talk about it. We have to do it.
Whitehall doesn't always know best. Different areas do have different health needs. Doctors and other front-line NHS staff, together with representatives of the communities they serve, should have the freedom to be responsive and to innovate to meet these needs. This is the purpose of foundation hospitals.
Such hospitals will remain an integral part of the NHS but will be run by and for the local community. The care they offer, as now, will be based on need, not ability to pay. They can't make profits or charge for services. They will be subject to NHS inspections and standards as well as being able to use the new Agenda for Change pay agreement we negotiated with the health trade unions.
Far from being a betrayal of Labour values, they are based on the Labour principles of community, of involvement and democracy. The real betrayal would be to recognise - as we do - that we need to improve our public services but refuse to make the necessary changes to bring about that improvement.
Our hope and intention is that all hospitals will become NHS foundation trusts within a short period of time. Alan Milburn will announce this week that, by the autumn, every NHS hospital will have a target date for being able to become an NHS foundation trust within four or five years - and that the extra help and financial support will be provided to raise standards everywhere.
Some of our best performing hospitals and those keenest on becoming foundation trusts are in some of the most deprived areas of our country - in Hackney, Liverpool, Doncaster, Bradford and Sunderland, for instance.
I've met some of the people who want to be in the first wave. They are absolutely committed to the NHS and excited and invigorated that they will now have the freedom to pioneer change they believe will improve the care they deliver. This is not a reform being foisted on a reluctant and resistant NHS. This reform is one being demanded by front-line staff who believe, rightly, that they - not me, not Alan Milburn, not the Department of Health - are best able to meet the health needs of local people.
The driving force for these reforms is to improve patient care. Sometimes, that argument has got lost in all the controversy but it is worth remembering. As renowned cancer professor David Kerr said in a letter to me last week: 'Foundation status will make it much more likely that clinicians will become engaged in service improvement; that local solutions will be found to overcome barriers that stand in the way of optimal care; that patients and their carers can have a voice that helps shape their service.'
So it's not clear to me why some people suggest that NHS foundation hospitals will create a two-tier health system. Unless, of course, it is the discredited idea that we can't allow any hospital to have greater freedoms or improve unless all hospitals do so exactly at the same time. I can't agree with that and neither, I believe, does the public.
When the welfare state was created - a time, we should remember, of food rationing - universal and collective provision was rightly the major driving force. But people now expect more from every aspect of their life - higher quality, greater convenience, more choice. If we fail to meet these needs, then we not only fail the public but also seriously damage the whole concept of collective provision.
There is a lesson we should learn from our history of misjudging the mood of our supporters. It was originally a Labour idea that council-house tenants should be offered the chance to own their own properties. But Labour decided it was too radical and opted for the quiet life and backed off. We allowed the Conservatives to adopt the idea as their own and ludicrously present themselves as being on the side of ordinary, hard-working families.
This one policy came to symbolise how we had lost touch with the aspirations of working families. It was an error of historic proportions. If we turn our back on public-service reform now, we will be making another one. I am determined not to let that happen.
· Talking point Will the NHS revolution work? Email debate@observer.co.uk Plus more in our online special. www.observer.co.uk/nhs.
