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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.
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
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
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
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
FOX: We're not going to
be drawn into a sterile debate...
HUMPHRYS: You won't even make that
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
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
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
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
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
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
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
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
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.
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
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
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
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
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
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