BBC On The Record - Broadcast: 02.12.01

==================================================================================== 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 ==================================================================================== ON THE RECORD RECORDED FROM TRANSMISSION: BBC ONE DATE: 02.12.01 ==================================================================================== JOHN HUMPHRYS: Good afternoon and welcome back to On the Record. There's been a lot happening on the domestic political front while we've been reporting on the war and the big story this past week has been the Health Service. In the next hour I'll be talking to the Health Secretary Alan Milburn and to his Conservative Shadow Liam Fox. The Government wants to raise the extra money needed to improve the NHS through taxing us ... but how? And is there a better way. And we'll also be reporting on the implications of the European arrest warrant. Might there be more Britons languishing in Greek jails? That's after the news read by Peter Sissons. NEWS HUMPHRYS: Thank you Peter. Gordon Brown laid it on the line for us this past week, we're going to have to pay higher taxes to improve the Health Service. Tony Blair agreed. But how? Will the extra cash come from straightforward tax increases or is there another way. That's one of the things I'll be talking to the Health Secretary Alan Milburn about later in the programme. But the Conservatives have their own questions to answer in this area. They want to change things and maybe get us to pay more for our own treatment, just as they do in many European countries whose health services we envy. That's why their leader Iain Duncan Smith and the Health Spokesman Dr Liam Fox are off to Sweden tonight. Well Dr Fox has already been to Germany to have a look at their Health Service and David Grossman went with him. DAVID GROSSMAN: The Conservatives long journey to the next election is beginning with a little trip. Dr Liam Fox the Shadow Health Secretary is today visiting Germany, a country with hospitals so efficient the only trolleys in the corridors are moving and enquiries about waiting lists meet with blank incomprehension. In this happy land of medical plenty the Tories are looking for a Health policy. DANIEL FINKELSTEIN: The Conservative Party's looking all around Europe at solutions that other countries are using successfully to blend private finance with public finance. ANDREW LANSLEY MP: The NHS is not being sustained at the moment at an adequate standard, in a sense the issue is not should the NHS change or not? It must change. GROSSMAN: If the NHS was ever the envy of the world they certainly seem to have overcome their jealousy in places like Berlin. The Conservatives think that the way they deliver healthcare here, particularly the mixture of public and private provision could have important lessons for the UK, and for their chances of assembling a set of policies on public services that the electorate will take to. It's not hard to see why the Tories are looking to Europe for clues on how to improve the NHS. In the treatment of many diseases patients are significantly better off than they are in the UK. With prostate cancer for example, sixty-seven point six per cent of patients in Germany survive at least five years after diagnosis. In France the rate is only slightly less at sixty-one point seven per cent. But within the UK England has the worst survival rate, way down at forty-four point three per cent. With Leukemia too, five year survival rates in Germany are thirty-nine per cent, in France forty-four point nine per cent with England lagging well behind at twenty-seven point nine per cent. RUTH LEA: I think the first thing if you look at different types of cancers then the survival rates tend to be much poorer and poorer in this country than they do on the Continent, but I think where you really see the difference is in things like waiting times and waiting lists. If you talk to doctors in Germany or in France they just don't understand the concept of a waiting time, here we understand it only too well and I think that's where the biggest problems are. GROSSMAN: The Think Tank Civitas hosts a seminar on Health. Until recently the German system was a bit like German cuisine, largely ignored overseas. It's recipe with a greater role for the private sector is essentially unchanged since Bismarck's day, but is now very definitely in vogue. The message from Professor Friedrich Breyer of the University of Konstanz is that it's a system based on choice and autonomy, with the state, companies and individuals all contributing to achieve results that can leave the NHS standing. PROFESSOR FRIEDRICH BREYER: I wouldn't call the NHS the envy of the world, because the way patients are treated in this system is more favourable in most European countries. We have free choice of physicians, we have practically no waiting lists. GROSSMAN: Undoubtedly, one reason why they're able to achieve significantly better results on the Continent is that their health systems are far better funded. The proportion of the country's earnings spent on publicly funded healthcare in Germany is seven-point-nine per cent, in France it's seven-point-three per cent, whereas in Britain it's just five-point-six per cent. The funding gap doesn't end there - when you add the amount of private money spent in each country the total in Germany becomes ten-point-six per cent, in France nine-point-six per cent and in Britain just six-point-seven per cent. LEA: I think it's absolutely vital that you get more money into a healthcare system, clearly we do pay less as a percentage of GDP than they do on the Continent, certainly in France and Germany, and I think the biggest shortfall here is actually on the private sector rather than the public sector, although we fall down on the public sector as well. I think the key thing is, yes we can see that Gordon Brown's going to put more taxpayer funded money in, but with changes to healthcare, you've got demographic changes, you've got technology changes, you've got changing expectations, at the end of the day I think people will have to be incentivised to spend more of their own money on healthcare if we're really going to get up to the standards of the Continent. LANSLEY; I'm sure it will be the case in the long run that publicly funded healthcare is part of a mix and people who are able to make a contribution do make a contribution to it, probably primarily through employer-funded health insurance packages. GROSSMAN: Dr Liam Fox makes a house call. Inside Berlin GP Dr Roland Krasser's surgery it's modern and well-equipped. In Britain The Prime Minister has this week re-committed Labour to pushing NHS spending up the EU average within four years. But any new money it seems must come from general taxation. That could leave the Tories clear to propose more private finance. Coming to Europe and looking for ideas about how to reorganise the NHS is one thing. Taking those ideas back to the UK and trying to convince a sceptical British public is another matter altogether. Some Conservatives fear that however attractive the idea of putting more private sector involvement in the Health Service might be to them it's just the sort of policy that could terrify an already hostile British electorate. FINKELSTEIN: I think that the problem of involving private finance, involving private organisations in the National Health Service, in having some measure of mix between public and private insurance, has not, is not the scary concept that it was five years ago, partly because the Labour Party has talked so much about these things. Nevertheless, behind all those things lie severe dangers that people will worry that something they value, free NHS at the point of use, might be being endangered, so the Party's got to come up with radical interesting ideas that can make a real difference while at the same time reassuring people that it won't change the things that they value the most and that's a very difficult combination, it's not impossible but it's difficult. GROSSMAN: Andrew Lansley and Liam Fox struggle to lift Tory gloom during the last election campaign. Then their message on Health concentrated on Labour's failings, definitely not proposing radical Tory solutions. LANSLEY: I think the world has moved on, I think the experience of the last four years has said to the British public that Labour didn't have the answers that they thought they did in 1997 and I think the public now are more open-minded about the changes that are going to be needed in the future in order to provide healthcare, and I think that may therefore give the Conservative Party a considerable opportunity. GROSSMAN: But are voters really any more receptive to new ideas now? On the Record commissioned some research to see how such policies might go down with voters. We asked: If the Conservatives proposed that a higher proportion of healthcare be paid for by private insurance, would you approve? Thirty-one per cent did, whilst fifty-seven per cent disapproved. We also asked: If the Tories proposed that some treatments currently provided for free by the NHS should in future be paid for privately by patients, only nineteen per cent thought it was a good idea whilst seventy-two per cent didn't like the idea. Finally, and perhaps more encouragingly for the Tories when we asked if the Conservatives proposed making private hospitals play a bigger part within the NHS, fifty-three per cent approved whilst thirty-six pr cent disapproved of the idea. FINKELSTEIN: The Conservative Party knows that radical solutions are necessary, it doesn't believe that the current system could be managed as it is, but on the other hand, if you propose radical alternatives you immediately run into the problem that people may distrust those solutions and particularly if they're advanced by a Conservative Party they don't traditionally associate with caring about the NHS, so it's a big opportunity, but it's also a big problem. GROSSMAN: It's back to the airport for the Tory health team for the flight home. Having lots of ideas from abroad will certainly help - they're off to Stockholm tonight to give the Swedish system a check up. The real test though is turning all these air miles into a workable prescription for the NHS and getting UK voters to swallow it. 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. HUMPHRYS: And that then is the Conservative view. The Government is quite clear on at least one principle, the extra money for the NHS must come from the State. But that still leaves various possibilities as to how it is raised and whether, for instance, it should be ring-fenced or hypothecated in the jargon. Gordon Brown has also said that the NHS will have to show it can improve itself if it's to get all the extra cash. How will it do that, I'll be asking the Health Secretary Alan Milburn, as I said, after this report from Terry Dignan. 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 going. 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 way. 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 capacity. 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 choose. 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 been mentioned. 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 him alive. 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 required. 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. HUMPHRYS: A dozen British people are still in prison in Greece because they went there to do a bit of plane-spotting and ended up being accused of spying. Poor souls. They've now spent nearly a month in the cells without even being charged. That couldn't happen here, but it's commonplace on the Continent. And now, as Paola Buonadonna reports, we're about to sign up to a European directive that will allow people in Britain to be arrested on the say-so of a European judge. PAOLA BUONADONNA: Plane spotting - an unusual hobby perhaps but is it spying? The fight against terrorism in Europe has focused politicians' minds on the need for quick action and tough legislation. But that creates a different kind of danger for the ordinary person. The twelve British plane enthusiasts arrested in Greece appear to be the victims of a culture clash. The Greek authorities don't appreciate foreigners taking an interest in their military. After twenty-four days in custody they still haven't been charged - just one of the many stark differences between the British and the Greek justice systems. Here in Britain tough new anti-terrorism measures are being rushed through Parliament. But there's also a European law on the way which could be even more wide-ranging and has received even less scrutiny. Next week home affairs ministers from across the EU will agree the final wording for a common definition of terrorism and a European arrest warrant for all serious crimes. The following week Tony Blair and his colleagues are expected to seal the deal at a summit in Belgium. It will be the biggest step so far towards a common European justice system - yet it's hardly been discussed. GWYNETH DUNWOODY MP: These are fundamental constitutional changes. Very important changes for you and me. They should not be rushed through in this unmannerly, untimely and dangerous manner. OLIVER LETWIN MP: We want to make sure that except in the very restricted case of terrorism, we don't have an arrangement where British policeman can be sent on a mission to arrest someone for a court in another country. GRAHAM WATSON MEP: Potentially it is a very big step towards one legal and police area in the European Union and it is being done without sufficient democratic scrutiny. BUONADONNA: Another court appearance for the twelve Brits but still no resolution. For some the case of the plane-spotters is a warning bell. They argue that involving the EU in criminal law could lead to far more miscarriages of justice. DUNWOODY: It's extraordinary that they've not even been charged. I'm very concerned that a British citizen should be put in this situation in this country, which is quite possible. In other words being arrested on some very 'iffy' evidence and then presumably taken anywhere else within the European community. BUONADONNA: The Belgian summit will produce a European arrest warrant to replace lengthy extradition procedures. A judge in any EU country could order the arrest of the citizen of any other for cross-border offences without the need for evidence. It applies to a long list of crimes, ranging from terrorism, to drugs, fraud, computer hacking, even xenophobia which is not a crime in Britain. British authorities will have to arrest the suspect and hand them over within sixty days. LETWIN: This arrest warrant would have a very wide power as it's currently conceived and that would mean that somebody who was arrested for quite small offences in a place like Greece could indeed be arrested in the UK, even if the person had returned to the UK. BUONADONNA: One British lorry driver knows all about being falsely accused of a crime abroad. At a lay-by on the Belgian border he swapped trailers and picked up a sealed cargo. He thought he was carrying plastic boxes. In France he was stopped and customs officials found 128 kilos of cannabis inside. That's when his ordeal began. DAVID BENNEY: I was arrested, I was then sort of handcuffed to the wall and questioned for twenty-four hours during which I wasn't given any food or drink, then I was transferred to the police station. I was then taken to, up in front of a judge and put in prison on remand, where I spent fourteen months waiting for a trial. Everything you get from the Court or the prison is all in French and there's no official translator in prison, so you just don't know what you're signing or what you're reading. There were seventeen men to a cell of all nationalities, so you can imagine what it was like in there. MILLIE BENNEY: I did feel isolated - I nearly lost the house. I just couldn't afford to really go out there, so I had to sort of like just limit myself to like three times in that whole fourteen months. BUONADONNA: The Benney family is slowly getting back to normal. Their middle son is turning six, and this year his dad will be there to celebrate. But it's hard to forget the bitterness of the forced separation. And despite being cleared of all charges David Benney has still not received an apology or compensation. Campaigners who fought to bring his case to public attention fear they will be even busier in the future. STEPHEN JAKOBI: The Euro warrant is based on a totally false notion that all justice systems are equal and good within the European Union. It's perfectly clear that for example the Greek justice system is not as good as the Dutch or British justice system and all the governments are busy selling this great lie. BUONADONNA: This is where David Benney spent fourteen months of his life - the remand centre in Dunkirk. As a foreigner prisoner he faced enormous difficulties - getting translation, proper legal advice, and most importantly bail. None of these basic safeguards are included in the European arrest warrant as it stands despite fierce lobbying. When EU leaders sign on the dotted line in just twelve days time they won't have to take into account suggestions from the European parliament here in Brussels. Yes, MEPs were consulted but they have no power to change the proposals. Nor will the British Parliament have much say. Yes, MPs and Lords were briefed on the proposals. But when the Lords looked at the legislation recently they were only given a copy in French. And when the text is finalised on Thursday it's going to be extremely difficult for anybody to change it. Short of the government making a complete U-turn on this the European arrest warrant will be a done deal in a fortnight's time. WATSON: This is being done without adequate discussion, debate at European level and in particular without the oversight of any parliament which can propose and force through amendments to the legislation being proposed by the governments. BUONADONNA: We asked the Home Office to respond to these concerns and explain why this measure is needed now and in such a hurry. But no Home Office minister was available for interview. In a statement they acknowledged the European arrest warrant marks a step change in European co-operation. They said it's aimed at serious cross-border crime and Britain cannot afford long delays in extraditing suspects to other EU countries which are, after all, mature democracies bound by the European Convention on Human Rights. David Benney is trying to make up for lost time. But it's not easy to catch up with the lives of his children. BENNEY: You're never gonna get the years back that you've missed. I've missed an awful lot, I've missed the littlest one starting to walk and his first day at school and things like that, you know it's, you can't get it back. JAKOBI: You're alright provided you take all your holidays in Bognor Regis and you're never mistaken for somebody else overseas you'll be fine, but if you ever go for a Spanish holiday or a holiday in the Mediterranean you are at risk and it's like lightning, lightning doesn't strike often but God when it does you know about it. DUNWOODY: What is appalling is that the first that most people will know is when it is applied and if it's a high profile case there will be enormous outrage and at that point, people will say, why did you let this happen? BUONADONNA: The plane-spotters caught in Greece continue to protest their innocence. If the European arrest warrant becomes law many more bewildered Brits might find themselves being purported to a distant prison on the orders of a foreign court. HUMPHRYS: Paola Buonadonna reporting there. And that's it for this week. If you're on the Internet don't forget about our web-site, we'll be back either as On The Record or The War Report, depending on what happens, at the same time next week, until then, good afternoon. 24 FoLdEd
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.