Intended for healthcare professionals

Book Book

The Government's Annual Report 98/99

BMJ 1999; 319 doi: (Published 27 November 1999) Cite this as: BMJ 1999;319:1442

This article has a correction. Please see:

  1. Rudolf Klein, emeritus professor of social policy and senior associate
  1. King's Fund, London

    The prime minister

    Stationery Office Books, £2.99, pp 88

    ISBN 0 10 144012 X

    Rating: Embedded Image

    One of the occupational diseases of all parliamentary ministers, whatever their party, is a chronic sense of being misunderstood and unappreciated. If only they could speak directly to the public, if only they could break through the distorting screen of the media, then their real achievements would be understood and applauded. With their policies and actions constantly being misinterpreted, as they see it, they search out every opportunity to put the record straight From this flows the concern with managing and massaging the media From this springs the eagerness of ministers to rush to the radio and television studios, whatever the hour. From this, too, comes one of the innovations of the Blair era: the government's annual report to the people. The aim of this, as the prime minister explains in his introduction to the 1998-99 edition, is to bring together “in one document a progress report on how we are doing in meeting our manifesto commitments, the values that guide us, and the targets we are trying to achieve.”

    Labour's 1997 manifesto, the report notes, contained 177 commitments for the five years of the parliament. As of 1 July, 90 of these had been “done, met or kept” (the precise significance of these semantic distinctions is not clear) and another 85 were “on course or underway.” Only two remained to be timetabled for action. “Our influence in the world is growing,” Blair rhapsodically concludes. “Our public services are steadily improving…. The economy has avoided lurching from boom to bust…Most importantly we are beginning to look like one nation again—a society coming together not torn apart…. There is a way to go, but we are on the right track.”

    The Labour government clearly has a formidable record in terms of the sheer volume of legislation passed and the number of new policies introduced. It has put more money into key services like education and health, though the scale of the increase is less than its public presentation would have us believe. It has managed the economy successfully. It has introduced radical constitutional reform. It has, albeit almost surreptitiously, engaged in a mild redistribution of income.

    But activities are not the same as outcomes, nor should aspirations be confused with achievements. This point emerges clearly from the way in which the report deals with the NHS. So, for example, it claims that the manifesto commitment to making hospital boards more representative of local communities has been met. Where is the evidence to back this claim? The process of selecting non-executives remains as opaque as ever, and the suspicion remains that one lot of placemen and placewomen has simply been replaced by another. Much, too, is made of NHS Direct—an interesting experiment, the impact of which, however, remains to be evaluated. Inevitably, the report also gives much prominence to the drive to reduce waiting lists but disregards the opportunity costs of making this a priority. And while many of the innovations listed—such as the National Institute for Clinical Effectiveness and the Commission for Health Improvement—have great potential, everything will depend on the way in which policies are implemented.

    Such niggles may be naive: public self assessment is unlikely to lead to public self criticism. This conclusion, however, prompts a further question. Why should anyone bother to buy and read the report? There is no obvious answer. Clearly, ministers want the report to have a wide audience. It is remarkably cheap and is generously illustrated with photographs taken by “a cross-section of public employees,” to whom disposable cameras were sent for the purpose (inviting the conclusion that taking photographs is best left to professionals). It even has a cut-out section inviting comments (though it does not tell us how many readers took up the invitation in last year's edition) But what may have started as an exercise in opening a direct line to the public has ended up as an exercise in self congratulation, and the report is unlikely to make the list of bestsellers. In this case, too, the motives of ministers may be misunderstood, and with reason.


    • Reviews are rated on a 4 star scale (4=excellent)

      The BMJ Bookshop will endeavour to obtain any books reviewed here. To order contact the BMJ Bookshop, BMA House, Tavistock Square, London WC1H 9JR. Tel: 0171 383 6244, Fax: 0171 383 6455 email: orders{at} Online: (Prices and availability subject to change by publishers.)

    View Abstract

    Log in

    Log in through your institution


    * For online subscription