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Last Updated: Sunday, 26 March 2006, 10:23 GMT 11:23 UK
Crisis in NHS?
On Sunday 26 March 2006 Andrew Marr interviewed Patricia Hewitt MP, Secretary of State for Health

Please note "BBC Sunday AM" must be credited if any part of this transcript is used.

Patricia Hewitt MP
Patricia Hewitt MP, Secretary of State for Health

ANDREW MARR: Now the headlines over the past week have not been very good for the Health Secretary or the Health Service.

We've got NHS madness, 25,000 NHS staff sacked in weeks, and much like that. Welcome Patricia Hewitt...


ANDREW MARR: ... this morning, I should say first of all. Can you give us a definitive figure, or at least a rough figure on the number of NHS staff who are going to lose their jobs?

PATRICIA HEWITT: Well let me start Andrew by reassuring NHS staff because people looking at these headlines over the last week or so would be forgiven for thinking that practically every job in the NHS was about to be made redundant.

And that is complete nonsense, and I just wish we'd had a fraction of the headlines for the 200,000 or so staff that we've actually taken on in the NHS over the last eight years, and when the figures come out for the last 12 months, which they haven't been published yet, we will see further increases, I suspect over about 30,000 more staff in the NHS which is why, of course, we're able to treat so many more patients and save so many more lives than we were doing before.

ANDREW MARR: Nevertheless, looking at all the Trusts around the country, people have assembled a figure of something like 20,000-25,000 doctors and nurses whose jobs are going to go because of the current financial crisis. Now is that nonsense or is that true?

PATRICIA HEWITT: That figure has come from the Conservative Party and I have to say that I think David Cameron and the Conservatives are playing a very dangerous game here. I think what we're seeing is a deliberate attempt to undermine public confidence in the NHS and it's coming from a party that..

ANDREW MARR: So you would be...

PATRICIA HEWITT: ...but, no, let me just make the point, because David Cameron and the Conservatives voted against the increases that we made in the National Health Service, they're now pretending that the NHS can have some kind of blank cheque, but at the same time Cameron has committed them to a new economic policy that says year in, year out, there will be cuts in public spending which would be disastrous for the NHS. I don't think that they are serious in their policies on the NHS for the very simple reason that they don't believe in it.

ANDREW MARR: So you would be horrified if that figure of 20,000 turned out to be true, you don't recognise it is nonsense?

PATRICIA HEWITT: Well I don't recognise it for the simple reason that if you take the hospitals that have been in the headlines over the past few days, I mean, for instance, Wolverhampton or Darlington or the Royal Free - and you listen to the leaders of those hospitals, what they're saying is they want to get rid, they want to cut the number of their agency staff and their temporary staff.

They want to have reductions in jobs through natural wastage because, as they make themselves more effective, more day case surgery for instance, they can treat patients better and faster but in some cases with fewer staff.

ANDREW MARR: I know of lots of examples of young doctors, physiotherapists, experienced nurses, who can't get work at the moment. And at the same time, since Labour came to power, we have seen an extra 68,000 administrators, a vastly higher rate of increase than anything, 68% increase compared with about a quarter up on doctors and nurses. Now that under anybody's terms is not good management, is it?

PATRICIA HEWITT: Well it's not good figures, Andrew, because actually we've got over 78,000 more nurses than we used to have in the NHS.

And if you look at these figures that get bandied about for administrators and managers, that category includes people like the porters, the medical record-keepers, the medical secretaries, the receptionists, who are absolutely vital if the doctors and the nurses are to do their jobs. We've actually got fewer than 38,000 managers and senior managers. We've got ten times as many nurses, four times as many beds as we have managers and senior managers.

ANDREW MARR: In London there are specific examples of Trusts which are advertising for senior administrative roles, quite a few of them at the same time as they're laying off doctors.

PATRICIA HEWITT: Well Andrew I think you're referring to the Evening Standard's screaming headlines on Friday. The Royal Free, which does have financial problems, and is quite rightly making itself more effective. It turned out they were also advertising for four risk assessment people.


PATRICIA HEWITT: Now, we've checked with the hospital. And what the hospital says is first of all they've got a very tough group of experts, clinicians, amongst others, who look at whether any new job or any vacancy, really ought to be filled. And in this case they decided they should be, for the simple reason, that it's about protecting patients' safety and making sure that as they re-organise their staff and their staff rotas to make themselves more efficient, they don't compromise the patients' safety and the quality of care.

ANDREW MARR: Can I put it to you - a lot of people look at the huge amount of money that's gone into the NHS, the fact that there have been these financial crises, the fact that there are lots of jobs, of doctors and nurses, going or not being filled at the moment because of them.

And they say this is actually an organisation which can't be properly run from the centre, which needs a radical re-think, radical devolution, of a kind that we haven't seen before. And that's the only way through it. People like you have actually got to give up a little bit of power and stand away from the NHS.

PATRICIA HEWITT: Well I would agree with that, and we always said that with this record investment we're making in the NHS, had to come changes and reforms to the way we do things. And what's actually happening is that we're moving right away from the old monolithic NHS where you used waiting lists to control the budgets, and where you shuffled money from the overspending organisations, from the under spending organisations, usually in the poorer parts of the country, to the overspending organisations.

These financial problems have been there for years. But our reforms mean that we're moving, we're creating a new NHS where patients have got more choice, GPs have much more freedom and responsibility to get the best for their patients. The money follows the patient and each hospital has to take responsibility for delivering the best care, with the best value for money, instead of assuming that somebody else is going to come along and bail them out.

ANDREW MARR: It's patently not well run overall at the moment. I mean there's a senior official, I think, from your Department, a former senior official from your Department, on the television tonight saying that the NHS is not delivering value for money.

PATRICIA HEWITT: What we're actually delivering is more patients treated faster than ever before, more lives saved for instance from breast cancer and heart disease.

ANDREW MARR: Can you honestly look at the public, as it were, and say that the money that's going, that's been going into the NHS, has been well spent?

PATRICIA HEWITT: What I'm saying in a report they're publishing tomorrow, is that if you look at the winter...

ANDREW MARR: ...but you can't say that actually..

PATRICIA HEWITT: Actually, Andrew, I can, but that we can do more. But just remember, we have just come through the coldest March for nearly 40 years. If this had happened ten years ago, maybe even five years ago, don't you think we would have had - we did have ten years ago - the cancelled operations.

We had patients lying on trolleys in A & E for hours on end. We had a winter beds crisis in the NHS year in, year out, ten years ago. Now, the coldest winter for years, there hasn't been that at all. And what we've been able to do is carry on giving people better care. Now there is still more to do. And if you take...

ANDREW MARR: Sorry, is "still more to do" code for saying yes there has been a bit of mismanagement, and not all the money has been well spent. Because that is, as it were, the commonsense view of people all round the country?

PATRICIA HEWITT: No, Andrew, what it says...

ANDREW MARR: Not at all?

PATRICIA HEWITT: Andrew. What I'm saying is that in the NHS which, if it was a country, would be the 33rd largest economy in the world.

There is always room for improvement, and particularly with the way medical technology is changing, there is considerable room for making much better use of the resources we've got in the NHS. If you take...

ANDREW MARR: ...but you don't think we've got too many managers and administrators, and paper-pushers in the NHS?

PATRICIA HEWITT: Oh we're reducing them as well. And part of the reorganisation that we're doing this year in the NHS is designed to save money on administrative costs. They've been falling as a proportion of the total spend, I want to see them fall faster.

But you know, with the new technologies, as for instance we do more day case surgery, as we look after people in their own homes. I was with nurses in Wolverhampton two days ago who were showing me the small pieces of diagnostic equipment that they can now take to patients in their own home, cutting emergency admissions, saving money, and shifting care out of hospitals into the community where it's better for patients but it's also better value for money.

ANDREW MARR: We were talking about the smoking ban in Scotland. It's going to come to England in a little over a year's time...

PATRICIA HEWITT: It'll be here...

ANDREW MARR: ...and you're pleased to see it...

PATRICIA HEWITT: The summer of next year, the summer of next year, and it'll be a huge step forward

ANDREW MARR: And as tough as in Scotland in England do you think?

PATRICIA HEWITT: It's going to be a comprehensive ban on smoking in virtually every enclosed workplace and public place.

ANDREW MARR: Finally, Nick Robinson was dropping a broad hint there that there is a move to radical reform of the Lords after all the loans funding, and possibly a change of heart in terms of an elected second chamber. What's your own view on that?

PATRICIA HEWITT: Oh I'm very strongly in favour of an elected House of Lords, that's what I voted for last time we had a free vote on this subject. And I do think that that is one of the radical ....

ANDREW MARR: That's where're going, that's where we're going.

PATRICIA HEWITT: I think that's where we're going.

ANDREW MARR: All right.

PATRICIA HEWITT: ...but I think on the loans business, again it's the Conservatives who really have to answer the question: Who are the secret lenders who have been bankrolling the Conservative Party?"

ANDREW MARR: Well they're popping up all over the place. Patricia Hewitt thank you very much indeed.



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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