http://www.guardian.co.uk/comment/story/0,,1350314,00.html

We can be consumers and citizens
Reject the dogma that public is always good, private equals bad

John Reid -UK Health Secretary
Saturday November 13, 2004
The Guardian

Mothers struggling to cope with the pressures of family life have been the
inspiration for our new policies on public health, but they are also
underpinned by a left-of-centre political theory that can be summed up in
the phrase: moving from advice from on high to support from next door. The
task of progressive government can be simply expressed - to provide
security and expand opportunity for people in a changing world. Providing
security means understanding the future, predicting the challenges and
developing new tools to address new threats - from international action on
people trafficking or terrorism to neighbourhood action to tackle
anti-social behaviour.

How we create opportunity must change, too. Instead of a state that sees
people as passive and uniform, our aim is to expand and support individual
choice, to balance rights with responsibilities, to design policies and
services that meet individual needs and that are shaped and enhanced by the
people themselves, as individuals, in families and in communities.

People change their own lives. People like Amanda Acker, a Cambridgeshire
catering assistant who lost five stone after her GP advised her to join
Weightwatchers. She made the change herself, supported by the local NHS.

Of course, not all individuals can take their own opportunities with equal
ease. Some live in more constrained circumstances than others do. So people
should not be left to sink or swim. Wherever possible government should
support hardworking families, because people's own ambitions are the engine
of national improvement. Ultimately it is through their own effort that the
disadvantaged overcome their disadvantage. Government intervention should
supplement, not replace, this individual effort.

Government must gather and distribute the resources that translate choice
and opportunity into a reality for the many. It is only through the
collective resources provided to the NHS, for instance, that a greater
degree of information, power and choice - hitherto a monopoly of the few -
can become a reality for the many.

In a civilised society, individual rights have to be balanced by individual
responsibilities to others. The vehicle for arbitration and enforcement of
those responsibilities is the democratically elected government.
Anti-Social Behaviour Orders for instance. Or protection from second-hand
smoke. Though prohibitive for the few, the aim of these is a pleasant
community or smoke-free environment for the many.

The state has a particular role to play in the protection of the most
vulnerable. Opportunity based on informed choice generally assumes maturity
and fit ness. In a civilised society we have a greater obligation to
protect the weak, the vulnerable and the young. This duty of protection is
often shared. In the protection of children, for example, parents can look
to governments for support, but the prime responsibility rests with them as
parents.

And finally, just as we have always recognised the limitations of the
market in the equitable distribution of goods and services, we also
recognise the limitations of the centralised, bureaucratic state. The
expectations and ambitions of 60 million different people demand a far
higher level of personal attention, convenience, control and power than
that offered by the uniform "one size fits all" service of yesteryear.

So, in terms of health improvement, we reject not only the crude
characterisation of state intervention as "Nannyism", but also the idea
that people's health can be determined solely by government edict or
legislation.

We reject the dogmatic assertion that public always equals good and private
always equals bad. It posits the same old false dichotomies. It separates
the individual from the collective in a way that can only help our ene
mies. So to the traditional ethos of public service we need to add another
element of customer care - organising public services around the
convenience of the public - if we are truly to meet modern expectations.

We need to recognise the harmony as well as the difference between
consumerism and citizenship. To force the left to choose between
consumerism and citizenship cuts progressives off from one of most people's
main contemporary experiences.

Thus, New Labour's political stance is clear. We support people who better
themselves. We insist that people's rights and opportunities must be
balanced by responsibility to others. We stand for protection for the most
vulnerable, especially children. And we see a role for government in all
three, a role that does not contradict but sustains opportunity.

The creation of New Labour was not an event, but the start of a process.
And since that process began, more than 15 years ago, the world has already
changed in so many ways. So, none of us should think that just because we
bought a ticket for the game 10 years ago that it will give us entry
tomorrow. The price of power is permanent renewal.

· John Reid is health secretary

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