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JOHN HUMPHRYS: But first, the big story
of the week - the Health Service. Correction - the big story of the next
four years. That's what Tony Blair thinks it will be and who would argue
with him? The public services have become the main battleground between
the two big parties and this past week it's got personal. Iain Duncan Smith
cast aside the moderate approach he's cultivated since he became the Tory
leader and we saw some real bare-knuckle brawling in the House of Commons
on Wednesday. Who won? Well, it's hard to tell because the battle is still
being waged, even though Labour say they want to draw a line under the
argument over the way a 94 year-old woman was treated in a London hospital.
In the midst of all the emotion of the past few days it's not been easy
to see what the parties really want out of the Health Service over the
coming years and how they intend to get it.... and where they differ. So
let's talk to both sides.
For the government, the
Northern Ireland Secretary John Reid, who's in our Belfast studio and,
first, the Shadow Health Secretary Liam Fox.
Dr Fox, time to call a
truce on the use of individual cases, such as that of the old lady?
DR LIAM FOX: Well I think this case has
actually come to an end in terms of the details emerging on that one. I
think there are general points to be made about when you use individual
cases in politics. Number one of course has to be that the individual concerned
wants their case to be raised, which of course was what happened here when
the family themselves wanted to raise the case and did so with the Evening
Standard. The second thing I think has to be taken into account is, is
this an isolated case or is it something that shows a general trend and
the reason that I think this case had resonance with the public and the
reason that the government had such an incredible response to it was because
up and down the country people will say, well I know something similar
that happened to my next door neighbour or my granny and we've already
had the Audit Commission report showing that in Accident and Emergencies
up and down the country, an independent report saying that things have
been getting worse, patients have been waiting longer.
HUMPHRYS: But you yourself can't
have been very happy about it. I mean you've been reminded of what you
said back in 1992, dredging up personal cases of misery to find out the
one that's gone badly wrong in the NHS, etc etc. It's loathsome.
FOX: Well, if it's the
one case that's gone wrong and the point I'm making is that I think that
most of the public will say this is happening a bit too often. We all know
of cases of people who have been waiting in Accident and Emergency and
then of course we have the two consultants today from the Kent and Canterbury
Hospital, working there for over twenty years, saying that this has been
happening, not on a one off, but actually quite often and this is a case
where consultants are raising the cases on behalf of the patients.
HUMPHRYS: So we might see Iain
Duncan Smith on the floor of the House of Commons tackling Tony Blair in
quite this same way in the future, unless of course he's getting a bit
nervous after the treatment he got last week.
FOX: Well, it is perfectly
legitimate to continue to press the government on the quality of the health
care that we get. And you know, it's been a very strange tactic by the
government, the first response was to deny that anything had happened,
the Health Secretary said that the...it was almost untrue what the family
had said, it was fiction. The second response was to try to smear the
family, they didn't care about the relatives...this old lady had some racist
problem which I think most people found pretty disgusting and the third
one is now to say, if you raise any complaints at all about it, you must
be trying to undermine the NHS itself. Well, I wonder how that explains
doctors who are raising their own complaints on behalf of the patients.
HUMPHRYS: So, you are going to
keep doing it?
FOX: Well, that's our job,
is to raise the issues that the public are unhappy about...
HUMPHRYS: And if it means individual
cases, then so be it?
FOX: Well, if individuals
want their cases to be raised and these cases are indicative of what is
happening in the wider picture, then that will continue to happen.
FOX: ......if individuals
want their cases to be raised and these cases are indicative of what is
happening in the wider picture, then that will continue to happen.
HUMPHRYS: The fundamental charge
against you from Labour is that you are seeking, deliberately, to undermine
the NHS and there is something in that isn't there, because you want people
to pay more privately for their care and that inevitably will undermine
the NHS. That's bound to happen isn't it?
FOX: No, it's not a case
of undermining the NHS and this of course.....
HUMPHRYS: ..but you want people
to pay more privately for their care, that is what you want to do.
FOX: No and this is a preposterous
argument that if you raise legitimate concerns on behalf of patients, that
you're setting out to undermine the NHS or to damage the morale of doctors
and nurses inside the service. I mean I've worked in casualty, I know
how difficult it can be, but doctors and nurses are not a separate group
from the patients, they actually care about.....
HUMPHRYS: But I'm making a slightly
separate point here, I'm making the point about you wanting us to pay more
privately and it is that, ultimately, that will undermine the NHS, the
whole ethos of the NHS.
FOX: Well, what you have
to do if you want to do what the Prime Minister says, to bring our care
up to other countries and our levels of spending up, is that you will have
to have expenditure that goes on top of whatever you're doing in the NHS.
It is not a question of either/or, it will be a question of augmenting
it and that will also mean that we have to have a quality, publicly provided
healthcare system. And, you know I think it's very important in all of
this, that we remember what the essence of this debate is, it's not about
the system, it's about the patients. And if there's a difference emerging
between the parties, I think it's that we see the patients as being at
the centre and the system should try to accommodate them. Labour seem
to be saying, you must defend the system at all costs and try to squeeze
the patients into it. Well, I think there is a fundamental, philosophical
difference.
HUMPHRYS: Yes, but the point about
the undermining point, is that if you do undermine the NHS in all sorts
of different ways and it might be by raising the kind of case you raised
on Monday, on Tuesday or whatever, or Wednesday, you will then encourage
people, people will then say, oh it's a bloody awful service, I will sign
up for a bit of private medicine. That is the effect that you seek in
effect.
FOX: What I would like
to see is a wide debate on how we provide proper healthcare to people in
Britain, how it can be that the fourth richest country in the world is
being overtaken by countries who are a lot poorer than we are, and I want
a proper debate on how we think about funding the service, how we go about
organising the service, and I think that one of the prime problems the
government's had this week is they can't decide whether they're the government
representing taxpayers and those who receive public services or whether
they are themselves the NHS.
HUMPHRYS: Mm, but the reason that
I'm pressing you about this is because of something that you said just
a few months ago and let me quote it to you: "it was a mistake merely to
promise to match Labour's spending plans, the funding handicap of the NHS
comes from our inability to top up state spending with private income".
Well, that proves doesn't it, that you want to replace the NHS with something
different. It might be better, it might be worse, but it would not be
the NHS that we presently have, that's the point.
FOX: If I'd wanted to use
the word replace, not top up John, I'm sure I would have done so.
HUMPHRYS: But if you top up sufficiently
then you fundamentally change the NHS, that is the point isn't it?
FOX: No, it's not topping
up the NHS, it is making sure that beyond the NHS we also have other provision,
and we're also able to access that. It means going beyond what we have
at the present time, it's quite clear that the NHS as we have at the moment
is not actually giving people in Britain the quality of care they require,
and I think that all of us should be very concerned about whether we're
simply accepting a model which was designed in the nineteen-forties and
trying to apply it to the Twenty First Century.
HUMPHRYS: Yes, but they would say,
they do say, look at least we are putting the money into it, might even
have to raise taxes to do so and that's going to improve the service.
You're not even prepared to go that far.
FOX: Well, I think that
we have to ask with taxes having been raised and the government undoubtedly
having spent billions extra on the NHS where it's gone, because we're certainly
not seeing when people are using the service is this benefit. We know
that taxes have been raised, we all know our taxes have gone up and yet
patients are waiting longer to see their GP, they're waiting longer in
Accident and Emergency, there are over a hundred-and fifty-thousand extra
people on a waiting list just to get on the waiting list, so clearly it
is not working, there is something fundamentally wrong with a system that
leaves....
HUMPHRYS: The lesson you draw from
that is a bit more private spending and not necessarily a lot more public
spending.
FOX: The lesson I draw
from that is that we need to be looking at the experience of other countries
to see where they've been successful, where we haven't, how we organise
the system, how we fund the system, all these questions. It's time for
a proper mature debate in this country and to get away from what I think
has become an intellectually appalling level of debate that we've had to
suffer in recent years.
HUMPHRYS: Liam Fox, thank you very
much indeed.
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