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Transcript of Andrew Lansley interview

30 January 11 12:45 GMT

On Sunday 30th January Andrew Marr interviewed Health Secretary Andrew Lansley MP.

Please note 'The Andrew Marr Show' must be credited if any part of this transcript is used.

ANDREW MARR:

When David Cameron was asked why the government was in such a hurry to push through its radical reforms to health and education in England, he answered simply: "If not now, when?" But almost nobody expected the demolition of so much of the structure of the NHS in England. Tomorrow MPs debate those changes - the abolition of tiers of management, GPs taking control of almost the entire budget, and the private sector likely to play a much bigger role. Well I'm joined now by the Health Secretary Andrew Lansley.

ANDREW LANSLEY:

Good morning Andrew.

ANDREW MARR:

Good morning and welcome. I went back and I read the coalition agreement before this interview and I was really quite struck by the fact that it talked about opening up the NHS to more democracy and more openness, and then went on to talk about the PCTs, the primary care trusts, being given extra people on the boards and so on, and the PCT this and the PCT that. Nowhere was there any indication that PCTs were actually going to disappear entirely.

ANDREW LANSLEY:

Well actually if you look at the manifestoes of the two parties, pretty much all the essential parts of the reform process were there. We made it very clear, and have done for years, that we wanted to transfer the responsibility for commissioning - that is designing and purchasing services for patients to general practitioners. We and the Liberal Democrats were both of us clear in our manifestoes that we wanted to cut the administration costs. The Liberal Democrats set out that they wanted to …

ANDREW MARR:

(over) Not blow up the administration and to move it.

ANDREW LANSLEY:

Well I mean you talk about everything changing in the NHS. In truth actually, tiers of management is precisely what we need to get rid of because if we - as we made clear in our manifesto and the coalition agreement - if we are going to devolve decision making close to patients, give patients more power, give the frontline clinicians more power, we can't have tiers of management.

ANDREW MARR:

So when did you decide …

ANDREW LANSLEY:

There are fifty thousand, fifty thousand administrators in primary care trusts.

ANDREW MARR:

When did you decide that the primary care trusts were going to have to go entirely?

ANDREW LANSLEY:

We decided that in late May, early June.

ANDREW MARR:

So quite …

ANDREW LANSLEY:

After the coalition.

ANDREW MARR:

After the coalition agreement?

ANDREW LANSLEY:

Yeah, we did. And for a very simple…

ANDREW MARR:

(over) So can I ask …

ANDREW LANSLEY:

(over) Well let me explain. For the very simple reason: because if you've transferred the responsibility for designing and purchasing services to general practice consortia and if you've transferred the public health responsibility and the democratic accountability to local authorities, there wasn't a job to be done by primary care trusts. What's the point of keeping tiers of management if there's not a responsibility in that organisation?

ANDREW MARR:

Well you mention accountability and openness. At least primary care trusts, like the regional bodies, as public bodies were open. Members of the public could go along and listen; reporters could go along and take notes. How many meetings a year will the new GP commissioning bodies have to be open to?

ANDREW LANSLEY:

(over) How many … How many people have ever known …

ANDREW MARR:

(over) They're going to be completely closed, aren't they?

ANDREW LANSLEY:

… what their primary care trust is? You and I are talking about primary care trusts. You know there may be a handful of people watching us - well I hope there's more people watching us rather than the tennis - but the people watching, of the people watching us, I suspect only a handful have ever really understood what a primary care trust is at all, yet there's fifty thousand administrators in there. And there's no accountability through this. Who elected the members of primary care trusts? Nobody. There's two kinds of accountability that I'm really concerned really to build through the legislation we bring in. One is the accountability of professionals for the results they achieve and, with patients, the ability to exercise choice; and the accountability through local government, so that actually the people we elect, the people who are genuinely accountable to us, they … And this is where the account…

ANDREW MARR:

(over) But that won't … Sorry …

ANDREW LANSLEY:

(over) But the public can go …

ANDREW MARR:

(over) … that won't affect the GP commissioning trusts.

ANDREW LANSLEY:

(over) … they can go to the Health and Well-Being Board, which is where the general practice comes together with local government to set out what are the needs of their area and how are those commissioning plans going to work. At the moment …

ANDREW MARR:

(over) But if a G… Sorry, if a GP commissioning unit decides…

ANDREW LANSLEY:

(over) Group.

ANDREW MARR:

… group decides to move from one hospital to another or do something quite radical, people are not going to know about the discussion before that until afterwards.

ANDREW LANSLEY:

(over) Yes they are.

ANDREW MARR:

(over) Where?

ANDREW LANSLEY:

(over) Yes they are because that commissioning plan has to be agreed in the Health and Well-Being Board of the local authority, which is a publicly open and publicly accountable body. So actually the accountability through the legislation is going to be enhanced. Because at the moment we've got a situation … You know you take a situation like you know reconfiguration of hospitals at the moment. What has happened time and again is that local people might complain about it, even the GPs might be against it and the local authority might be against it. They complain to the Secretary of the State. The Secretary of State says, "It's not my decision. It's all a local decision by the PCT." The PCT says, "Well we're doing it because the Department of Health told us to do it." There's no way into that at the moment.

ANDREW MARR:

What is going to be the redundancy cost of all those people from the primary care trusts?

ANDREW LANSLEY:

From the overall administration?

ANDREW MARR:

Yes, what's your estimate?

ANDREW LANSLEY:

Well we set it out when we published the bill. It will cost in total just about a billion pounds in terms of potential redundancy costs.

ANDREW MARR:

Right.

ANDREW LANSLEY:

We expect to save £5 billion over the course of parliament. This is a reform that pays for itself within two years.

ANDREW MARR:

(over) Well can we just stay on the redundancy costs? The reason I want to stay on the redundancy cost issue is that when we look at who is actually going to be doing the same sort of job for the GPs, it makes sense to suggest that quite a lot of the people who are currently doing it for primary care trusts …

ANDREW LANSLEY:

(over) Will carry on.

ANDREW MARR:

(over) … will move across …

ANDREW LANSLEY:

(over) Yes, they will.

ANDREW MARR:

(over) … and do it for the GPs.

ANDREW LANSLEY:

Yes. We estimate …

ANDREW MARR:

We're going to pay them …

ANDREW LANSLEY:

No, we estimate about half of the …

ANDREW MARR:

(over) … a billion pounds to move.

ANDREW LANSLEY:

No, that's not right at all, because actually what we've set out is our expectation is that about half of the … at least half of the primary care trust staff will continue to be employed. They won't be made redundant at all. You know it's the old TUPE rules - that they can carry on working for these new statutory bodies. So to that extent, you know this is already happening. Andrew, we're not debating this here in a vacuum. The general practice commissioning consortia are getting together. There's 141 of them got together, representing more than half of the country.

ANDREW MARR:

Okay.

ANDREW LANSLEY:

All over the country, they are already working with their primary care trusts to identify the teams and the people who will transfer.

ANDREW MARR:

Right.

ANDREW LANSLEY:

Sometimes they're going elsewhere.

ANDREW MARR:

You want to see more competition in the system. You want more private competition in the system. Yes?

ANDREW LANSLEY:

Well you say that.

ANDREW MARR:

Well …

ANDREW LANSLEY:

Competition. Why do you say private competition?

ANDREW MARR:

Because there is already …

ANDREW LANSLEY:

(over) Why should it not be NHS organisations who … ? See when Labour did it …

ANDREW MARR:

Well hold on a second. Can I just answer? Because you know very well that when you came into power, there was already a new system for competition within the NHS inside the NHS.

ANDREW LANSLEY:

Yeah, yeah.

ANDREW MARR:

So more competition can't be more NHS competition because that's already there, so it has to be private competition.

ANDREW LANSLEY:

Well okay. Well then, strictly speaking, the answer to your question is no, I actually want competition in the NHS. There is strictly speaking already meant to be a system of open competition inside the NHS.

ANDREW MARR:

And you think it's not working?

ANDREW LANSLEY:

Well it's not that it doesn't work. Actually it's just rather absurd that you have a completely separate organisation called the Competition and Cooperation Panel and an organisation called Monitor that is meant to look after foundation trusts. But actually we want to create a single organisation, bring those together, who is responsible for regulating all of the providers.

ANDREW MARR:

(over) But you would like to see more private involvement in the NHS?

ANDREW LANSLEY:

No, what I want to see is the best providers wherever they may be. You see the point I was going to explain to you is when Labour gave the independent, the private sector a chance you know to provide additional capacity, they rigged the market for them. They said we're going to guarantee that you get paid whether or not the patients choose to go to you and we're going to pay you 11% more than the NHS price. I'm not going to do that. They stopped NHS foundation trusts bidding for that capacity. So I believe, I actually do believe in competition and I think NHS trusts can do the job.

ANDREW MARR:

(over) But do you think it's more likely that we'll see more private involvement in the NHS?

ANDREW LANSLEY:

I don't know. I'm not deciding whether they should or they shouldn't. The decisions about who provides services will be made by patients who exercise choice. And, remember, when the social attitude survey two years ago asked the public did they think they should have a choice of the hospital for example that they should be treated in, 95% said yes they did think they should have a choice.

ANDREW MARR:

Yes.

ANDREW LANSLEY:

And the GPs in their consortia, they will be able to make a choice too about the services that they purchase, you know the contracts they have for who should provide services to them. I mean it is slightly absurd, all this …

ANDREW MARR:

(over) One of your …

ANDREW LANSLEY:

… because, remember, GP practices are mostly independent contractors to the NHS.

ANDREW MARR:

Yes, yes. Everybody pretty much inside the NHS - all the big bodies and lots of MPs, including some of your own colleagues like Andrew George, the Liberal Democrat MP - say that there is risk in this. That this is a huge shake-up; there will be some chaos; it will be a rocky road.

ANDREW LANSLEY:

(over) No, they don't say there'll be some chaos. There will be of course …

ANDREW MARR:

Chaos is a word used by …

ANDREW LANSLEY:

(over) What's the risk of carry on as we are? Is that we carry on and don't get the outcomes we should relative to other countries, that we don't improve services and results for patients as we should. If we carry on as we are, we won't be able to remove £5 billion this parliament out of the administration costs of the NHS …

ANDREW MARR:

(over) But this is a big bang.

ANDREW LANSLEY:

… get it back into the frontline.

ANDREW MARR:

This is a big bang change. If things don't go …

ANDREW LANSLEY:

(over) It's not, it's not. No …

ANDREW MARR:

(over) Well you're removing two layers of administration.

ANDREW LANSLEY:

(over) Two tiers of management. How many people have been … How many patients have actually been treated directly by a primary care trust or a strategic health authority?

ANDREW MARR:

(over) Well that's not their job, that's not their job.

ANDREW LANSLEY:

No, that's why it's …

ANDREW MARR:

(over) Their job is to run the system …

ANDREW LANSLEY:

(over) No, exactly.

ANDREW MARR:

(over) … and you're removing the two things that run the system at the moment, so it is a big change.

ANDREW LANSLEY:

(over) No, no I'm not. I tell you what actually runs the system - is general practice already makes most of the decisions about the care of patients in the community and their referrals and prescribing. Hospitals …

ANDREW MARR:

(over) So you wouldn't say there's risk involved in this?

ANDREW LANSLEY:

(over) … hospitals provide most of the secondary care and tertiary care to patients. I'm not interfering with them. I'm giving them greater freedom on both sides of that equation.

ANDREW MARR:

So when your colleagues say there is risk - and that is a word used again …

ANDREW LANSLEY:

(over) I didn't say there wasn't risk.

ANDREW MARR:

(over) So there is risk, there is some risk …?

ANDREW LANSLEY:

(over) Of course there's risk. Of course there's risk because there's change. But actually if we don't change, the greater risk is that these problems that we have at the moment that we have to deal with won't be solved. We need to get not only spending more in the NHS. We're going to increase the budget by £10.7 billion over the life of this parliament. But we discovered under Labour spending money isn't the answer. We have to deliver the results for patients.

ANDREW MARR:

Alright.

ANDREW LANSLEY:

And we don't get the results we should compared to other European countries. If we did …

ANDREW MARR:

Alright. Okay.

ANDREW LANSLEY:

… we would save thousands of lives.

ANDREW MARR:

Andrew Lansley, thank you very much indeed.

ANDREW LANSLEY:

Thank you.

INTERVIEW ENDS

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