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The attack on professionals started when Stephen Dorrell was a Minister of the Crown. The attack on Universities with Oxford College Statutes being challenged by new Quangoes demanding "teaching plans" - or the imposition of National controls on schools because of defects in London schools.

Labour simply took it as a green light for Socialism by Decree and has totally usurped the system and structures. They took control of the General Medical Council and seduced the BMA so now medics no longer trust their professional bodies to safeguard their careers or interests.

There is a general assault throughout the world on Medicine - it costs too much for ageing populations so governments aim to ration but find scapegoats for the shortcomings as they proclaim each new dawn.

"All Shall Have Prizes" was a book title which encapsulates the era of populist politics promising everyone "personalised" teaching or medical care if only the obstructive power of the professionals is broken.

Both parties played this game, now Labour has decided a doctor will be anyone The State declares to be a doctor irrespective of training or professional bodies. They have GP contracts which are transferable to private companies, and which use the word "contractor" in place of the word "doctor".

Britain is moving in the direction of Walter Ulbricht's earthly paradise and lots of people are getting out before they decide to build a Wall

I am very much looking forward to seeing the report, eve if it does come out in stages. The public servces have been ruined by ten years of Labour goverment. The natural statist instinct to build tiers of bureacracy into public service infrastructure has done great damage. Particularly in the NHS which often has several people doing the same job and doing it differently. The question of de-centralization is vital. The Labour government has introduced massive centralization because it does not trust people outside of its own political power base. The Conservative party must return power and decision making to manor, to the people, and away from the big mistakes being made by big government.

Effective mechanisms for patient and parent choice will be vital. Despite Mr Dorrell's words I do worry about being beholden to the kind of teachers who disgrace themselves every Easter at teachers' union conferences. I realise they are the militant wing of 'the profession' but also of great concern to me is the trendy teaching theories that young teachers are exposed to in order to get their PGCEs. A generation have experienced the teacher training models of Ted Wragg educationalists and it will take another generation to turn things around.

at teachers' union conferences

Those are political events for the politically motivated - the rest of them are usually too exhausted to want to spend their vacations with such loons

Jennifer, interesting point about teaching's militant trend. The educational system has been riddled with ideology since the 1960s and that is the cause for educational failings. I can clearly remember studying history and the way our classroom was adorned with posters reflecting the glorious bolshevik revolution.

I certainly remember being conscious of political imput during lessons even to the point of being told that we shouldn't believe all the nasty things we heard about the USSR in the media. I specifically remember the teacher preaching about how there was no unemployment or inflation in the Soviet Union.

Is this the same Stephen Dorrell who as Health Secretary in 1996 trusted the professionals so much that he launched the biggest, most expensive and by far the most damaging food scare in history (BSE)?

You remember - the one that was going to be "worse than AIDS", according to Dorrell's own professional advisors, with the Channel Tunnel blocked with concrete to protect the rest of Europe from the plague in Britain?

This promises to be a very interesting and important report. Professionalism should be all about serving a higher cause than oneself. Politicians should perhaps be the first to embrace that concenpt, followed by managers.

Regarding education and teaching, I think it's fair to say that the left are much more influential in key subjects such as history, english and political teaching in our schools. Taking history as an example, I was taught the Industrial Revolution, Europe in Revolution and Victorian history. Interesting as these subjects are, they were heavily slanted towards a socialist revolutionary agenda our history teachers were so fond of. In English, for example, we were taught Animal Farm, but to quote my English teacher, the book was "not anti-totaltarian, but simply concerned with the missuse of power in any context".

How about this: parents and pupils are offered two options, one is the current curriculum, and the other is (for example) includes things like (say) British history from 1630-62, or the Georgian times, or post war Britain, the rise and fall of the empire - and these subjects are classically taught. Children being taught this would, I feel, have a better sense of who they are and why they are.

Surely the antipathy or even hostility towards our heritage many teachers exhibit is also a factor in social breakdown? The family is much more important, but education is also up there I think.

This could be one of the most important reviews regarding public services. The existing arrangements stopped working properly some time ago but have been going downhill for a long time. Britain's public services are going nowhere until this matter is sorted.

The problem is obvious. Voters hold politicians to account but the organisation and expertise is run by unelected public servants. In an attempt to assuage voters politicians have brought more control to themselves, unless the cycle is broken it can only get worse.

Tom Tom is right to point out that we are heading to be like East Germany. I am reading "The Berlin Wall" at the moment and the similarities with how Labour run us are frightening. (Including economic statistics!) But I suggest he falls into the easy way out trap of blaming Conservative and Labour parties. Many experts confronted with critisising Labour keep their government funded brownie points by claiming Conservative policies are the same. It's a cheap get out like saying Man U and Accrington Stanley do the same. We have, in today's Sunday Telegraph, an "expert" missrepresenting Conservative education policy to avoid being seen as too anti-Labour. In this debate we need to watch this carefully.

Big point coming out of Dorrells report so far is that individual professionals accept their responsibilities. That's the big idea.

There is no doubt that Britain is fast becoming 'Statist'. We are being monitored and indexed. For the first time in my life I feel oppressed by a British government. Freedom is slipping away by degrees. Each new piece of legislation seems to empower the state and makes us smaller.

This worries me: it hints at 'producer capture' where teachers/doctors/civil-servants tell us what's needed, and expect us to like-it-or-lump-it and fund it whether it actually fits our needs or not.

That's all rather redolent of the 1970s isn't it? If Conservatism means anything at all we should seek to empower the consumer, not the provider. The customer is always right.


David Belchamber "Professionalism should be all about serving a higher cause than oneself."

Tanuki "If Conservatism means anything at all we should seek to empower the consumer, not the provider. The customer is always right."

What we need to do is to both encourage professionalism and empowering the consumer. I hope Dorrel's report to this end include's a hefty dose of performance related pay, with the consumer deciding through feedback whether the performance has been met(not some Whitehall Mandarin). That way you reward those that are actually achieving useful results as the public see it. It should encourage not just a professional attitude but an innovative and goal oriented focus that will make those who love what they are doing and feel pride in their public service the ones who are actually paid most.

Performance Related Pay ? GPs went onto that with their new contract, met the targets, and then had the DoH and media attack them for fictive earnings - simply because they performed as per contract.

Quality Outcomes





Practices as independent providers of NHS services

As private businesses, practices are able to choose whether or not to accept work over and above the delivery of essential services. Practices get paid for the services that they provide and their withdrawal from any services will have financial implications. For example, if a practice chooses not to participate in a particular enhanced service it will not be paid for that enhanced service.

Statistics from the Health and Social Care Information Centre show that on average each practice has achieved 91% of the points available, with high levels of achievement against all indicators.

This is equivalent to 959 out of a possible 1,050 points, under the Quality and Outcomes Framework.

Described as "the world's most comprehensive database on the prevalence and management of common chronic diseases", the data assesses how well doctors are rated on criteria including appointment times and chronic disease care - areas which determine their level of payment.

Under the GP contract, which was signed by 99.9% of general practices, practices are rewarded for the quality of care they give and not just the number of patients they treat.

The surgeries' performance was assessed from April last year across some 153 separate targets including access, patient experience, clinical areas, and organisation. The clinical areas covered include coronary heart disease, stroke, blood pressure, diabetes, cancer and asthma.

Each point achieved attracts a payment to the practice. This varies according to disease prevalence and patient numbers, but for the average-sized practice was worth £77.50 in 2004-05 and increased to £124.60 in 2005-06.

The figures are believed to have exceeded the government's expectations, on the basis of which they budgeted for an average of 730 points, according to the NHS Alliance.

But because practices have delivered such high quality, initial estimates are that costs will be around £200m higher than originally planned



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