................................................................................
 
                                 ON THE RECORD 
                             FRANK DOBSON INTERVIEW        
 
RECORDED FROM TRANSMISSION BBC-1                                 DATE:  7.12.97 
................................................................................
 
JOHN HUMPHRYS:                         Frank Dobson, a fortnight before the 
election, you, your party put the frighteners on people by saying there were 
fourteen days to save the NHS.  So, not surprisingly, people thought what you 
had in mind, what had to happen was a revolution.  But your proposals actually 
aren't revolutionary at all are they?  They're evolutionary rather than 
radical. 
 
FRANK DOBSON:                          Well, what we're saying to people in the 
Health Service, and what the professions are saying to themselves, is that they 
want to produce what's called "evidence based medicine", so that what's been 
provided for people is based on scientific evidence of what's good for people, 
and I think if they're aiming for evidence-based medicine, then we're under an 
obligation to give them evidence-based organisation.  People in the Health 
Service want change, but they're sick to death of the huge changes which were 
made by our predecessors time and time again, which didn't work, which left a 
mess, including the mess that we've got now, and we owe it to the people in the 
Health Service who're working desperately hard to provide all of us with a good 
service, that we keep the changes to a minimum, and we try and test out any 
proposals before we introduce them right across the country.
                                                                        
HUMPHRYS:                              So therefore you're keeping the basis, 
the essence of the Tory reforms? 
 
DOBSON:                                No, we're not keeping the essence of the 
Tory reforms.  What we're saying is, because we're not silly, that there were
some advantages and improvements came about as a result of the changes that the 
Conservatives made, but there were greater disadvantages.  So what we want to 
do is to build on the better things that came out of those changes, and to 
discard the worst things.  That's the sensible thing to do, it's a pragmatic 
approach, and it commands the support of the vast majority of the doctors and 
nurses and other people working in the Health Service. 
 
HUMPHRYS:                              Well, let's look at one of the things 
that came out of the Tory reforms then, and that's giving GPs budgets to buy 
their different services with, the so-called fund-holding GPs.  Now, you're 
saying you want all GPs, because not all went for that - something over fifty 
per cent went for it - not all went for it - you're saying you want all GPs in 
effect to have control of the purse-strings, the difference is that they would 
be in big groups of practices, commissioning practices, rather than individual 
GP practices. 
 
DOBSON:                                Well, as I explained to you before the 
programme and to your producers John, we're producing a White Paper on Tuesday, 
which I've got to report first of all to the House of Commons, and I can't 
disclose the details of what's in that paper, because quite frankly if I've got 
to choose between upsetting you and upsetting Betty Boothroyd, the Speaker, 
then in my mind's eye she's a lot more fearsome than you are. 
 
HUMPHRYS:                              Wouldn't I know that for a moment - I'm 
not asking for the details. 
 
DOBSON:                                No, there are limits to what I can say 
therefore. 
 
HUMPHRYS:                              But you did already tell - I mean you
talked before the election about..... 
 
DOBSON:                                Yes. Generally speaking what we would 
like to see is all the GP practices in the country put on the same footing, so 
that we don't have privileges and advantages for one group of GPs that aren't 
enjoyed by the other group of GPs, because of course, if one group of GPs or 
one section of GPs, about half of them, have got advantages, the others have 
got disadvantages, and that means that the patients of the other half are 
suffering disadvantages, and so our general idea is that we would like to see 
the GPs in each area getting together and commissioning from the community 
services and from the hospitals the services that they all want.  Because we 
think - our general approach  - I mean I think it was described as a difference 
in wording - but it isn't a difference in wording.  The present organisation of 
the Health Service is very competitive at one level, setting one group of 
doctors against another, setting one hospital against another.  We think that 
that's a silly way of going about things and it's been a harmful way of going 
about things, and we believe that it's better for people in the National Health 
Service to be working together for the advantage of patients rather than 
working against one another. 
 
HUMPHRYS:                              Coming to that if I may, but effectively 
you're extending the Tory principle in this particular case.  You've accepted 
the broad principle that GPs should be in the driving seat, should have cash of 
their own to do with what they think is right, you're extending that principle 
to all GPs? 
 
DOBSON:                                Yes, but we believe that they should be 
getting together, all of them, and not individual practices, because that's 
proved to be very bureaucratic and producing a huge paper chase.  We think it's 
better if we have a system where all the GPs in a particular area are getting 
together with community nurses and other professions as well and saying, this 
is what we want from the services in our area. 
 
HUMPHRYS:                              But Chris Smith, your predecessor, he 
was Shadow Secretary for Health - he did suggest that some practices individual 
practices might be able to hold onto their funds.  Is that part of what you're 
thinking? 
 
DOBSON:                                Well, again, I can't tell you that 
because that's part of the detail that..... 
 
HUMPHRYS:                              But he talked about himself, that's why 
I raised this question.
 
DOBSON:                                Yes, but our commitments in the 
manifesto were that we would try to produce a commissioning system in which 
all the GPs and all the community nurses and the other professionals in an area 
would be level pegging.  There'd be a level playing field, they would all be 
able to work together to the benefit of all their patients rather than getting 
into artificial competition with one another. 
 
HUMPHRYS:                              So given that these groups of GPs would 
hold the purse strings, would be in the driving seat, they would in effect be 
doing - and I know it's a word that Secretaries of State for Health hate - 
politicians never talk about it but other people do - rationing.   They would 
actually be rationing what the NHS has to offer, what we, the patients can take 
from the NHS, saying we think this should happen, we think that should 
happened, we think maybe that shouldn't happen, either because we can't afford 
it or whatever.  They would be doing that. 
 
DOBSON:                                What they'd be doing would be setting 
the priorities that they thought .. 
 
HUMPHRYS:                              Comes down to the same thing doesn't it? 
 
DOBSON :                               No, it doesn't entirely.  There are 
differences in meaning between priorities and rationing, but let's not get into 
all that sort of - browsing through the dictionary sort of job in the middle of 
a Sunday after - Sunday lunch-time - but what they would be doing would be 
looking at the needs, the health needs of the area as presented to them by 
people who'd come to their surgeries, who go to their practice nurse, who go to 
the community nurse, looking at those and saying: well, this is the sort of 
thing that we need from our local hospital. 
 
HUMPHRYS:                              But they'll have limited budgets with 
which to buy that sort of thing.... therefore... 
 
DOBSON:                                There have always been limited budgets.  
The budget for the National Health Service has been limited from the day it was 
first introduced. 
                                                                             
HUMPHRYS:                              Of course, but not for GPs. I 
mean a GP - you wouldn't have - what..we saw that in that film, that man being 
told, that patient being told by his GP: sorry, but I don't have the money.  
That never happened in the past. 
 
DOBSON:                                Half the GPs have had budgets, the
fundholding GPs have had budgets and they've had to keep within those budgets 
and it doesn't appear to have caused any great problems does it.  There have 
been no examples so far as I know, of people not being treated because their GP 
didn't have a budget. 
 
HUMPHRYS:                              Well maybe that was because the slack 
was taken up somewhere else.  If all GPs are holding budgets, perhaps it will 
be different.  
 
DOBSON:                                Well what we've had to do is to try to 
make sure that when people turn to the Health Service, it's a modern and 
dependable Health Service. When they go to their GP, when they go to the 
practice nurse, when they go to the Out Patients, or when they're an In 
Patient, it's there when they really need it and it's top-quality care.   
 
HUMPHRYS:                              And what about the drugs, we talked 
about hospital beds and all that, what about the drugs being there when they're 
needed. Presumably, one of the reasons that you want to keep GPs in the driving 
seat is where budget-holding GPs have operated, they have had the amount of 
money they can spend on drugs capped, one way or the other, because there's a 
finite amount of money. Presumably you believe that there will be a kind of 
universal capping from now on, or once all of this gets into swing and 
therefore that will solve, or at least help to solve the problem of 
over-spending on drugs.  
 
DOBSON:                                I don't think we want to pay too much 
attention to the drugs budget. 
 
HUMPHRYS:                              Really? 
 
DOBSON:                                Doctors have other budgets as well. 
 
HUMPHRYS:                              Oh but it's a massive amount of money 
isn't it.  
 
DOBSON:                                Well it is a massive amount of money but 
it's there.. the drugs are by and large prescribed for the benefit of patients 
and they do patients good most of the time and sometimes it's better to 
prescribe a drug which keeps somebody out of hospital rather than not 
prescribing them and then going into hospital.  
 
HUMPHRYS:                              But you don't telling me - you've 
already said that there is a finite amount of money. You're not telling me that 
there will be absolutely no limit on these new fundholding groups of practices 
and how much they can spend on drugs. 
 
DOBSON:                                What I said, John, was that there are 
other aspects to the spending of the GPs. 
 
HUMPHRYS:                              Yes but this is one of them and a not 
unimportant one. 
 
DOBSON:                                It's part of the total and half the GPs 
have had limits to their budgets, genuine limits to their budgets and most of 
the others have had notional limits to their budgets but again I can't give you 
full details of what we're preposing in the White Paper.  But what we need to 
do, is to always make sure that GPs, when they are considering the treatment 
that they're giving people, their first priority has to be the interest of the 
patient concerned, and that is obviously the top most priority.  So they can 
also bear in mind the costs of what they may be doing. 
 
HUMPHRYS:                              Precisely and in that case, given that 
they have to bear that in mind, given that there is bound to be some sort of 
cap, otherwise a budget means nothing at all if there is no cap on it, some 
patients might not get the drugs they need.  
 
DOBSON:                                Well, there have been no examples of 
that up to now and I can assure you that the system that we're putting forward 
will not involve that in the future.  
 
HUMPHRYS:                              So there won't be a cap. 
 
DOBSON:                                People should be reassured about that, 
they won't be told by their GP, you can't have the drugs that I think are good 
for you because I haven't got any money left.  
 
HUMPHRYS:                              You told us before the election, it was 
a very important part of your manifesto, that you would get rid of the internal 
market within the National Health Service, but you are keeping what is called 
in the jargon, the purchaser/provider split.  Now, if you have somebody who's 
buying something and if you have somebody who's selling something to somebody
else, then unless I'm very much mistaken, that is a market.  
 
DOBSON:                                No well it isn't a market and what we'll 
be saying is, that the GPs in a particular area, together with the community 
nurses and others, will be saying these are the services we want from our local 
hospital but we won't be expecting them to behave in a competitive manner in 
the way that the present system has required them to do because that has 
introduced all sorts of ludicrous inefficiencies and waste into the system.  
One of the problems has been that although places may have been apparently 
competing with one another, hardly anybody knew what their costs were and what 
we are saying is, we don't want them competing in future, but we will have them 
comparing.  One of the best ways of keeping down costs, for instance, is let's 
take two great cities.  In Leeds, at the moment the people running the Health 
Service in Leeds, don't know - a lot of the people there don't have access to 
the cost of providing the services in Leeds.  They certainly don't know what 
the comparative costs are in the great city of Manchester, the other side of 
the Pennines.  We believe that they can learn from one another and instead of 
these figures being kept secret for commerical, competitive reasons, the 
figures will all be spelt out, so that people can learn from one another.  
 
HUMPHRYS:                              Right, and having learnt, these group of 
GPs says, we don't like that hospital, it charges too much, it's not efficient, 
it's outcomes aren't as good as they ought to be, we'll go to another hospital. 
Can they do that, will they be able to do that? 
 
DOBSON:                                Well, they will. 
 
HUMPHRYS:                              Well, it's a market isn't it.        
 
DOBSON:                                But that's not the sensible way of 
looking at it, is it. 
 
HUMPHRYS:                              It's the only way of looking at it.  
 
DOBSON:                                No, the object must be to make sure that 
the hospital they have their doubts about, improves its standards.  
 
HUMPHRYS:                              Oh, in the ideal world yes. How are they 
to be encouraged to.. 
 
DOBSON:                                It isn't in an ideal world, John.  In an 
ideal world, people's local hospital will be producing top quality services at 
properly comparable prices.  
 
HUMPHRYS:                              But in the real world, they won't all be 
doing that, will they. 
 
DOBSON:                                But in the real world, we will, for the  
first time in the history of the Health Service, have in place a system, which 
will be setting proper standards of performance. 
 
HUMPHRYS:                              I understand that.  I understand that. 
 
DOBSON:                                Clinical performance, and also proper 
standards and management performance. But I come back - let me make this clear. 
From the point of view of the patient, there is no benefit in competition which 
denies them access to their local hospital, which is convenient for them and 
their relatives. 
 
HUMPHRYS:                              Yes, but... 
 
DOBSON:                                ..and forces them, as under the present 
system sometimes, to go to a hospital twenty or thirty miles away. 
 
HUMPHRYS:                              But, you're having it both ways here.  
You're-you're saying to me- 
 
DOBSON:                                Well, maybe- 
 
HUMPHRYS:                              Let me put this question to you. 
 
DOBSON:                                Right.  
 
HUMPHRYS:                              A very clear question: you're saying to 
me the GP has a choice - that is the essence of this market.  You concede as 
much.  You didn't use the word 'market' but-Right-but nonetheless, the GP has a 
choice or the group of GPs has a choice. 
 
DOBSON:                                The group of GPs. 
 
HUMPHRYS:                              The group of GPs have this choice.  That 
doesn't effect the working of the market in one real sense.  They don't like 
that hospital because it doesn't meet those standards that you want - all 
hospitals ultimately can meet.  They can, therefore, go to another hospital.  
Now, that would mean - would it not? - if this is to mean anything at all - 
that that other hospital might even have to close down because those GPs say: 
sorry, you're not doing the job well enough.  Now, I accept your point that you 
want that hospital to improve.  It may not be capable of improving it.  It may 
not improve quickly enough and, in the meantime, the GPs will have taken their 
patients elsewhere.  That might happen.  
 
DOBSON:                                Well, I think, it's highly unlikely 
because it would be stupid.  Suppose- 
 
HUMPHRYS:                              Look? 
 
DOBSON:                                Supposing there's a town with a District 
General Hospital and its standards are not high enough and its costs are too 
high.  To close it down, would be to punish the people who live in the area.  
 
HUMPHRYS:                              Of course, it would but that's the- 
 
DOBSON:                                And- 
 
HUMPHRYS:                              -end result of the doctors having their 
choice.  
 
DOBSON:                                No. No, no, it isn't.  What we want to 
do is to give power to the doctors to insist- 
 
HUMPHRYS:                              Exactly! 
 
DOBSON:                                -on standards but we then put in place a 
system which will guarantee to deliver the standards.  
 
HUMPHRYS:                              But, you're suggesting there that that 
hospital hasn't been trying, you see.  In the past, it may have been doing its 
damnedest.  It, simply, can't come up to.. now.   
 
DOBSON:                                But, why should doctors- 
 
HUMPHRYS:                              Well, you should tell me why should that 
be? 
 
                                       Instead of asking me why should that be, 
say: Look at what is happening in the Health Service - what has happened 
since the Health Service began.  Look at any other area of human endeavour.  
Some people are better at doing things than others for whatever reason that may 
be.  Now, you're saying to the doctors you can choose.  They will say - some of 
them - inevitably.  They've already said so when we've had fund holding GPs 
individually - different individual practice.  They will say: that's not good 
enough, we'll go somewhere else.  Tell me why that shouldn't be? 
 
DOBSON:                                But, that isn't the object of the 
exercise and it isn't but it- John-let me, let me- 
 
HUMPHRYS:                              I'm saying it's the outcome, not the 
object.   
 
DOBSON:                                Let me finish.  You need to start off 
with the object of the exercise.  The object of the exercise, from the point of 
view of the local GPs, from the point of view of Community Nurses, is that the 
people who live in City X will get the best services and they'll get them 
locally and they will bring pressure to bear, to make sure that that is done.  
What has been missing from the National Health Service in the past and, 
certainly, under the system we've inherited is some national machinery for 
helping them bring it about.   
 
                                       And, what we're going to do is we - with 
the professions because it's got to be led by the professions - we're going to 
establish professional standards of performance in all spheres - national 
standards - and, then, the hospitals will be expected to meet them.  We're 
going to also lay down national standards of management performance which the 
hospitals will be expected to meet.  And, that way we'll raise the worst up to 
the average and the average up to the best.  That's the object of the exercise 
and it's only if you see the additional weight and influence for the doctors 
and nurses in a particular locality, it's only if you see it in parallel with 
our proposals for spreading best practice and raising standards that you get 
the full picture. 
 
HUMPHRYS:                              Alright.  Let's look at the resources 
available to the NHS.  Now, you've been consistent in saying... great 
swathes out of the bureaucracy and that way we're going to save huge amounts of 
money and that will help.  The Kings Fund - you heard them there - said you're 
not actually going to be able to cut that amount, if you're gonna do the kinds 
of things you're talking about and they're experts in this area.   
 
DOBSON:                                Well, they're not.   
 
HUMPHRYS:                              Well, come one.  Somebody else is an 
expert.  
 
DOBSON:                                For a start-for a start, he doesn't know 
what we're proposing because he hasn't seen our White Paper.  
 
HUMPHRYS:                              Well, he may-He has just confirmed that 
group practices- 
 
DOBSON:                                No.  
 
HUMPHRYS:                              -for instance, are going to be the 
backbone. 
 
DOBSON:                                But he-But he doesn't know what we're 
proposing.  
 
HUMPHRYS:                              Alright.  
 
DOBSON:                                So, it's foolish for him either to claim 
that he's an expert about something he, apparently, can know nothing about and, 
also, he was saying these things are terribly expensive. 
 
HUMPHRYS:                              Will you tell me how much you're going 
to save there? 
 
DOBSON:                                Well, I can tell you that we will save.
Our new system will improve standards and, at the same time, save- 
 
HUMHPRYS:                              How much? 
 
DOBSON:                                -hundreds of millions of pounds and I'll 
give you a precise figure on Tuesday.  
 
HUMPHRYS:                              Alright.  Well, let's assume-  
 
                                       Alright, give me precise figures, then.  
Let me give you hundreds of millions of pounds, then. Some people will argue 
about it but let me give it to you.  Nonetheless, you have been saying for the 
past eighteen years the NHS is desperately under-funded.  Now, what the 
Government has done for the past eighteen years is give the NHS year on year 
three per cent extra - sometimes more - but three per cent on an average across 
that time - three per cent extra.  Now, you cannot guarantee that it will 
continue to get a three per cent extra.  It, certainly, won't for the next 
couple of years.  So, therefore, it will continue to be under-funded, won't it? 
 
DOBSON:                                Well, the National Health Service by any 
reasonable argument has been under-funded since it came into existence.  But, 
what we are determined to do and we committed ourselves to it at the General 
Election is to increase funding, in real terms, year on year.  And, we've set 
in train- 
 
HUMPHRYS:                              By three per cent? 
 
DOBSON:                                No, we didn't say that.  But, don't ask 
us to keep promises we never made.  
 
HUMPHRYS:                              Oh, no, no, no!  I'm asking you a 
question. 
 
DOBSON:                                We said, in real terms.   
 
HUMPHRYS:                              It- 
 
DOBSON:                                We've set in train a really thorough 
going examination of all the costs and the benefits of the National Health 
Service and we - because we want to put in place - a longterm, stable and 
expanding system of finance for the Health Service and we will get that sorted 
out by the middle of next year.  
 
HUMPHRYS:                              Do you think it needs to get three per 
cent extra year on year? 
 
DOBSON:                                Well, I don't know, at the moment.  
 
HUMPHRYS:                              But, you've known for the last eighteen 
years it needed more, much more than three per cent.   All of a sudden- 
 
DOBSON:                                But it- 
 
HUMPHRYS:                              -you're in power and you don't know. 
 
DOBSON:                                Well, let me say what I do know.  I do 
know this that we found an extra three hundred million pounds to help cope 
with- 
 
HUMPHRYS:                              Yeah....... 
 
DOBSON:                                No.  Three days' spending - get it 
right. 
 
HUMPHRYS:                              It depends how you work this out. 
 
DOBSON:                                Don't-don't... 
 
HUMPHRYS:                              I'm talking about a Health Service that 
cost forty-two billion pounds a year.  
 
DOBSON:                                A hundred million-Hundred million pounds 
a day is what the Health Service spends.  We found three hundred million 
pounds.  I was advised, by my advisers, by the doctors, by the people in the 
National Health Service who run the National Health Service that that was the 
sum of money that was required.  And, that money was found.  That money is 
already going into helping cope with the problems of this winter.  But, it's 
not true that you can't save money out of bureaucracy.  We did it. 
 
HUMPHRYS:                              We've had that.  We've had that 
discussion... in the longer term.  
 
DOBSON:                                No, no, no, no, no - let me explain.   
 
                                       We said that we would shift money out of 
bureaucracy into patient care. We were faced very soon after we came into 
office with a decision whether to go ahead with the eighth round of fund 
holding.  There is twenty million pounds set aside in the budget we inherited 
for the bureaucracy of fundholding.  We've shifted.  We've stopped that.  We've 
shifted ten million pounds, which is now going into improved breast cancer 
treatment for women all 'round the country and five million pounds to-trying to 
bring up to a proper standard Children's Intensive Care.                      
 
HUMPHRYS:                              Waiting lists are going to go on rising, 
aren't they?  That's the reality of all this.  You can't guarantee that three 
per cent.  You're not going to fight for it, apparently.  Therefore, waiting 
lists are going to up. 
 
DOBSON:                                No, no.  Don't start speculating about 
what I do on the extra three per cent.  
 
HUMPHRYS:                              Well, are you going to fight for the 
extra three per cent? 
 
DOBSON:                                I'm not accepting your figure of three 
per cent.                               
 
HUMPHRYS:                              But, you- 
 
DOBSON:                                What I am-What I am saying is this: 
 
HUMPHRYS:                              But, nevertheless.... 
 
DOBSON:                                We've found the-We've found the extra 
money, John, to help the people who work desperately hard in the Health Service 
to cope this winter and we've put in place arrangements which will make it more 
likely that they will be able to cope, by improving their relations with local 
Social Services, so that they're keeping people out of hospital, who should'nt 
go in and we're getting people out who should be out of hospital and back in 
their own homes, getting that done quicker.  Sensible improvements of that sort 
and we're putting a huge extra sum of money into the National Health Service 
next year.   I think, it's an extra three million pounds a day. 
 
HUMPHRYS:                              It's certainly not three per cent, is 
it?   
 
DOBSON:                                We never promised three per cent. 
 
HUMPHRYS:                              Nope! 
 
DOBSON:                                You're asking us to keep promises we 
never made.  
 
HUMPHRYS:                              Frank Dobson, thank you very much, 
indeed.  
 
DOBSON:                                Thank you. 
 
 
 
                                ....oooOooo...