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ON THE RECORD
ANN WIDDECOMBE INTERVIEW
RECORDED FROM TRANSMISSION: BBC ONE DATE: 23.5.99
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JOHN HUMPHRYS: Ann Widdecombe, you say the NHS cannot do
everything, even if you spend a bit more. So you want more of us to pay spend more towards
our treatment. That�s it in essence.
ANN WIDDECOMBE: In essence what I am saying is that the NHS has
never been able to do everything but with the increasing amount of new medicine, new drugs,
new surgery coming on stream there is an ever growing gap between what is demanded and
what it can actually supply. And what I am saying is that even though of course, of course
any future Conservative Government will go on increasing spending, in real terms year on year
of course we will do that, there�s no doubt about that at all. Yet, even that will not be enough
and even if there were to be under any government a substantial tax increase, that still would
not be enough. Now, once you�ve accepted that and the evidence screams at you that that is
so with people not being able to get Beta Interferon and so on. Once you have accepted that
that is so, then you really have a choice, you either accept increase rationing because you are
so committed to doing things the way we�ve always done them, that you�d rather accept
increase rationing than do anything new. Or, you say, we�ve got to look at new ways to get
money in on top of that extra spending which the Government will put in. So it�s not a
substitute. You are not saying farm out what you do, you are saying let�s look at ways at
getting additional monies in so that we can do more.
HUMPHRYS: Which means more of us paying more out of our
own pockets.
WIDDECOMBE: That is one option, if by that what you mean is
more people taking out individual medical insurance. There are other options, for example
employers insuring, maybe even self-insuring their workforce. Getting money in from the
private sector itself through the private finance initiative or through partnerships.
HUMPHRYS: In addition to buildings that is, we�re not talking
about just putting up.
WIDDECOMBE: We already do buildings..
HUMPHRYS: Precisely.
WIDDECOMBE: In addition to buildings, getting the private sector
to put its own money in. For example, in one or two places but not enough, the private sector
has supplied a scanner, it has paid for the scanner, both sectors use it. Now, the NHS quite
clearly is using a scanner that it hasn�t paid for, it�s that sort of plus. If you have, as
everybody knows, take one that everybody�s familiar with, if you have a private ward in an
NHS hospital that actually brings income in to the Health Service, which the Health Service
can then use and spend. So there are all sorts of ways. I think there is a danger and I think we
saw that in just looking at those vox pops that you�ve just done - or experts that you�ve just
done. I think there is a danger because it�s the way we�ve always done it in this country, and
we can�t look wider of simply saying that private medicine equals Bloggs taking out an
insurance premium. That is a part of it, but it�s not the whole of it and above all, I can�t stress
enough, this is additional, it�s not substitute.
HUMPHRYS: Those medical savings accounts that we heard
about. You�ve got another expression for that.
WIDDECOMBE: We�re looking at what we call Health Tessas. I
stress again we�re only looking at them. We haven�t, you know, it�s certainly not policy at
the moment. We�re looking at a whole range of things.
HUMPHRYS: What do you mean a Health Tessa.
WIDDECOMBE: Well everybody knows how a Tessa works. I
mean one of the nice things is trying to get something that is familiar to people and the idea
would be, might be, it�s not policy, might be. But you save and the savings are dedicated
specifically towards medical care and services as and when you need then. The beauty of it of
course is that if you don�t need them, then you can take the money at the end of it. So, that is
just one of umpteen and I stress umpteen possibilities. I don�t want everybody to run away
and say this is what the Tory Party is going to do. We are still looking.
HUMPHRYS: But why should we do that for instance, when
we�re paying our taxes, we expect the NHS to provide.
WIDDECOMBE: Well of course all the examples of trying to get to
people to take more responsibility for their own health, probably involves some measure of
tax relief other than actually getting private sector money into the NHS, which I am very keen
on as quite a big block way of getting money in. The question is simply this. If you accept
that the NHS can�t do it all, then you�ve got to accept that we must have proper partnerships,
we must have other ways of doing things. If the NHS were doing it all, nobody at the moment
would be taking out any form of private medical insurance because you would say, well it
doesn�t matter. The NHS does the whole thing. It never has been able to and everybody out
there knows that there is a huge gap between demand and supply that is not going to be
bridged just by carrying on the way we are.
HUMPHRYS: But we�d have to have, as you say, they�d have
to be incentives to encourage us to take more responsibility for our own health care.
WIDDECOMBE: I think it would be very difficult to persuade
people to just simply to go and take more responsibility without offering them incentives and
what we have to look at is what those incentives will deliver. It�s no good saying vaguely let�s
have an incentive. I want to know the likely result of that incentive. What it�s going to cost,
how many extra people it�s going to bring in, bearing in mind that it might only otherwise
benefit people who are already taking out private medical insurance. No point in that. There�s
got to be an incentive that has a real and measurable effect and that is why, although
everybody is clamouring to know what we are going to do, we�re examining so many different
options, trying to crunch the figures, trying to come up with what is effective.
HUMPHRYS: Because at the moment people want (a funny
noise somewhere round there - we�ll assume the whole set isn�t going to blow up). At the
moment people will buy the insurance, private insurance because they want a better service.
They want to go in to be treated when they want to be treated, they want to have a nice fancy
private ward or champagne for dinner, or whatever it happens to be. I mean that is itself an
incentive. Now it�s difficult to see, apart from a very substantial and serious tax incentive,
why unless that�s what they are after, people should bother with it.
WIDDECOMBE: The very fact that at the moment they do bother
with it, the very fact that at the moment the NHS does use the private sector, it does it on a
very limited scale but if you take the waiting lists initiative, a lot of the waiting lists initiative
at the moment is being delivered by the private sector for the NHS under contract. Now one
of the things, you see, we do get very tied up, as I have just said, on Bloggs taking out an
insurance policy, that�s just one portion.
HUMPHRYS: A big one though.
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WIDDECOMBE: Not necessaily. I mean, I think the single biggest
improvement we could bring about is actually getting private sector money in by contracting
at favourable rates, now fundholding was doing that. Fundholding was doing a very great deal
of buying services from the private sector at very favourable rates and therefore releasing
money that can be spent to treat more patients.
HUMPHRYS: That�s not real money is it, I mean if a
fundholder says�
WIDDECOMBE: But it�s getting more for it. That is the point.
HUMPHRYS: He might be getting a bit more for it. Yes. It�s
not actually new money for ��
WIDDECOMBE: But gross that up. If you gross that up and
people are getting more for the money which the NHS is spending, that makes a substantial
contribution, but you are right, that again, like Bloggs and his insurance premium is only a
part. But if you get a very large partnership going, whereby the private sector is committing
quite substantial funds into that partnership, then you are starting to make progress. We are
looking at such a range but at the core of this always, and I must stress, that at the core of this
always, is that we will go on expanding the public sector at the same time, there is no question
of hiving off responsibilities onto the private sector.
HUMPHRYS: But at the moment, just to go back to the private
insurance rather, at the moment it�s what, six-and-a-half million people or thereabouts
covered by private insurance. You would be happy to see that spread, that figure to grow.
WIDDECOMBE: They already do for example, twenty per cent of
all acute elective surgery, that�s things like hips, cataracts, those sorts of things, they already
do twenty per cent of that, I am quite happy to see that grow, because what we know is that
they do that well, that they do it so well that the NHS itself contracts with them, and what I
would like to see is a growth there, because, to put it very crudely, the more the private sector
does, the more free the NHS is to do the things that it does not do at this moment, because
what is being ignored in this discussion we are having, we talk about rationing as though it is
some great theoretical thing�..
HUMPHRYS: Politicians are normally terrified to talk about
rationing.
WIDDECOME: Well I�m not.
HUMPHRYS: They won�t use the word.
WIDDECOME: Well I�m not, I use it all the time.
HUMPHRYS: I have never yet met a NHS Secretary of State for
Health that even uses the word.
WIDDECOMBE: Well you�re looking at a Shadow one that�s used
it ever since her appointment. But can I just put rationing in context. What rationing means is
that we have a three-tier Health Service in this country and on the top tier are those who get
their NHS treatment or who choose to go private quite voluntary. On the next tier down are
those who can�t get their NHS treatment, either because the operations or the drugs aren�t
available, or the delays are too enormous, and they don�t choose to go private, but they can
often at huge personal cost, I mean we have got people in this country selling houses in order
to buy Beta-Interferon. But on the third tier, are people who don�t get their NHS treatment
and they couldn�t go private if they didn�t eat. Now those people are totally dispossessed
under this system, and what I�m saying is that if we can share the burden more, the NHS can
reach out towards those dispossessed people and do more than it is doing at the moment.
HUMPHRYS: But this, that clearly �..
WIDDECOMBE: That�s what�s happening.
HUMPHRYS: Well, yeah. But the danger in more people going
private, and ultimately, there is no reason according to your logic, there is no reason why half
the population for instance shouldn�t take out some sort of private medical insurance, you
wouldn�t have a problem with that would you?
WIDDECOMBE: I think it�s a somewhat exaggerated aim, but let�s
take it from theoretical purposes. Let�s take it from theoretical ����.
HUMPHRYS: �.You would then end up with the NHS in
danger of becoming a kind of safety net service for those who couldn�t afford it.
WIDDECOMBE: No, and I see exactly why you�re saying that.
And that is why I have said right from the start that we don�t want to hive off responsibilities,
we want to share, but we want to go on expanding in the public sector, we want to
go on expanding year on year, what I am saying is, that itself won�t be enough, but it will
always be there, a big thriving National Health Service that can do ever more and more. I don�t
want it to become a safety net service, I know that there are some theorists who say that will
be a good idea. I think actually it would be a very bad idea. What I want is a true partnership.
It�s both sectors doing most things. I think there are some things that at the moment the
private sector cannot do.
HUMPHRYS: But the danger of what you�re suggesting, you
may not want this to happen, but the danger is, let�s assume you do have half, not necessarily
half the entire population�..
WIDDECOMBE: Then��.
HUMPHRYS: OK, but let�s say, half the middle class, or sixty
per cent of the middle class, entirely possible, that is, because an awful lot of them already do
private health insurance, they will stop, forgive me for using the word, because it�s what your
political opponents used to use, stakeholders, they will stop becoming stakeholders in the
NHS, then you have a real problem on your hands.
WIDDECOMBE: They won�t. We�re all stakeholders.
HUMPHRYS: If you�re paying privately.
WIDDECOMBE: Yes. �A� because we all still pay our taxes, even
if you get some relief, you will still pay a large ��
HUMPHRYS: �.and they�ll resent it.
WIDDECOMBE: �but �B� we all use the NHS because the fact is
that we all depend very heavily on the NHS indeed for accident and emergency services, most
people still use the NHS at primary care level. If you actually look at where the private sector
has developed, it does twenty per cent of the sort of elective surgery I was discussing, hips,
eyes, things like that. It does a third of all mental health care, it does eighty-five per cent of all
elderly care. So it�s developed in specific areas, and there are other areas where we assume
that the NHS is the first port of call and where it must be excellent, for example, we will be in
a very bad way indeed if we don�t have an excellent and expandingly excellent accident and
emergency service which you and I use. It doesn�t matter how insured we are, if we go out
there and drop down with a heart attack, you and I have a stake in the NHS having a first class
excellent service.
HUMPHRYS: No reason though why if we have a sufficiently
expanded private sector they shouldn�t do that sort of stuff as well, and then it would expand
to the extent where you know, we drop down in the street or something or get knocked down
by a car, because you�ve got your private health thing you just get taken to a private hospital.
WIDDECOMBE : No, these are fantasies because this is not what
I�m working towards. That would be so if what I had said right at the start was: I want the
private sector to take more and more of what the NHS does and to shrink the NHS. In fact
what I�ve said is the exact opposite. I�ve said I want to go on expanding the NHS, but that
won�t be enough and I need an addition, an addition on top of that, and it�s to private monies,
whether it be from an individual, an employer, or the private sector itself that I�m looking for
the addition. I still have a vision of a huge and expanding Health Service.
HUMPHRYS: Right, but the question is how much expanding.
Why don�t you instead of saying private partnership and all that, why don�t you say: let�s do
what the Germans and the French do. Let�s spend substantially more, not just another penny
in the pound or tuppence of thruppence on the pound - a third more as they do. They spend
a third more than we do on their National Health. Let�s do that.
WIDDECOMBE: Have you analysed it.? When you look - and
you�ve now hit, I think inadvertently, the whole nub of the problem, because when you look
across OECD, even if you exclude America which has a huge private model, in case you think
I�m pulling a fast one, let�s exclude America. - if you look across the developed world what
you actually see is that yes, there is a difference between what we spend and they spend, but
nearly all of that difference is made up not by public spending, but by private spending. That
is the essence of our problem.
HUMPHRYS: I�d love to argue that with you.
WIDDECOMBE: No it�s there. It�s there in all the independent
OECD statistics. That is the essence of our problem. They do spend more GDP and the
difference is the private addition.
HUMPHRYS: Ann Widdecombe, must end it there. Thank you
very much indeed.
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