BBC On The Record - Broadcast: 02.12.01

Interview: DR LIAM FOX MP, Conservative Health Spokesman

Says the Tories are considering ways in which health care might be paid for more by consumers rather than through general taxation.

JOHN HUMPHRYS: Terry Dignan reporting there and with me in the studio is Dr Liam Fox. I have to say, who has arrived within the last fifteen seconds or so, so out of breath, not made up, but well done for making it, we had a bit of a problem getting you here, our fault not yours. Anyway, Labour, the Government is committed to the European average, presumably it's committed to the European average and presumably you will meet that? DR LIAM FOX: Is the Government committed to the European average? The Prime Minister told the House of Commons he'd an absolute commitment to do so. I read in the Independent this morning that he's not. I think either the Prime Minister is committed or he's misleading the House. HUMPHRYS: What do you think? FOX: I've absolutely no idea, because according to which paper you read this morning you get a different government policy on health. It seems that they are all over the place in complete chaos and it's a shambles of a policy. HUMPHRYS: If he is committed and possibly you'll be asking him that again in the House of Commons... FOX: I imagine we might. HUMPHRYS: I thought it was possible. If he is committed presumably again, you will match it? FOX: Well, there has to be a proper debate about it. We've got into this very sterile debate in the UK now about just money. What I've been doing going round Europe is looking at different European systems and how they deliver better care and I think we have to start the debate from a different point, which is what are the outcomes, what is the health system actually delivering in the UK. As I think I made this very point on the same programme some time ago, if you look at some of the indicators, for example stomach cancer, your chances of being alive in five years with stomach cancer in Britain I about seven per cent. In France, that's twenty-four per cent, in Germany it's thirty-five per cent. In the States it's forty-two per cent. Some things in the UK are actually a death sentence and that's unacceptable, so what we have to determine is how do we get a system that gives people in Britain the same chance of surviving these things as other countries. That requires a far wider debate than Labour is seemingly willing to undertake, so the Conservative Party will undertake it. HUMPHRYS: Will undertake it and when you rattle off that list of countries, you're obviously thinking of Germany which is where you've just been, you will want - you would want I imagine to match the best in Germany. FOX: And other countries too. It's not just Europe.... HUMPHRYS: It will cost money. FOX: I heard Kenneth Clarke this morning saying that the Conservative Party should be looking wider than Europe, at countries such as Australia and New Zealand and Ken will no doubt be delighted to know that that's in fact where I started. I started in Australia and New Zealand and there are a very wide range of issues to consider, how much money do you spend, that's obviously one of the issues.... HUMPHRYS: Answer, a lot. FOX: And - a lot, and probably a lot more than we spent in the United Kingdom to be frank, over the last forty years. And.... HUMPHRYS: Ah, well now, this is the point isn't it? FOX: No, it's not just the point... HUMPHRYS: It's not just the point but it's quite a very big point. FOX: The point is also how you arrange your health care system and how you fund it. Now we have in this country, have always had a very centralised system run from the centre and under the reforms currently being carried out by Alan Milburn it will become even more centralised than it is at the present time and I think that's entirely the wrong approach because I wouldn't want to jump to conclusions but certainly looking at the countries we've had so far, unless you have a system that's driven by the patients then you can't get a quality system with good outcome. HUMPHRYS: Alright, but however the system is organised as you acknowledge it is going to need a great deal more money. Now, I'm not quite clear to be perfectly honest whether you committed yourself in one of those answers or not, to matching the Government's commitment and I put the word "commitment" in inverted commas if you prefer, bearing in mind what Tony Blair said this morning, but nonetheless the Government's commitment to match the European level of spending by 2005. FOX: We're not going to be drawn into a sterile debate... HUMPHRYS: You won't even make that commitment? FOX: No, I won't be drawn into a debate because there's no chance of us being in charge of the Health Service, up to that point, that's up to the Government what they spend up to 2005. We're looking beyond that at the sort of widespread reforms that we need in the United Kingdom to get us up to the sort of outcomes they get in other countries. Now you're talking about the Government's commitment. The Chancellor gave a commitment on Tuesday to spend another billion in the next year on the NHS. On Wednesday, he told the Sun newspaper that the NHS wouldn't get another penny until it had been reformed in his way, so I'm not entirely clear what the commitment is week never mind in the long term. HUMPHRYS: Well, issues that I'll be raising with Mr Milburn in a few minutes, but do you think, and this hardly rests on profound policy thinking over the next few years, because I accept you're not in government, you don't have to make decisions for a while, but do you think that people should pay more themselves for their own health care, a straightforward simple question that. FOX: I think there are a lot of attractions in people being willing to look at the systems that they have in other countries, where the level of private spending on top of what the state spends is a lot higher than it is in the United Kingdom. It's also interesting to note that in the United Kingdom last year that eighty-four per cent of our spending came from the NHS on health, four per cent just came from insurance, but eleven per cent came from self pay, people using their own money from their own income or their own savings to supplement what was happening. So in fact there may well be a case that the public are actually moving ahead of the politicians here and trying to get themselves the freedom that the NHS won't give them. HUMPHRYS: Okay, will let's rattle through the options then, that face you, if you're looking at that as a sort of broad policy option. These are the options that I'm inviting you to consider. You don't have to commit yourself to them, because as you say you don't have to commit yourself to them yet, but consider, first of all that we pay directly for some bits of the service such as they do in France and indeed Sweden. FOX: Well, there are a huge number of range of things that people do. In France... HUMPHRYS: That's one, well let's just deal with that one in...... FOX: There's a lot of misconception abut what happen in France and I've been reading some very strange accounts of the French system in the papers recently, but what happens in France is that the state of course pays for eighty per cent, individuals will pay about twenty per cent, but the state will reimburse a large number of them and because so many people have supplementary insurance through mutual societies in France, only about five per cent of people pay anything at all. So this idea that the French are handing vast amounts of cash over to the doctor when they see the doctor is a complete misconception. HUMPHRYS: But they do pay more than we do..... FOX: They do make a contribution. There are things about the French system....... HUMPHRYS: And that's something you think we should consider. FOX: It's something that should be considered. Of course we would be very foolish not to consider all these things and I think that to have a closed mind and to say that only one possible system can be applied to the UK as the Chancellor is doing, is to deny people in Britain the chance to get up to the sort of outcomes and quality of care they get in other countries. HUMPHRYS: And would that approach of yours go - apply to the other two options that I was about to put to you. One is individuals taking up more of their own insurance however they do it, and two, encouraging companies to take out insurance for their employees, those are also things that you would consider? FOX: Well and the other one is social insurance, which is the one you didn't mention. There is social insurance, there is taking out more private insurance and of course that means a very different thing in different countries. In the United Kingdom people will tend to not want to take out private insurance because it's very expensive. They will claim it's got too many exemptions and so therefore they don't think it's value for money. In Australia for example when you take out private insurance it's what's called community rated with the risk spread across all those who buy the insurance which is the same price for everybody. That's something worth looking at. HUMPHRYS: Okay, ... FOX: The Australian model is very successful. HUMPHRYS: Just a final quick thought. You know as I do that the public are broadly sceptical about pretty well all of these other options. They may not know precisely what they want, but they're sceptical about all of these, in spite of that you are prepared to consider them? FOX: We have to do what we think is right, and if that means that we have to then make the case to the public to tell them why the NHS is no longer the envy of the world, why we've been falling behind for a long time and that there is a better way to give us the quality of care we deserve in this country, that's what we have to do, that's what responsible politicians do. HUMPHRYS: Liam Fox, thanks very much indeed and thanks once again for making such a Herculean effort to get here in time and you don't look too bad without make-up either. Many thanks.
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.