On the eve of his election victory in 1997, Tony Blair famously declared that Britain had 24 hours to save its derelict National Health Service.
So it is acutely awkward for his successor, Gordon Brown, that, 10 years on, his government is scrambling to fend off accusations of crisis in the NHS following a damning report about hospital infections that critics say is symptomatic of a wider malaise in British healthcare.
Health Secretary Alan Johnson was forced to apologize in Parliament this week after it emerged that at least 90 patients in southeast England died as a result of infections picked up in the hospital.
The Healthcare Commission, a national watchdog, blamed safety lapses and overcrowding. It painted a bleak picture of teeming wards where overworked nurses didn't even help patients to the bathroom.
Government officials have sought to portray the crisis at hospitals in the Maidstone and Tunbridge Wells district as a one-off. But opposition members of Parliament and health-service experts say the cost and staffing pressures affecting the trust are widespread, and that many other "primary care trusts" that manage local health services are struggling.
"The problem is not just Maidstone and Tunbridge Wells," says John Lister of the Health Emergency pressure group. "The outbreak ... exposed a weakness that exists in trusts up and down the country, given the way they are forced to run."
Dr. Lister says government-imposed targets have instilled a commercial culture, resulting in "perverse" imperatives like cost-control and "productivity" driving decisionmaking in hospitals. "It's the burger-bar style of efficiency – the more you can do with fewer staff the better," he says. "But patient safety seems to come at the bottom of the list.... The Hippocratic oath has gone out of the window."
Labour has made much of its bid to "rescue" the NHS. It has presided over a kind of permanent revolution, recruiting tens of thousands of doctors and nurses (many from overseas, leading to charges of inadequate domestic training), building hospitals with the private sector, revamping hospital funding, and encouraging competition. It has also spent money: The NHS bill is to rise from £35 billion in 1998 to £110 billion (about $224 billion) by 2011.
But critics say the extra billions have not always been well spent. A recent survey said Britain ranks 17th out of 29 European countries on a range of healthcare benchmarks, including quality of service, length of wait times, and patient information.
"We are surprised that given the massive spend on healthcare, Britain is not faring better," says Kasja Wilhelmsson, director of European affairs at the Health Consumer Powerhouse, a Brussels-based healthcare research group that conducted the survey. "For waiting times, they are pretty close to the worst in Europe. And outcomes [of treatment] is not high either.
"More money isn't the solution. You need to restructure and think in different ways," she adds.
Six million-plus Britons now have some form of private health coverage, though access to private specialists is controlled by overtaxed NHS general practitioners (GPs).
Surveys and comments indicate that morale at NHS – with 1.4 million staff, the third-largest employer in the world – is low. Doctors are furious at new recruitment and promotion rules. GPs are nervous about plans to open surgeries on weekends. Nurses rail against low pay.
This week, a survey of GPs found 1 in 6 wanted to leave. The Nurse of the Year, Justine Whitaker, said she was quitting the NHS.
""Every time something new is introduced," she told BBC radio, "that means more time at my desk and less time with my hands on a patient."