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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.
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