BBC On The Record - Broadcast: 02.12.01

Film: DAVID GROSSMAN follows Conservative Health Spokesman Dr Liam Fox MP to Germany to discover alternative ways of arranging health care.

DAVID GROSSMAN: The Conservatives long journey to the next election is beginning with a little trip. Dr Liam Fox the Shadow Health Secretary is today visiting Germany, a country with hospitals so efficient the only trolleys in the corridors are moving and enquiries about waiting lists meet with blank incomprehension. In this happy land of medical plenty the Tories are looking for a Health policy. DANIEL FINKELSTEIN: The Conservative Party's looking all around Europe at solutions that other countries are using successfully to blend private finance with public finance. ANDREW LANSLEY MP: The NHS is not being sustained at the moment at an adequate standard, in a sense the issue is not should the NHS change or not? It must change. GROSSMAN: If the NHS was ever the envy of the world they certainly seem to have overcome their jealousy in places like Berlin. The Conservatives think that the way they deliver healthcare here, particularly the mixture of public and private provision could have important lessons for the UK, and for their chances of assembling a set of policies on public services that the electorate will take to. It's not hard to see why the Tories are looking to Europe for clues on how to improve the NHS. In the treatment of many diseases patients are significantly better off than they are in the UK. With prostate cancer for example, sixty-seven point six per cent of patients in Germany survive at least five years after diagnosis. In France the rate is only slightly less at sixty-one point seven per cent. But within the UK England has the worst survival rate, way down at forty-four point three per cent. With Leukemia too, five year survival rates in Germany are thirty-nine per cent, in France forty-four point nine per cent with England lagging well behind at twenty-seven point nine per cent. RUTH LEA: I think the first thing if you look at different types of cancers then the survival rates tend to be much poorer and poorer in this country than they do on the Continent, but I think where you really see the difference is in things like waiting times and waiting lists. If you talk to doctors in Germany or in France they just don't understand the concept of a waiting time, here we understand it only too well and I think that's where the biggest problems are. GROSSMAN: The Think Tank Civitas hosts a seminar on Health. Until recently the German system was a bit like German cuisine, largely ignored overseas. It's recipe with a greater role for the private sector is essentially unchanged since Bismarck's day, but is now very definitely in vogue. The message from Professor Friedrich Breyer of the University of Konstanz is that it's a system based on choice and autonomy, with the state, companies and individuals all contributing to achieve results that can leave the NHS standing. PROFESSOR FRIEDRICH BREYER: I wouldn't call the NHS the envy of the world, because the way patients are treated in this system is more favourable in most European countries. We have free choice of physicians, we have practically no waiting lists. GROSSMAN: Undoubtedly, one reason why they're able to achieve significantly better results on the Continent is that their health systems are far better funded. The proportion of the country's earnings spent on publicly funded healthcare in Germany is seven-point-nine per cent, in France it's seven-point-three per cent, whereas in Britain it's just five-point-six per cent. The funding gap doesn't end there - when you add the amount of private money spent in each country the total in Germany becomes ten-point-six per cent, in France nine-point-six per cent and in Britain just six-point-seven per cent. LEA: I think it's absolutely vital that you get more money into a healthcare system, clearly we do pay less as a percentage of GDP than they do on the Continent, certainly in France and Germany, and I think the biggest shortfall here is actually on the private sector rather than the public sector, although we fall down on the public sector as well. I think the key thing is, yes we can see that Gordon Brown's going to put more taxpayer funded money in, but with changes to healthcare, you've got demographic changes, you've got technology changes, you've got changing expectations, at the end of the day I think people will have to be incentivised to spend more of their own money on healthcare if we're really going to get up to the standards of the Continent. LANSLEY; I'm sure it will be the case in the long run that publicly funded healthcare is part of a mix and people who are able to make a contribution do make a contribution to it, probably primarily through employer-funded health insurance packages. GROSSMAN: Dr Liam Fox makes a house call. Inside Berlin GP Dr Roland Krasser's surgery it's modern and well-equipped. In Britain The Prime Minister has this week re-committed Labour to pushing NHS spending up the EU average within four years. But any new money it seems must come from general taxation. That could leave the Tories clear to propose more private finance. Coming to Europe and looking for ideas about how to reorganise the NHS is one thing. Taking those ideas back to the UK and trying to convince a sceptical British public is another matter altogether. Some Conservatives fear that however attractive the idea of putting more private sector involvement in the Health Service might be to them it's just the sort of policy that could terrify an already hostile British electorate. FINKELSTEIN: I think that the problem of involving private finance, involving private organisations in the National Health Service, in having some measure of mix between public and private insurance, has not, is not the scary concept that it was five years ago, partly because the Labour Party has talked so much about these things. Nevertheless, behind all those things lie severe dangers that people will worry that something they value, free NHS at the point of use, might be being endangered, so the Party's got to come up with radical interesting ideas that can make a real difference while at the same time reassuring people that it won't change the things that they value the most and that's a very difficult combination, it's not impossible but it's difficult. GROSSMAN: Andrew Lansley and Liam Fox struggle to lift Tory gloom during the last election campaign. Then their message on Health concentrated on Labour's failings, definitely not proposing radical Tory solutions. LANSLEY: I think the world has moved on, I think the experience of the last four years has said to the British public that Labour didn't have the answers that they thought they did in 1997 and I think the public now are more open-minded about the changes that are going to be needed in the future in order to provide healthcare, and I think that may therefore give the Conservative Party a considerable opportunity. GROSSMAN: But are voters really any more receptive to new ideas now? On the Record commissioned some research to see how such policies might go down with voters. We asked: If the Conservatives proposed that a higher proportion of healthcare be paid for by private insurance, would you approve? Thirty-one per cent did, whilst fifty-seven per cent disapproved. We also asked: If the Tories proposed that some treatments currently provided for free by the NHS should in future be paid for privately by patients, only nineteen per cent thought it was a good idea whilst seventy-two per cent didn't like the idea. Finally, and perhaps more encouragingly for the Tories when we asked if the Conservatives proposed making private hospitals play a bigger part within the NHS, fifty-three per cent approved whilst thirty-six pr cent disapproved of the idea. FINKELSTEIN: The Conservative Party knows that radical solutions are necessary, it doesn't believe that the current system could be managed as it is, but on the other hand, if you propose radical alternatives you immediately run into the problem that people may distrust those solutions and particularly if they're advanced by a Conservative Party they don't traditionally associate with caring about the NHS, so it's a big opportunity, but it's also a big problem. GROSSMAN: It's back to the airport for the Tory health team for the flight home. Having lots of ideas from abroad will certainly help - they're off to Stockholm tonight to give the Swedish system a check up. The real test though is turning all these air miles into a workable prescription for the NHS and getting UK voters to swallow it.
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.