Tony Blair, the British Prime Minister, and his Labour government have struggled to reverse the decline of the National Health Service.
Long waiting times for treatment, a perennial winter bed crisis and iniquitous "postcode prescribing", under which the availability of expensive new treatments depends on where you live, have left what was the world's flagship health service a shadow of its former self.
But the NHS is fighting back. On a recent visit, The Irish Times looked at two schemes that aim to transform the way care is given and restore confidence in Britain's battered health service.
Dr Aidan Halligan is director of clinical governance for the NHS. A graduate of Trinity College, Dublin, he was headhunted in 1999, from his post as professor of foetal medicine at Leicester University, to head the support team that helps NHS hospitals deliver a new kind of service that has the patient as its focus. But it is also supposed to be marked by more accountability. It's called the clinical-governance agenda.
Clinical governance is a somewhat opaque term. Halligan interprets it as referring to "the patient-centred delivery of an accountable health service that is safe and of high quality. It is also important that care is delivered in an open and questioning environment". A tall order? "Certainly, there are no quick-fix solutions for my vision of a service in which patients feel they have received high-quality care," he says.
"Every patient is the only patient" is a theme that Halligan and his team convey at every opportunity. "Users are the only arbiters of the health system" is another. "Staff need to feel valued, that their contribution is recognised and that they are empowered," says Halligan. "Systems awareness is also integral to any high-quality environment."
Halligan's Clinical Governance Support Team provides five programmes for hospitals and NHS trusts - the administrative units that can consist of all the hospitals in a town or city, or perhaps be national specialist centres - to enable the cultural shift away from the traditional hierarchical system to take place.
More than 324 hospitals and trusts have enrolled in the team's general programme. Aimed at "unpacking" and mapping the process of care, it teaches teams of front-line health professionals how to rebuild the care process with maximum input from patients and on the basis of the best evidence-based practice.
An example of how the initiative works is the care of stroke patients at the Royal Bournemouth and Christchurch Hospitals NHS Trust. The challenge facing the support team was that each of the trust's sites had a different way of treating the condition, which was leading to concerns that some patients were receiving a poorer standard of care.
Since the support team organised a programme for multidisciplinary teams from the hospitals, the trust has implemented a single policy for treating the condition. Patients with strokes are now admitted to hospital rapidly, and specialist treatment begins more quickly. So successful has the model become that it has won awards and been adopted as a model for the United Kingdom by the Stroke Association and the Royal College of Physicians.
Under clinical governance, patients are to have a greater say in the way the NHS is run and the way services are designed and delivered. Patients will receive copies of any letters that their consultants send their GPs, for example. Every hospital will have a patient advocate and advisory service. And new proposals will be "reality tested" on patients before being implemented.
A patient-safety programme is a key element of the clinical-governance changes. By taking away the blame culture of the National Health Service and applying a critical-incident model borrowed from the airline industry, the support team hopes to create a culture in which mistakes are openly reported in an environment that focuses on prevention.
Former BBC health correspondent Richard Hannaford, who for many years reported on the NHS, gives his verdict on the Republic's health system, page 16