................................................................................
ON THE RECORD
DAVID BLUNKETT INTERVIEW
RECORDED FROM TRANSMISSION BBC-1 DATE: 13.2.94
................................................................................
JOHN HUMPHRYS: Well David Blunkett, you do have a
problem don't you, between those who say we must spend basically as much as is
needed and those who say we must make no commitment.
DAVID BLUNKETT: Well there's always been the clash
between hope and aspiration on the one hand and prudence and hard headed
reality on the other and it's not some sort of gigantian clash between two
people; that is really a very silly way of looking at it. What we need to
examine in the next eighteen months, two years, is what we can do to re-use
resources, not merely within the Health Service but re-use the massive tax take
which the Conservatives are inflicting from this April. Fifty pounds a month
on the average family this year, rising to eighty pounds a month next year.
How we can re-use that, instead of applying it for Conservative priorities and
for matching their own incompetence, bridging the gap between income and
expenditure to putting people to work, to getting more taxes and National
Insurance into the coffers and to spending it on health and education and other
vital Social Services. But it goes further than that John, it's not somehow
how do you find more revenue from the public, it's how do you link what you're
doing in terms of creating economic growth and prosperity with essential public
services and I believe very strongly that investing in good health and in the
Health Service can make a substantial contribution to that growth and
prosperity.
HUMPHRYS: And investing means putting more money
into it, in very simple terms.
BLUNKETT: Yes it can be and I'll give you an
example, a partnership with the private sector. This last week, the health and
safety executive, revealed that sixteen billion pounds a year was lost to the
economy through the hundred and eighty million days lost each year, it's a
staggering total in sickness and ill health and injury, with people being
absent from work. If we could just work together with business and the trade
unions to get a fraction of that down, we'd automatically increase our
productivity, our competitiveness and our ability to raise money. That would in
turn, feed back into the Health Service as well as preventing ill health, so
we'd get the best of all worlds.
HUMPHRYS: And in the long term that may well prove
effective, MIGHT prove effective, but in the long term. In the short term
you've got to do something...
BLUNKETT: I accept that totally, I think finding
some of those resources that are currently being squandered in the Health
Service - what an eighteen hundred per cent increase in the cost of senior
management, the doubling of the amount spent on company cars for the Health
Service, the whole business and commerical ethos that's being created, we can
do something with that. But there are lots of tricks up our sleeves, this is a
consultation paper, it's designed to stimulate debate and to get people
thinking about these issues and I think we can do that, I think we can say to
people: Look, if we need more ambulances, high quality, well-equipped ambulance
services with paramedics, linking in with new forms of accident and emergency
facilities in GP practices and health centres. When you spend on ambulances
and equipment you don't throw money away, you actually stimulate growth and
productivity and the productive economy in the private sector. You buy those
ambulances and that equipment, you therefore stimulate your productive economy.
HUMPHRYS: But you've got to find the money to buy
those ambulances or the new hospitals, or whatever it may be, you have to find
that money and that involves, does it not, a commitment to spend more money?
BLUNKETT: Well it involves investment on the one
hand and re-using resources on the other. Just to underline the point, we're
not interested and I think those who are arguing prudence are right in this
respect, that somehow we need to charge people out there more tax, the Tories
as has just be revealed over the last fortnight are actually levying more tax
on the British people than any Labour Government has ever done. We don't need
more tax we need fairer taxes, we need to re-distribute the way in which the
tax yield is distributed onto people and we need to challenge something else as
well. Of course, you have to pay for improvements in the Health Service,
wherever the money comes from, but if we're going to grasp the exciting
possibilities of key-hole surgery, of new technology, molecular and genetic
research and we're going to apply them for the benefit of everybody, we are
going to have a debate about whether that should be done through private health
insurance and charges or whether it should be done through tax revenues.
Now, those who say, well the private
sector's the one that's going to deliver the goods, are accepting that it's the
wealthy who would be able to pay for the advances for the technological
developments, for their families to receive health care that the rest of us
can't and if they can afford the private health insurance then they can afford
progressive fair taxation.
HUMPHRYS: And therefore, the logic of that is that
you improve the health service by making greater use of tax money, by levying
more tax...
BLUNKETT: The better use of tax resources because
at the moment we're paying for, even on the government's figures, almost three
million people to be paid to stay at home. Fancy paying trained nurses and
health visitors and home helps to stay at home rather than to be doing a job of
work. Fancy losing their tax and National Insurance contributions that they
pay back in when they've got a job. It's a crazy way to run an economy.
HUMPHRYS: So, if you're going to re-employ those
people, if you're going to have more nurses and more doctors, I keep coming
back to this fundamental issue, it costs more money and you are saying, are
you? - because I'm not quite sure whether you're saying this - we are prepared
to charge...to increase the tax take if we have to.
BLUNKETT: Well I'm saying that the tax take as a
whole, is already high enough, the distribution of that tax take is something
which we will be debating, including the Treasury colleagues in a
non-adversarial way, not as some sort of knock-out contest, over the next
eighteen months. Their job is to ensure that the British people trust us, that
we are not feared by people in terms of the amount of taxation we'll take from
them and we've got to prove that public expenditure, that a reaffirmation of
the importance of public spending is about quality services that all of us
want. And I think there's a very important area here that we have to argue
over the next two years and that is this; that public spending can often be
very much more efficient in terms of the use of resources than the split
between private and public and the Health Service is a classic example of that.
Where the private sector are duplicating facilities, they're using resources
that could go into the Health Service and they're switching away from a planned
investment in the technology and the primary care of the future.
HUMPHRYS: You see when I talked to John Smith
about exactly this issue the other day, he said...I said where's the extra
money going to come from? You'd have to raise taxes wouldn't you? And he said
no, for a start we'd have one point eight billion pounds extra because that is
what we would save as a result of eliminating waste and so on. Now that isn't
realistic is it?
BLUNKETT: Well I heard John being interviewed by
you from Glasgow and he said the speed of what we could do would be determined
by the level of growth we achieved and I agree with that entirely. The speed
of what we can do is a crucial factor in ensuring that people believe our
promises, that we don't live in a kind of fairyland where we promise people
things that (a) they don't believe and know and (b) they know we couldn't
deliver anyway. So I'm a realist, I ran a council as a realist for seven years.
HUMPHRYS: Well then if you're a realist you'll
realise that that one point eight billion that he said, I think you've said in
this document 'waste in the NHS', you're going to save, actually isn't very
real is it? You're not going to save that one point eight billion.
BLUNKETT: Well we pointed out and John pointed
out, that the Tories spent one point two billion on simply setting up the new
commerical, competitive internal market..
HUMPHRYS: Precisely, and that's been spent...
BLUNKETT: The business system. We then earmarked
and highlighted six hundred million extra which is currently being wasted and
mis-used and the six hundred million we can apply and John never...John never
said that we could immediately apply one thousand eight hundred million pounds
in the first year we get in. Over a period of time of course we'd be able to
squeeze that out but I'm not pretending that there won't be more money needed
for the Health Service and it will come from a number of sources, including
economic growth.
HUMPHRYS: But you say, we'll be able to squeeze
that out, you won't be able to squeeze that out at all because most, the vast
majority..proportion of that one point two million that you mentioned first has
already been spend, you're not going to be able to get it back again and the
six hundred million that you say has been wasted - I mean let me give you some
examples of the sorts of things it's been wasted on, according to your
document. It says, for instance, fifteen million pounds was wasted because of
dripping taps, now you're not going to stop taps dripping under a Labour
Government.
BLUNKETT: What you are going to stop is the
drip-drip of money being mis-used out of the Health Service including, and I
welcome people, write in everybody, get this document from us "Health 2000",
look for yourselves about what we're saying, eighty-five million pounds is
currently going on tax relief for individuals over sixty taking out private
health insurance. What a farce to actually...
HUMPHRYS: But that's a separate issue, you're not
dealing with the point that I just raised.
BLUNKETT: Not it is not another issue. Eighty
five million that can be reapplied and we illustrate that in the document by
saying that's twenty-two thousand hip replacements for older people who could
be living independently and with dignity if those operations were carried out.
That's not an airy-fairy suggestion it's an absolute concrete proposal.
HUMPHRYS: But what is airy-fairy is to suggest
that there is anything like one point eight billion pounds that you could
restore to the National Health Service because the way you would change things.
BLUNKETT: I repeat, I heard the interview John
Smith did not say that we could apply that money over night by simply turning
the clock back. He did not say that, he said that there was waste and
bureaucracy and everybody knows there is, they've seen it, we've revealed it
over recent months very effectively.
HUMPHRYS: We're talking about an organisation that
employs a million people, the biggest employer in Europe, there's always going
to be waste, there's always going to be bureaucracy, there's always going to be
dripping taps and what I'm suggesting to you is that it's positively misleading
to produce as part of the statement that you've just held up, this other little
document that's part of it "Waste in the NHS" a catalogue of one point eight
billion pounds of waste, that's what it says and the implication is that you're
going to save that, you're not going to save it.
BLUNKETT: Ah an implication is a very different
matter. And nobody would forgive us if we hadn't revealed the mis-use of
resources, while people are lying on trolleys there is money being used simply
to operate the system. Nothing to do with dripping taps but to operate the
competitive contract system which has replaced the previous way of funding and
organising the NHS.
HUMPHRYS: Right, well that a separate...
BLUNKETT: ...and it's a very important one because
what they're called - transaction costs - of simply operating the internal
market, the business ethos, the commercialisation, that we can tackle. It will
take time...
HUMPHRYS: But you're not going to sack every
bureaucrat are you?
BLUNKETT: We've not suggested that we sack
bureaucrats, in fact we found out that over the last three years the government
has spent ninety-six million in redundancy pay offs, paying people off, and a
lot of them have been nurses. We've lost twenty-seven thousand nursing and
midwifery posts over the last five years. What a scandalous way of carrying on
when there's been an extra thirty-six thousand managers and administrators,
some of whom have been needed but not all of them.
HUMPHRYS: Well let's go back then to how you would
pay for those nurses if you were to give them their jobs back again. You've
already accepted that this one point eight billion isn't any kind of panacea,
that's not going to be a sudden lump of money that you will have to spend on
your first day in office, manifestly, so where - to repeat the question,
forgive me that I am repeating it ...
BLUNKETT: You're very welcome.
HUMPHRYS: ... where is the money going to come
from?
BLUNKETT: Well, I've explained already that there
are resources that can be drawn in - and the eighty five million is only one of
a number of examples that I've given, substantial sums of money that can be
drawn in. You said that the drip was a little bit of a sideshow. I think that
cars for senior executives increasing from five to twenty four million in
trusts alone - nothing to do with health authorities or the Department of
Health, just in trusts - I think another nineteen million is another
contribution and we are going to build those up.
Secondly, we are determined to switch
resources into the Health Service as part of that economic growth and I gave
the example of occupational health and I've given the example of how investing
is part of the employment programme, the economic growth and industrial
programme of a Labour Government. We could aid the Health Service and in
return we would get money back.
Thirdly, we will want to look at the
issue of earmarking, which was dealt with on that film that we saw at the
beginning. There isn't just simply the issue of earmarked tax, you know,
there's the issue of earmarking existing funding that is available through the
squandering of resources and there's the issue of earmarked growth. In other
words a contract with the British people, something that was mooted by John
Smith when he was Shadow Chancellor before the last general election, that we
would say to people this is the way we are going to spend your money, any
additional growth will be committed on these priorities. That's a contract
with the British people that overcomes the mistrust which has existed
previously about whether we were a high spend party. We are not. We spend on
services, they spend on economic incompetence. In other words, theirs is a
policy of tax and cut. I am talking about taxation being redeployed to high
quality public services.
HUMPHRYS: So you're not talking, when you talk
about an earmarked tax or a hypothecated tax, whatever you want to call it, you
are not talking about what the Liberal Democrats were talking about at the last
election - and that is a penny extra earmarked in their case specifically for
education, in your case specifically for health because that's what a lot of
people believe that you ...
BLUNKETT: It's a possibility.
HUMPHRYS: A strong possibility?
BLUNKETT: I think ideas should be welcomed. I
think we should spend the next year not merely on this document and on the
Health Service, debating sensible, prudent ideas. John Smith and Gordon Brown
in the last six weeks have both said that the issue of what's called
hypothecation in whatever form is worth taking a look at. It's about winning
support again for decent public services, John.
HUMPHRYS: And you have said that you've got to get
the British people used to the idea that they are going to have to pay more for
the Health Service. They are going to have to put more into it. I mean, you
have said that.
BLUNKETT: Well, people who argue for private
health insurance accept it. What they say is that the well-off will buy
themselves out of a safety net service, that the NHS will be split. There will
be a safety net service for most people. There will be the cutting edge of
technology and the best services for those who can afford private health
insurance. Not only is that a scandal in terms of the way we actually apply
ourselves to a healthy nation and the productivity and growth that comes from
it but it's also inefficient because, you see, what happens is the private
sector provide the cheap high turnover, the non-acute work, they don't have
vast overheads, they leave those, they transfer those overheads to us in the
NHS with the acute, the intensive care, the long-stay work. The more they do
that the more the overheads push up the unit costs of running the Health
Service. It's a simple economic equation that the more you do outside through
private health the more you cost the rest of us and we are determined to tackle
that. We can't abolish private health but by goodness we can levy a charge to
reflect the true cost of how much the NHS is being drained by private health
insurance.
HUMPHRYS: Do you accept the basic principle that
the NHS is under-funded?
BLUNKETT: Yes, I do.
HUMPHRYS: Therefore ...
BLUNKETT: I believe it's still the most
cost-effective system in the world because it isn't substantially yet split
between private and public because it is still organised, even with the Tory
changes, on a more planned basis than other systems in the world and most
people look to us with great pride at our NHS and that's what we're going to
restore. But of course I make comparisons. The Dutch, the Germans, the French
spend five pounds public and private on health for every three pounds that we
spend. Long-term aspirations are different to the ability to be able to win
people in a general election to what they are prepared to pay not when they say
it to an opinion pollster but when they are in the booth casting their vote on
general election day.
HUMPHRYS: So you are prepared to draw attention,
as you have in your document, to the fact that a much greater proportion of
gross domestic product is spent in countries like France and Germany on health
than is spent in Britain. You are prepared to draw people's attention to that,
but you are not prepared to say on behalf of a future Labour Government 'we
will correct that imbalance and if that means spending more tax on the Health
Service so be it'.
BLUNKETT: Well you know perfectly well why I am
not prepared to make grandiose promises ...
HUMPHRYS: Well, I'd like to hear you say that.
But why is that a grandiose promise?
BLUNKETT: ... and the reason is very clear indeed.
That the Conservatives did a hatchet job on April 9th 1992 by totally
distorting long-term aspirations which we must have with the reality of what
could be achieved in the first year of a Labour Government and we are not going
to fall into that trap ever again. We wish to be in office to carry out our
proposals and our hopes and aspirations ...
HUMPHRYS: But isn't that rather dishonest?
BLUNKETT: ... rather than in glorious opposition.
Of course it's not dishonest. I'm making it clear this lunchtime. People out
there are having their lunch. We respect people who tell the truth rather than
pretend.
HUMPHRYS: Well, what you're saying in that case
then is 'we are not prepared to make any specific commitment but I, David
Blunkett, are sitting here today saying I am making a commitment to make a
commitment at some future date'.
BLUNKETT: I didn't say that we wouldn't make
specific commitments. I said that we have a consultation paper out for
consultation till next year on the future of our Health Service. Our Health
Service, our prevention measures, our new public health agenda, our switch to
primary community care which can only be planned by public service, it can't be
planned by the internal market. The commitment to putting patients first,
giving patients new rights, for women to see a woman doctor, to choice of
hospital, to rights to complaints and procedures of redress, all those things
aren't about costs but where there are costs we will be honest about it in
going into a general election. There's nothing dishonest, that's common sense.
HUMPHRYS: All right, and that honesty includes
saying 'we are so scared of what the Tories might pin on us if we make these
commitments that we are going to hold off making those commitments for as long
as possible'. That's what you are effectively saying.
BLUNKETT: Well, I think this lunchtime I've
indicated very clearly indeed, as I have with interviews with you over the last
three weeks on the Today Programme on Radio Four, that I'm not scared of these
issues at all.
HUMPHRYS: Others in your Party are though.
BLUNKETT: I am highly confident that ...
HUMPHRYS: Gordon Brown is.
BLUNKETT: No he is not. If we say to people ...
HUMPHRYS: He said 'we are making no commitments,
we have no commitments'.
BLUNKETT: ... He's right. We haven't. This
document is a consultation paper.
HUMPHRYS: Well, we're angels on the head of a pin,
the difference between an aspiration and a commitment.
BLUNKETT: Oh, come on. Three years, potentially,
to a general election. I mean, these lot are going to hang on for grim death
until eventually they're whittled away and there's going to be a general
election even if they like it or not.
HUMPHRYS: And then you will have to make a
commitment.
BLUNKETT: We are going to plan over the next two
years our priorities. We are going to put policies together so you are not
separating out policies for economic growth and full employment with those that
spend on public services, but we are going to integrate those policies. That
is a confident party prepared to take people with us to debate these issues but
not to go 'snap' so that the Tories can run a two-year campaign adding up every
potential little snippet of money that they can trawl out and lie about them -
as they have already on this document - pretending that we have made
commitments which I thought your film went out of its way to illustrate we
hadn't made.
HUMPHRYS: David Blunkett, thank you very much.
BLUNKETT: Thank you very much indeed.
...oooOooo...
|