BBC On The Record - Broadcast: 02.12.01

Interview: ALAN MILBURN MP, Health Secretary

Reiterates the Government's commitment to reach the European average of health spending by 2005 and explains how he intends reforms to the NHS will give more choice to patients.

JOHN HUMPHRYS: Terry Dignan reporting there, well the Health Secretary, Alan Milburn, is in our Newcastle studio. Good afternoon, Mr Milburn. ALAN MILBURN MP: Good afternoon, John. HUMPHRYS: Can we clear up this thing about the commitment to achieving the European average of spending by 2005. Are we committed to that or are we not? MILBURN: Yes, that's precisely what we're aiming to do and we're making good progress towards it. The European average at the moment I think is around seven point nine per cent of GDP across the European Union nations, we reckon that by 2003/4 will be at around seven point six per cent. So we are well on target to reaching that eventual aim. HUMPHRYS: The reason I ask the question though, as you'll know, is that Mr Blair said on Wednesday in the House of Commons, straightforwardly in an answer to a question from Charles Kennedy - are we committed? - he said of course. This morning, in the Independent on Sunday, to whom he gave an interview, he said "I'm not deciding the spending levels now but in broad terms we've got to match other European countries". Now, those are two very difficult answers aren't they. MILBURN: No, I don't think they are actually because there's a process underway here, Tony set out on the Frost programme a year or so ago, what our eventual aim was, which was to get up to European levels of spending on average. That's what we need to do and indeed the Wanless Report published just last week confirms what we all know, that we've had health care on the cheap for too long in this country, that we lag way behind in terms of spending and therefore some of the outcomes in health care that Liam Fox was talking about earlier and therefore we need to bridge that gap and we can do that over time. We are actually the fastest growing health care system of any country, major country in Europe right now. That's because of the extra levels of investment that are going in. There's a lot of catching up to do but as I say, by the end of the 2003/4 financial year, we will be at around seven point six per cent of GDP compared to an average of seven point nine per cent. And then for 2003/4 and forward to 2006, we'll be considering these issues in the spending review process that is now underway, informed helpfully by what Mr Wanless will come up with by the time of Gordon's budget next year. HUMPHRYS: Indeed, but two small problems with that. One is you use the word 'aim', Mr Blair used the word 'commitment' in the House of Commons on Wednesday and the other... MILBURN: ....not too terribly hung up on that to tell you the truth... HUMPHRYS:, no, well I think it's terribly important you see because if I can just finish that point, said aim and you said eventually. Now it was much more specific with Mr Blair than that wasn't it, he said there is a commitment to reach that figure by 2005, financial year 2005. Now there is a big difference there. MILBURN: That's what we're seeking to do John, precisely what we.. HUMPHRYS: ....seeking to do but is it a commitment. MILBURN: That is what we are seeking to do, that is what we want to do. Yes, that is what we want to do and Tony set that out again in the House of Commons this week and made the more, I think, important general point, that there's no such thing as a free lunch when it comes to health care and what Wanless usefully describes in my view, is the fact that first of all we have lagged way behind. Secondly, he assesses what is necessary in order to meet the demands on the National Health Service and then thirdly, we will have to decide what levels of investment we need to put into the NHS over a period of time to get up to European levels of the expenditure and hopefully, continue to grow the National Health Service, not just for a few years but for many decades. And in the end there are only one or two or maybe three ways of financing that gap, either we do it through general taxation, or we do it through social insurance systems like they have in France and Germany, or you get as Liam Fox seemed to be indicating, the Conservative position, that is that more and more people will have to pay for more and more aspects of their health care. One thing is absolutely clear, whatever happens, if we are going to have a health care system in our country, and a National Health Service that is up with the best in Europe, rather than behind the rest, then some way or other we are going to have to pay for it and sometimes, this is presented in my view as if, you know, through general taxation you are going to have to pay more, but through some other system, it all comes for free, it doesn't. HUMPHRYS: Well exactly. MILBURN: What we have got to decide, is what is the best way forward in order to get up to European levels of funding and to give our people, genuinely a health care system that is amongst the best in the world. HUMPHRYS: But what you said in that answer was "the best", the truth is surely isn't it, that you are not going to be happy with merely the European average because of course, averages have good countries and then bad countries. What you want, is that we should match the very best, whether it is France or Germany, or Sweden, that's the objective isn't it. MILBURN: I think that's what people in this country will be looking for, but what they will also know, is that for decades and decades and decades, our spending on the National Health Service, on health care generally in this country has lagged way behind. So we have got to take this one stage at a time. As I say, we are now putting more money in, that is beginning to bite in the National Health Service and you can see that with the extra doctors, the extra nurses. This year for the first time in thirty years in this country, we are actually increasing the number of beds in hospitals that have been cut back for thirty years and now they are rising. You are getting the waiting times down for the heart operations, we are making good progress actually on getting the waiting times more generally down for hospital operations, but we can only continue to sustain that if for the long term, we are prepared to put in sustainable and rising levels of investment and that is precisely what we are committed to doing. HUMPHRYS: And they will have to rise considerably, won't they, if we are talking about matching the best because Germany at the moment, ten point six per cent of GDP, France, nine point six per cent, Britain, six point seven per cent. Those are the World Bank figures, so there is a great yawning gap to make up there isn't there. MILBURN: There is, there's a huge gap to make up and I don't think anybody other than a fool or a mad man really believes that a few years of extra spending going into the National Health Service, which is what is happening now, can reverse decades of under spending in the National Health Service. It takes years to train the doctors and the nurses, to build the new hospitals. We've got a huge hospital building programme going on right now, actually the biggest that the National Health Service has ever seen. But it takes some time for these things to produce results. I think what is interesting about the Wanless figures actually, although people talk about the gap between our level of private spending and our compared to French or German levels of private spending. Actually, if you analyse the gap very closely between UK spending and German and French spending, you'll see actually that the biggest proportion of that gap is made up by under investment through public spending.... HUMPHRYS: ...well, exactly... MILBURN: the case of both France and Germany and it is that that we are beginning to put right now with the National Health Service as I say, growing at a much faster rate than other major European countries health care systems. But heaven knows, there is a huge gap to make up. HUMPHRYS: And that's the question that I wanted to address because clearly a lot more public spending needed. Now, the question is, how that money is raised? We are supposed to be having a debate about this and I wanted to check with you, I suppose, whether that debate is still open, that's to say, is there still a debate, a genuine debate, aiming to arrive at a consensus, as to whether that extra public spending is raised through general taxation, or a hypothecated - hideous word - hypothecated, ring fenced tax. Is that debate still open? MILBURN: Yes it is, we are going to have a debate, we're having a debate now. You've had Liam on your programme earlier, the newspapers today are full of debate about this issue. I think... HUMPHRYS: ...and the Cabinet? MILBURN: I think where the point of consensus I think lies, John, although I wasn't terribly clear from Liam Fox's answer that this was the Conservative commitment, I think there is now a recognition in this country that for decades, we've had health care on the cheap, that the National Health Service and the brilliant people who work in it, have been short changed and that what we now need to do, is not just get the investment in, but undertake some pretty far reaching and fundamental reforms, to ensure that we get the very best value for money for the extra investment that is going in. That is the debate that needs to take place and I personally believe that we should be very confident about the position that Gordon set out last week in the House of Commons. If there is a debate to be had about what is the best method of raising extra funds for the National Health Service, then actually raising money through general taxation has much going for it. And I think what Liam Fox and Iain Duncan Smith will find as they undertake their trips through Europe, is that actually there are very many downsides to the social insurance system. It lowers extra costs on employers and on jobs, the big concern in both France and Germany from the employers' federations there, is that actually these amount to taxes on labour mobility and productivity and that the best and fairest way actually, of raising money for a country's health system, is probably through general taxation, but let's have the debate. HUMPHRYS: And as far as you're concerned, that debate is as I say, is still open, the possibility of an hypothecated tax has not been ruled out and that debate is happening, not just in the newspapers and on this programme but within the Cabinet as well. MILBURN: Well I think...I watched Gordon this morning on the Frost programme and he quite rightly said that there is a debate to be had about all these issues. I think we've got to get this right in terms of how this ... HUMPHRYS: ...I thought he'd rather shut down the hypothecated version actually from his point of view, did I misread him there? MILBURN: Sorry? HUMPHRYS: I thought he'd rather closed down the possibility of an hypothecated tax himself. MILBURN: I think what he said is that there is a very important debate to be had, first of all, about assessing the level of demands and the challenges that the National Health Service will face and I suppose that is the first part of the Wanless Report, which he's now produced. Secondly, we need to consider how best to close that gap and indeed what level of funding will be required to do so. And finally, we've got to set out a very clear programme, not just of extra investment going into the NHS, but some big structural reforms to make sure that we have a service that is much more responsive to the needs of the patient and gets good value for money for the taxpayer. HUMPHRYS: Yes, because we're putting in billions more now, as you say, and it doesn't really seem to be making a great deal of difference to people's experience of the NHS, does it? MILBURN: I don't think that's true actually. Of course, look, there are real problems in the National Health Service, nobody denies that. I say that in every interview I do with you and other people John, but there are very real signs of progress too, we've got the biggest hospital building programme under way. We've got seventeen thousand more nurses, we've got seven thousand more doctors, more beds this year for the first time in thirty years. We're spending, this year alone, around two hundred and fifty million pounds on new and improved drugs, prescribing of cholesterol lowering drugs, that can prevent heart attacks ever taking place in the first place, they're up by one third, in just one year. The number of heart operations is dramatically up, but look, I don't deny for a moment that there are very real problems in the NHS and this is going to take some time to put right. That's what we said in last year's NHS plan, we said then that this was a plan for both investment and reform, that wasn't just for one or two years, but was going to take ten years and we've got to be honest with the British people about this - it is going to take some time to turn around. HUMPHRYS: And you'd agree, would you, that some things in some areas of the NHS are going backwards? MILBURN: Well I think there are real problems and I think actually what we've got is some pretty differential performance and indeed your own film suggested that. We've got some hospitals like Heartlands in Birmingham which is doing very well and getting the waiting times down. We've got some hospitals which already have a maximum wait of six months for a hospital operation, others are struggling with a wait of eighteen months, but what I'm absolutely confident about is that by Spring next year as we said we would, we will achieve two things. First of all, there will be a maximum wait for operations of fifteen months, down from eighteen months. That is still too long, but it's a staging post to where we need to get to which is a maximum wait of six months and then finally of three months and secondly, that for people waiting for heart operations, because of the fantastic progress that the heart surgeons, the cardiologists, the nurses and others are making, we can go one stage further and say that by Spring next year, nobody will be waiting more than twelve months for a heart operation. That is too long but it represents real progress going on and you know the Prime Minister's phrase about this seems to me to be absolutely right, the glass is half-full and not half-empty and what is more it is being topped up and providing we have the courage to keep putting the investment in and crucially, to make the reforms that are needed in the National Health Service we can make further progress. HUMPHRYS: But as you say, those waiting times are still hugely too long as far as everybody listening to this programme is concerned. It is being suggested now that if we can't get to the sort of levels you talk about, if we have to wait more than six months for instance for an operation, you're prepared to say well then we can go privately, on the NHS, as it were, or go somewhere in Europe to get it done, is that right.Are you going to suggest that? MILBURN: These are issues precisely that we are considering now. You see there is a big programme of reform going on in the National Health Service and I think if you talk to people in the NHS most people would say that it isn't a case of too little reform, actually there's a huge amount of reform going on. We've got the National Standards in place for the first time now, National Inspection too. We've got, I think, a better relationship between health and social care. We've got good incentives for the first time on the hospitals. If you're doing well as a hospital, you should have more freedom and more resources to do even better, just like the schools. If you're doing badly, there should be more help and support and where necessary, intervention. And yes, I think there is a more sensible relationship now between the public and the private sectors and what we are trying to move towards and this is where I want to take the reform programme is away from the old style National Health Service, a monolithic top-down organisation, an old style nationalised industry, towards an NHS that is much more responsive to its patients, much more diverse, with a greater plurality of providers where you have both the private sector involved and the public sector too. So that you expand the capacity available to NHS patients and yes I happen to believe that what we should be doing is offering patients more choice and particularly for those people who've been waiting longest for treatment and we are considering right now how best that could be given effect so if you've say, been waiting for six months for a hospital operation, rather than being stuck in a long queue, we should be able to say to the patient, look, there is an alternative here. Would you like to be treated in another NHS hospital, that might have a shorter waiting time, or a private sector hospital, or if it suits you, and it matches your clinical need, maybe you should be treated in Europe. HUMPHRYS: And when are we going to be able to make that decision for ourselves then? MILBURN: Well I hope that we'll be able to do that very shortly and indeed I hope to be saying something more about this over the course of the next week or so. We now have an extra one billion pounds going into the National Health Service in the UK, that's around eight hundred and fifty million pounds, as a result of Gordon's pre-budget report last week. And what I want to do with that is to get the waiting times down and to drive further reforms into the National Health Service and I've always said this and indeed I've been saying it loud and clear over the course of the last week since Gordon spoke in the House of Commons, that if we're going to have more investment in the National Health Service, then that has to be matched with more reform. Now that is what we need to do because I simply do not believe that what people would be prepared to do is to put more money into the National Health Service without seeing that actually that is going to produce results, more reforms therefore will be needed. HUMPHRYS: And should GPs, should doctors themselves be able themselves to make wider choices on behalf of their own patients, in other words, you know, to have much more independence? MILBURN: Well I think actually that I'd like to get to a position where with the really good hospitals, rather than them being simply controlled from the centre, they should have more freedom to get on and do the job, frankly I have to worry less about the good hospitals, the ones that I really have to worry about are the poorly performing hospitals and what we now have is a means to ratchet up performance in all NHS hospitals and in primary care too. That's what the modernisation agency is about, it's what the independent inspectorate, the Commission for Health, improvement is all about, but where I really want to get to is a position where if you like it isn't just GPs who have choices about where patients are treated but crucially it is patients themselves who have some choice. HUMPHRYS: Have to end it there I fear. Alan Milburn, thanks very much indeed for joining us.
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.