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Last Updated: Sunday, 6 November 2005, 13:46 GMT
Jon Sopel interview
Please note BBC Politics Show must be credited if any part of this transcript is used.

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.

On Politics Show, Sunday 06 November 2005, Jon Sopel interviewed:

  • Health Secretary, Patricia Hewitt MP

Patricia Hewitt MP
Health Secretary, Patricia Hewitt MP

Interview with Patricia Hewitt

JON SOPEL: And I'm joined now by the Health Secretary, Patricia Hewitt. So that's the future is it - for these primary care trusts - that you'll go and get your ankle seen to at Boots or your asthma drug seen to at the supermarket pharmacy?

PATRICIA HEWITT: What we saw on that, on that excellent report was one example of a primary care trust making exactly the kind of innovation that patients and the public want to see. With that Poly Clinic, something like a community hospital, that's taking a lot of care out of the acute hospital, and bringing it much closer to patients, much more convenient for them and actually much better value for money too.

Now that's exactly the kind of thing that we were discussing at the enormous event we had last week, a thousand people in Birmingham, helping us to design the future of local health care

JON SOPEL: So in a word, you don't mind who is providing it as long as it's getting provided. So you could be having your tonsils done at Boots for example, or your sprained ankle done at Sainsbury's, providing they've got a pharmacy there with someone else able to do it?

PATRICIA HEWITT: What we saw in Sheffield, what we're seeing all over the country is NHS facilities, provided free at the point of need. And yes, in a few cases, we've got I think some GPs in London who are using Boots to deliver weight management services to their, to their patients. But what matters here (interjection) the best service for patients.

JON SOPEL: Yeah, but do you see that expanding.

PATRICIA HEWITT: It will, it will expand if patients value it, if it works, and if it offers good value for money. But Jon, the point here is that the NHS has always used the private sector and I'm not just talking about the drugs companies or the building firms that built the hospitals, I'm talking about the GPs themselves who are one of the most important and one of the most popular parts of the NHS - the vast majority of them have never been salaried employees, they've been private business people owning and investing very often in their own premises and contracting to the NHS.

JON SOPEL: What about health visitors for example, do health visitors become outside the NHS, contracted out if you like and become part of, I don't know, global health visitors international incorporated

PATRICIA HEWITT: No, of course not.


PATRICIA HEWITT: You're talking as if we were going to privatise the NHS and we're not doing anything of the kind. And I realise there's been some real confusion, I think misunderstanding, uncertainty about health visitors and other community staff. And (interjection)

JON SOPEL: Hang on. Let me just quote you this quote from Sir Nigel Crisp when he wrote to staff at the end of the July, he said 'the direction of travel is clear. PCTs, Primary Care Trusts, will become patient led and commissioning led organisations with their role in provision reduced to a minimum' . So that all the provision will be done elsewhere.

PATRICIA HEWITT: That is what some primary care trusts have already done. There are some that have never provided their own services. You've got the health visitors and staff like that in an NHS care trust. There are others who are separating within one organisation the commissioning of services from the provision of some of those services.

But I made it very clear in the House of Commons last week, and let me say it again to you, that where you've got health visitors and other community staff employed now by their Primary Care Trust, they'll continue to be employed by their Primary Care Trust, unless the PCT decides locally that they want to change the arrangements in order to get (interjection) better services.

JON SOPEL: The Chief Executive went too far in this letter.

PATRICIA HEWITT: We've clarified the position because there was misunderstanding about that.

JON SOPEL: So that's a yes.

PATRICIA HEWITT: And as I said, as I said last week, PCTs who are directly employing staff will go on doing so unless they decide because it's going to be better for patients to change that position.

JON SOPEL: But they will be answerable to you won't they, the Primary Care Trusts.


JON SOPEL: Yes. So you will decide won't you. Won't you take a view on whether you think it is better that some of these services are provided outside or in house.

PATRICIA HEWITT: The thing that matters all the way through this is what is best for patients. And as we saw in your report and many of us have seen all round the country, you've got Primary Care Trusts in many places doing a superb job, designing and providing these community services that all of us actually need and want.

JON SOPEL: I guess people are just trying to work out how radical these reforms are that you want to do. Because at certain times they sound very radical when you read the Chief Executive's letter. John Reid for example, he said when he was Health Secretary, for the foreseeable future, certainly in my life time, the National Health Service will not only be the main provider of health care in terms of commissioning and so but will overwhelmingly be the direct provider. Now, Sir Nigel's vision is very different from that.

PATRICIA HEWITT: All that Sir Nigel was reflecting in that letter was the fact that, as I said earlier, a number of Primary Care Trusts made their own decision not to provide their own services. That doesn't mean those services were privatised.

If you look at Brighton and Hove for instance, where the Primary Care Trust simply focuses on commissioning. In other words designing and getting, securing the services that people need for their locality. The actual community staff are employed by a different NHS organisation, it's an NHS Care Trust.

JON SOPEL: With their role in provision reduced to a minimum is what he said.

PATRICIA HEWITT: But as I've made it clear Jon, and as I said, not only to parliament last week but also to the unions and the professional bodies, where the primary care trust is employing staff like the health visitors and district nurses, they will go on doing so unless they decide, following full local consultation, that they want to do otherwise. But the test here in any change of services, is what is actually going to be best for patients.

JON SOPEL: So what you're trying to do is to ensure a more patient friendly, patient led service, by ending the resources with the patients, to where so far as possible, he and his GP wish him to go. Is that broadly right?

PATRICIA HEWITT: When we talk about a patient led NHS, what we mean is patients having more choice and more voice, more say in their services. We mean stronger primary care trusts, who are responsible for the NHS locally and we mean more responsibility and accountability for the GPs themselves.

JON SOPEL: So the quote I've just given you is broadly, is exactly what you're trying to do because that was Kenneth Clarke in the House of Commons in 1989 when he was Health Secretary. So you're going back to GP fund holding.

PATRICIA HEWITT: We're not going back to GP fund holding for a very good reason. What GP fund holding did was to create a two tier service because only some were doing it. It had the GP fund holders, all trying to contract with all the different hospitals. You had the hospitals competing on price which was appalling and actually reduced the quality of service. But the one good thing that it did for those GPs who were fund holders, it gave them real freedom to (interjects) ... improve services ...

JON SOPEL: But you're reinventing the purchaser provider distinction ...


PATRICIA HEWITT: ... let me just make this rather important point. There was one good aspect of GP fund holding. It gave GPs more freedom to bring services out of the acute hospital, for instance employing a physiotherapist in their own surgery instead of sending their patients to the hospitals. Now we (interjection) ... not for some, but for all GPs with this thing that's in the jargon called practice based commissioning.

JON SOPEL: Well, if it's all so good, why are the staff so worried.

PATRICIA HEWITT: I think there was a real fear that they were going to be driven out in to some form of private provision or whatever, and as I've said and said repeatedly, where the PCT is employing staff, not all do, but where they are, they will continue to do unless they decide locally, with proper consultation, that it could be done better ... (overlaps)

JON SOPEL: (overlaps) ... There are two hundred and fifty thousand people now, employed by Primary Care Trusts. Give your assessment of five years down the line where we'll be. How many of them will still be employed directly and how many of them will find themselves employed in separate companies or by Boots the Chemist or by whoever else.

PATRICIA HEWITT: I think the vast majority of them will continue to be employed directly by NHS organisations, whether that's a primary care trust or a care trust, or indeed as we're starting to see in some parts of the country, staff themselves, nurses for instance, creating their own employee led social enterprise (interjects) ...

JON SOPEL: Would you put a percentage on it. How many ... (interjects)

PATRICIA HEWITT: Which I think is a very good idea. And I'm not going to put a percentage on this for the very simple reason this is not top down. This is about getting patients and the public within each community, saying what they want and the Primary Care Trust and the GPs responding to that more effectively.

JON SOPEL: Well let's come to the wider question now which is I suppose, put simply, will any of this fly, given the state of the Labour government and the mood of Labour MPs at the moment?

PATRICIA HEWITT: Of course it will and yes, it's been a very difficult week. It's been difficult because I think we're all saddened to see David Blunkett's resignation, but it's also been difficult because we are having to make very difficult decisions on terrorism, the most immediate issue, but also on public service reform. But if we don't make those difficult decisions now, having promised to do so in the manifesto on which we've just been re-elected, then let's be very clear about where we'll be in a couple of years time.

We will have given up the centre ground, the progressive centre ground of politics to the Conservative Party under a new leader. And we will be on the defensive because having asked people to pay more on contributions towards better public services, we won't be delivering what they want and what we've asked them to pay for.

JON SOPEL: But it's just that the government looks so different now. I mean take a, look at what happened with your proposals on the smoking ban. They were shredded by the cabinet with real time leaks going on against you.

PATRICIA HEWITT: There were leaks and there were briefings and I think all of us have leant lessons from that.

JON SOPEL: Did you find it uncomfortable?

PATRICIA HEWITT: But the important thing, the important thing was that on 99% of the policy, there was complete agreement. And the bill that I have just introduced in to the House of Commons will ensure that from the summer of 2007, smoking will be banned in every restaurant, every office, every factory, virtually every enclosed public space and work space and it's only the 1% on which there was disagreement, not only let me say inside the government but right amongst the public?


JON SOPEL: People could argue about the percentages because some would say what you've gone from is a total ban to a partial ban. So some would say you've got 50%.

PATRICIA HEWITT: No, we're doing exactly what we said we would do in the manifesto, which is a total ban with the exception of the genuine membership clubs and the pubs that don't serve food.

JON SOPEL: And then you went and gave an interview where you said, "My own very strong hunch is that it's only a matter of time before we have the total ban."

PATRICIA HEWITT: I think that's right and what I've said and what ... (interjects)

JON SOPEL: So John Reid is going to be out manoeuvred ...


PATRICIA HEWITT: ... what we've all agreed is that we will review the position within, by the end of three years, so that we can see how things are working both with the ban in the vast majority of places, and the partial position, with the non-food pubs, the drink only pubs. We'll review it. But you know public attitudes to smoking ...


JON SOPEL: If you've got that strong hunch, does that mean that the compromise that you've come up with at the moment, you believe to be unworkable?

PATRICIA HEWITT: The compromise that I have come up with is exactly what we put in the manifesto, and were just elected on. There are difficulties, practical difficulties with every policy option. That's why in the end we thought the best thing to do was simply the one that we'd put forward in the manifesto and been elected on.

We'll review it in three years and you know, public attitudes towards smoking are changing so fast and people so strongly want protection from second hand smoke, that yes, I think that this will be not just a huge step forward for public health in itself, but actually, we will soon take that final step of the total ban that so many people want to see.

JON SOPEL: Just coming back to the cabinet travails in general terms. Is Tony Blair going to get 90 days that people can be held in custody without trial?

PATRICIA HEWITT: We're trying to get a consensus with the opposition parties on that because frankly, protecting our people from international terrorism shouldn't have anything to do with party political debates. We'll have to see how people react, having, as I hope they will have done, spoken to their Chief Constables and indeed their constituents, over the last few days. But that's a matter, as the Prime Minister and Charles Clarke have made very clear, that they're still discussing.

JON SOPEL: What would you say to your back benchers who are thinking about this because they, it all seems to be rolled up in to other criticisms of the government and their anger?

PATRICIA HEWITT: Well I would say, look very closely because it's on the Metropolitan Police website at what Andy Hayman, the Deputy Commissioner for anti terrorism has said to us. I looked at that very carefully as you'd expect with my own background in human rights, and it seems to me with the extraordinarily difficult investigations that are now having to be done with weeks of trying to de-code computers, sift through evidence, interview people, talk to the police service in maybe half a dozen other countries, go through interpreters in many cases, both with the interviews here and with the international work, I believe, as the cabinet does, that the police have made that case for 90 days and I don't think this should be a matter for kind of salami slicing, oh we don't like 90 days but you can have a little bit less.

I think people have to face up to the responsibility of how in this very difficult situation we best protect people and give the police the powers they say they need to protect all of us.

JON SOPEL: As things stand, at the moment, as I speak to you now, do you think you can get a majority for ninety days?

PATRICIA HEWITT: I certainly hope so and it will be a matter of frankly, the opposition parties facing up to the responsibility that they have, with us, on something that is not a party political issue, to secure the safety of our public. It is the first duty of any government.

JON SOPEL: Okay, Patricia Hewitt, thank you very much indeed.


End of interview

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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