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Breakfast with Frost
Alan Milburn
"Every NHS hospital can become a Foundation hospital"
Interview with Alan Milburn, MP, Health Secretary May 4th, 2003

Please note "BBC Breakfast with Frost" must be credited if any part of this transcript is used

DAVID FROST: Well now on Wednesday night there will be a vote in the Commons on the Government plans for reforming the National Health Service and the focus is on, obviously on foundation hospitals - and the focus is now on Alan Milburn. And here he is. If we look at this figure of the people who are saying they're going to rebel, the old Labour, left wing Labour vote, where 130 plus rebelled before on Iraq, do you expect the number to be more or less than that?

ALAN MILBURN: I'd be surprised if it were that many. I mean we don't know because we obviously haven't had the vote on this and I mean obviously it's a controversial policy because otherwise we wouldn't be having this debate but I believe profoundly that it's the right way, it's the right one for the National Health Service. Because what we need out there is more responsive services and the only way of getting that David is to make sure that you've got power and resources devolved down to local level.

DAVID FROST: And John McDonald said yesterday, one of your fellow Labour MPs, that in the wake of the disastrous local election results, the Labour Party is being destroyed from within, it's lost its core vote, New Labour is alienating traditional and progressive supporters alike with its failed policies of privatisation. You obviously don't agree with that.

ALAN MILBURN: You'd be surprised if I did.

DAVID FROST: I'd be amazed, we'd have a major scoop on our hands. But obviously a number of Labour MPs and workers at the grass roots level do believe that.

ALAN MILBURN: Yes, I mean I understand their concerns about this. As I say it is a controversial policy but I do think it is the right one. But what we're doing is putting the resources into the NHS now, and there's no argument about that - the National Health Service is getting more money than it's ever had before and that's good and it's beginning to produce a dividend, I think, for patients, improved services and shorter waiting times. But ultimately you can't sustain these improvements unless you get the power out there to the local staff who provide the services and unless you get a greater say for the local communities who get those services. And that's what the foundation trusts are about.

DAVID FROST: And why are foundation hospitals not two-tier NHS, as a lot of your critics say?

ALAN MILBURN: For one very, very simple reason. That is that every NHS hospital is going to get the opportunity of becoming an NHS foundation hospital. And that's what I want to see over the course of these next four to five years. And indeed I'm going to be bringing forward a new hospital improvement programme, to help some of the hospitals who are a little bit further behind to raise their standards of performance, so that they get the help, the support, the expertise, and - crucially - the resources. Now this has never been about two-tierism, it's about raising standards everywhere. I'm not interested in levelling down. What I'm interested in is levelling up, so that every patient gets the opportunity of having a good hospital and no hospital is left behind.

DAVID FROST: Right, now that's one, one angle that people take about the fact that it's not, not true Labour style, etcetera, etcetera. Now the other level of criticism comes from people who feel that you're not going far enough and that in fact Gordon Brown has succeeded in turning this from a major move into tinkering. And the examples they say of that, that they were going to be free, these hospitals, to borrow any sum, the Chancellor refused, he'd get the bad debts, so now they will only borrow within the, coming off the NHS budget. They were going to expand private wards or wings, now their private practice will be capped at present levels. They can no longer set their own pay rates, like they were going to do, because the whole NHS will use new "Agenda for Change" pay rates, and there are more. But to just take those three examples, is it not true, perhaps, that these critics are the ones who are right in saying that Gordon Brown has gutted this, gutted this plan?

ALAN MILBURN: No, I don't think that's right. I mean there's a lot of sort of myth and misconception, frankly, about what this policy is all about. The idea is that these hospitals remain NHS hospitals, they treat NHS patients, that they have greater freedom than they have now to run their own affairs, and that must be right. But you can't run the National Health Service as if it's the Chinese red army, from an office in Whitehall. That simply can't be done. The people who do the treating and the caring and the managing out there, those are the people who need to be in the driving seat and I think you've got to give local communities a bigger say. And there's good reason for that. You see, the NHS has got great strengths, in my view - I passionately believe in it. It's in my blood, just like it is in every other Labour Party member's blood. But the National Health Service has got to be changed, and the reason for that is not because it's failed somehow but because the world has changed, and if we're going to get more responsive services, then you've got to get the power and the control and, I think, the money out there so that the people doing the treating and the caring - the doctors, the nurses, the managers - those people are in the driving seat. And there's another very good reason for it, you know, and that is over 50 years, all too often, the poorest services have been in the poorest communities. Now that's not fair and it's really got to be put right.

DAVID FROST: And Tony Blair said he would have resigned if the Iraq vote had gone against him, and so on. Do you feel that way about this vote on Wednesday, or is it not a resigning matter?

ALAN MILBURN: Well we're not in that position - and I don't believe that -

DAVID FROST: You don't think you could lose?

ALAN MILBURN: Well I don't think we're going to be in that position, to be frank about it, but I mean obviously we've got to have the debate and the argument and indeed that is what has been going on during the course of these last few months. Obviously, I've been discussing the issue with lots of Labour colleagues, and I think the bill is a better bill as a consequence of that. For example, people were saying originally that this is only going to be for six or a dozen hospitals. I'm not interested in that. What I'm interested in is raising the standards of performance everywhere. And that's what we need to do and I think the way to do that is to get the right combination of resources and reforms going in. Now is really not the time to back away from reform.

DAVID FROST: And was there any truth in that front page story, Alan, yesterday, in the Times, that suggested that a degree of bumping up or fiddling had been going on and that there were ten trust hospitals that you had to bump up from two star status to three star status, in order to get enough foundation hospitals? Is that true?

ALAN MILBURN: Well actually, no it isn't true, and actually I remember the time that we produced these star ratings which, you know, signify how well an NHS hospital is doing, but the accusation then was completely the reverse - that somehow or other we'd done down the NHS hospitals. But this is an objective measure of performance and in future, actually, it's going to be done by the independent inspectorate for the National Health Service. And what it shows is unsurprising really, and that is that some hospitals are better than others. Now what we've got to do is make sure the money is in there, we've got to make sure the people who are in charge of the hospitals are the local communities and the local staff, and that way you'll get improved, more responsive services for patients.

DAVID FROST: And so you're predicting a resounding victory on Wednesday.

ALAN MILBURN: Well I'm not in the game of laying bets but all I'd say is that I think the argument needs to be had, the debate needs to be had, and I think the argument is the right one, it's a controversial policy but it's been widely welcomed by many people in the National Health Service.

DAVID FROST: And what you're saying is that under the current structure they can't be as good as they will be under the foundation hospitals because of the over-centralisation?

ALAN MILBURN: Yes, basically. I mean what people have got to understand about the National Health Service is that it is a very centralised system. Now it's done great work over 50 years, it's treated millions of people according to the right values, the ones that I believe - care should be free in my view at the point of use and it should be based on your need, not your ability to pay. However, if you're going to get sustained improvements and services, it isn't the politicians who need to be in charge of the National Health Service, the people who need to be in the driving seat are the nurses, the doctors and the managers, and we've got to give a greater say to the local communities who receive those services.

DAVID FROST: And on related health topics, Alan, there was a story, a strong story in the Standard this week that as a result of Gareth Thomas's backbench bill you are really looking seriously at the idea of banning smoking in hotels, restaurants, maybe offices, maybe pubs or not, but is that true?

ALAN MILBURN: Well I think we've got to look at Gareth's bill. I don't think anybody, well most people anyway, don't really like smoking in public places like restaurants, but I think the best way to go about these things, if you possibly can, is through voluntary agreement rather than by banning things. Now we're in discussions with the industry and many restaurants and pubs and clubs have already taken action, either to set aside smoking areas - and that's good - or alternatively to stop people smoking all together. So I think we want to continue this, those discussions - I think that's the right way forward - but in the meantime Gareth Thomas's bill is something that we need to look at.

DAVID FROST: So there could be legislation on smoking?

ALAN MILBURN: There could be but actually I - to tell you the truth David - I'd prefer to avoid that, if I could, because I think these things are always done better in cooperation and true agreement rather than me saying look you've got to do this or you've got to do that. And I think many people in the industry, the hospitality sector, restaurants, pubs and clubs, nowadays recognise the very, very many people who, you know, come through their doors, frankly don't really like people smoking. So I think the best way forward is to do that through voluntary agreement if we possibly can.

DAVID FROST: Well I think that you should do whatever you must about cigarettes but leave out cigars.


DAVID FROST: A personal appeal. A personal appeal.

DAVID FROST: But the other thing, what about the story on the news today about the smacking and about that being verboten, forbidden, legislated against, particularly in the case of childminders. Is that a wise move, with your health hat on, or is it the nanny state?

ALAN MILBURN: I think you've got to be careful about these things, haven't you? And certainly this measure is not about telling parents how to bring up their kids.


ALAN MILBURN: But equally there's got to be some protection for children and nowadays nobody would be very happy if teachers and nursery nurses started hitting children, so there's an anomaly here that needs clearing up and that's in relation to childminders. And it is just worth saying that very often the kids that they're looking after are much younger than school age children and they're even more vulnerable, so you've just got to get the balance right with these things.

DAVID FROST: And with the news of a reshuffle coming up, would your preference be to stay where you are and see through some foundation hospitals or go into new fields like the foreign office or something like that? Which would you rather do - move or stay?

ALAN MILBURN: I tell you, at this time of year, it's rather like everybody's birthday, it comes around every year this, doesn't it, these reshuffle stories and there's always speculation. But I'm very happy where I am. You know, I really am, and I think there's a job of work to do. I think we're just getting ourselves into the position with the National Health Service now where it's beginning to move forward and I was very interested in what the, this modernisation board that's been set up, from the BMA and the Royal Colleges, what they were saying the other day, where they were saying the NHS is turning the corner - that's good.

DAVID FROST: Alan, thank you very much indeed.


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