BBC On The Record - Broadcast: 02.12.01

Film: TERRY DIGNAN asks whether the extra money given to the NHS by the Government has produced improvements in health care.

TERRY DIGNAN: Eight weeks ago this would have been impossible. Retired air traffic controller Ray O'Connell was so ill he could barely walk. Now that he's had his heart by-pass operation, he can live normally. But it's no thanks to the NHS. He had to go private. RAY O'CONNELL: If you're told that you can expect a massive heart attack at any time in the next twelve to eighteen months and you're not going to survive and the waiting time on the NHS waiting list is anything from twelve months to two years, there is no choice, no choice whatsoever. DIGNAN: Here at the Department of Health, Alan Milburn is spending billions of extra pounds to produce a better NHS, although ministers are warning of even further reforms to the Health Service to make sure the money is being used effectively. Yet even these reforms and extra money may not be enough to achieve the transformation the Government requires. So Labour is seriously considering putting up taxes to pay for even further big increases in health spending by the time of the next election. Government spending on health - in real terms - after taking into account the effects of inflation in the three years up to 2004, will rise by an average of three point four billion pounds a year. Tony Blair promises that by the end of the financial year 2005/6 UK health spending will reach the European Union average. If the Government uses the narrowest definition of this figure, three point five billion pounds a year would be the extra needed, according to the Institute for Fiscal Studies. But the Institute says we'd have to put in another twelve billion pounds a year to come anywhere near France's health expenditure and even then we'd be a long way behind Germany. Ministers have told Birmingham Heartlands and all NHS hospitals, to reduce the time patients have to wait for treatment. Staff here are succeeding, says the Commission for Health Improvement. But many other hospitals are struggling to treat patients quicker. So the Chancellor, Gordon Brown, is warning that before the Health Service gets another penny of extra funding, it must show big improvements in its performance. JOHN EDMONDS: I think a lot of ministers and a lot of back benchers in the Labour Party are worried that the Government has set itself a very tough target of making not just marginal improvements but massive improvements in the Health Service by the next election. And there's really no sign at the moment that they're going to be able to deliver those massive improvements. DIGNAN: The Government is especially worried about waiting times. Labour promises that by 2005, outpatients won't wait longer than thirteen weeks for a first appointment. Inpatients will be treated within twenty-six weeks. But ministers are frustrated that there's been a slow start to reaching these targets. JOHN APPLEBY: In order to fulfil those targets the NHS will have to do a lot more activity. In crude terms, it's going to have to see a lot more patients and we know from recent statistics from the Department that this is simply not happening at the moment. DIGNAN: The figures show that the number of patients being called for 'elective' surgery - operations planned in advance - has been falling. ACTUALITY: I'm just going to pop this round your arm, alright. It is going to get tight. DIGNAN: And there's disappointment at the Department of Health over other levels of activity in the NHS, too. JULIAN LE GRAND: The activity levels, the levels of the number of patients treated and so on, is not increasing as fast as the Government thinks it should, especially in the light of the fact that all, the Government's been putting in all these extra resources and I think there's a real worry about that, about where is this extra money going. DIGNAN: The King's Fund, a think tank, has looked at how extra spending is affecting patient care. It's being eaten up by NHS inflation which is running higher than general pay and price rises. There's more spending on junior doctors' training, health authorities are clearing their debts and they're giving priority to targets for treating heart disease, cancer and mental illness. So health administrators have little left over to spend on targets for cutting overall waiting times. JOHN EDMONDS: Most people in the Health Service think that they're in the middle of a whirlwind at the moment, a whirlwind of paper, a multitude of targets, not all of which can be met. I mean people say if you've got three targets you can manage. If you've got three hundred targets forget it because you're being pulled every which way. DIGNAN: And shortages of trained doctors, nurses and equipment may make reducing waiting times even more difficult, for surgery especially. So, next year the Government is to pay for a hundred thousand people to be treated privately. Some hospital administrators are concerned about where this is leading. DR MARK GOLDMAN: In the longer term, I would like to think the investment will go into the NHS, so that we can develop that capacity. It is after all the same NHS personnel, the same NHS-trained people who are working in the private sector. They're not delivering better clinical care than we could in the NHS. They simply happen to have the capacity. JOHN APPLEBY: I think what's really underlying a lot of this stuff, especially buying care from the private sector, is a realisation that in order to meet, again, the key targets within the NHS plan on waiting times and other things, what the NHS needs is to expand its capacity very rapidly and it can't do that overnight. DIGNAN: Those who regard the National Health Service as Labour's greatest historic achievement worry about Government plans to buy treatment in the private sector and they say their apprehension is shared by Alan Milburn, who, it is argued, is merely following orders. DAVID HINCHLIFFE MP: I think there's a tension between the Prime Minister's views on the direction of the Health Service and the Secretary of State. I suspect the Secretary of State is probably nearer to me in terms of my view on involvement of the private sector, but he is clearly required to pursue a policy that does mean more involvement with the private sector, does not have the traditional Labour Party commitment to a collectivist view of the Health Service within State provision." DIGNAN: But even if the Government provides the NHS with all the operating theatres, beds, doctors and nurses that it needs, there's a worry that some hospitals will still fail to perform as well as this one. So Alan Milburn wants to give patients the right to decide - with their GPs - where they should go to get the best and quickest treatment. Some believe this could mean a return to the Conservative idea of competition in the Health Service. JULIAN LE GRAND: I think that we are beginning to see a revival of the idea of competition, the idea that hospitals perhaps need to compete with one another for the custom from local GPs. Now we've been down that route once before with the Conservatives' internal market and it had its pluses and it had its minuses but I think the Government is now coming to the view that an increased degree of competitive pressure on hospitals, will be no bad thing for the hospitals and that it also might give greater choices for patients. JOHN APPLEBY: I think what I and others find difficult to see is quite how you, you make that a reality unless you allow in a sense money to follow the patient. Now if you allow resources to move round the system following referral patterns for GP s and so on, then maybe you can see how you can introduce some more choice for patients. But I have to say that, that sort of model looks very like the internal market which this government came in to power avowing to dismantle. DIGNAN: At the moment most patients are sent to local hospitals by their GPs. The Government plans to give GPs working together in Primary Care Trusts a budget of forty billion pounds a year. It's being suggested by ministers that they'll be free to use the money to buy care not just at local hospitals but wherever their patients choose. JULIAN LE GRAND: The real problem that they will face is that if they seriously start moving their money away from their local hospital they will in - the hospital will, may well go bankrupt, or close to bankrupt, there'll be enormous political pressure on them, in order to, to remain, to keep their services with the local, local hospital. DAVID HINCHLIFFE MP: I believe that the choice that people should have is a choice to ensure that at their local hospital, they have access to the very best possible treatment that can be made available in their own area. I don't believe that within any health care system, there is a collectivised State system based on the key principles that we've had since the 1940s, it's possible to offer the kind of choice that's been mentioned. DIGNAN: Despite extra money there are still has too many queues. But Labour politicians can't afford to linger. Because unless voters notice improvements to the Health service, more of them may switch to the private sector. JULIAN LE GRAND: Now once that happens, the NHS is probably on a downward slope because they will start pressurising for things like tax relief on private health insurance, they will say well why should we pay twice over, we're paying our health insurance, why should we pay for the NHS as well. DIGNAN: Ray O'Connell can now enjoy retirement. Yet he feels angry that he had to pay for an operation to keep him alive. RAY O'CONNELL: I've not had the final bill in yet, but it's going to come about fourteen thousand pounds, which I object very strongly to paying, obviously. You know I've contributed to the NHS all my life and I really haven't used it very much, and when I need it, it just isn't there. DIGNAN: The Government wants the NHS to provide the kind of treatment the O'Connells had to pay for. Expectations have been raised that this is what Labour will deliver. But there are severe doubts over whether it can produce the reforms - and the money - that's required.
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.