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Sunday, 23 July, 2000, 12:48 GMT 13:48 UK
Alan Milburn
BBC BREAKFAST WITH FROST HOSTED BY PETER SISSONS INTERVIEW

ALAN MILBURN MP HEALTH SECRETARY JULY 23RD, 2000 Please note "BBC Breakfast with Frost" must be credited if any part of this transcript is used PETER SISSONS
In a moment I'll be speaking to the Health Secretary Alan Milburn but first a message for you about the Breakfast with Frost website. [FILM CLIP]

PETER SISSONS
So now you know, the government's national plan for the NHS comes out this week and it probably can't come soon enough and a government commissioned report put together by the Virgin Group says the Health Service is poorly managed and the patients were often let down. Well I'm joined from our studio in Heathrow by the Health Secretary Alan Milburn who's just flown down from his constituency, good morning Mr Milburn.

ALAN MILBURN
Good morning Peter.

PETER SISSONS
Now is this massive injection of cash first of all enough to save the NHS?

ALAN MILBURN
Well it's certainly more money than the NHS has ever had before and I think what we've got now is a once in a lifetime opportunity to get the basics right in the National Health Service to make sure that we've got the right number of doctors, the right number of nurses, the right number of beds in the system but above all else to make sure that we redesign the whole system of health care in our country because anybody who looks at the National Health Service will realise that overwhelmingly it's a 1940's system that is operating in a 21st century world and I think that explains, along with under-funding that we've seen over very many decades, that explains the real frustration that the doctors and the nurses and the other staff of the National Health Service have. They're doing a brilliant job but all too often they've got to fight the system rather than having the system work with them and now what we've got a chance to do is to put alongside each other huge investments with far-reaching reform.

PETER SISSONS
In one of those famous leaked memos Philip Gould says the government's too late on the NHS, why couldn't this national plan have been produced three years ago, why couldn't you have come to government with a national plan in your briefcase?

ALAN MILBURN
Well for a very simple reason, because we didn't have the money then, we had to do what was right at the time, we had to stabilise, we had to do what was right at the time.

PETER SISSONS
It could have been a wish list?

ALAN MILBURN
We had to stabilise the public finances, the public finances were out of control, frankly the NHS finances were out of control, you have to remember that when we got in the debts in the National Health Service were rising, the number of student nurses had been cut, there weren't enough doctors, bureaucracy had been built up and bed numbers had been cut. Now it's taken some time to stabilise that, we've produced quite a lot of reforms already but now what we've got an opportunity with these big cash injections now going into the NHS is to bring about some far-reaching and fundamental changes and I think what people will see when the NHS plan is published later this week is the most fundamental and far-reaching changes that the Health Service has seen since it was created in 1948.

PETER SISSONS
One of the reforms you've already carried out or at least announced is the abolition of the internal market, now how many bureaucrats have lost their jobs as a result of that so far?

ALAN MILBURN
Well actually quite a lot and over the course of this...

PETER SISSONS
What's the number?

ALAN MILBURN
Well over the course of this Parliament we have pledged to save 1 billion from bureaucracy which we're recommitting to front line patient care.

PETER SISSONS
How many have lost their jobs so far?

ALAN MILBURN
And that is, and that is the right thing to do, well I haven't got the numbers off the top of my head but what I do have at the top of my head is the fact that by the end of this Parliament we'll have saved 1 billion in bureaucracy, that was built up under the previous government, it's been cut down under this government, we've got to continue to do that because what counts in the National Health Service is front line services and so we've got an opportunity now, as I say, to get the right number of beds in the right places and the plan will promise more beds in the system, it'll probably promise a big build-up in the number of nurses, doctors and therapists in the system but it will also promise a fundamental overhaul of the way that the system works because all too often the staff feel frustrated but patients feel even more frustrated.

PETER SISSONS
Do you accept the, the report by the Virgin team which has begun to appear in our newspapers, it's pretty damning not just condemning poor management of the Health Service which doesn't auger well for the way the money's going to be spent but they're out of touch, they're in palatial offices, there is this deadening bureaucracy, low morale and hospitals, perhaps most worrying of all they aren't even clean?

ALAN MILBURN
Yes in fact I commissioned the report from Virgin Atlantic because what I wanted to do since they have a good reputation for customer care, I wanted them to look at the National Health Service through their eyes if you like, through the eyes of an organisation whose interests are in customer care and sure what they've come up with is some pretty damning conclusions and everybody knows that this is the case, although for very many people the National Health Service is very reliable, for far too many people it just isn't responsive enough. Sometimes the care isn't there, often the services that patients receive aren't for their convenience, sometimes the wards aren't clean and usually it isn't clear who is in charge in the wards. Now all of these things have got to change but that means that you've not only got to put more money in to get the nurses and the doctors in place but we've got to change the way that the whole system works, to genuinely centre it around the patients and what the plan will be doing when we publish it later this week is setting out how we're going to tackle some of these fault lines that run through the National Health Service, that in part are a result of the way that the NHS was created in 1948. So we've got to do away with these absurd demarcations between staff where nurses are prevented from doing some jobs because they've been regarded as jobs that only doctors can do, well that's ridiculous and that means the patients have to wait too long for treatment. We've got to do away with the divisions between Health Services and Social Services because that means that elderly people don't get out of hospital quickly enough when they're ready to leave and you've got to put on a new footing the relationship between the National Health Service and private sector hospitals to make sure that capacity is there for people so that they can get their operations when they need it and most importantly of all so that we can get these long waiting times down.

PETER SISSONS
But if, if this money doesn't make an impact and you know we can have an election in a year or 18 months or so it's, would you accept that Labour's credibility is going to take a heck of a knock and that you may well then have to start looking if these billions don't do the trick at a much more radical reform of the Health Service, a large dose of privatisation perhaps?

ALAN MILBURN
Well certainly that's what the Conservatives are now saying, they're now saying that we should use NHS money to subsidise people who incidentally have already got private health insurance to take it out, well I don't believe that's the right way forward for Britain, we don't want to be spending the NHS's money subsidising people who have already got private health insurance to create a two-tier system where you have fast track treatment and care for those who can afford to pay and slower third rate services for those who can't. Now what I believe and what the government believes is that the principles of the National Health Service are absolutely right, care should be available according to clinical need and not ability to pay but what we've got to do is make sure that its practices are modernised so that we have faster services, higher quality, that the care is there, that the food is good, that the wards are clean now that's what we've got the opportunity to do and over the course of the last few months we've been working very hard with senior doctors, senior nurses, managers working together trying to put together this NHS plan to take the NHS into a new era, to get rid of the 1940's system and to make sure that we have services that are faster and more convenient for the patient because it's the patient's interests that comes first.

PETER SISSONS
But you see you're under pressure, the Prime Minister puts pressure on you with, well he doesn't put pressure on you, because what we know from leaked memos that the pressure is on you, he wants initiatives, he wants bite, he wants himself to be associated with success, he's going to make the announcement about the national plan, is he not, this week?

ALAN MILBURN
Yes Tony will be doing the statement later this week in the House of Commons about the NHS plan and that's a good thing...

PETER SISSONS
But it's all about...

ALAN MILBURN
It's a good thing that the Prime Minister has been working alongside me and the doctors and the nurses and the managers, we've brought all of these people in to help to put together this NHS plan so it's as much the property of the National Health Service as it is of the government, that's a good thing that the Prime Minister wants to make sure that the NHS is getting the resources for getting the reform that it needs too and I believe this really is a once in a lifetime opportunity we have.

PETER SISSONS
Can you assure the Prime Minister who, to whom you are answerable immediately that enough will be done say before next winter to avert another winter crisis in the National Health Service which is the last thing he wants in beginning what could be an election year?

ALAN MILBURN
Well look I think we've got to be very straight with the public about this, turning around the National Health Service and making it a genuinely patient-centred service is going to take time and the NHS plan will be very, very clear and explicit about that. There are some things that we can do quickly and some things that take time so for example we put in an extra 150 million this year to build up a number of critical care beds, there'll be hundreds more critical care beds this winter than there were last winter and a lot more critical care nurses too, so things will be better there. But what we've got to do as well is to get the nurses trained and the doctors trained and that does take time. So I think what the national plan will be saying when we publish it later this week is this, that we can make steady year-on-year progress by getting the investment in and getting the reforms in so that patients over time will see a bigger and better service but what we will not be saying is that somehow a magic wand can be waved and we can conjure trained nurses and trained doctors out of thin air, we can't, that would be dishonest. The public care about the National Health Service, it's their National Health Service and we have a duty and a responsibility to be straight with them about what can be achieved and when it can be achieved.

PETER SISSONS
Now Tony Blair doesn't like the word guarantees, will there be guarantees for patients in the national plan?

ALAN MILBURN
Yes what patients will see is a big build up in the capacity of the service and by that I mean that we're going to have thousands of extra doctors and thousands of extra nurses

PETER SISSONS
But will there be a guarantee about how long you wait and how long before you get seen?

ALAN MILBURN
Yes we've been looking very closely at that and what we want to do is to make sure that the waiting times come down because frankly far too many people wait too long for treatment, it is true that around three quarters of people wait around an average of three months for an operation but some people wait 18 months or more and that's, in today's world just simply isn't good enough and that's something that we've got to change. The big limiting factor as far as getting waiting times down is just the sheer ability to get the numbers of doctors and nurses in so the plan will promise that we're going to get waiting times down but we'll do that in a staged way and in a way that is deliverable.

PETER SISSONS
You mentioned earlier involving the private sector in some way, tell me a little bit more about that, are these empty beds which the private hospitals have going to be rented by the National Health Service?

ALAN MILBURN
Well that's something that we've been talking to private sector hospitals about, it seems pretty obvious to me that if there is spare capacity in private sector hospitals, if there are spare beds and spare operating theatres and the National Health Service can take advantage of them that is a good thing providing of course that it's good value for money for the taxpayer and it offers high standards of care for the patient and after all if we can do that, if the NHS can buy care from the private sector the care will remain free and NHS patients will be treated as NHS patients. So again the plan will be exploring these issues too because what we've got to do is remove all of these absurd hangovers from the world of 1948, outdated consultant contracts, outdated ways in the way in which we employ GPs and other staff, the demarcations between nurses, doctors and other staff within the National Health Service, the division between health and social care. These lie at the root of the really big problems that patients and staff experience in the National Health Service where the service is all too often feel as if they're just not responsive enough to the needs of the individual patients and all of that has got to change so there is going to be fundamental and far-reaching reform here.

PETER SISSONS
And how long before, briefly how long before the Health Service revolution is there?

ALAN MILBURN
Well I think we've got to kick-start it immediately and we've got to start building up the capacity straight away, we've got to get the nurses, the doctors, the beds into the system, that is going to take some time.

PETER SISSONS
Five years?

ALAN MILBURN
Well I think what the plan will set out, we know that we've got funding for the next four years, sustained funding incidentally and that is very, very important because not only has the National Health Service been under-funded for decades but in addition to that the funding has gone up and down too much so nobody has been able to sensibly plan. So we've got the funding now for this year and for the next three years at a much higher level than we've every had before, over these three, four, five years the National Health Service would be expanding in funding terms by around a third in real terms so that gives us a big opportunity and that is the sort of timetable that the national plan will be setting what. What we can do quickly, what we can do over four years and being honest with the public about some of the changes that will take longer than that.

PETER SISSONS
Secretary of State, thank you very much for joining us.

END

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