On the Politics Show, Sunday 29 June 2008, Jon Sopel interviewed Alan Johnson MP, Secretary of State for Health
Alan Johnson MP
JON SOPEL: The Health Secretary, Alan Johnson joins me now.
And we heard the person there from the King's Fund, talking about people not liking the post code lottery and the papers are full that you're going to end it for drugs. How?
ALAN JOHNSON: Well, by, in a number of ways. We announced in our cancer strategy in December that we think we can speed up the process.
The National Institute for Health and Clinical Excellence was only established in 1999, it's been a huge success, it's world class, people all over the world are trying to replicate it. But the process was too slow and what we've - sometimes two years before a drug went through the process.
First of all a drug has to be classified as safe, then NICE look at the drug to see whether it's clinically effective for use in the NHS and then it has to consult publicly on its decision, that whole process, as I say, took two years. We think we can bring that right down to a maximum of six months, basically because we can get NICE actually working on the drug to see whether it's going to be effective before it's actually licensed as safe. So by the time it actually is available, much of the NICE work has already been completed.
JON SOPEL: I just want to hear it in your own words. Are you saying that the post code lottery will be dead, gone, finished, history.
ALAN JOHNSON: Well we are saying that because we are now, we're launching a constitution tomorrow, and I want to announce that in parliament, but it will be a series of rights for patients and one of those rights will be that if NICE has approved a drug, it must be available on the NHS everywhere.
Now, that's the case at the moment, in the guidance that goes out, but there's been some pretty difficult stories about it not being applied. If we make that a patient right, and we switch it so that patients are empowered to actually enforce that right, together with the other improvements that we're talking about. We think on NICE approved drugs and treatments, we can end that post code lottery.
JON SOPEL: Regardless of costs? Because what happens if you've got an NHS Trust that's in deficit ... (overlaps)
ALAN JOHNSON: Regardless of costs - well fortunately, there are very few of those now. We went through a very difficult process to move - despite all the extra money that was going in, there were some trusts that were in deficit. Now, virtually all of them are in surplus.
But look, once NICE has approved a drug, it's approved it on the basis of, this is clinically and cost-effective for use within the NHS and therefore it has to be available everywhere. So that, that examination and analysis on costs has already been made and PCTs then are obliged to actually provide that drug.
JON SOPEL: (overlaps) So you said yes to regardless of cost. But what is the additional cost if every, every health trust is able to, has to prescribe every drug that's available.
ALAN JOHNSON: Well, because as I said, at the moment, despite the guidance there are cases where some drugs are not made available, even though it's been through PCT process. That will then change and that will mean a bigger demand for that. There's also the ... (interjection)
JON SOPEL: But that means an additional cost doesn't it.
ALAN JOHNSON: It does mean an additional cost yes.
JON SOPEL: So where does the money come from.
ALAN JOHNSON: About a hundred million. We're providing it from the centre.
JON SOPEL: Right. So it only costs a hundred million to get rid of the post code lottery.
ALAN JOHNSON: Not just the post code lottery. We think (interjection) ... on drugs and treatments. There is the other part of this which is that while NICE are looking at a drug and we hope that will be very quick, it can still be available, it's been licensed as safe. In those circumstances the PCT themselves have to make a decision about whether to actually allow its use, even though it's not been through the NICE process. There, there has to be much more consistency and much more transparency. If it's been rejected in those circumstances, then patients need to know the reason why.
JON SOPEL: And on time scale, when will this be in place by.
ALAN JOHNSON: Well we think it can be in place pretty soon. We've already started the work on this. As I say for cancer drugs, it was part of the cancer strategy in December. So I think in this, the 60th anniversary year of the NHS, it would be a good time to actually get that process finessed. It will take a little while yet, but we don't see any reason why we can't get to a situation where six months maximum and about three months in reality.
JON SOPEL: You don't think that announcing this is going to lead to a massive increase in the cost of prescription drugs with pharmaceutical companies thinking, they've got to prescribe it; this is Christmas for us.
ALAN JOHNSON: We've just done a deal with the drug companies called the, the PPRS negotiations, where there will be a reduction of 5%, could be 7% over the next five years in heads of agreements that we've reached with all the pharmaceutical companies. So no, this is about the public getting a fair deal. When we asked Ara Darzi to conduct this review, one of the principle points was to ask patients, staff and the public how we can improve clinical care and this was a clear message that came back, right across the country.
JON SOPEL: And you said it is a legal right that these people will have, be entitled to these drugs if they have been NICE approved. If it's a legal right, will people be able to sue if they don't get them.
ALAN JOHNSON: They'll be able to take their rights through the courts if they're denied. I mean I would hope that first of all through the NHS internal complaints procedure that these issues will be dealt with ... (interjection)
JON SOPEL: Okay. I hope this isn't an arcane question but if they sue, are they suing the primary care trust or are they suing the government.
ALAN JOHNSON: Well in a sense they're suing the NHS but look, they've got the right at the moment to ensure, through judicial review and other cases, the problem is they have to use it too many times I think because of inconsistencies across the country. We're looking for a consistent approach, NICE can now speed this process up to a far greater degree and therefore we believe this is a major, major step forward in the prescription of these new drugs.
JON SOPEL: Can we just talk about the way that you've been running the health service. We're going to be speaking to your conservative opposite number, Andrew Lansley in a minute, where they make the charge that this government has been far too interested in process targets, for example the length of a waiting list, rather than outcomes - ie are people living longer as a result of the treatment. Isn't that right. Shouldn't you just be judging the success of your policies, not by introducing a target, but by seeing what the outcome is.
ALAN JOHNSON: Course you have to be interested in both. But look if you read the history of the NHS, right back from 1948, there was always this stubbornly long waiting list. A famous historian of the NHS said the captain always shouted their orders from the bridge and the crew carried on regardless. People were waiting eighteen months to two years for life saving operations. Many people died on waiting lists. That had to be tackled. By the end of this year, no one will wait more than eighteen weeks between the GP saying, you need treatment and actually receiving that treatment.
On average it will be about nine weeks. If you look at cancer care, when we came in to government, less than two thirds of people who had suspected cancer, were seen within a fortnight. Now it's 99.8%, almost a 100%. All of these thing are important to the public and with a vast system like the NHS, a million people treated every thirty six hours, there did need to be some accountable action by politicians to resolve that situation. Now, I think we've been through the era of top-down targets and a large part of what Ara Darzi, who's an eminent surgeon, continued to work in the NHS through this review, as well as being a government minister four days a week - what he has identified is now, we can, through various methods now, ensure we're much more accountable to patients locally, without needing those top-down targets from the centre.
JON SOPEL: Let me just ask about something else. It sound like a target. Apparently, one of the recommendations tomorrow from Lord Darzi is that you will be doing performance measures of the compassion of nursing teams. Really.
ALAN JOHNSON: Well, really - because what we've found is that whereas you can measure things like efficiency and safety and it's very important, a large part of a patient's experience in the NHS, is the compassion and a big, big factor in why people are satisfied because by and large they receive that compassion. Where they don't, where they find that there's poor service, where their dignity is actually diminished, then they can have the greatest operation from an award leading surgeon, but their experience of the NHS will have been damaged. Now, we've worked with the Royal College of Nursing, who are very keen on this, by actually interviewing patients and by asking them to say whether their care was satisfactory, in those sense of whether the compassion was there, whether their dignity was preserved, we can actually improve that. You can't improve what you haven't measured and so we can introduce a, a system there to improve that.
JON SOPEL: And you're going to have nurse led practices. One, what will they do, two, does it mean a smaller role for doctors.
ALAN JOHNSON: Well no, the answer to the latter point is no. There are nurse led practices at the moment. Once again, the message from the front line across all the regions because there's been thousands of people involved in this review, has been we could do so much more if we were empowered, for instance on sexual health, on midwifery, on the kind of treatments for older people, podiatry etc.
If we were kind of freed up within community care to actually have more control over the services we provide, and so we ought to encourage more social enterprises to be set up. The problem with that was NHS pensions. People didn't want to risk their NHS pension. We've resolved that we think and that means that we can get much more local engagement, local ideas, as to how to resolve these problems, within the whole of an integrated NHS care service, that will not in any way diminish the role of GPs.
JON SOPEL: Can I talk to you about one other anniversary and probably maybe slightly less to celebrate, which is the first year of Gordon Brown as being Prime Minister. You couldn't blame him could you if he suddenly said, do you know what I've had enough of this.
ALAN JOHNSON: It's a tough job being a Prime Minister, but let's just stay with the heath thing for a minute. It was Gordon, when he came in a year ago, that said, we have to get a grip on health care acquired infections. We have to get more matrons in to our hospital wards. We have to ensure patients have better access to primary care and we have to ensure that we tackle some of these problems that we've just been talking about, about post code lotteries. Now, he's led that and in terms of Gordon's approach to these things, I guess in the analogy of Wimbledon, I mean Gordon's not interested in strutting his stuff on the show courts and he's quite happy to do it on the outer courts, which makes him quite unique for a politician. But in terms of what he is achieving, in very difficult circumstances, I think it's been a good year.
JON SOPEL: But then why are you absolutely flat lining in the polls, I mean it's serious isn't it the political situation.
ALAN JOHNSON: Well, if you just judge everything by the polls I think that ... (interjection)
JON SOPEL: Well I'm talking about real polls, Crewe and Nantwich, you know, Wendy Alexander going. There's a whole pile of things I could list of things going badly wrong.
ALAN JOHNSON: Well hang on yes. A couple of constituencies and Wendy Alexander is an issue that maybe we'll get time to talk about but in terms of how you conduct yourself as a Prime Minister, all of this stuff, and I think that was the, this is the tenor of your question, can make you feel, is it really worthwhile, in today's 24/7 society, being a Prime Minister is a very difficult job. For Gordon, it's decency, it's intelligence, it's dedication. He's got those factors which make him, I believe, well-equipped to be a Prime Minister.
JON SOPEL: You make a very interesting point there about the 24/7 media age and all the rest of it and the scrutiny. Do you think he's well equipped for that sort of age because you said he's not a person for the show courts. A lot of politics is about being on the show courts.
ALAN JOHNSON: I do. Well, some of it is yes, that's true in today's society. I think what the public want is someone who has the courage, the decency, the integrity, the intelligence to solve the major problems we're facing all over the world. I think in Gordon we've got that. He will never, ever, try to be some kind of show biz personality, that's not Gordon and his personality shouldn't change. But I think increasingly, as the focus comes on policy and integrity and dedication and decency, I think people will like what they see.
JON SOPEL: Alan Johnson, than you very much for being with us.
END OF INTERVIEW
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The Politics Show Sunday 13 July 2008 at 1200BST on BBC One.
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