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
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
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, no, well I think
it's terribly important you see because if I can just finish that point,
once..you 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
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
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
HUMPHRYS: ...well, exactly...
MILBURN: ..in 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
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
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?
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
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.