Is it the same pill from both sides? 20/2/01

Dr Liam Fox MP:
In priority areas, I want to make sure that we are able to treat the sickest patients first. Under the current waiting list initiative, we are getting examples of consultants being told by the health service managers to treat more minor cases to get the waiting list down quickly. We have seen it in cancer surgery, in hip replacements. I want to make sure that patients who are sicker than others get their treatment first. That means in priority areas, such as cardiac and cancer care, we give a guaranteed maximum waiting time based on individual patient's circumstances. When I was practising as a doctor, I didn't see average patients. I saw individuals. That is what we need to get down to. We don't treat average patients in the health service. We treat individual patients with their own needs, their own family history and past medical history.

Jeremy Vine:
For those patients to move forwards more quickly, they'll have to leap-frog other patients, who may also have existing guarantees.

Fox:
If you are saying that patients with cardiac problems, who are requiring coronary bypass surgery, or cancer patients shouldn't be treated before people with varicose veins or hernias, then I would disagree with you. I think we need to understand that in the UK, our outcomes in terms of our survival and cure rates for some of the world's biggest killer diseases are way behind those in other countries. We have slumped to number 19 in the world league for life expectancy. That is not acceptable.

Vine:
Have you costed the effects of telling all these patients that they can move forwards more quickly than they otherwise would?

Fox:
The question will be that we set the priorities within the budgets and shift money from elsewhere. By abolishing the waiting list initiative, that will free up £340 million for front-line services.

Vine:
Let me ask you about a letter from Richard Holmes, the chief accountant for University College Hospital, basically saying there isn't enough money in the NHS to meet the demands due to higher pay for junior doctors, higher costs for drugs and so on. This must concern you as well, since you are sticking to the same spending levels as Labour.

Fox:
Yes, it is very concerning. What it indicates is we have a service where there are so many targets from the centre that those who are having to deliver the health care feel they can't meet it. We need to decentralise the system and say we have one or two priority areas which we want to make sure our outcomes improve up to the level of the European average and allow those in the frontline to make their own decisions.

Vine:
You are seriously saying that spending the same amount of money that Labour are promising to, you will pay higher pay for junior doctors, higher costs for drugs that this letter complains about?

Fox:
What we cannot do is do what the current Government has, which is have targets for everything but priorities for nothing. We have to ensure what comes out of the system are the targets we are setting for it in terms of clinical outcomes. At the moment, the Secretary of State is asking for greater and greater powers to control the service through the current Health and Social Care Bill. That is going to exacerbate the problems and make it more difficult for managers and financial managers to manage the system.

Vine:
Dr Fox, thank you. Mr Milburn, what do you make of this letter?

Alan Milburn MP:
It is normal at this time of year. There is a negotiation going on between the hospitals providing the services, and those who commission the services at a local level. That is not decided by me but locally. So it should be. This is not particularly unusual this time of year.

Vine:
Are you saying they are fibbing?

Milburn:
I am saying there is a negotiation going on between the hospitals and the health authorities and the primary care groups who commission the health care. It's perfectly normal at this time of year. Since that letter has been written, I have increased training budgets in the National Health Service by 11% from April next year. Much of that money will go to the teaching hospitals that claim that there is a gap in funding.

Vine:
One of the things that Dr Fox said in his speech is, "Realists know, even if politicians won't admit it, that rationing exists in the NHS." Are you prepared to concede that?

Milburn:
I think I am the first health secretary to use the "r" word to talk about rationing, and to say that in every health care service, whether it's the National Health Service or a privately funded service, priorities have to be set. They have got to be set. It's not a question of whether these priorities have to be set but how they are set. We have a new way of doing that through the National Institute of Clinical Excellence, which determines whether or not treatment and care should be made available according to their effectiveness.

Vine:
In your concordat that you famously signed last year, you said the NHS will buy care from the private sector when necessary. It's difficult to work out where the distance is between the Conservative and the Labour position on this.

Milburn:
There is a world of difference between what we are doing, which is using NHS money, where it is appropriate, to buy up spare capacity in private hospitals, for example, spare wards in operating theatres, to treat NHS patients for free, and what Liam Fox is proposing, which is to spend £500 million worth of public money that could be invested in the National Health Service, and instead to use that to subsidise people who have already got private health insurance. It's clear from everything that Liam Fox, Michael Portillo, Ann Widdecombe and a succession of Conservative frontbenchers say that they want to force more and more people to pay for the cost of health care.

Vine:
You won't debate with him but he is shaking his head.

Milburn:
I am sure he is shaking his head. That's what he has been saying for a year or more.

Vine:
Mr Milburn, Dr Fox, thank you both very much.