|
====================================================================================
NB. THIS TRANSCRIPT WAS TYPED FROM A TRANSCRIPTION UNIT RECORDING AND
NOT COPIED FROM AN ORIGINAL SCRIPT; BECAUSE OF THE POSSIBILITY OF MIS-HEARING
AND THE DIFFICULTY, IN SOME CASES, OF IDENTIFYING INDIVIDUAL SPEAKERS,
THE BBC CANNOT VOUCH FOR ITS ACCURACY
====================================================================================
ON THE RECORD
RECORDED FROM TRANSMISSION: BBC ONE DATE:
05.03.00
====================================================================================
JOHN HUMPHRYS: Good afternoon. Britain's
health care is in a worse state than other countries in Europe. I'll be
talking to the Health Secretary Alan Milburn and asking him if the government
is REALLY prepared to spend what's needed to give us the NHS we deserve.
British helicopters are now
joining in the relief effort in Mozambique. But is it all too late. I'll
be talking to the Defence Secretary, Geoff Hoon and asking him why we didn't
go to help sooner. That's after the news read by Sian Williams.
NEWS
HUMPHRYS: What can we do to
make health care in Britain as good as it is in the rest of Europe. I'll
be asking the Health Secretary, Alan Milburn, about the Government's plans
for the NHS.
JOHN HUMPHRYS: But first, Mozambique.
As we've just been hearing in the news summary there is now a massive
amount of aid building up at the main airport waiting to be distributed
to the hundreds of thousands of people in desperate need. RAF helicopters
will be helping with that. But they could have done so much more to rescue
people if they'd been there earlier, they arrived only yesterday. The Defence
Secretary, Geoff Hoon, is in our Derby studio.
Mr Hoon, we'll come to that
in a moment if we may. Can you just tell me what the latest is with those
helicopters, what they're doing, whether they're active at the moment?
GEOFF HOON: The latest I've heard is that
two helicopters are now flying missions. One is on a rescue mission to
try and see whether there are any further people requiring saving from
the water, a second actually delivering food aid, and two more are being
prepared, the crews have worked overnight and we hope to have them flying
later today I hope.
HUMPHRYS: But it's being reported
that they can't get to the north of the country which is where if there
are people still stranded they will be.
HOON: Well, we are still investigating
that situation. As you are probably aware we had a ship sailing with five
more helicopters that we hope will be getting to Beira by Thursday and
that may help in that part of Mozambique.
HUMPHRYS: It'll be a bit late by
then won't it?
HOON: Well, I appreciate that,
but we were told originally the ship would take some nine days to get there
from the Gulf. It was a difficult decision as to whether it was the right
thing to send it, we judged it was. Obviously there's some delay but it
really has moved very quickly. It's picked up medical supplies in Muscat
on the way. I think it will provide a valuable assistance on Thursday because
it is packed with food, it's a supply ship, it has as hospital on board,
as I say it's picked up some medical supplies, so I'm sure by Thursday
it will provide some help.
HUMPHRYS: But I thought it had
been judged at the start of last week that it was not worth sending that
ship, that it would cost too much money for the benefit that it would be
able to provide when it eventually got there, so with that announcement
on Friday it began to look a bit like a kind of political judgement rather
than a strategic one didn't it?
HOON: Well, no, it's always a difficult
call. We always knew because it was in the Gulf that it was going to take
up to nine day to get there. It's going to take rather less now, but nevertheless
it's very hard to predict in this kind of emergency what will be the situation,
and as many people have quite rightly commented in this kind of crisis
it is the case that frankly we're often behind the curve. As far as the
ship is concerned this is our opportunity to get ahead of the game because
if the waters do continue to recede, there's some reports now that they
are beginning to recede, frankly we know what kind of problems we will
face. We will face disease, we will face hunger and a supply ship packed
with medicines, packed with food, with a hospital and indeed a surgeon
on board I believe by Thursday will be able to provide some real help.
HUMPHRYS: Which will be greatly
appreciated no doubt, but we don't have a lot to be proud of as far as
our performance in this disaster is concerned do we? I mean had we set
out earlier with the equipment, the helicopters that were needed we could
have saved lives and we didn't do so, because as Clare Short told me last
week, the Ministry of Defence wanted too much money.
HOON: I simply don't accept that.
I think we have a ...
HUMPHRYS: That's what she said.
HOON: Well, I believe we had a
great deal to be proud of. People worked in both departments extraordinarily
long hours, very hard to make sure that we had helicopters in the first
place available, and as I say then the ship. We were first asked on Tuesday
about providing helicopters. A decision was taken early the next day.
By then we had despatched a team of Marines to Mozambique to recce the
landing situation because frankly we had to hire an enormous aircraft,
an Antonov to get the helicopters inside, to get them down there. A lot
of preliminary work had to be done to achieve that.
HUMPHRYS: Yes, but a lot of bureaucracy
went on didn't it. I mean Clare Short was absolutely clear, she said that
she asked the MOD to supply helicopters and when they told how much it
was going to cost her department she said it was going to, let me quote
you, I'm sure you'll remember it, the MOD was charging very high prices
and coming in very slow. The MOD asked the full cost of the operation,
and that comes in very, very expensive, and so she went elsewhere. Well,
we're talking about a couple of million pounds here, and it staggered a
lot of people, I think staggers them still that that should have been the
case when people were clinging to the tops of trees and facing death we
couldn't say: right, let's do it, to hell with the cost at the moment.
Let's just go, and then worry about the bureaucracy afterwards.
HOON: Well, can I make it clear,
there wasn't any delay caused by any kind of bureaucracy. What Clare was
talking about quite rightly, and I would have taken precisely the same
decision in her situation. How do we get helicopters there quickly, and
obviously the best way, the best value for money is to hire, charter, lease,
get hold of helicopters in the area. That's what she did, she was quite
right to do that.
HUMPHRYS: She did. Well, sorry,
let me just stop you for a moment because it was for you to do that, it
was for you the MOD to charter that, one of those big Antonov aircraft,
and they came back and said it's going to be too much for us to do that.
I've talked myself to serving RAF people who've said: Look, off the record
sadly, because they're serving RAF people.: We wanted to do it, we could
have done it. We could have got those choppers there within twenty-four
hours if they'd given us the go-ahead, and they didn't because the politicians,
I won't use the language he used - the politicians are arguing among themselves.
HOON: Well that simply wasn't the
case. We had the Antonov. We managed to get the helicopters on board
and they're now there. But it is an enormous exercise and it's an enormously
expensive exercise and I quite understand why Clare judged it right, as
I would have judged it right, to ensure that in the first place that we
got locally available aircraft on the scene quickly, as the crisis unfolded,
as we realised that things were actually still getting worse we then had
to look at how we could get more helicopters there, that meant hiring this
Antonov and that meant disassembling, in part at any rate, the helicopters,
getting them on board and flying them down there. There were two distinct
stages in this and inevitably that second stage, getting aircraft from
the United Kingdom to Mozambique is an enormously expensive and difficult
process.
HUMPHRYS: But when it came down
to it you did ultimately halve the price, instead of the two point two
you charged one point one billion pounds to Clare Short's department.
If you could do it then at that stage a couple of days later why could
you have not done it earlier? Why could you not, as I've said, say 'look
let's not quibble about even a couple of million pounds at this stage,
let's just go and do it.'? You're not answering that question you see
Mr Hoon.
HOON: Well that's precisely what
I actually did, I said, ' look, let's get on with this. Let's get this
sorted out. Let's get them down there.'
HUMPHRYS: But you didn't. Clare
Short said you didn't. She said so on the Today programme on Friday morning.
HOON: No. What actually happened
was that the two departments discussed in particular, for example, whether
a particular amphibious unit should be sent. Clare decided, understandably,
that that wasn't an immediate priority therefore that wasn't required.
In addition, contrary actually to the Treasury rules that govern the way
these things work, I decided that it was necessary to offset the cost of
the operation that these helicopters would otherwise have been engaged
in.
HUMPHRYS: When? When did you decide
that?
HOON: Wednesday. So these things
were done very quickly and frankly cost was never an issue, bureaucracy
was never an issue. We got those people down there as quickly as we possibly
could.
HUMPHRYS: But you were asked on
Tuesday. I mean even if it was twenty four hours delay that was twenty
four hours too long. We knew what was happening. You see it isn't as
if it suddenly happened over that weekend. This had been going on for....
the cyclone struck a month ago, people were in very serious trouble, very
nearly three weeks ago now, they were clinging to the tops of trees last
weekend, I mean that's the point. People died because we didn't get there
quick enough. That's the upshot of it all isn't it?
HOON: I simply don't accept that.
As I say there were two stages in the process: The first stage was to
get helicopters there as quickly as possible. That was done by hiring
local aircraft and then in addition when we saw the full horror of the
situation we judged it was right to get British aircraft from the United
Kingdom down there very quickly.
HUMPHRYS: People saw the full horror
of the situation a lot longer than you did in Whitehall and Westminster
in that case.
HOON: Well I do appreciate that
and, indeed, it's part of the problem that we have to confront these days.
It's possible for you and your colleagues, quite rightly, to get pictures
back from terrible situations like Mozambique.....
HUMPHRYS: Pictures that you were
able to see......
HOON: Which we were able to see
but unfortunately we cannot get helicopters there as quickly as you can
get pictures back again.
HUMPHRYS: Yeah. Well you see that's
where people argue all the time. People say, 'Yes, with the right will
they could have done that, they could have got that plane very, very much
more quickly, they could have put their helicopters on.' There simply
wasn't the will to do it because there was this bureaucratic infighting,
whether it was because Clare Short and your man at the MOD didn't get on,
whether it was because of the cost, whatever it was - it took too long.
The question is now I suppose - what have we learned from it?
HOON: Well I don't accept that
it took too long. The request came on Tuesday evening, a decision was
taken early on Wednesday and frankly we were chartering an aircraft and
doing the work necessary to get the helicopters inside on Thursday. I
do not see how it could have been done any faster.
HUMPHRYS: Okay, well what have
we learned? Have we at least learned now that people, that one minister
shouldn't have to go to another minister and say 'what would it cost me
to do X Y and Z? If people are dying should we not be able to say - there
is money, let's make available if it comes out of a central fund or whatever
the heck it happens to be, can we not just do it in future?'
HOON: Well that's what happens
and I recognise that that's what always ought to happen. I also recognise
that when we have these kinds of crisis' we all want to respond even more
quickly than practicality allows for but I assure you that there was no
delay, no lives were lost as a result of any kind of bureaucratic delay
in the United Kingdom.
HUMPHRYS: Have we learned anything?
HOON: Certainly we always learn
something from these situations. There were problems on Thursday and Friday
bureaucratically and diplomatically and we need to find ways of ensuring
that we can communicate both with a government in South Africa and a government
in Mozambique. There are always lessons to be learned from these situations
and I assure you that we will learn them.
HUMPHRYS: Geoff Hoon, thanks very
much indeed.
HUMPHRYS: This week the government
will tell us what the NHS is going to do to fight heart disease. Britain
has one of the worst records in Europe. So another new initiative. Another
priority. Pretty soon all will be well with the NHS. Well, no it won't.
There is not enough money to make it better. And it's not only the sceptics
who make that point; it's the government itself. Indeed, Tony Blair no
less has said more money is needed to match the standard of health care
in the rest of Europe. We fall well behind. The Health Secretary Alan
Milburn is with me and I'll be asking him about the strength of the government's
commitment to the NHS after this report from Robin Aitken.
ROBIN AITKEN: The NHS is on the critical
list; laid low by a combination of a shortage of money and increasing patient
demands. Despite the devotion of its staff the service is fraying at the
edges and public faith has been shaken. Like their colleagues elsewhere
in the country the staff at the Intensive Care Unit at Walsgrave Hospital
in Coventry have coped with a difficult winter; a slightly worse than
average 'flu epidemic made the limitations plain for all to see.
The problems of the NHS
are now common ground. The government acknowledges that there are too
few beds and staff shortages. There's a recognition too that some patients,
with serious conditions, are having to wait much too long for treatment.
To put these things right more money has to be spent and the government
has chosen the average health spending of our European neighbours as the
target we should be aiming for.
According to the most
recent figures the United Kingdom spends just six point eight per cent
of the nation's wealth, or GDP, on health care; only Ireland, among EU
countries, spends less. The Germans spend most with ten point seven per
cent, Holland spends eight point five per cent. The EU average is eight
point six per cent. Tony Blair's ambition to match the EU average means
the UK would have to spend up to a quarter more on the NHS.
The victims of Britain's miserly
health spending have often been people experiencing crisis in their lives.
Last February Duncan Shepherd suffered an angina attack. In September he
was told he needed a heart by-pass operation but that he might have to
wait 14 months for it. Rather than risk it he decided to go private.
He had to re-mortgage his house to meet the bill of eleven thousand six
hundred pounds. It destroyed his trust in the NHS.
DUNCAN SHEPHERD: I felt I'd been shunted into
a corner after paying supposedly national insurance contributions to protect
the very problem that I'd got, I felt really frustrated about that and
I felt very very scared as well. Because I knew if I didn't do something
or if we didn't do something I was probably gonna die before Christmas
last year. And it would have left my family unprotected. We had to do something.
AITKEN: At the cardiac unit at
Walsgrave Hospital in Coventry they are conscious that they are struggling
to keep abreast of demand. Dr Stephen Evans and his surgical team perform
twelve hundred open heart operations each year - about the maximum that
facilities and staffing allow. Even so it means tolerating waiting times
that make the doctors uneasy.
DR STEVE EVANS: We don't let anyone wait
more than twelve months by and large for cardiac surgery although in some
parts of the West Midlands that is pushing out to eighteen months which
is the maximum limit that the government have said we should run to. I
personally think that's too long.
AITKEN: Because people presumably
die while they were on that list?
EVANS: Well they... the worst scenario
is that some patients will die and of course they've also got a disabling
and unpleasant condition which is relatively easily fixed.
AITKEN: Perhaps Holland shows us
what the NHS could be like if we spent more. Dutch spending on health care
is just about the EU average and what you get for money like that is hospitals
like this. This is the University Hospital in Groningen and it provides
an enviable level of health care.
ACTUALITY:
AITKEN: As the man in charge of
the Thoracic centre in Groningen, Professor Tjaek Ebels usually gets what
he wants. These state-of-the-art facilities are typical in Holland's Health
Service. Professor Ebels doesn't claim the Dutch system is perfect - but
when people need major surgery they get it. Fast.
PROFESSOR EBELS: The government has put more money
into cardiac health care. Increased the operating facilities, cath labs
and what have you so in conjunction with diminishing of coronary heart
disease, which is obvious right now the waiting lists have virtually disappeared.
AITKEN: The statistics show the
extra money other countries spend works. According to the most recent coronary
heart disease statistics in the UK there were two hundred and forty-three
deaths per hundred thousand men aged between 45 and 64. Compare that to
the Western European average of one hundred and fifty-three and Holland
with just a hundred and thirty-six. Of course it's not just health care
that matters but diet too. Even so, we compare badly even with our northern
European neighbours.
Doctors at the Walsgrave
hospital would like to be able to provide the level of health care delivered
by European hospitals. This week the government will unveil a National
Service Framework for coronary heart disease (it's already published the
ones for cancer treatment and mental health) - the aim is to provide better
and fairer treatment right across the country.
PROFESSOR GEORGE ALBERTI: I have tremendous faith in the
National Health Service frameworks as a principle because what they aim
to do is to set uniform standards of care across the country. I think
that a lot of the problems will take a long time to resolve. For example
with heart disease where we need to be doing double the number of operations
we are doing at the moment. That takes time to build facilities, train
staff and so forth. But with reasonable resourcing increases now we can
start to rectify some of the immediate problems.
AITKEN: For all its sophistication
some of the NHS's needs are very basic. Britain has fewer doctors, nurses
and beds per head of population than most other EU countries. For hospitals
like the Walsgrave the National Service framework for coronary heart
disease could mean more demand because there'll be more referrals by GPs.
And the Coventry Hospital already runs at maximum capacity.
EVANS: I'm an intensive care consultant,
it's one of the hats that I wear and it's actually very difficult to find
beds for patients. We're constantly shuffling patients between intensive
care, high dependency and the wards and running virtually a hundred per
cent occupied the whole time. With that kind of occupancy the whole system
starts to break down I'm afraid.
PROFESSOR HOWARD GLENNERSTER: It's too tight in a whole number of respects
and you know the crisis at Christmas and afterwards is an example of that.
There's no slack to take account of emergencies.
AITKEN: One of the government's
objectives must be to avoid replays of stories like that of Mavis Skeet,
the Yorkshire woman who was diagnosed as suffering from cancer but had
her operation postponed four times - and was then told it had become inoperable.
Such heart-rending cases undermine faith in the NHS.
Cancer treatment - like
the radiotherapy department at Walsgrave - is now subject to new standards
laid down in a National Service framework; but it too is likely to drive
costs up
The Government has designated
coronary heart disease and cancer treatment as priority areas. But for
that to be anything more than a pious hope significant sums of money have
to be spent. The new generation of radiotherapy machines like this can
cost up to two million pounds - and even when you've taken that decision
in principle there's inevitably a time-lag before better results show through.
STEPHEN THORNTON: If you look at the next financial
year much of that money is already fully committed. We have to pay an
increased pay bill as a result of the pay review bodies. We've got to pay
the impact of the European working time directive, we're paying - staff
pension contributions that have gone up by one per cent. There's a whole
series of cost pressures that NHS trusts face next year and by the time
they've paid for all of those there is precious little money left to invest
in modernisation. And what little money there is, is going to have to go
in cutting waiting times and making sure we can manage any potential emergency
care crisis next winter. There's virtually nothing left for investment
in some of these areas. For instance in Coronary Heart Disease and in cancer
care and in mental health.
AITKEN: The Prime Minister set
the target of matching EU average spending within five years. A judgement
on whether that's going to be achieved will be possible this July when
the government unveils its Spending Review. But many in the NHS believe
that it needs a generous cash boost now on top of the planned increments
if patients are to notice any difference.
SIR GEORGE ALBERTI: I feel that to really kick
start things, to cheer everyone up to get a safe service running we would
probably need about ten per cent now and we could spend that without difficulty.
There are people in the training pipeline who could be appointed and for
example over the last couple of years only half the number of new consultant
appointments have been made that have been allowed by the government and
that is because trusts have not had the money to make the appointments
but the people are in the pipeline training.
JULIA NEUBERGER: I suspect that there will be some
interesting negotiations between Gordon Brown and the Prime Minister as
to precisely how the money is going to be found and indeed how much of
the money is going to be found quickly. Because the other thing that I'm
sure the Prime Minister is frightened about is if he doesn't get some money
going into the service this side of the comprehensive Spending Review then
frankly we're going to have another winter crisis next year and it'll probably
be as bad as this.
AITKEN: Money is also needed to
address the NHS's guilty secret; rationing, even of drugs for vital cancer
treatment, has been a hidden reality in the service for years. At the
moment decisions about the treatment are taken by individual doctors and
health trusts according to what they can afford. Some critics now argue
it's time for the politicians to be up front about rationing.
NEUBERGER: I have no doubt that the public
should be involved in these decisions. It seems to me quite ludicrous for
politicians to say either that there is no rationing when there patently
is and what has been happening is that it's being done surreptitiously
and it's been rationing by postcode if you like. And secondly however much
money you put into the system you'll always have to make some hard decisions.
There will always be one lot of priorities to be set against another.
AITKEN: In future it's going to
be more difficult for trusts to deny treatments because of the National
Institute for Clinical Excellence. This new body will tell the NHS which
treatments work and which should be made available.
THORNTON: The National Institute
for Clinical Excellence will undoubtedly recommend that there are new drugs
and new techniques, which in their view are both clinically and cost effective
and if you like should be part of the National Health Service and should
be available for patients. The problem for the NHS is going to be when
that happens are we going to be able to afford it. At the moment NICE is
doing a study looking at taxons, the class of drug used for seriously ill
cancer patients. And I think the likelihood is they will come out and they
will say that in certain circumstances those drugs probably are clinically
and cost effective. Many of my colleagues in the service fear that decision
because they know the impact that it will have on them financially
AITKEN: For the patients at the
Groningen University Hospital spacious modernity is part of the package.
Single sex wards are the norm. This is a system which has found the money
to attend to the details. But in its rush to raise standards some feel
that Tony Blair's government is trying to do too much, too fast.
THORNTON: One of the problems with
the government's approach though is that there are too many initiatives
there are too many priorities. So in addition to coronary heart disease,
we also have mental health which is another pressing priority, then there
is managing the waiting list, then there is managing the winter ah, emergency
crisis, then there is building up primary care and so on and so forth.
And the problem that those of us who have responsibility for management
of the health service find is, there is that there is an ever increasing
number of initiatives and priorities and only a limited amount of money
to go around.
GLENNERSTER: Expectations are rising faster
than the Health Service has been able to keep up with. It's not that the
Health Service hasn't spent more you know, significant increases as the
governments always telling us, all governments tell us, that's true. But
it's not keeping pace with the kinds of convenience, kinds of standards
of personal care and all the rest that people have come to expect.
AITKEN: In order to quell the chorus
of criticism in recent weeks the government has been trumpeting announcements
about extra beds, more staff, higher standards and significant new money.
Inevitably this has raised expectations sky high. The political cost of
failing to deliver could be very high too.
HUMPHRYS: Robin Aitken reporting
there.
JOHN HUMPHRYS: Alan Milburn let's pick
up that point that he made at the end there about beds. This is an enormous
problem isn't it. We have far fewer beds per head of population than our
continental cousins, Germany has twice as many as us for instance. We should
have as many beds as them should we not?
ALAN MILBURN: We should certainly have
more beds in the health care system that is absolutely true. While I don't
know quite what the German figures are but what I do know is that over
the last ten, twenty years, the number of acute beds in hospitals has fallen
enormously. I think we have lost about forty thousand hospital beds during
the last twenty or so years and my view about this is that, look if we
are going to deal with the demands that an ageing population brings and
there are more and more old people and we've seen some of that this winter
with a lot of very elderly people in hospital prone to respiratory illness
and flu and so on. And that is the sort of situation that the NHS is going
to have to deal with, not just for one winter but for others. And if we
are going to do the sort of activity rates that we want to do in the National
Health Service now, as we expand the Health Service, then we will need
to see more beds in the system. And my view about hospital beds is that
the trend rate of decline that we've seen with the number of beds falling
simply can't keep pace either with an ageing population or indeed with
the increased activity that we want to do. So we want to expand the number
of beds but we have also got to make sure that we get the right beds in
the right places and it isn't just a question of getting more beds into
hospitals, it's also a question of making sure that we get beds in the
appropriate place. For example, we know now from this National Beds Enquiry
which we just published, that there are around twenty per cent of hospital
beds are inappropriately occupied, often by elderly people, they've come
into hospital, they've been properly treated and they are ready to leave.
They can't leave because they are not ready to go home and they need a
step down, they need an intermediate level if you like to build a bridge
between hospital and home and that is what we are going to do. We are going
to have more beds in the home care system, more active rehabilitation,
more recovery services, precisely in order to get people back on their
feet again.
HUMPHRYS: So how many more do you
think we need?
MILBURN: Well the National Beds
Enquiry said that over the course of next three or four years, we might
need up to four thousand more beds in the whole care system. Now there
are some choices to be made about where those beds are best provided. My
own view about this is that what you need to do is certainly need to expand
some beds in the acute sector in hospitals, we know and your report has
just pointed to, for example, the problems that we had with critical care
beds and we need to expand the numbers there. But when we talk about beds,
by and large we are not just talking about pieces of wood and iron...
HUMPHRYS: ...you're talking about
people..
MILBURN: ...exactly. Christine
Hancock from the Royal College of Nursing got this absolutely right when
she said look, you know the issue here is not just trying to get beds,
it's trying to get trained staff. I can buy beds in any high street but
I can't get is trained nursing staff and trained doctors, I certainly can't
get them overnight. But thankfully there is some good news there because
we are expanding the numbers both of doctors and nurses. I think we are
beginning to turn the corner on nursing shortages in the National Health
Service. We've now got about four and a half thousand more nurses in place
now in the NHS than we had a year ago and we've launched this very big
recruitment campaign that I hope will get more nurses and physiotherapists
and scientists into the Health Service.
HUMPHRYS: So you accept the logic
that says it's all very well to talk about efficiency but there is such
a thing as being too efficient in the sense that if you are operating at
a hundred per cent capacity as some of the hospitals...one of the hospitals
we saw in that film were, you have no slack so eighty five per cent is
the maximum bed occupancy that you should be able to tolerate. You accept
that theory, that principle.
MILBURN: I think it is true to
say that we need more capacity in the National Health Service and that's
what modernisation is all about. It's both about expanding the services
but changing the services too. So yes, we need more beds, yes we need more
doctors and we need more nurses and we are getting more of those. But we
need to change the whole of the way the Health Care system works. So as
I say, for example we need to see a new emphasis, particularly with an
older population on this form of active rehabilitation and recovery that
we haven't had in the past. It simply hasn't been there and it's not surprising
that when I went to St. Thomas's Hospital in London with the Prime Minister
on Tuesday and we talked to consultants in Accident and Emergency there
about whether they had enough beds in A&E they said well yes and no. Well
what do they mean by that? - they mean yes they do have enough beds providing
further down the hospital system, further down the care system, there are
enough beds there and if I go and talk to staff, as I do in acute wards
in hospitals, they will say if we could use these beds more appropriately
and ensure that we could get people discharged at the right time into the
community, into step down facilities, into rehabilitation and recovery,
then sure we can make better use of the facility that we've got. So it's
both a question of expanding the capacity and changing the way facilities
are delivered.
HUMPHRYS: Since you acknowledge
that capacity has to expand, it is odd isn't it that the newer hospitals
have fewer beds than those that they are replacing. We were looking at
the figures just yesterday, two thousand five hundred beds were lost, you
acknowledge yourself that many beds have been lost in the last few years,
two thousand five hundred beds were lost in the first eleven new hospital
schemes, that's over the last five years. So this is rather odd isn't it,
that we are building smaller hospitals with fewer beds to replace larger
hospitals with more beds, when we need more not fewer beds.
MILBURN: Well I'm not sure where
those figures come from because I can tell you what the real figures are
because we actually build the hospitals...
HUMPHRYS: ..comes from the King's
Fund, pretty reputable..
MILBURN: ..it is very reputable,
indeed, it's a very good organisation but you know I can tell you what
the real figures look like. We've got this enormous hospital building programme
under way now, actually the biggest hospital building programme that the
National Health Service has ever seen with thirty-seven new hospitals either
being built or in the pipeline. When I as Minister of State, prior to becoming
Secretary of State announced the first wave of these new hospitals, the
fifteen, actually the numbers there showed that the number being built
through the private finance initiative route and the number of beds available
through the PFI route were broadly the same as if it had been built with
exchequer capital. But I think what we have got to start moving away from
you know, is this idea that the whole problem can be solved by expanding
the number of hospital beds..
HUMPHRYS: ..but you have acknowledged
that that is absolutely crucial in the first five minutes of the interview...
MILBURN: But what I am saying is
that what really counts is the number of beds in the whole care system.
You have got to get the right number of beds, but you've also got to get
them in the right places too. So sure, of course we need more critical
care beds in hospitals, sure if we are going to be...
HUMPHRYS: ...three times as many?
MILBURN: ...we need a lot more
critical care beds in hospitals and that means that we have got to have
more critical care staff. It means that we need more consultants, it means
that we need more nurses too. But I tell you what will happen, if we expand
the number of hospital beds without expanding the number of beds at an
intermediate level, in cottage hospitals and community hospitals and in
step down facilities, precisely to give older people the sort of rehabilitation
and recovery that they require, the whole system will become snarled up.
HUMPHRYS: ...you better stop shutting
cottage hospitals for a start.
MILBURN: Well what we have got
to do is give cottage hospitals a new lease of life and what I want to
see for example is to turn them into more active institutions that do what
old people, like people of our generation want. What they want is to live
an independent a life as possible, that all too often John, what happens
is an old person comes into hospital, they have their treatment in care,
and they end up being discharged into a residential home or a nursing home.
And they are literally banged up there for life. Now residential and nursing
care is of course appropriate for some people but not for all. And I want
to provide a choice for people, but that means that we have got to reform
the system, modernise the care structure to make sure that we are starting
to manage the health system as if it is one system rather than a series
of competing, free standing health institutions.
HUMPHRYS: Let's look then at heart
disease. Again, you're not going to argue with this, we have the worst
record in Europe, and you're going to do something about it. What are
you going to do, we hear about a heart Tzar for instance?
MILBURN: Well, tomorrow in fact
we'll be launching what amounts to a national crusade against heart disease,.
This is a blue-print that has been draw up by Sir George Alberti and some
of the leading clinicians in the land to tackle Britain's biggest killer.
Around a hundred thousand people a year have died from coronary heart
disease, many of those deaths are preventable, and we will try to prevent
them by better prevention and earlier intervention, because that can make
a real difference. What this blue-print does is look at the sort of services
that are required in every aspect of the care system, not just in hospitals
where of course we need to see faster access to surgery, a point illustrated
in your film, but we also need better prevention too, and what the blue-print
will be laying out is a whole series of measures to speed up intervention
and to put a new emphasis on prevention as well.
HUMPHRYS: Surgical intervention
if necessary. So it's reported that you will have a three-month target
for a by-pass operation, is that right - three-months waiting list for
that?
MILBURN: Well, you'll have to wait
and see what is published tomorrow, but what I will say is this, that we
need to get the waiting times for heart surgery down. It frankly isn't
acceptable that people have to wait in some cases for eighteen months for
heart surgery at the moment. But I can only get the waiting lists down
as I build the capacity up, and the truth is right now that we've inherited
an NHS that is under-doctored, where we have a shortage of nurses, and
where we have a shortage of trained staff too. Indeed when we got into
office the number of nurse training places had been cut. As a consequence
we are having to turn this round and build up the capacity of the NHS,
so for example I think at the moment we only around one-hundred-and-seventy
heart surgeons in the National Health Service, and that simply isn't enough,
so I'm going to build up the capacity, but it takes time to get there,
it simply takes time to train nurses and to train doctors.
HUMPHRYS: Well, that's fine except
that what Professor Alberti of whom you speak approvingly says, is that
they're there, they're waiting, but they cannot afford - the hospital
trust cannot afford to create the consultancy posts because there isn't
enough money.
MILBURN: Well, we are creating
the consultancy posts
HUMPHRYS: Because there isn't enough money.
MILBURN: Actually we are creating
the consultancy posts and one of the very first.....
HUMPHRYS He says only half of the
ones that are needed..
MILBURN: Well, one of the very
first things that I did when I became Secretary of State, is I said: 'Look,
there are two key priorities for us aside from mental health which is a
very important set of services, and that is improving heart disease services
and improving cancer services. Why, because they are the two diseases
that are killing most people off in this country.'
HUMPHRYS: And why haven't you appointed
twice as many as Professor Alberti said you could have done?
MILBURN: And what I said at the
time is that I was going to create and extra four hundred consultant posts.
That is what we are going to do. An extra three-hundred and thirty cardiologists,
and an extra eighty cardio-thoracic surgeons , Now the extra eighty cardio-thoracic
surgeons, heart surgeons, will be in effect a fifty per cent increase on
what we have, but you've got to train them, and it takes time. They don't
grow on trees.
HUMPHRYS: With the best will in
the world, that isn't the point. The point is that they are there, they're
waiting, they're registrars, senior registrars or whatever. Professor
Alberti himself the source on these matters says they are there but there
is not the money to create the consultancy posts.
MILBURN: But that isn't true.
HUMPHRYS: Well......
MILBURN: That simply isn't true
John.
HUMPHRYS: ....on that film.
MILBURN: With the greatest respect
it simply isn't true, and what I've said is I want to see more doctors
in training and indeed we have put more doctors into training. We have
created.....
HUMPHRYS: Will you able to provide
the money to allow them to become consultants?
MILBURN: Hold on. Hold on. We've
created an extra one thousand medical places in universities, one of the
first things that the Government did when we came into office, and at the
same time as they people go through training, and remember it takes five,
six or seven years to fully train a doctor before they can become a consultant,
as they come through we will create the consultant posts, and that is a
commitment that I've given, for example for cardiology and for heart surgery,
because we need more of them.
HUMPHRYS: You've obviously not
satisfied Professor Alberti on that one. What about the other. He says
that you need to double the number of heart operations being carried out
at the moment. Do you accept that?
MILBURN: I certainly think that
we need to dramatically expand the number of heart operations. Well, I
think you'll have to wait 'till tomorrow to see what the National Service
framework says, but there is no doubt whatsoever in my view that you've
got to do two things: One, you've got to increase the number of heart
operations that take place, and secondly you've got to bring down the waiting
times that it takes to get treated. People are waiting far too long to
be treated at the moment, and we've got to change that, but as I say you
can only bring down the waiting times as you build up the capacity and
that means getting more doctors and nurses into the system. But the other
thing that we've got to do aside from expanding the services is to reform
the services too, to modernise them, so for example tomorrow I will be
announcing that we are going to establish so new fast track chest pain
clinics. So if you go along to you GP with suspected angina in the future
you will have a guarantee of being seen by a hospital specialist within
two weeks, rather than having to wait two months or longer to be seen.
Why - because if you've got angina it must be pretty worrying for you,
it must be one of the worst times in your life from a patient's point of
view. Secondly the sooner we can get you seen the sooner we can get you
treated and put you on the road to recovery. Now that is what I mean by
modernisation, the expansion and reform in the way that services are provided.
HUMPHRYS: That would be terrific
if I popped along to the clinic and they said: yes, you've got a problem,
you need an operation. You need it now, very, very soon indeed. But then
you see the problem is, Professor Alberti and his colleagues say, : Well,
I'm sorry, we'd love to be able to do it, but we can't, we haven't got
the surgeons to do it, we haven't got the money to appoint the surgeons
to do it. So how soon are these things going to happen? It's all very
well there being as many modernised clinics as you like, but it's ......
start the operating.
MILBURN: Well, they're going to
start happening from April this year.
HUMPHRYS: Yeah, fine.
MILBURN: So we're going to start
rolling them out....
HUMPHRYS: Clinics are no good without
the ....
MILBURN: Yes, of course.
HUMPHRYS: ..... people who can
operate on you if the clinic says you need an operation
MILBURN: That is absolutely true,
but remember a lot of people with angina and suspected heart disease, a
lot of people need various forms of treatment and it isn't just heart operations
that they need, they need better drugs, sometimes they need simple things
like exercise and better diet, and these fast track chest pain clinics
will be in a position to provide that sort of advice. So it's a change
for the system, but it's an expansion to the system as well.
HUMPHRYS: Can I offer you a part
solution here, that does not come from me, but from people who know much
more about these things than me, and that is this, that you have too many
priorities in the Health Service as we speak, and your biggest priority
right from the very beginning, the thing that helped you to win the election
was pledging to cut waiting lists. Now that's all very well, to say people
don't like waiting lists, of course they don't, none of us likes to be
on a waiting list, but the problem with it is that it does distort priorities.
Now you say , you go along to your chest clinic and you can have an operation
more quickly. You could have it a darn sight more quickly if people who
run hospital trusts and authorities weren't so obsessed because you have
told them they must be obsessed with cutting the waiting lists. And they
say: well, we can cut the lists a darn sight more quickly if we do half
a dozen varicose veins operations than if we do a triple heart by-pass,
so get rid of that waiting list pledge for a start.
MILBURN: Well I believe in one
thing in politics and that is that if you make promises you should keep
to them.
HUMPHRYS: But if you've made a
mistake, you should get rid of it (both speaking at once)
MILBURN: It isn't a mistake John
and I'll tell you why. As you cut waiting lists so you cut waiting times
and that is what people care about.
HUMPHRYS: Not if you've got to
wait even longer to see a consultant......
MILBURN: Well I tell you that is
the case because when we came into office as everybody knows waiting lists
were going like that, they peaked and they're coming down and since they
have been coming down......
HUMPHRYS: Waiting time to see a
consultant hasn't come down........
MILBURN: ..... and since they're
been coming down the time that you wait as an inpatient for an operation
has fallen as well and it's pretty much common sense isn't it? If you
go along to the supermarket which queue do you choose to wait in? You
choose the shortest queue, of course you do because there's an intimate
link between the size of the list and the length of time that you wait.
Now it is important that we get the waiting lists down not just because
we said we would, although it is important that we keep our promises, but
also because it is the right thing to do and when I, tomorrow, announce
that there is going to be a shorter waiting time to get access to cardiac
care in the national health service, people I hope will say that that is
the right thing to do because the emphasis is (both speaking at once).....
the emphasis is on clinical need which is the criticism that you're making.
I want to see the emphasis to be on clinical need, it should always be
on clinical need and it's exactly the same with cancer if I may say so.
What we've done there is again the right thing. Of course we're investing
in extra cancer services, modernising the equipment, getting more doctors
and more nurses in, but what we're also providing is a new and modern way
to get access to care so that if you go along to your GP and you have suspected
cancer and you need an urgent referral from your GP, rather than having
to wait for months on end now by the end of this year, by the end of the
year 2000, you will be seen within a fortnight by a hospital specialist.
HUMPHRYS: Alright. Excellent.
Every body will say that's terrific but are you saying to me this morning
that if that means that the person who comes along with the varicose veins
problem therefore, as a result of that, has to wait longer and common sense
says that if we have X number of patients, we have X number of surgeons,
if the priority for those surgeons becomes that particular thing those
patients, some of them, are going to have to wait longer. Are you happy
with that and if you saw....... Lets me finish the question because it's
a hugely important one, if you saw that the number of patients waiting
for less urgent operations was increasing, was increasing, so that your
actual target was not met but that the number of patients with the truly
serious conditions, cancer or heart problems was decreasing would you be
happy with that and would you be prepared to go into the next election
saying - 'All right, we didn't quite do what we intended to do with that
promise but look what we have achieved.'
MILBURN: Well it all depends on
the capacity because the people...........
HUMPHRYS: ..... of course it does..............
MILBURN: Well I know but this is
the important thing you see because it's back to this issue that George
Alberti quite rightly raised in your film about the number of heart surgeons
that we have. We've only got a hundred and seventy heart surgeons. We
need to expand the number of them and frankly the people who operate on
varicose veins aren't the same people who are operating on hearts and therefore
what you've got to do is expand the number of staff who are able to undertake
these clinical procedures. That is precisely what we're doing. Now if
people want to criticise us for expanding the number of staff, that's fine,
but if people also want to criticise us for saying 'look, it's too slow'
well look, I accept that, okay and I accept that it is extremely frustrating
for people to have to be told to wait but with the best will in the world
what I can't do John, is conjure, trained cardiologists and trained cardiothoracic
surgeons. Well I just can't.
HUMPHRYS: Well he says that they're
their already and it's just a matter of cash which would help them. This
is the problem isn't it. It is, in the end, you say it's about training
but what the doctors tend to say is, and people like Stephen Thornton........
yeah, of course that's part of it but it's also about money and if they
had the money they could turn those registrars, senior registrars into
consultants because they are there waiting they simply don't have the money
to fund the consultancy posts. So given all of these pressures - let me
quote what Stephen Thornton, Chairman of the NHS Confederation said, 'There
is precious little money left to invest in, what you describe as being
absolutely vital - 'modernisation'. You've got to have a short term cash
injection have you not?
MILBURN: Well we've put extra money
into the National Health Service for the next financial year, I listen
very carefully......
HUMPHRYS: But it's eaten up the
extra money you put it. It's eaten up in higher wages, working time directive
costs, higher pension coverage - it's gone. It's already gone.
MILBURN: That's what Stephen says
but I don't think it is quite right actually......
HUMPHRYS: Oh - somebody else who's
got it wrong?
MILBURN: What we've done is we've
increased the amount of money that is going out into the National Health
Service to the health authorities from the First of April they will get
six point eight per cent on top of what they're getting this year. Now
look, I recognise of course that there are very real pressures out there,
there are, and things like the working time directive and the fact that
we've had a big increase in the price of generic drugs nobody denies that
those pressures are there but they're taken account of in the amount of
money that we've put out into the service.
HUMPHRYS: But it's not as high
as you said. It's not actually six and a half it's actually four and a
half per cent in real terms.......
MILBURN: In real terms.......
HUMPHRYS: ..... but it's four and
a half per cent in cash terms. Let's talk in real terms..........
MILBURN: It's six point eight per
cent........
HUMPHRYS: Well let's talk in real
terms (both speaking at once) It's normally ten per cent. Professor Alberti
says it should be ten per cent.
MILBURN: ...... and that is a real
increase, that is an increase on what is going on in the current financial
year and listen, all sorts of clinicians and all sorts of doctors and managers
have very different views about how much the National Health Service needs.
At the time that we did this first comprehensive spending review that
has given the NHS the biggest cash injection it has ever seen - well let
me finish this point - the argument about this was that what the NHS needed
was a real terms increase of three per cent per annum. That is what it's
had for the last twenty-five or thirty years and many reputable organisations
and individuals argued for around three per cent. We haven't given it
three per cent. We've given it fifty per cent more than that. Around
five per cent in real terms.
Now if we can continue to
manage the economy well we can continue to get those sorts of increases
into the NHS and yes, over time, we will expand the National Health Service,
the number of staff in the NHS, but we'll change it too because it isn't
just a question of getting more money into the system it's using that money
to lever in real practical changes. Let me give you a good example of
that - just to finish this point because I think all too often, particularly
over the last few months the debate has been all about money for very understandable
reasons but there's another side to the money coin and the other side is
modernisation.
We are modernising Accident
and Emergency Departments. We've put in I think an extra one hundred and
fifty million pounds to modernise A+E's because they're needed to create
more space, to make sure that people have shorter waits. But it isn't
just a question of getting the three quarters of hospital A+E's that need
investment modernised, new buildings so that they look better and feel
better and there's more space, we're also modernising the way that those
A+E's work and that means crucially, getting nurses to the front end of
the hospital so that they're in a position to treat the patient first,
to triage them. That means making better use of nurse skills rather than
just assuming that nursing is just one discipline, medicine is another.
What we've got to do to
modernise the NHS is to break down these demarcations between staff because
if we do that the consequence is that patients will get faster and better
care. Now that is what we're doing and people like George Alberti want
to see an expansion in doctor numbers but what they also recognise is that
the traditional division of labour between medicine and nursing is something
that has to come to and end and it does.
HUMPHRYS: Alright, but what the
King's Fund says, you
heard Julia Neuberger there, if you don't get more cash now, we are...on
top of what you've already talked about, we are going to see another crisis
in the NHS this coming winter and you know the kind of damage that does
to you.
MILBURN: Well don't forget that
at the time of the
pre-Budget report in November, Gordon Brown held out the prospect of more
money for the National Health Service. What he said then and I think this
is a very very good idea indeed, is that in future rather than simply increasing
taxes on tobacco and putting that into the general government kitty, in
future if there are real terms increases in tobacco taxation, then that
money will be ear-marked for the National Health Service and he talked
then about increases which could amount to some three hundred million pounds.
Now, we will wait and see what is in the budget which is in a few weeks'
time.
HUMPHRYS: But you are going to
ask him for the money over and above that, for more money over and above
that, bearing in mind the Prime Minister's pledge a few weeks' ago.
MILBURN: What the Prime Minister
talked about was an increase from the comprehensive Spending Review, from
the next spending review..
HUMPHRYS: Which of course is not
going to be anything like enough to take us to that happy state where we
are going to be in line with our colleagues in Europe...
MILBURN: Oh yes it is...
HUMPHRYS: No, what every single
health economist who has done the sums - independent health economists
- who has done the sums on this says it's absolute nonsense. Those figures
that the Prime Minister used were simply wrong and we can go into the figures
in some detail if you like. Do you know what's interesting about this discussion
we are having, that all these outside experts, the King's Fund and Professor
Alberti and heaven knows who else, the IFS - Institute for Financial Studies...
MILBURN: Fiscal studies...
HUMPHRYS: Fiscal thank you.. they
are all wrong, it's only the Department of Health that's right.
MILBURN: No, no, it isn't only
the Department of Health but actually I am very happy to go through the
figures if you like and you know what Tony Blair said was absolutely right.
Providing we can manage the economy well, providing we do that and continue
to get stability and growth in the way that Gordon Brown has managed.
Then, if we continue what we have been doing over the last couple of years,
over this year and the next year and the following year, yes we will get
real terms increases, not at three per cent which is what has been happening
in the past, but at five per cent and the consequence of that is that we
will get up to the EU average...
HUMPHRYS: ...it would have to be
five point five per cent to get to the EU average everbody says..
MILBURN: ..it will take time, it
will take time to get there but there is absolutely no reason providing
we continue to manage the economy well that we shouldn't do that.
HUMPHRYS: It will cost not five
per cent. It will cost an extra five and a half per cent according to
all these other people that I have been quoting because the European average
is eight point six per cent and that's taking the lowest, that's an OECD
figure, you believe in the OECD, you always say look the OECD thinks we
are doing well when they say that, when they say other things you don't
believe them.
MILBURN: There are a lot of figures
being bandied around. I read an article in I think this week's British
Medical Journal saying it wasn't five and a half per cent, it was eight
and a half per cent...
HUMPHRYS: ...that's confusing two
figures, we're talking on one hand about how much...(both speaking at once)
MILBURN: ..that was about the EU
average and it was about what the Prime Minister said on the Frost programme.
The point is this, that we can expand the National Health Service and we
will expand the National Health Service and we will do so providing we
continue to manage the economy well.
HUMPHRYS: Well you see there's
a provision there, you are not guaranteeing...
MILBURN: There's a provision to
everything John...let me explain what I mean by that, with the greatest
of respect about this, you don't know whether if there was a recession
tomorrow you are going to be sitting here in this TV studio interviewing
me because the BBC revenues may take a downturn and...
HUMPHRYS: I do know that Gordon
Brown for instance is going to give away two and a half billion pounds
because he is going to cut a penny off income tax. Now if you were serious
about the putting extra money into the NHS, he could do that. He could
say you can have that instead. Politically unpopular with some, very popular
with others and you believe this is the priority, so you can't have it
both ways.
MILBURN: But there is the nub of
the argument you see. Here is the nub of the argument, why is it do you
think, that we are now in the position rather than giving the NHS what
it has had over twenty five or thirty years when the Conservatives were
largely in power and gave...
HUMPHRYS: ..gave about the same
over the last twenty-five years...
MILBURN: ..no that isn't the true.
It isn't true. We are putting in an average of around five per cent in
real terms. The average previously was around three per cent in real terms.
Why is it that we can do this? - we can do it because we are managing the
economy well, because we are doing the right things, taking the difficult
decisions and I am sure... sure in our first two years it was difficult.
It was difficult precisely because we had to turn the economy round and
we had to get rid of the structural deficit that we inherited. But because
we have done that, we are now in a position, providing we can make the
economy continue to grow, to give the NHS the sort of increases that it
needs.
HUMPHRYS: Alan Milburn, thanks
very much indeed for joining us this morning. And that's it for this week.
Until the same time next week, good afternoon.
...oooOooo....
21
FoLdEd
|