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Page last updated at 11:44 GMT, Sunday, 28 November 2010

Transcript of Andrew Lansley interview

On Sunday 28th November Andrew Marr interviewed Health Secretary Andrew Lansley.

Please note 'The Andrew Marr Show' must be credited if any part of this transcript is used.

ANDREW MARR:

Well the government's going to announce its plans for improving public health this week. In general, the poor die earlier than the rich - as ever - and we still, all of us, collectively drink and smoke too much and eat the wrong things. But isn't that down to us rather than the government? Well I'm joined now by the Health Secretary Andrew Lansley. We'll talk about that in a moment, but let's start off with the story this morning about this grading of hospitals, the so-called Dr Foster Report. For those people who don't understand it, it grades hospitals by lots of different things - including mortality rates and, thus, MRSA infections - and there's some quite troubling news in this report.

ANDREW LANSLEY:

Well I think what's quite important is that Dr Foster are independent of government and they are looking at a range of things. I think actually in past years, there was a problem in that they tried to create in effect a single league table and now they're looking at a range of things, whether it's mortality or the Thrombolysis after stroke - a range of different factors - and looking at where there are hospitals that appear to have poor figures relative to what you would expect. And I think it's quite important to look at them together. From my point of view, I think this is really welcome because what I'm looking towards is an NHS where people are held to account for the quality of what they do not because government tells them, but because the public are able to see the information, people are free to publish the information, and patients increasingly are given control and choice about the care that's provided to them.

ANDREW MARR:

So what happens you know if I look up a newspaper or I go online and I find that my local hospital, maybe where a relative is in at the moment, is very high up the league table, has a worryingly high mortality rate. What in practical terms can I then do about it?

ANDREW LANSLEY:

Well in the first instance, of course, you should be sure that your GPs locally who are commissioning - in future they'll be commissioning the care from that hospital - that they are making sure that the quality of what is being done in that hospital is the quality you'd expect. And, for example, one of the things in Dr Foster this morning is about the extent to which people are getting blood clots in hospital that are then causing deaths, and I think we've had something like 25,000 deaths a year associated with blood clots and many of those are avoidable. So it's actually about are the quality standards - and I published quality standards back in June from NICE about this - are those being met and are they contracting to ensure that's being provided. But then you know sometimes it's about as an emergency who are you admitted to. Other times, it's actually about who do you choose to provide your operation? For planned operations like a hip replacement or something, you can choose.

ANDREW MARR:

Yes.

ANDREW LANSLEY:

You should be able to choose which hospital you go to. So you should be able to look at results and be able to make decisions about that.

ANDREW MARR:

And make a choice, make a choice and put pressure on. Ann Widdecombe was being characteristically eloquent about the lack of ward sisters in hospitals.

ANDREW LANSLEY:

Yes.

ANDREW MARR:

A lot of people would agree, in fact everybody that I've talked to about hospitals over the years has said why aren't there ward sisters (or sometimes matrons) back in charge of the wards, and yet it never happens. Everyone talks about it; it never changes. Do you understand why they're not there.

ANDREW LANSLEY:

I completely understand. The point is it's not there aren't ward sisters and matrons. Go to any hospital, you'll find wards that are run by senior nurses with matrons. The point is do they have the power, do they have the responsibility inside the hospital? I mean the reforms that I'm talking about are absolutely about that. They're about ensuring that we really deliver power to the frontline in hospitals and hold people to account.

ANDREW MARR:

But if you're also, if you also want hospitals …

ANDREW LANSLEY:

(over) But if you're going to drive this, you've really got to focus on quality and that's … You see what Dr Foster are doing this morning, which is I think absolutely right, is they are focusing on objective measures of quality and that is the basis upon which people should be held to account.

ANDREW MARR:

Here is a philosophical problem, a lot of people would say, which is that if you want to put ward sisters back with proper control over wards, so that they can get people the healthcare, the medicines and so on that they need, at the centre you would want to do something about that, you would want to say to hospitals this is how to run yourselves, and yet your reforms are really about devolving power.

ANDREW LANSLEY:

They are about devolving power, yes absolutely.

ANDREW MARR:

And so how can ensure that ward sisters return? You can't, can you?

ANDREW LANSLEY:

No, it's a straightforward combination. I mean the NHS is a national organisation, but it is best delivered locally. And in hospitals, we want hospitals to have greater autonomy. We want inside hospitals, for the teams that are responsible for looking after patients to have greater control and responsibility. We want GPs in the community collectively to do so.

ANDREW MARR:

(over) But so many are badly run at the moment. How do you make them …

ANDREW LANSLEY:

(over) But the point is it is about national standards, national funding and national standards combined with a devolved delivery of services that responds directly to patients. That's the key to reform.

ANDREW MARR:

And the crucial part of your reform is handing 80% of the National Health Service budget to GPs to decide where their patients are going to go. Now I worry about, and a lot of people would worry about how this is going to change the relationship between the patient and the GP. So if I or somebody else goes into a hospital and sees their GP and is worried about something that they think might be pre-cancerous or whatever, and the GP says, "No, it's fine, don't worry", then there's a trust there because you know that the GP is there to look after your own health.

ANDREW LANSLEY:

And that will still be true.

ANDREW MARR:

But if the GP is also in charge of the budget and worrying about the costs of this and that, aren't we all going to be worried that the GP is making decisions based on money rather than on healthcare?

ANDREW LANSLEY:

Well there was a problem. If you remember back about 13 years ago, there was a thing called fund holding, GDP fund holding …

ANDREW MARR:

Yeah.

ANDREW LANSLEY:

… where that was part of the problem, which is why the NHS reforms don't allow that to happen. The GPs collectively …

ANDREW MARR:

How?

ANDREW LANSLEY:

Well the GPs collectively - it's not individual practices but working in an area - will manage the budget to try and get the best results for their patients and will be measuring the outcomes and they will have outcomes for their patients. They get rewarded … I mean if they save money on the budget, they don't get that money. That patient budget is there to be spent to deliver the best outcomes and the GPs are rewarded for the outcomes that they achieve. So actually from your point of view as a patient sitting with a GP, you have exactly the same interest. The better the result …

ANDREW MARR:

And I'm not going to be worried that they're going to save some money by not sending me off for some consultation?

ANDREW LANSLEY:

No, because if they save money, it doesn't turn into money in their pocket. They get reward …

ANDREW MARR:

(over) Okay, so another …

ANDREW LANSLEY:

… for delivering the best results for you. That's the point.

ANDREW MARR:

Alright, alright then. Another question about it, which is that …

ANDREW LANSLEY:

Actually, I might say …

ANDREW MARR:

… which is that this bureaucracy … It's a job, it's an administrative job that somebody has to do …

ANDREW LANSLEY:

(over) Of course it is. Yeah, absolutely it is.

ANDREW MARR:

… and at the moment primary care trusts do it, and in the future it's going to be GPs. Now most GPs, whether they're working in a group or not, don't have the admin backing and the time to do this, so they're going to have to create a new bureaucracy around …

ANDREW LANSLEY:

(over) They will create … They will have some support around them, of course, yeah.

ANDREW MARR:

So how are you sure that this new bureaucracy based around GPs is going to be smaller than the bureaucracy you're removing from primary care health trusts?

ANDREW LANSLEY:

Well for two reasons. Firstly because we are going to control the amount spent on administration. I'm going to reduce over the next four years by £1.9 billion the amount spent on administration in the National Health Service. I mean in England, for example, we have about 35,000 GPs. There are about 60,000 administrators in primary care trusts. So it's perfectly possible for us to save money and to put the kind of commissioning support behind GPs we need. But let me just say this other thing. What is this about? It's about the management of care of patients for which GPs are already responsible. They make most of the commissioning decisions because they do the referrals, they do the prescribing. Bringing that together with the management of resources, it's fundamentally more effective and more efficient to see the two things together.

ANDREW MARR:

Alright.

ANDREW LANSLEY:

At the moment, we have decisions being made about referrals by a committee and bureaucracy separate from the decisions being made by our doctors and nurses on our behalf, and they should be the people who are driving the decisions about priorities.

ANDREW MARR:

Well we'll see how that goes. Let's move onto some of the other health care issues, public health issues I should say. Is it true that you want to remove the packaging from cigarette packets and make them all one colour?

ANDREW LANSLEY:

One of the things we are going to look at is whether there is a case for plain packaging of cigarettes because, remember, we've taken steps in the past as a parliament and a government to try and reduce the level of smoking, but it is very persistent. I mean, for example, we have a level of smoking that leads to about 80,000 deaths a year. We have to treat smoking as a major public health issue. We have to reduce the extent to which young people start smoking, and one of the issues is the extent to which display of cigarettes and brands does draw young people into smoking in the first place.

ANDREW MARR:

So how would this work in practice? Would you therefore not have any sort of Benson & Hedges or Marlboro or Camel or whatever it is adverts at all at the point of sale? Would you have packets that all looked the same?

ANDREW LANSLEY:

This is an issue we're going to consult on. Essentially yes, they would be packets that all looked the same. They would have clearly the name of a brand on it, but no other brand identification.

ANDREW MARR:

Why is this your job? Why is it the job of government to decide whether people should or should not smoke?

ANDREW LANSLEY:

Because 80,000 lives a year are lost as a result of tobacco.

ANDREW MARR:

But people know the risks, people know the risks.

ANDREW LANSLEY:

Well …

ANDREW MARR:

They can make judgements themselves.

ANDREW LANSLEY:

Yeah, well why did we ban smoking in public spaces? Because actually we don't want people to have …

ANDREW MARR:

(over) Because there was a secondary smoking issue.

ANDREW LANSLEY:

We don't want to be in a position … Yes, secondary smoking is important too, but also what we have to make sure is that young people don't start smoking and we have to treat tobacco as the serious public health issue it is and try to make sure … And this is a kind of you know behavioural philosophy. If young people are in a situation where brands and tobacco …

ANDREW MARR:

(over) Are you really convinced that they …

ANDREW LANSLEY:

… is being pushed to them in their local supermarkets and stores, they are more likely to start smoking.

ANDREW MARR:

But if one packet is gold and another packet is red, I don't see that that's going to make people more likely to smoke?

ANDREW LANSLEY:

Well actually I think the evidence … We'll see how the evidence emerges.

ANDREW MARR:

Okay.

ANDREW LANSLEY:

Australia, for example, are going down the path of plain packaging. We will see what the evidence looks like.

ANDREW MARR:

Let me ask you quickly about two other things. Breast feeding, the story that employers are going to be obliged to make time and space available so people can breast feed at work. Is this true?

ANDREW LANSLEY:

You say "obliged". What we're looking at is a range of ways in which we can work with businesses to improve public health because actually my experience already is that we can make much more progress more quickly by working with the business community to deliver improving public health, and I think employers recognise that they have a social responsibility as well and that's what we're working on. See this week we will be publishing a public health white paper which I think will take a radical new approach to public health, working across government and beyond government to ensure that we really impact on the determinants of health. And just in this example …

ANDREW MARR:

Okay.

ANDREW LANSLEY:

… when you start out in life as a baby with your family, that's a critical time. It's why we're investing in health visitors to support families when babies first come home; it's why we're going to double the number of family nurse partnerships which are targeted on the families that have the greatest need; it's why our breast feeding rate in this country is amongst the lowest in Europe. About eight weeks after birth, after babies are born, the breastfeeding rate in this country is 46% and it should be higher than that. So we do need to support mothers to breast feed.

ANDREW MARR:

One last point. It's reported that you're going to have a minimum price for alcohol, so that people can't have you know special one-off deals and so on; that there'll be a bottom level price for alcohol of all kinds. Again is this true?

ANDREW LANSLEY:

What's reported, accurately, is that we have said as a government - and it's in our coalition programme - that we are going to ban the below cost sales of alcohol because we do have to have a combination here. We have to have action by government to ensure that things that are impacting damagingly on people's health are prevented, while at the same time creating … As you know, we're very keen to ensure that we don't over-regulate, that we minimise regulation; that we work with the business community, with the local government and voluntary organisations actually to support people to make decisions because it does come down to responsibility. We've tried a lot of things and we do need occasionally to intervene. But more than that, we need actually to support people …

ANDREW MARR:

Okay.

ANDREW LANSLEY:

… and especially some of the poorest in our society need to have the greatest support because health inequalities are too wide …

ANDREW MARR:

Alright.

ANDREW LANSLEY:

… and we need to deliver improvements in the health of the poorest in this country the fastest.

ANDREW MARR:

Andrew Lansley, thank you very much indeed for coming in this morning.

ANDREW LANSLEY:

Thank you.

INTERVIEW ENDS




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