DAVID GROSSMAN: The NHS is gazing into a brighter
future . The Chancellor has poured in billions of new money in his Budget
and the Health Secretary has followed this up with a set of reforms that
are on paper at least radical. It all amounts, it's claimed, to a revolution
in the way that healthcare works.
Amid the thousands of words that Ministers have used to describe their
health reform programme, two above all deserve detailed scrutiny, devolution
and choice. The government says it's going to devolve decision-making and
spending in its new-look NHS down to the surgeries and wards, to doctors
and nurses. And that within a few years, patients will have complete choice
as to where and when they receive treatment. But some doubt whether the
government's really prepared to let go of day to day control of the NHS
or that ultimately patients will have any real meaningful choice.
The government has already
lavished billions more on the health service. IN the last year, the total
NHS budge in England rose from forty-four and a half billion to over forty-eight
point eight billion pounds. A huge rise but the results so far have been
harder to spot. Over the same period the average wait for an operation
has fallen hardly at all from four point two months in Two-thousand, to
Two-thousand and one, to four-point-one months in Two-thousand-and-one
to two, a fall of just about three days.
PROFESSOR JULIAN LE GRAND: The government pours money in,
nothing happens. I mean one of the interesting things at the moment is
that the government's been putting a lot of money into the NHS, and of
course is going to put a whole lot more, but activity and the amount of
activity going on in the NHS has remained virtually static. And the government's
really rethinking its strategy, how to deal with that.
GROSSMAN: As well as extra funds,
ministers believe that the key to delivering on their health pledges is
to devolve power and spending in the health service down to those who take
the temperatures and give the injections. In order to do this, they've
set up three-hundred-and-two primary care trusts in England and given them
an increasing chunk of the NHS's cash to spend In a few years ministers
say these PCT's will control three-quarters of the entire NHS budget. And
ministers have plans for hospitals too. They say that the better ones will
become almost completely independent. But critics say if you examine the
fine print on these freedoms, that ministers still retain far too much
control, far too much ability to micro-manage almost every aspect of health
In Exeter Dr David Jenner starts his rounds - he's been part of one of
the pilot Primary Care Trusts that's already been up and running for a
year. He says the principle behind them is sound but too often local initiative
is stifled by the requirement to meet national targets. In practice too
much of his budget he says, is spent for him by Whitehall.
DR DAVID JENNER: Because the government is still
very concerned that demonstrating value for money, they are very keen to
see benefit from the money they invest. And that is expressed through what
feels on the ground, like central control. I think the time has come now,
they, they've, they've made the steps, they've set up PCTs as the new organisation,
to let these organisations go a bit and have more freedom to address things
RABBI JULIA NEUBERGER: Quite a lot of Primary Care Trusts
have complained bitterly that they don't get any freedom, that everything
is ear-marked, they're told they've got to meet this target, spend the
money on that, got to do this, not do that, et cetera. And there's been
a lot of that, that's because this government tends to be interventionist
because all governments tend to be interventionist. But, if the government
is serious about making this work, it will have to stop earmarking the
GROSSMAN: Most of Dr Jenner's patients
who need hospital treatment end up here at the Royal Devon and Exeter.
The Chief Executive Angela Pedder runs one of the best hospitals in the
NHS. The government's given it a maximum three star rating and says in
future such hospitals could be given a lot more freedom from central control,
but how much more is as yet unclear.
ANGELA PEDDER: The freedoms really haven't
yet been fully articulated, I mean what does it mean in practice, how am
I going to work those, those issues through. From this trust's point of
view we believe that we're part of a wider healthcare community, we have
to work in partnership with primary care, with local general practice.
And what we wouldn't want is any organisational structure that put additional
boundaries and barriers between us working in that seamless way,
GROSSMAN: On the children's ward
Thomas the tank engine does his rounds. The government's promising the
best hospitals much more than just the freedom to paint the food trolley.
Many believe a crucial test of how much freedom they'll really have is
whether these hospitals will be able to set pay and conditions for their
LE GRAND: I think as yet the government
really hasn't quite decided exactly what new freedoms these new foundation
hospitals or hospitals with earned autonomy are going to have, but it's
clear that if they are going to try and achieve some of the ends that the
government wants them to achieve, they've got to have freedoms over staffing
decisions, about hiring and firing staff, about the way those staff are
used, within the hospital or within the, within the trust.
GROSSMAN: Paramedics, ready for
any emergency. The government could soon face its own crisis from Unions
and many Labour backbenchers. They're fiercely opposed to giving some hospitals
complete freedom fearing it will lead to a two tier system.
DAVID HINCHLIFFE MP: If you ended up through the
foundation system with significant differences on pay rates and pay scales
from area to area, you would end up denuding certain areas of staff because
they would clearly move towards those areas able to pay more money, that
would be not in the interests of the NHS and certainly in the interests
of the majority of patients.
BOB ABBERLEY: We've got a recruitment and
retention crisis, the last thing we need is hospitals trying to pinch other
people's staff by paying more money. Now of course we want to see staff
paid better salaries but we don't want to see it at the expense of the
GROSSMAN: And what happens to the
less successful hospitals, the ones with no stars? Previously the government
has said that it doesn't matter who runs hospitals just so long as they're
well run - and that outside organisations like charities or the private
sector could be brought could take control.
LE GRAND: I think that it is quite
likely by the time of the next election that there may be one or more hospitals
that will be run either on a not for profit basis on mutual basis or perhaps
even on a private sector basis. I mean already in Sweden for instance
there's a, which is also a country of long established traditions of hostility
towards the use of the private sector, there's a private sector hospital
running, there's private sector organisation running a major hospital
in Sweden and rather successfully.
HINCHLIFFE: There is a belief among many
Labour MPs that the use of the private sector is not necessarily the right
way forward for the health service. I think most people have accepted that
as a short term measure to reduce waiting lists. We've had to grin and
bear it but any longer term relationship I think will be seriously questioned
by very many Labour MPs.
GROSSMAN: It's fair to say that
patient choice wasn't a high priority when the NHS was established. In
the current set up you really only have one choice, you can either take
what you're given, however bad, or you can pay for the entire cost of your
treatment in a private hospital, always assuming that you can afford to.
But the Health Secretary, Alan Milburn says that patient choice will be
the driving force behind the new NHS. That funds will follow patients around
the system, rewarding popular and effective hospitals, even paying for
some patients to be treated in private hospitals. But can this patients'
paradise really be delivered by Two-thousand-and-five, the government's
deadline for bringing it in.
NEUBERGER: I don't think it's clear quite
what the government means about everybody having absolute choice in the
health service over where they go by Two-thousand-and-five. What I think
will have happened by then, if this works, is that a great deal more of
a choice will go down to the Primary Care Trusts, that patients will be
far more involved and they do need to be in how those are run, and there
will be discussions about you know, what is the most sensible thing to
do? I don't think it'll be a question of you know you going to go and
have your heart transplant at the hospital down the road 'cos it happens
to be convenient and you would like it in August 'cos that's when you're
on holiday, because I don't think there's a reasonable way of making that
kind of decision and we won't have that kind of capacity anyway.
GROSSMAN: So it may be that it's
really GPs and not patients who have the choice of where and when operations
happen. So what could you do if your local Primary Care Trust has a contract
to one particular hospital - and you don't want to go there - given that
PCTs cover such a large geographical area , do you simply have to move
house? The Conservatives say the government's commitment to patient choice
shouldn't be taken at face value.
DR LIAM FOX: This is fantasy land. And
we know that the choice is not a word that 's part of Labour's lexicon,
they believe in a top-down service where the state will tell you what it
is you're allowed to have. And patients will not get choice.
GROSSMAN: It's always busy at the
Royal Devon and Exeter. But if patients or GPs do really get more choice
what happens to the hospitals that can't attract patients? Will the government
really stand by and let them close?
NEUBERGER: Either hospitals or more likely
individual bits of hospitals, individuals services would have to close
if that were, if it were a lot of Primary Care Trusts saying, sorry, it's
not good enough. And you have to accept that if you really give power
on a local basis and you really include patients in that, they will say
sometimes, this service isn't good enough, and if services aren't good
enough they shouldn't be functioning.
ALAN MILBURN: Investment plus reform equals
results - we will be happy to be judged by them.
GROSSMAN: Patients and staff have
heard the speeches and are looking forward to a vastly improved NHS - there
are still many uncertainties about how it will work - but with all the
extra money the government's put in, if the Health Service doesn't start
improving fast, one resource ministers could soon be very short of is,