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
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
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
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
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
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
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