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BMJ. 2007 May 5; 334(7600): 919.
PMCID: PMC1865395

Blair trumpets Labour's investment in NHS—and stands by his reforms of the past decade

Prime Minister Tony Blair has trumpeted his government's investment in the NHS over the 10 years since he came into power and has hit out at the media for always focusing on the negative.

“The single most difficult thing is to get a sense of balance,” he told an invited audience of health service managers, doctors, nurses, and NHS leaders at a breakfast meeting on Monday at the health charity the King's Fund in London. His comments came days before he was due to announce the date of his handover to his successor, Gordon Brown, the current chancellor of the Exchequer.

The prime minister was speaking almost 10 years to the day since he won the election in 1997 and set in train a series of reforms, including the introduction of the private and independent sector as alternative healthcare providers to the NHS and giving patients a choice of provider.

“We've obviously got a great deal of work to do to take people with us on these reforms,” he said. “However, I personally think that [these reforms] will stay in place. I can't see any government turning their back on that.”

Mr Blair spoke after various speakers, including James Johnson, chairman of the BMA, gave a brief overview of the state of the NHS in the last decade. All speakers acknowledged the investment in the NHS over that period. Annual growth over the decade has averaged 6.6%, whereas for the whole of the period 1949-50 to 1999-2000 average growth was 3.4%.

“There is not a single person [who has spoken] who hasn't acknowledged the improvements,” said Mr Blair as he began his speech. He cited the “real improvement” in waiting times, which, he said, had been the main problem when Labour came into power. “When you ask patients who have used the system what their experience is, it is much more positive than the general perception.” Yet media reports failed to reflect this balance, he said.

He acknowledged that in its first couple of years of government Labour “didn't push through fast enough with the reform agenda.”

“I always thought that dealing with reform before you had investment was going to be difficult,” he said, and he criticised the previous government for its legacy of underinvestment in health care.

But he acknowledged the difficulties of keeping staff on board during the reforms.

“If you ask any major corporation while they were going through enormous change how easy it was to have people on side, they would say that's the difficult part,” he said, adding that once the reforms were fully in place people would understand them better.

Mr Blair sought to allay fears of additional NHS reforms, reiterating his belief that the current model was the best for its future development, and he stood by his decision to encourage competition within the NHS.

“When we started to introduce independent providers and choice, that was when we started to get real falls in waiting times. There needs to be a way—if a service is not good enough—for having a choice and a different system in place,” he said. “I can't see this basic framework changing.”

He raised his concerns at proposals, mooted by Gordon Brown among others, of an independent board for the NHS that might enable the NHS to distance itself from political interference.

“I would be very worried if it became a means to avoid taking decisions,” he said. “In the end, somebody has got to take the decisions.”

But despite his beliefs that the structure was right, he warned that the NHS would never be able to stand still in the rapidly changing world of healthcare provision. “The basic framework will be in place—but this is the 21st century. There is no walk in life where change is not going to happen. What we have got to get used to is a process of continual adjustment and change.”

But his government had ensured the future of the NHS, he said. “If you think about the challenges we face and where the service is heading in the next decade, at least we are having arguments about how to improve it rather than to prevent it collapsing.”

He acknowledged that some of the decisions are hard. “It's really difficult when it's happening, but you've just got to hold your nerve,” he said, likening the decisions over the NHS to the those over university funding arrangements, which had now been accepted and were, he said, benefiting universities.

Responding to questions from the audience, he admitted that it might have been better to have had fewer reorganisations in the past decade. “However, I think from where we were at the time it seemed the right thing to do. But of course in retrospect it would be better to avoid it.”


Articles from The BMJ are provided here courtesy of BMJ Publishing Group