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TERRY DIGNAN: For those who use private
medicine, it's a speedy journey to treatment. But it's taken Labour much
longer to reconcile itself to the private sector.
UNNAMED WOMAN: Good morning. Welcome to the London
Independent.
DIGNAN: The Tories were once accused
of privatising the NHS with internal markets. So the speed at which Labour
has embraced the private sector has shocked many in the party. The Government
now pays for NHS patients to be treated in hospitals like this one, the
London Independent. The next step is for the private sector to take over
NHS services.
The Government regards this as a bold and radical agenda. It's certainly
alarmed the unions and many Labour MPs. Some even talk of a war against
privatisation. Yet supporters of the private sector aren't too happy either.
They fear the policy may be watered down if ministers try too hard to placate
their critics.
PROFESSOR JULIAN LE GRAND: On the one hand it's being pressurised
by its traditional supporters, the public sector unions particularly, to
rule out the use of the private sector in health and education. On the
other hand it can see the logic of actually looking to who provides the
best service, whether it's in the private sector or the public sector.
Now, those two things run into conflict and I think you are seeing government
ministers finding that conflict quite difficult to manage.
DAVID HINCHLIFFE MP: I feel that within the Parliamentary
Labour Party there would be tremendous opposition to any moves in terms
of increasing the existing role of the private sector in the National Health
Service.
DIGNAN: When Tony Blair's battlebus
arrived in Birmingham for the launch of Labour's election manifesto, few
in the party realised what was in store for public services. In England
and Wales the private sector was to be given the green light. Services
would remain free but there'd be no ideological bar to managing them privately.
TONY BLAIR: There should be no barriers,
no dogma, no vested interests that stand in the way of delivering the very
best services for our people.
JOHN EDMONDS; The whole idea of private
sector management in the health service, seemed to come up in the campaign
out of nowhere. I mean I've been a part of the policy commissions of the
party and that wasn't discussed there. There is a hint of it in the manifesto
- a bit surprised that was included. But then the Prime Minister made a
speech with a bigger hint and of course what then happened is the journalists
were told 'have a look at the report by this think tank, IPPR' and a few
bits of that were leaked and what we found then was a bit of a hidden agenda.
DIGNAN: The private sector is moving
into the NHS inexorably. Labour has embarked on a hospital-building programme
using the Private Finance Initiative. Under PFI new hospitals are paid
for and maintained by commercial companies. Even though some argue PFI
doesn't provide value for money, the IPPR, which is close to Labour, will
call this week for the policy to be extended.
LE GRAND: I think the logic of
PFI sends you towards saying, well what the government has to do is significantly
increase the role of the private sector in education and health. You can't
leave them just simply operating the ancillary services - it doesn't make
any sense, it doesn't work properly. What you've got to do is actually
be bolder and actually have the private sector manage - even own in some
cases - the whole organisation.
DIGNAN: Supporters of private sector
involvement believe the health service could be transformed by an influx
of the kind of commercial expertise that this hospital has.
ANTHONY COLMAN MP: I think there's a situation
where certainly in my experience having been a director of a FTSE 100 company
that you can get a situation where you as a private sector person, you
are perhaps more results orientated, more directional and more achievement
orientated than perhaps often occurs in the public sector.
DAVID METTER: You need management systems
and you need people that are motivated in order to be able to produce the
efficiencies on the scale that you need. And there's reason to believe
that the private sector would be able to do this better than the public
sector.
DIGNAN: Why do you say that?
METTER: Well the public sector
generally is not motivated by efficiency or what underlies efficiency is
the need for profit.
DIGNAN: Staff here know that the
London Independent must make a profit to survive. That may have become
easier now that these hospitals are taking in NHS patients whose operations
are paid for by the taxpayer. But many Labour MPs and union leaders are
promising confrontation with the Government if ministers go further and
allow a big expansion of the private sector into NHS hospitals.
HINCHLIFFE: I don't see that they've a
great deal to offer. I think that many of the examples of services that
have gone from public into the private sector - Railtrack for example -
very topical at the moment, don't auger well for what could happen in the
National Health Service.
EDMONDS: Whether or not there's
going to be a row depends on how far the government intends to go. If the
government simply wants to use spare capacity in the private sector, in
private sector hospitals, for extra operations, no one is going to object
to that. But if it means bringing private sector management, private sector
practices into the health service and the profit motive into the health
service, I think there's going to be a tremendous reaction from the public,
never mind the trade unions.
DIGNAN: While ministers have been
keen to talk up private sector involvement in the NHS, some of their recent
announcements suggest they're nervous of this policy. They've placed some
areas of the health service off limits to the private sector. It's argued
the Government's attitude appears contradictory. For example, ministers
say clinical staff such as doctors and nurses won't be treated in the same
way as ancillary staff many of whom have been transferred to the private
sector. And the Government is to experiment with keeping even ancillary
staff within the NHS at two PFI hospitals.
LE GRAND: Most people who've looked
at PFI think that's going in the wrong direction. If anything we should
be moving the other way towards actually giving the private sector more
control rather than less.
EDMONDS: The government's made
a series of statements ruling out things, clinical services will not be
privatised. Ancillary staff will not now be automatically transferred to
the private sector. That doesn't really leave anybody left. So it's very
difficult to see how the private sector can manage a hospital in these
circumstances, when the staff are apparently staying in the public sector.
It seems to me to be a recipe for a mess and I think the government has
got a lot of clarifying to do.
DIGNAN: At a private hospital like
this everyone is on a contract. If you're not up to the job, you're out.
Commercial organisations say they need the power to hire and fire if they're
to perform efficiently.
ANAESTHETIST: Good morning, sir. Welcome
to theatre. My name's Ron and I'm your anaesthetist for today.
DIGNAN: According to the private
sector, if it's to manage NHS staff, it must have control over them.
ANAESTHETIST: Here we go, just breathe
away normally, nice slow deep breaths. Off we go to sleep.
METTER: The issue does arise if
the employees are seconded what managerial controls and disciplines do
the service providers have over these employees. Now if they are able to
terminate their employment or terminate the secondment for poor performance,
for example, then some of the issues fall away.
DIGNAN: So, it's unclear how far
Tony Blair is prepared to go in allowing private management to run parts
of the NHS. The acid test is this - does he mean it when he says that neither
dogma nor vested interests should stand in the way of using the private
sector.
Labour says some of twenty new surgical units could be privately-run.
It could be an important step in evolving the private sector's role. Opponents
fear this will happen by stealth which could explain why again there's
vagueness about the proposal.
EDMONDS: The reference in the Labour
Party manifesto to special surgical units and the fact that these might
be managed in the private sector, I think adds confusion to confusion.
I mean special surgical units are what we used to call hospitals. So are
these going to be managed in the private sector? And are the doctors and
nurses in these particular establishments going to be managed by the private
sector? We don't know. We think not and some statements from the government
suggest not, but we're still not clear.
LE GRAND: What the government is
intending to do is use the private sector in a more incremental way. For
instance, if they set up new services like a specialist cataract operation...factory
in a sense, a specialist, a specialist unit that would just do cataracts,
that could be managed by the private sector. Pathology services could be
managed by the private sector. And in the long run, that may well evolve
towards actually transferring a whole hospital to the private sector and
seeing, comparing how that works in contrast to the public sector.
HINCHLIFFE: Well I would personally see
that as being a complete betrayal of everything the Labour Party stood
for, since the 1940s, when we introduced the National Health Service. I
think it would quite frankly cause outrage within mainstream Labour Party
circles who are already uneasy about some of the noises being made about
greater involvement of the private sector.
DIGNAN: Independent hospitals are
offering NHS patients the best that money can buy. Now Tony Blair wants
private sector expertise to be extended to the public sector. He's being
advised to allow companies to take over a number of NHS hospitals.
LE GRAND: If we were moving towards
something like ten per cent, I would think that would give quite a useful
gingering up process for the National Health Service and that might be
the target to aim for.
DIGNAN: The Government wants to
go in the direction of more private sector involvement in the NHS. But
will the pace at which it pursues this policy be slowed by attempts to
reassure opponents of the idea?
HINCHLIFFE: We're gonna go half-way and
I don't believe that that's achievable and I think that the problem that
the government have got at the moment is how they can in practical terms,
bring this new ideology into the health service without it having quite
damaging effects.
LE GRAND: I think the government
does have to start presenting a consistent picture on this, I think that
they are committed to some sort of bold transformation of public services
and all credit to them for that, but that does mean that they are probably
going to have to bite the bullet, of certain areas, like involving the
private sector to a much greater extent than they previously have so far.
DIGNAN: So has Tony Blair got the
nerve to take the NHS into the bright new world of the private sector?
If he really believes that's the way to transform the health service, he's
going to have to take on those he calls the forces of conservatism - the
unions and their allies in the Labour Party. He says he's got the scars
on his back from previous confrontations. This time the stakes are much
higher.
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