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JOHN HUMPHRYS: From Wednesday the National
Health Service will have a new boss. His name is Nigel Crisp and he will
not only run the NHS, but he'll be the most senior civil servant in the
whole department of health. Quite a job. Particularly since the NHS has
become probably the biggest problem facing the government. Mr Crisp is
with me. Good afternoon to you.
NIGEL CRISP: Good afternoon.
HUMPHRYS: I suppose I should start
by saying Good Luck! But let's clear up this two jobs thing first of all.
Because here you are, a civil servant responsible for the whole Department
of Health, but you're also running the NHS. Now, in the past we've seen
a certain amount of tension quite properly between the chap who runs the
NHS and the person who runs the department of Health because the NHS man
constantly says to him a lot, we need more money for - we want this, we
want that, you give us this, you give us that. You can't do that can you,
so there is a bit of a conflict here for you.
CRISP: Well, actually I think it's
easier than it's been for my predecessors, because for the first time we're
bringing health and social care together, and if you think about the Health
Service and about improving the Health Service we can't do that unless
we work very effectively across the whole range of government departments
and local authorities. And that's the advantage we get from bringing these
two jobs together.
HUMPHRYS: But you can't as it were
make demands on the permanent secretary because, or on his boss in a sense
because you are the permanent secretary and we want you, we who use the
NHS, want you to make those demands.
CRISP: Well, let's be clear, the
main part of my job responsibility is the modernisation of the NHS, and
that's what I will really be thinking about, and I will certainly be making
demands on behalf of the NHS both externally in terms of funding but also
internally about how we need to change to meet the challenges of this.
HUMPHRYS: There are massive expectations
resting on you aren't there. You're not going to be able to deliver on
those expectations, certainly in time for the next election are you?
CRISP: Well, we've got big expectations
and rightly we've got big expectations. We've had a very large increase
in money, and we've got a very good national plan, an NHS plan which brings
together a whole lot of new ways of doing things, and we're going to see
improvements. Many of those improvements will take some time, but already
you can see some things happening, already we know that if somebody has
got suspected breast cancer then they will be seen by a specialist within
two weeks, we need to roll that out for other cancers, that'll take some
time. So what we aim to do is to not only make some long term big changes
in the NHS but make sure that we see those happening month by month, year
by year.
HUMPHRYS: You have a crisis coming.
I say that because winter is coming and there's always a crisis in winter.
The BMA says that hospital beds are already running at full capacity.
There are bound to be problems aren't there?
CRISP: I've no doubt there'll be
problems, but when I think about this winter, and this is the part that
I've really spent a lot of time thinking about at the moment as you can
imagine, is we've got more capacity than last year, we've got more beds
in the system, we've got more nurses. In London alone there are two thousand
more nurses on the wards than there were this time last year. We're also
better prepared, better links with the voluntary sector, better links with
social care. But even with all of that we will undoubtedly have bits of
the Health Service come under real pressure for whatever reason.
HUMPHRYS: So, people are going
to have to wait, whatever happens to people who get sick as a result of
winter, people are going to have to wait for what might otherwise have
been routine operations for instance?
CRISP: Well, one of the things
we will do, is we'll switch some of our capacity, so some of our capacity,
some of our beds and so on, we'll be using for emergency care rather than
for elected care.
HUMPHRYS: Exactly, so people who
would have been in there for the emergency care.....
CRISP: Well, this happens every
winter to an extent. What we're doing this year is being a bit more systematic
and a bit more planned about it.
HUMPHRYS: .... As well.
CRISP: But that doesn't mean to
say that we will break any of our pledges around waiting lists. We will
still be determined to make sure that we hit our targets on waiting lists
over this period, and indeed the planning during the year has taken account
of the fact that we will do more planned work in the summer and more emergency
work in the winter, which is only sensible.
HUMPHRYS: But you're still having
to get a quart into a pint pot.
CRISP: We need more capacity.
I mean the NHS plan is a very honest plan, it says we've got real problems.
I think I'm the first chief executive of the NHS who's coming in saying
we need more beds, and this is a serious commitment that we're making about
this. We do need to see more capacity, we're gradually getting more capacity
as I've already said.
HUMPHRYS: But we've been building
smaller hospitals as a result of the PFI and all that.
CRISP: Well, let me give you the
example of University College hospital in London which was approved over
the summer, and it's part of my current responsibility in London. There
we looked at the plans and we sent them back and said we need more beds,
so at UCL... (INTERRUPTION). Well, it's the first one in a train, and
what we're now expecting is that when any new hospital is being built whether
it's through PFI or through some other route we will only be approving
it provided we see there are adequate beds across the whole system.
HUMPHRYS: So as far as the coming
winter is concerned you will not, will you, be going to the Chancellor,
and we've got his autumn statement coming up of course this week, and saying:
I need more money?
CRISP: We've already got a lot
more money in the system. We could always use more money in the system.
We will have pressures, but I think the key, the most important thing
for us to do is how we deal with those pressures, so if we do get a crisis
in a particular hospital how do we respond, how does the whole NHS and
social care network in that area respond to it, how do we make sure that
we deal with the problem as soon as possible?
HUMPHRYS: One of the problems,
one of the problems you've got right now, today, is this thing with flu
jabs. You want people to go and get them, especially the elderly people
to go and get their flu jabs, you're running this terribly expensive newspaper
advertisement campaign with Henry Cooper flexing his muscles and all that
sort of thing, and yet the jabs aren't there, the vaccines aren't there
for doctors, at least one in five doctors do not have the vaccines. It
seems bonkers to go spending a fortune on an advertising campaign and not
having the injections there for people to have.
CRISP: It's a very successful campaign,
and in the early...
HUMPHRYS: What, without the vaccines?
CRISP: .. we've already seen a
large proportion of the people that we want vaccinated, vaccinated. We
need abut eight million doses of vaccine to cover the people we think need
vaccinating. We've got eight-and-a-half million out there in doctors' surgeries,
we've got another two-and-a-half million to come. Some of that, we're
having a difficulty with one of the suppliers, but what we are finding
is that in a few places, and I don't think it's as much as one in five
we've actually had some difficulties with delivery of the vaccine.
HUMPHRYS: Well, but, but from your
own figures, one in five of the vaccines are not there. And I talk to
doctors, my own GP, who says, look, I can't do it because I haven't got
any vaccine.
CRISP: Well, the evidence that
I've seen, and again, I have looked at London, em, is that we do have the
vaccines out there, we do have eight-and-a-half million, we don't necessarily
always them exactly in the right place, but we will get them in the right
place, we will ensure that we do have the vaccine available to people,
and that we can build on the success of what is a successful campaign.
HUMPHRYS: Well, wouldn't it have
been more sensible to hold the campaign off, until you knew that all the
vaccines were in place, so that everybody who goes along for the GP, and
who qualifies to have one of these jabs, can have one.
CRISP: There is a time lag in producing
vaccines and what we've had, is, as I said, we've got eight-and-a-half
million vaccines out there, we need another two-and-a-half million, and
we've got a problem with about one-and-a-half million of that which is
coming from a particular supplier, who has had difficulties in production.
HUMPHRYS: You talked about getting
extra beds during the winter crisis. Now one of the ways obviously to
get better, extra beds, is to go to the private sector. There seems to
be no ideological opposition now to, because the government, because the
government seems to have conceded that, let's use the private sector, have
you actually said to local authorities, to NHS Trusts, and all the rest
of it, now look, if you have a problem, get an arrangement in place.
Sort it out, work out the contracts or whatever, you've done it, is it
all formalised so that during this winter we will not see the situation
where you have people who can't get a hospital bed and there are hospital,
private hospitals with empty beds coming out of their eyes.
CRISP: What we've actually done,
is we've asked every Health and Social Services Community, so the Local
Health Authority area, to come up with a really comprehensive plan for
winter...
HUMPHRYS: ...asked or told?...
CRISP: ...we've told them to do
that. And we got them back to us at the end of September and we are working
those through with them. Now in most of those cases, they are actually
looking at what extra capacity they can get from elsewhere. I mean, the
job for hospital managers as you'll appreciate, is to try and get the best
deal for their patients in whatever way, and it is sensible and practical
for us to use the private sector, um, where that will take a bit of pressure
off the system, take a bit of pressure off staff, make sure that we can
get some urgent cases in, which might otherwise not come in if we got an
awful lot of er, er, emergency work coming in. But, let me just give
you, give you an example. I looked at one of these plans last week for
an area of London and they have already decided that they are going buy
forty extra operations from their local private hospital for orthopaedics.
Now, that's forty operations, ones which they were worried might not get
done otherwise, but that's in the context, forty operations in four months,
that's in the context of in London us admitting two-and-a-half-thousand
people every day.
HUMPHRYS: Quite
CRISP: So, it's a helpful contingency.
And we are asking, as I say, Health Service managers, to look at every
way of trying to make sure that we keep up the level of our service and
that we reduce the pressure on staff over winter.
HUMPHRYS: In other words, we can
be satisfied that during this coming, this, this coming winter, there will
be no private hospital beds sitting there with people who would otherwise
have gone into NHS, can't get into the NHS, wondering, why can't I go into
a private one, there will be no empty private hospital beds, in effect.
CRISP: No, clearly I can't go that
far and the reason...
HUMPHRYS: Why not?
CRISP: ...the reason for that is
two-fold. Firstly, it needs to be local decisions by local people about
what's needed. And those need to be based on two things. Firstly quality.
BOTH SPEAKING TOGETHER
CRISP: Well, we have to make sure
that they are up to the standard. And that's the first point. And the
second thing, is that it's also got to be good value for money for the
public purse. And we cannot be in the position of saying that we will
use every private sector bed in the country. We need to make sure that
as our managers are looking for contingency plans, that they negotiate
sensible and reasonable deals locally, that can only be done locally.
HUMPHRYS: Mmm. But I mean, if
somebody desperately needs a bed, and it's going to cost another fifty
quid to put somebody in 'x' private clinic, you're not going to say, you
can't go, are you.
CRISP: Well, if somebody desperately
needs a bed, then it is the responsibility of the local health care system
to find a means....
HUMPHRYS: ....at whatever cost?...
CRISP: ...a bed, and we've had
examples of that in the past, as I'm, I'm sure you, you well know, where
we have used the private sector, if that is the only way. But what we
are actually saying here, is that not just when people desperately need
beds, but when we want to try and make sure that we're maintaining the
service, let's think about what capacity is available locally, if it's
the right quality, if it's also the right price, because I'm not going
to give any blank cheques to the private sector around this, then let's
make sure that we use that as part of the whole range of things that we
are doing to try and make sure we run this Health Service effectively over
the winter.
HUMPHRYS: This is going to be a
big test for you, isn't it? Perhaps the big test for you. If we have
another winter crisis in let us say, two years from now, you will have
failed, won't you.?
CRISP: Well, you can never guarantee
what might happen, and never precisely predict the future. I think I,
and the managers in the system need to be tested on two things. First
one is, how well have we prepared? Have we done all the things that it
is reasonable and sensible to do? Have we done the contingency planning,
and then secondly, when something goes wrong, and things go wrong, how
well do we respond? How quickly do we respond? Those are things we need
to do. And you know how well the NHS responds to a crisis.
HUMPHRYS: Well, sometimes well,
sometimes deplorably, but there we are. And one of the reasons why it
can't respond perhaps the way it ought to is a shortage of staff, nurses
and doctors. Now you talk about extra beds, and you talk about bigger hospitals,
and all of that is fine, but not if you cannot staff them with nurses,
and we are told, by the Royal College of Nursing, that there are twenty-thousand
vacancies at the moment, let alone having to staff new and bigger hospitals.
CRISP: Yes, you're quite right
that staffing is the real constraint on the growth in capacity.
HUMPHRYS: Well how are you going
to sort that?
CRISP: We are already seeing an
increase in the number of people in post. There are two figures here,
there's the numbers in post and the number of vacancies. We in London
have increased the numbers of posts in London, we have also increased the
numbers of nurses in staff, er, nurses in post. And we need to see that
continuing. And there's a lot of ways of trying to do that. I mean, one
of them is about making sure that the working environment is good, making
sure that people have opportunities, another one is about training more
people, bringing more people back into nursing....
HUMPHRYS: ...And pay.
CRISP: ...and pay is clearly an
important issue.
HUMPHRYS: Christine Hancock of
the Royal College of Nursing says a substantial pay rise for every nurse
would kick start recruitment, motivate nurses to return and encourage others
to stay. Do you agree with that?
CRISP: I think pay is very important.
I think this government has a good record around increasing pay, it's got
a commitment to its staff, it recognises the importance of nurses, pay
is part of the overall package that we need to have in place to provide
housing for people. I mean the issues in London are very much around housing
and things like that.
HUMPHRYS: So there will be, in
the words of Christine Hancock, a substantial - that's the word she uses
- a substantial pay rise for every nurse.
CRISP: No, again you are actually
asking me something that I can't make a commitment on or a comment on at
this stage.
HUMPRHYS: But it's crucial, you've
acknowledged that.
CRISP: It will be one of the issues
that I will be looking at when I start taking up the post...
HUMPHRYS: But you cannot do what
you want to do without those nurses.
CRISP: You are absolutely right,
the nurses are the constraint and the really - nurses and other staff -
are the constraint to development and that's why we have seen and are seeing
a lot of work on housing. We have got many more places for nurses in London
to accommodate...
HUMPHRYS: But let's stick with
pay for the moment because that is absolutely crucial and if you cannot
make that commitment, then you cannot do your job.
CRISP: You have already heard from
this government in the past very considerable commitment to nurses and
to paying nurses appropriately..
HUMPHRYS: It's words, it's words,
it's action that they want..
CRISP: Well let's see, as I say
this isn't an issue that I have yet picked up as I haven't yet started
the job. But it's not the only issue and it's not the only issue that
nurses tell us about.
HUMPHRYS: Another issue is this,
you talk about the jobs that they do, hugely important. When senior posts
become vacant, we are told again by the Royal College, the grading is reduced.
So in other words, a new nurse comes in to take a job that her predecessor
had at a certain grade, that grade is cut, so she has to take actually
rather less money than she would have otherwise got and that's happening
all over the place. There are nine thousand fewer jobs for senior ward
sisters alone. Are you going to stop that?
CRISP: One of the things that we
have done is seen an increase in grading for some nurses so we have got
nurse consultants now, which we haven't had in the past and which I think
the RCN approves of and supports. I haven't actually seen the figures you
are talking about, I mean clearly we do need to make sure that we are paying
nurses appropriately, grading them appropriately and that particularly
when we are asking them to take on extra responsibility and one of the
things again about the NHS plan is to say that the staff within the NHS
need often to think about doing different things. You will see nurses
extending their roles, taking on wider skills and we do need to pay them
appropriately to do that.
HUMPRHYS: Alright...
CRISP: ..so I'll certainly look
at the figures from Christine..
HUMPHRYS: Final thought then, on
modernisation. A lot of people believe that consultants stand in the way
of modernisation and one of the things that the government has said it
wants to do, as part of the national plan, is to say to consultants that
after you have trained you have got to work for seven years in the NHS
without going private. They are saying no we are not going to go along
with that. Will you stand up to them?
CRISP: We will certainly enter
into discussions with them...
HUMPHRYS: ..that's not what I asked
you - are you going to stand up to them?
CRISP: I'm sure that we will stand
up to them in the right place and at the right time. Doctors are very
important to the NHS as you obviously know, it's.. and we're bringing them
into all kinds of management roles in different ways, the example I gave
you earlier of cancer, that is being driven by a leading cancer specialist.
We need doctors within the systems taking authority and taking important
roles. We also need to recognise that we pay for the training of doctors
and the development of doctors and that actually in an NHS that is under
as much pressure as we've just talked about, we need to make sure that
we retain those doctors within it.
HUMPHRYS: So the answer to the
question whether you will stand up to them in one word is yes.
CRISP: Indeed.
HUMPHRYS: Mr Crisp, thank you very
much indeed.
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