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Last Updated: Sunday, 9 July 2006, 09:11 GMT 10:11 UK
Labour leadership
On Sunday 09 July 2006, Andrew Marr interviewed Patricia Hewitt MP, Health Secretary

Please note "BBC Sunday AM" must be credited if any part of this transcript is used.

Patricia Hewitt MP
Patricia Hewitt MP, Health Secretary

ANDREW MARR: Now one thing that Tony Blair really wants to get right before he leaves office, he says, is the National Health Service.

Ministers are trying to bring about a market revolution to achieve his vision of a modern, efficient Health Service driven by consumers - sorry, patients.

Now, critics say you can't run the NHS like a supermarket and more reforms are expected to be unveiled next week.

The Health Secretary, Patricia Hewitt's joined us to give us a preview, I hope, we'll see. Patricia, thank you very much indeed for joining us.

PATRICIA HEWITT: Good morning.

ANDREW MARR: Good morning. Can I just start with a sort of philosophical question. Do you think that overall private managers are more efficient, more competent than public sector managers?

PATRICIA HEWITT: No, not necessarily at all. There is good and bad and indifferent in the private sector, as all of us know from our experience as consumers. There is very good and sometimes bad and sometimes not so good in the public sector as well. The important thing here, and what we're determined to do, is to get the best possible Health Service for the patients and the public with the best possible value for money.

ANDREW MARR: And the best managers. I mean, clearly the reason I ask is there was controversy over a wrongly-issued advert which suggested that primary care trusts in charge of most people's healthcare across England and Wales, might be tendering to the private sector for people to effectively manage them to commission the health that they were buying, also possibly, from private sector, from private sector hospitals.

PATRICIA HEWITT: Well, the local primary care trust the local NHS are absolutely central to what we're trying to. They've got the responsibility and the accountability to the public for the very big budgets that we're giving them. And it's their job to get the best for patients within those budgets. Let me just explain the point, because some of those primary care trusts have come to us and said we think we will need to buy in some additional expertise.

It may be, for instance, in doing the very detailed sophisticated data analysis that helps you really understand the needs of your population, or help in managing the finances and so on. Now, if they want to buy in those services that's a matter for the board to decide. What they can't do is outsource the responsibility for the commissioning decisions. In other words, how they're going to get the best services for their local population.

ANDREW MARR: Because you could therefore have a situation where a private company, possibly an American healthcare company, working inside the primary care trust, was responsible for negotiating and buying healthcare, either from itself or from another private company on behalf of the NHS. And that's why some of your critics have said this is a line beyond which you should not pass because it is genuinely the privatisation of the Health Service.

PATRICIA HEWITT: I don't think there is any privatisation involved in this at all. We will never privatise the Health Service, and the primary care trust in particular, certainly cannot outsource their responsibility as public statutory boards for making decisions on behalf of the public. And indeed later on this week I'm going to be announcing proposals to give the public an even greater say in the decisions that primary care trusts are making. But if they want to buy in some additional expertise, and that may well be from the private sector, then the board should be able to do so. And that's why we were placing some framework contracts to enable that to happen.

ANDREW MARR: And so when this advert came out it was then withdrawn again. And you, or one of your ministers said oh it was badly drafted.


ANDREW MARR: It wasn't badly drafted, it was absolutely accurate wasn't it?

PATRICIA HEWITT: No, because it gave the impression that a primary care trust could, if you like, hand over to some private company that public accountability for commissioning decisions and they can't do that. Now we will be re-issuing the advertisement and we will be allowing primary care trusts, if they want to, to buy in that additional expertise that some have asked for.

But you raised the issue of conflicts of interest and of course we're going to make sure that no conflicts of interest of that kind arise. They can arise, some people would say, even within the primary care trust. Because already those PCTs have got responsibility both for commissioning the best services, but also in some cases providing the services themselves.

ANDREW MARR: Can you not see why some people would be very worried by this? To have private sector managers, powerful people, inside primary care trusts, dealing with quite often private hospitals outside primary care trusts. That that is two bits of private, as it were, talking to each other inside something which has always been public service?

PATRICIA HEWITT: Well, you've got to avoid the conflicts of interest. But the really important principle that is at stake here is getting the best possible health outcomes, the best health services, for patients and the public, always with the best value for money.

ANDREW MARR: Sure, I'm just trying to work out...

PATRICIA HEWITT: ...and if the private sector, if the private sector or voluntary organisations can help the NHS deliver even better services and get even better value for money, then of course we will use them. If they can't we won't.

ANDREW MARR: You don't think it's letting the wolf in the door?

PATRICIA HEWITT: ...and it really is as straight forward as that. The NHS has always used the private sector. GPs for instance, the great majority of them for the last 60 years have been self-employed, private professionals, who contract their services to the NHS and they don't get a salary from the NHS, their income depends on the profits they make from their practice. Now nobody objects to that. Most people have a very high regard, and quite rightly so, for their GPs.

ANDREW MARR: Do you think that the NHS is overstaffed?

PATRICIA HEWITT: I don't think the NHS is overstaffed. But I'm very proud of the fact, in fact, that we've so hugely increased the number of staff we have, over 85,000 more nurses than we had nine years ago.

ANDREW MARR: If you don't think it's overstaffed what do you think about the fact that 17,000 NHS people are losing their jobs and vast numbers of newly-trained doctors and nurses have little prospect of getting a job in the NHS from some time to come?

PATRICIA HEWITT: Well the reality is that some hospitals, a minority, have got themselves into rather serious financial trouble...

ANDREW MARR: And this is just local incompetence, is it?

PATRICIA HEWITT: A minority of hospitals sometimes, I'm afraid, because the old financial framework of the NHS actually concealed the fact that they were running an underlying deficit. They have taken on more staff than they can actually afford. And what we're seeing is a number of organisations now looking at whether they've got too many jobs, whether they need for instance to reduce the number of jobs generally not by compulsory redundancy but by not filling vacancies by natural turnovers.

ANDREW MARR: This is not just, is it, a few bad apples, or badly-managed apples, if you can manage an apple? It's a lot of hospitals, it's a lot of trusts scattered through the NHS who are in real difficulties. And I think people watching just find it incomprehensible, given the amount of money that has been poured into the NHS over the last couple of years, that wards have been closed, there are redundancies, there are nurses and there are doctors who are up in arms about this. They say this overall is a grotesque failure of management.

PATRICIA HEWITT: It's nothing of the kind. But there is a serious situation here. One in ten of our hospitals and primary care trusts have got serious financial problems - one in ten. Most of them.

ANDREW MARR: That's quite a lot, quite a lot isn't?

PATRICIA HEWITT: It's a minority but it's a significant minority and there are serious financial problems there. Now those unfortunately impact on the whole service. What always used to happen in the past, without anybody really even noticing, was that money was taken from the under-spending areas to bale out the overspending organisations.

ANDREW MARR: Perhaps not a bad system?

PATRICIA HEWITT: Well it was massively unfair actually. It was a bad system, because what it was doing was taking money from under-spenders who were generally in the much poorer parts of the country with much greater health needs, baling out organisations who'd often been overspending for years and still are, in the healthier, wealthier parts of the country...

ANDREW MARR: OK. Let me ask you...

PATRICIA HEWITT: And because that's not fair I'm absolutely determined to stop it.

ANDREW MARR: OK. Let me ask you as Health Secretary, whether you feel there is anything you could or should do about a 62-year-old woman giving birth? A lot of people will look at these pictures and say it's unnatural, it's wrong, and something should be done about it. In this context you're something.

PATRICIA HEWITT: Well, I understand that controversy. I think we have got within our own country one of the best sort of ethical frameworks for making these decisions. But at the end of the day these decisions have to be a matter for the individual woman and her husband, for the individual doctor. And of course in this case of course because she wouldn't have got that support from IVF here probably, she got it from Italy. But let me just make he point.

ANDREW MARR: But if this is the beginning of something which is repeated by other people, you're relatively relaxed about it are you?

PATRICIA HEWITT: Well we've seen a quite extraordinary transformation in fertility if you like, where really we are the first generation where you can have two women of the same age, one of whom is becoming a grandmother, where the other one is pregnant. And these are real changes in reproductive technology, in women's fertility taking place. But let's remember men have always been able to father children into their 60s, their 70s, even occasionally their 80s. So some of the furore about a woman having a child when she's 62, I think, there's a certain amount of gender hypocrisy there if I can put it that way.

ANDREW MARR: Gender hypocrisy. All right. Speaking of gender, or gender hypocrisy I don't know which. The John Prescott saga has ceased to be funny hasn't it?

PATRICIA HEWITT: Well, it's certainly ceased to be funny for him, but I think we're just seeing the press in one of their perennial lathers. I mean I saw in one of the papers this morning, the Sunday Times has learnt that John Prescott stormed out of Cabinet on Thursday. I was there, he didn't do anything of the kind. And I think a great deal of what's been written this morning and much of last week, is the same kind of rubbish.

ANDREW MARR: There's clearly nonetheless, campaigning going on for the deputy leadership in due course and we get it radiating out of the papers, and David Miliband's being touted everywhere this morning. Where do you stand on the importance of there being either a deputy woman Prime Minister, deputy woman leader of the Labour Party, or at least a woman right at the top of the ruling group if you like?

PATRICIA HEWITT: Well, Harriet Harman and I were arguing about 25 years ago that at least one of the leader or the deputy leader should be a woman. And I haven't changed my mind on that. But there is no vacancy at the moment for a deputy leader or deputy Prime Minister. And John Prescott, like all the rest of us in government, are just getting on with what we were elected to do.

ANDREW MARR: To the extent that you all can...

PATRICIA HEWITT: ...whether that is in the Health Services or schools, whether we're dealing with crime, making people's lives safer.

ANDREW MARR: And on David Miliband - would he be a good deputy leader?

PATRICIA HEWITT: Well that's just all more speculation and froth I have to say...

ANDREW MARR: I think it's coming from the centre of government, It's a well-sourced froth.

PATRICIA HEWITT: I've learned over many years not to believe a great deal of what I read in the press. I think the silly season has started rather earlier this year even if the temperature isn't exactly the summer that we'd hoped for.

ANDREW MARR: All right. Patricia Hewitt thank you very much indeed for joining us.


NB: this transcript was typed from a recording and not copied from an original script.

Because of the possibility of mis-hearing and the difficulty, in some cases, of identifying individual speakers, the BBC cannot vouch for its accuracy

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