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Thursday, 31 January, 2002, 09:03 GMT
What can be done to improve public services?
UK Prime Minister Tony Blair has given a keynote speech defending public service workers, amid a bitter running row over the state of the NHS.
Speaking in Newcastle, Mr Blair accused his opponents in the Conservative Party of trying to denigrate everything about public services.
The prime minister used the speech to champion the right of public sector workers to be defended from attacks they regard as unjustified as the hospitals row continues to rumble on.
But the Tories are keeping up the pressure over the treatment of Rose Addis, 94, whose family say she was left abandoned and blood-caked for 48 hours at the casualty department of the Whittington hospital.
The case has become a focal point for a row over the state of the health services in Britain and has opened a wider debate about public services in the UK as a whole.
What did you think of Tony Blair's speech? What can be done to improve the state of public services in Britain? Are senior politicians wrong to debate public service issues in this way?
This debate is now closed. Read your comments below.
Simon Moore, UK
History shows that throwing money at Public Services is not the answer.
What is required is a radical rethink of how our public services are structured. Funding levels and methods should be a consequence of these new structures.
Throwing money at bureaucracies just creates bureaucrats.
We have no one to blame but ourselves for the state of our public services. We have repeatedly voted in parties who promise lower taxes, or at least not to raise them. You get what you pay for. What part of that does the British electorate not understand?
Graham , London
This case is a microcosm of what is wrong with British politics. Neither Blair nor Duncan-Smith have any real interest in the NHS, Rose Addis, truth or doing the right thing. Their shared interest is simply to out-score the other at the dispatch box and hopefully cause the other party some embarrassment. Neither are fit to be anywhere near the reigns of power, let alone holding them.
The point about the current debate is not the facts of the individual cases quoted, but as the ever perceptive Andrew Marr put it, that we all know of someone who has been in hospital who has not received the sort of care that they should have done. Of course staff have low morale. If the government were to reward nurses at the same level as police officers then nurse recruitment would very quickly cease to be a problem. Politics is all about resources and priorities - what rattles Blair is that people have understood his real (as opposed to stated) priorities very clearly indeed.
A few years ago my late wife died of cancer. Apart from paying to get quick appointments with consultants, we used the Health Service over a 4 year period. It served us well, although there were times when we felt the service for various reasons could have been better.
It is unfortunate that we seem incapable of engaging in constructive debate that helps the service improve. My belief is that this could be done if we, the consumers, made a more direct contribution for what we get from it. Keep a National Safety net certainly but let those who can, contribute more for themselves. The health service should be accountable to those who use it and ultimately pay for it. Government should serve the people; not dictate to them.
I am also fed up with the doctors and nurses getting the blame. My wife has been a dedicated nurse for the last 42 years and my niece and her husband are both excellent doctors. It is not the fault of doctors and nurses that the NHS is in a mess. It is a combination of poor management from people in suits rather than care professionals and total lack of support from the Government except when it suits them.
The sooner this and future governments realise this the better the NHS will be. At the present rate it will collapse irrevocably in the not too distant future.
Since devolution, Scotland has spent the European GDP average on its health service, yet the NHS in Scotland remains way behind that of France and Germany. Perhaps if we went back to the drawing board and remembered what the core functions of the NHS were (health and its treatment) and stripped out those expensive indirect costs of excessive management (including the statistical collection data that takes up so much of the paper filling in time) and accountancy we might just make some headway.
The people that work in the NHS do a fantastic job even though they are underpaid, understaffed and do not have the resources of most of our European neighbours. Like most public services, the NHS needs more funding which means a tax increase. Most British people do not want to pay more tax and yet still complain when there is not enough money to sort these services out. Gross mismanagement from this government and others previously has not helped the situation either. Anyone suggest a better way of funding public services?
Chris B, England
Perhaps it's time we considered a pan-EU health service. Firstly pooling resources with the rest of Europe would allow our health service to improve more rapidly than any injection of cash and the bigger the health service the more it can create centres of specialised excellence. From the North of England I can get to, say, Amsterdam as easily and cheaply as to Harley street. Of course the implication is that our health staff would have to enjoy the same kind of status and pay as their continental counterparts. High time.
As a nurse, I feel a great deal of sympathy for the patients and relatives at the middle of this political storm. The pressures on all aspects of the NHS seem to be increasing. It seems that there is two main pressures on NHS beds at this time. 1. Emergency admissions via A&E and 2. Waiting list admissions. Try to make one situation better and it will make the other situation worse, a bit like a see-saw. There are only so many beds in any hospital at any one time, people can only move from A&E if there is a bed available. However, I feel that the Tories are doing nothing but pull a publicity stunt instead they should be working in conjunction with the Government on this issue.
The Tories added in too many layers of management in the NHS and it's about time that Labour lived up to their promises and gave us a chance. Stop wasting money at management level and start paying nurses and doctors what they are worth. Once Labour have done that more young people will be interested in going into the medical profession and the NHS will start improving.
Ian Duncan Smith is doing his job as the leader of the Opposition for raising the state of the NHS with Tony Blair, but in truth the previous Tory Governments and the present Blair Government have a lot to answer for in the way they have funded and managed the NHS, in particular the very low wages paid to NHS workers who work long hours and extremely hard. I have had treatment from both the NHS and the private sector. The British people must be realistic, you get what you pay for. The NHS can not exist like this anymore I believe Tax or National insurance contributions will have to be significantly raised to get the extra funding required for the NHS meet the ever increasing demands of the British nation, if people do not go for that option then the Government should make people who work take private health insurance as they do in Europe.
I lived with the NHS for forty years before having to leave the UK. It isn't perfect, but it might be better if successive governments would stop tinkering with it in an effort to hand it over to their private sector cronies. Consistent under-funding of the NHS, combined with public undermining of it, are the root causes of the trouble. The same thing applies to most of the other public sectors.
Prior to the Thatcherite government coming into power, the British people owned the following services: the railroads, the water system, the electricity system, the telephone system and the postal service. NOW all of these have been tossed back into the private sector which has asset stripped then whined about the cost of keeping them going. Most of this action has been prompted by some kind of hero worship by British politicians of the American system. Since poverty is rampant in America, more than a third of its population can't afford medical treatment while the other two thirds works just to pay their doctor's bills, how stupid has the British political philosophy been?
We need to stop taking this "management consultancy" approach to problems. Every time a problem crops up, Tony and co. commission a report to tell us what we already knew, and make speeches to cover their tracks. Meanwhile anyone who dares to criticise the Government is told to blame it on the Conservatives or accused of directly blaming the doctors! Yes, perhaps the Conservatives did treat the NHS badly, but Blair can't blame his own failures on them all the time.
I have worked as a doctor in the UK for a few years now, in NHS hospitals, and I have been constantly disgusted at the level of care that we can provide due to shortages of money and resources.
I am totally in favour of charges being introduced, starting from charges to see GPs on an appointment basis, this will dramatically cut down the number of people visiting their GP, which ultimately results in a congested health care system that is creaking under the weight of too many patients with unrealistic expectations.
Tim B, UK
As a Brit who moved to the USA 17 years ago, I was at first hesitant about the US health system. No longer. Its infinitely better, competition provokes improvement
Maybe its time to start scrapping the NHS, the Nat insurance contributions etc by selling off the hospitals and giving the proceeds back to the British people
John Nolan, UK
The two major factors that are going to improve the public service are money and management. It is time that the Government tackled a few of the "holy cows" that are holding back the transformation of the public services. I am sure the public servants will rise to the occasion once the Government makes the tough decisions it knows it has to make.
It's about time we had a realistic debate on the wholesale privatisation of public services. If the health service, police force and schools were put into the capable hands of business we wouldn't have to listen to an endless political argument between labour and the Tories. The truth is both want total privatisation and both pretend otherwise to attract voters. The truth is that nurses and policeman are overpaid, not underpaid. Business would sort these whingers out and pay them what they're worth.
As Chairman of Torbay and District Community Health Council, I would like to raise the issue of CHC abolition contained within the NHS Reform Bill, which is having its second reading in the House of Lords at the end of this month.
Surely the current political debate around the care of an elderly patient within an Accident and Emergency Department further reinforces the need to retain independent non-political Community Health Councils which are statutory bodies with a duty to represent patient and carers interests within the NHS.
This whole episode shows why people
have absolutely no respect for
politicians anymore. All they care
about is points scoring. IDS and Blair
are like a pair of squabbling children.
The sooner there is a "none of the
above" option on the ballot paper the
better, as none of them deserve my vote.
John Brownlee, England
Spend some money for God's sake. This is why public services in this country have all but disintegrated over the last few decades. The rot began with that embodiment of greed and selfishness - Maggie - and has continued unabated ever since.
All public services are best run by the local council. They are always in a much better position to understand local needs, and the local community can see directly where their taxes are going. Local firms and charities are usually very good at raising money for new equipment and wards at local hospitals. Get as much power away from Westminster as is possible.
Erling Nylund, Norway
Whatever the merits of the argument the Government's use of confidential patient information is unforgivable. It clearly indicates that Blair will do and say anything to defend his power. What a cheap man.
I have worked full-time for the NHS for 24 years. It is failing due to under-investment, low morale, lack of respect for staff and finally a lack of staff. The Tories caused all that in their 18 year rule. It takes 10 years post-A level to train a GP, how on earth can Labour be expected to put it right in 4-5 years?? Realism and a willingness to pay more tax are two missing features of most British voters. You have the NHS you deserve at present .....
A. Marco, UK
I was in hospital for a week in September and found that the nursing varied between excellent and appalling.
However, the principal fault was with the total lack of integration between departments and the lack of 24-hour cover by the diagnostic services such as haematology, x-ray and pathological laboratories.
If the management and organisation had been better I would have been out in half the time. Multiply that up by the number of patients being treated and the so-called bed shortage would vanish.
Tony has done what he is best at. Given yet another speech. The problem is I am fed up with talk; I would like to see some action now. Granted the Tories made a hash of things but the country has overwhelmingly given New Labour the chance to make things better. From where I sit almost 5 years down the line, things ain't no better. Stop talking a good job Tony and start doing one.
John B, UK
I believe it was a good speech and it will improve the level of NHS services in Britain. Now all we need is to see this happen.
As long as the Tories keep drawing attention to the public services that they were responsible for running into the ground through a sustained lack of funding they're never going to get any votes. They tried to highlight the poor public services in their election campaign and in doing so put everyone off voting them back in power to continue the wholesale privatisation of Britain. I think in this particular case the hospital would have been criticised no matter what course it took: either leave Rose Addis in her clothing and be accused of neglect or forcibly wash and change her and be accused of treating an old lady with no respect or care.
People in Britain should learn to appreciate what they have. They shouldn't take things for granted. It is so sad to see that people in Britain don't even try to have a look around the world and see that some people hardly get even a pain killer when they're dying of terrible pains, simply because they can't afford to buy one and their government can't afford to provide free services like here in the UK. Yet these people still pay their taxes and don't expect anything from the government and don't complain either. I suppose if health care was on sale in this country like in most countries in the world, maybe people would have shut their mouths and appreciated the care they get after working so hard to pay for their own health. So, please leave Mr Blair alone for goodness sake. He's one of the best prime ministers I have seen and he deserves a break.
RJ Peasley, UK
Does it matter whether they are being used as political pawns? The electorate love Blair no matter how poor he and his party are at running the country. He can let the NHS go to pot and he'll still get voted back in. Maybe more money needs to be spent on insane asylums for these wretched Labour voters.
Rob Murphy, Madrid, Spain
The real problem for Tony Blair is that he is already pouring billions more in taxpayers' money into the health service but is still failing to deliver. Throwing more money at problems is always the wrong answer. It has to be targeted investment by people who really understand the problems, not politicians trying to buy favourable headlines with the public's purse.
Teachers, nurses, doctors, police and social workers are expected to nursemaid society's failures and deadbeats. Parents abandon their kids and their old folk and instead of kicking their behinds we give them free publicity and compensation. The generations who were taught honesty, self-reliance and hard work are reaching retirement age. When that happens the UK, not just the NHS will go into meltdown. Start reversing the ubiquitous nanny-state mentality now or join the third world tomorrow (or sooner).
One more attack on health professionals. One more stab in the back. Further reduction of morale and further difficulty in recruiting staff. Wake up guys. Why are we shooting ourselves in the head?
It's interesting that since this story became public several other families have come forward to give similar accounts of how their relatives were treated at the same hospital. Iain Duncan Smith has done a good thing in bringing attention to an area that clearly needs it.
Bilal Patel, London, UK
I don't think that Blair should have refuted the allegations but instead asked that the matter be thoroughly investigated.
If the allegations are true then the hospital concerned needs to resolve whatever systemic deficiency led to the patient being treated this way.
The whole matter drips with political cynicism. Mr Duncan Smith no more cares about Mrs Addis than Jerry Springer cares about the "guests" on his show. The whole thing is exploitative and nasty.
I'm amazed at the number of people accusing Blair of hypocrisy in this matter. Once Rose Addis's family and Iain Duncan-Smith decided to make a media circus out of the event, rather than make an official complaint like most normal people, they gave up her confidentiality. I think medical staff have a right to defend their reputation when allegations are made against them. Remember who made the case public initially - it wasn't the hospital.
Perhaps Iain Duncan Smith might like to consider doing some research before opening his mouth in future. As of yet very little worthy of respect, let alone votes, has ever come out. Just when you think the Tories can't sink any lower, they manage to amaze, disgust and disappoint us.
My mother died recently at the age of 90. If she had done what she was told in hospital it would possibly have prolonged her life. I cannot complain for a second about the treatment she received for various conditions over the past five years under the NHS, quite the opposite. Considering her age she was rushed into hospital for everything she needed from observation to minor and major operations. The staff couldn't have been better. I will admit that to us here in Germany, English hospitals look a bit overcrowded and old fashioned but the care and treatment is marvellous. Over here we pay a fortune for our health care, it is a bottomless pit and I would not recommend this way of covering medical care to anyone. In the UK there is room for improvement but this must be balanced with a sensible budget.
Rose Addis's daughter arrived at her mother's bedside two days after she had suffered a head injury and wanted to blame someone else to cover her neglect. That is where it should have ended but a green and rash leader of the opposition went in with both feet and now he will learn the hard way that unverified fairy stories are no substitute for open debate.
Anders, London, UK
Only the Liberal Democrats have the courage to increase taxes to raise the billions that need to be invested in health, education and transport. Only they can make a difference. Labour will continue to shy away from taxation and real investment and the Conservatives will only cut taxes and privatise anything they can. We need public money for public necessities.
Time is running out fast for this government to sort out the mess in all the public sector services. They are living on borrowed time now. Blaming the Conservatives for what this government inherited has quite frankly worn extremely thin and can no longer be used as an excuse. The NHS is in freefall at present and it seems that no amount of money being poured into it will save it in its present state.
Iain Duncan Smith would do well to spend a week working in a busy A&E unit or a trauma ward before he opens his mouth about the health service again.
When are people going to wake up to the fact that the NHS is a bottomless pit and unless we actually do away with everything other than the A&E it will continue to be a substandard drain on the country as a whole.
It is unwise of the family of Rose Addis and the leader of the Conservatives to make public allegations which ignore the facts. While one can understand the anguish of the family even if it was the choice of the lady concerned to refuse personal care it is extremely worrying that a potential prime minister is so trigger-happy.
I have been an outpatient at the Whittington Hospital for many years.
During that time the staff have had many difficult times dealing with cutback after cutback, but throughout that time I have always been treated with courtesy and respect and have absolutely no complaints about the staff or the treatment from the Whittington. Well done and thanks to all the staff there from me.
If the Conservatives are going to launch an attack based on unverified rumours then what choice does the government have but to respond with the facts? I cannot believe the hypocrisy, if the facts had been checked in the first place then none of this would have happened. What were they supposed to do if not report the facts of the case?
It's difficult to know what the truth is in this case, but surely if the old woman's family were so concerned, couldn't they have changed her clothes themselves? Or complained to the hospital staff and got the explanation first hand? I wouldn't have let a relative of mine suffer for days without doing something much sooner.
Jon M, UK
I find it rather pathetic that it takes the alleged ill-treatment of a relative of a Conservative constituent MP before Ian Duncan-Smith bothers himself to criticise the Labour government and the claimed inadequacies of the NHS. I wonder if this big debate would have arisen had the patient in question been an ordinary member of the public?
Usually when someone is admitted to hospital, relatives fill in the gaps where things like overnight bags and clothes are concerned, so if a patient isn't visited by family members for two days, chances are the NHS isn't going to go out and buy you clothes. It's great to harp on about how bad the NHS is, but running to the press to exacerbate an already obvious problem is not the answer. In dragging one person's plight into the limelight, the family of Rose Addis have stripped another layer of confidence away from our hard working doctors and nurses.
Let's face it, the Tories are no friends of the NHS. Think back to how things were when they were in charge.
Do they realise that to strip and change her against her will is assault? If she had said a definite no to being changed out of her clothes, they wouldn't have forced her. Even if you are patently dying, and an ambulance has been called, if you refuse treatment and are conscious and in your right mind, paramedics can't force you to have it or go to hospital. And elderly people can be terribly difficult. It sounds like this family are on the way to claiming compensation and have stirred the publicity up for that end.
If Ian Duncan-Smith had deeper experience, he'd check his facts before opening his mouth. Innocent misunderstandings won't snowball if you get both sides of the story first.
Surely by disclosing the patient's details to the press without the her consent is a breach of the data protection act?
According to news reports, Rose Addis's family went to the Evening Standard first, so it seems as though the story was already made public. The accounts of your healthcare system go from one end of the spectrum to the other so it's hard to have an informed opinion on this subject. I do feel sorry for Rose Addis though.
Jon Cooper, UK
When a patient died at the Portman Hospital the Tories were conspicuously silent - but of course that was a private hospital. It seems IDS wants to make Tory health policy for the entire country on the basis of one individual's highly suspect complaint, regardless of the facts. Presumably that's how rail privatisation happened, some bloke on a late train muttered "they ought to privatise the damn thing" - so John Major did it!
You should treat others as you wish to be treated yourself. Nurses know if they left a 94-year-old lady in her dirty clothes for two days. We hear about the NHS needing more money, but dignity and respect cost nothing. The elderly check out of NHS hospitals every day and lie about someone being at home. They would rather stay at home alone as they believe they would die in hospital from the care (or lack of it) they receive. We will all be old one day - would you like to be left in dirty clothes for two days without a wash?
It's been said about the trains, and the same goes for the NHS. Blame the tories.19 years of no investment in any public services. We have to look at ourselves here. We want good public services but we don't want higher taxes.
I think it interesting that Rose Addis daughter took 2 days to visit her mother! There may be a good reason for the delay or it may just be that she had better things to do herself. Many old people in Britain are left to fend for themselves on their own with little contact from close family and often the only care and attention they do get is from the doctors, nurses and other care staff in hospitals!
Rick, Oxford, Britain
I had an experience at the casualty department at Monklands General Hospital in 1993 when I lost much of a finger in an accident at school.
I was seen quickly and efficiently and was kept in overnight because my blood level was so low and was only allowed to drive home when they had set up liaison with my local hospital in Paisley. Subsequent outpatient treatment in Paisley was always expeditious and on time.
As with this exchange in the Commons, it seems the detailed medical history of patients were given out by a government spokesperson as part of the rebuttal of the criticisms levied. Can we take it that Blair will now be giving out details of whether or not his baby son has had the MMR vaccination? Considering he has consistently refused to give out those personal details, why is it the case that when it's not his own family it's apparently fine to give out patient details to the Commons? Methinks a whiff of hypocrisy is in the air around Blair on this one.
My father recently passed away in the Whittington Hospital. I would like to applaud all of the staff there for their compassion, understanding and professionalism in the way they tended to a dying man and his distraught family. They kept us informed, and most importantly kept my dad comfortable, even giving us a room in his final hours, allowing us that extra privacy and quiet time. I have nothing but admiration for them, and the way they work in sometimes difficult circumstances. I am upset that the reputation of this hospital and its staff is tarnished. From first hand experience, they were excellent and gave my father the dignity he deserved. My story is a personal one, and hence I cannot comment on the experiences of others recently. But it is important that people know about all of the good work undertaken in the Whittington, and not get carried away by the political posturing currently taking place in the Commons.
I'll bet there would have been an even bigger outcry if the staff had forcibly washed and dressed Mrs Addis. This would surely have been a breach of her dignity and human rights. When some elderly people dig their heals in, nobody and nothing will budge them.
J Butler, UK
I think that the nurses, doctors and NHS professionals do an excellent job. The problems lie not so much with a total lack of funding but with where the money is being channelled. Do away with both the overpaid directors and managers as there is no justification for their existence and also the red tape and pay our nurses and doctors more money and attract more of them into the trade. Also it would help not to keep worrying about profits and what is cost effective. This is peoples' lives and health not commercial business. Also the other key must be to keep the NHS in the public sector. So please Mr Blair, keep the profit-only private sector away as this could affect the good work that is being done.
My son-in-law suffered an aneurysm and was kept alive by the prompt action of a surgeon. His treatment by several hospitals then onwards made one wonder if saving his life was worthwhile. We felt he was left alone far too long, dressings weren't changed and wounds from operations were festering, and the wards were filthy and stinking. But for the valiant efforts of my daughter, who made sure she was heard, and in fact made a total nuisance of herself, he would have died.
We thought no one in those hospitals honestly cared if he lived or died until he was finally moved to a nursing home nearer to where they lived. My daughter was with him every day and most nights during his recuperation and has finally got him home. During all this time (many years) she received no financial help from anywhere and relied on her family to support her. He will never be 100 percent but we love him and make sure he gets everything he needs.
The government says it is piling money into the NHS but one wonders where it is going. I don't think it is reaching the patients. By this I mean good nursing. I still have a rosy memory of nurses and hospital staff when if you were unfortunate to end up in hospital it felt like a five star hotel, and there was a sister on hand to make sure everything went to plan. As for hospital cleaning, it seems to be the poor relation as far as funding goes.
I'm sure all the NHS staff do the best they can, given the circumstances and facilities they have to cope with. I'm rather surprised that Mr Blair would allow the release of private details of a minors' medical treatment and history, whilst refusing to reveal whether his own child had the recommended MMR vaccine. Some people are obviously entitled to more privacy than others, don't you think?
This is an utter disgrace to the nation's health services. This proves the poor standards we have in our great nation of Britain. What can I say? How can one be proud to say they're British when such outrages acts are being committed within our much adored health services
At no time did the hospital inform any family member where our 88-year-old father was. But the actual treatment was done well even if the circumstances were not good. At that same hospital, emergency department waiting times are horrendous and patients have to wait anything up to 48 hours for a bed if needed, all the while waiting on a gurney. There are obviously organisational issues which need to be addressed, but overall we don't have it any better here in the USA and are bled to death financially by our greedy medical insurance people.
Alex Williams, Wales
Duncan Smith appears to be carrying on the Conservative tradition of tabloid politics. I think it highly irresponsible that he should use a newspaper story and a non-investigated complaint from his constituent in order to gain political capital from it. The hospital disputes the criticism therefore an investigation should be carried out. If the result of this shows negligence then Mr Duncan Smith might be entitled voice his concerns. Until then there are plenty of other areas where anyone might protest at Blair's lack of reform of the NHS, which is one of the country's greatest worries after education I believe.
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