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Wednesday, 30 May, 2001, 14:14 GMT 15:14 UK
Caroline Spelman quizzed

To watch coverage of the forum, select the link below:

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Caroline Spelman, the Conservative health spokeswoman answered your questions about the NHS and other health issues.

Subjects covered included NHS funding and whether private health insurance is the way to make the service better for all. Other issues included standards of cancer and coronary care as well as pay and conditions for workers in the health service.


Below is an edited transcript of the interview.

News Online Host:

Andrew Mason in Oxford asks, can the NHS ever be removed from government control and managed independently?

Caroline Spelman:

I believe that the NHS needs to remain within government control. But I think the way in which government interacts with the NHS can be changed. At the moment Whitehall is meddlesome in the running of our health service. My boss, Dr Liam Fox, would see a much reduced role for the secretary of state. The important role which government would retain would be regulating standards. That's a very important role to make sure that standards are kept high throughout the health service and that's one that's very important to retain but meddling in the minutiae of how individual hospitals are run is not a good use of government time. Those trusts should be given more freedom to run their own affairs.

News Online Host:

The internal market and fundholding created so many accusations of bureaucracy, and overburden of paperwork.

Caroline Spelman:

I don't think we've got a reduction in the paperwork under this government. And if doctors complain bitterly of the amount of time they have to spend form-filling, so do nurses. My sister is a nurse, trained and worked in the health service for 30 years, and she will tell you that she went into nursing to care for patients, not endlessly to fill out forms. So I think that is a criticism that has been quite fairly levelled at the government. But if you reduce the meddling role of government in the running of the health service, this will also reduce the bureaucracy.

News Online Host:

OK, let's move on and here's a question that will be reflected all over the United Kingdom. It's from Alan King in Stockport. He says, I've been waiting for two years and no date yet for my cataract operation. If elected would you look at any spare capacity in Europe for the carrying out of minor operations?

Caroline Spelman:

Well, I think we have to look at spare capacity wherever we can find it because people are waiting now so long for their treatment and in some cases to actually see a consultant in the first case that their condition sometimes becomes untreatable. And that is completely unacceptable. I'm sorry for Alan about the cataracts. I know how impairing that is. And certainly it can really cut down your quality of life because of not being able to see properly and waiting two years is unacceptable, and well beyond the promise that Labour made about the length of time that people would have to wait. But the fact is also for cancer and heart conditions in this country, we half the survival rates of some of our comparable other European countries and I think, yes, we really do need to tackle those waiting times. That's at the heart of it.

News Online Host:

The question, Alan King specifically refers to spare capacity in Europe. Would you export patients, or import spare capacity?

Caroline Spelman:

I don't have a problem with that. We have a capacity problem within the NHS, and it's quite clear that we need to bring in additional capacity. We have also said there is under utilised capacity in the private sector in this country and suddenly Labour have woken up to this realisation as well and talked about partnership with the private sector. Well, that's a turnaround. We always used to be criticised for wanting to privatise the NHS, and hey presto, Labour have now realised that working in partnership with the private sector we have additional capacity to treat conditions like Alan's in this country.

News Online Host:

So you think that Labour's compact with the private sector is just the way forward?

Caroline Spelman:

I do think it's a way forward. There is capacity there in the private sector that has always been willing to work with the NHS, it's just that ideologically Labour have refused to look at this before. Now they are, it's something that we have always advocated doing, and it will bring additional capacity to buttress our NHS.

News Online Host:

Many people on waiting lists will say, we've always had this problem with waiting lists, you had 18 years to sort it out, maybe we should give the government another four or five years just to see if they can do a better job.

Caroline Spelman:

But the point is that these waiting times, and waiting lists have got worse under Labour and also something very unpleasant has happened, which is in an effort to deliver the pledge of reducing waiting lists by 100,000, and that's only been delivered in statistical terms. The truth is that people are waiting longer to see the consultants in the first place. In an effort to reduce those waiting lists what has happened is minor conditions have been treated ahead of serious conditions. Now I think that's unethical. And we would argue that doctors need to be free to treat the sickest patients first. That's our policy.

News Online Host:

OK, moving on, a question from Tim Foster. He asks can we have a commitment from you that any ban on private practice for newly qualified consultants will immediately be reversed, thus allowing surgeons such as myself to return to the UK and the NHS.

Caroline Spelman:

Well, I perfectly understand that and I think that, again, it was another piece of pure ideology. Consultants in this country, as part of their initial contract working when the NHS was set up, it was always envisaged that they would have the opportunity to work both privately and serve the NHS. It's just crazy to think that there's some kind of finite supply when that happens. The fact is, and surgeons do tell me this, they're not doing surgery. They'd like to do more but so often when they're working their way through their operation list, they get, sort of 3:45, when they're down to keep working 'til five o'clock and the support staff are not there to get through the whole list. Now, they choose to go off and do more cases, privately, at other times of the day and we have no problem with that at all, we think they should be able to work in that way. They love their profession, they want to make their patients better. And we think that they should be able to work in that way.

News Online Host:

But if there's a backlog of operations because of poor management, then we should sort out the management so the surgeons can carrying on operating within the NHS, surely?

Caroline Spelman:

Well, Jeremy I totally agree with you on that and one of the fundamental problems is with the shortage of nurses, that's very often what may cause the operating list to fall. And with 12,000 nurses leaving the NHS every year, demoralised and fed up, it's not just about pay, it's conditions. With that vacancy rate in the NHS, my sister, for one, will always tell me that running a ward of geriatric patients with two or three vacancies means it's very hard for the other nurses who have to fill in for them. And so you're dead right. We've got to get the management right, we need to recruit more nurses, retain more of our nurses and that's the way that then surgeons can work to full capacity in the NHS.

News Online Host:

And how much money will be coming in to pay for this?

Caroline Spelman:

I've just sort of said, it's not, it isn't just about pay. It is also about conditions and nurses will also tell you that the NHS is a very inflexible employer. It doesn't have to be. I noticed that the Addenbrooke's NHS Trust was nominated as an employer of the year. Why? Because it offered really flexible conditions for its nurses to work. They could come back and re-train one day a month. They had flexible rotas to allow for their childcare commitments. Now if one NHS Trust can do it, why can't the other trusts do it? It is, after all, a national health service.

News Online Host:

Yes, spreading good practices, is obviously a very important part but many people are concerned about the spectre of cuts, which Labour claims will be generated by your planned reductions.

Caroline Spelman:

Well, let me just spell this out, plainly and clearly. I seem to have to do this on so many occasions, it's like everyone ignores what we've been trying to say for a very long time. We will match Labour's spending on the NHS. That is an absolutely unequivocal pledge and there is no question of cutting the amount of funding to our NHS.

News Online Host:

After three years?

Caroline Spelman:

There is no question of cutting the funding of the NHS. Putting additional capacity into the NHS and bringing standards of health care up to those of the average of Europe is going to take longer than three years.

News Online Host:

OK, let's move on to a question from one of your supporters, Victoria Master from Cambourne in Cornwall. She says as a new member of the Conservatives and a young disabled person, what will the Conservatives do to stop the NHS treating the disabled as second class citizens in this country?

Caroline Spelman:

Well, Victoria, I quite understand that and I think that there's a general problem with chronic and degenerative conditions and I feel that we have to tackle this right at the very start with medical training. I sometimes feel that doctors are trained, they want to make us better, but the reality is if a condition is such that there is no miracle cure, but that the condition can be managed and the quality of life can be improved, we need to encourage doctors to put more effort into that. All the accent on just curing people and making them better can result in people who suffer chronic conditions for a long time, even the whole of their life, suffering from a less, a less effective service. I'm very sympathetic to that. Let's start with the way doctors are trained to help people like you.

News Online Host:

Some changes in attitude need to go beyond party politics, don't they?

Caroline Spelman:

Absolutely. And, I, changes in attitude take quite a while to achieve, I can say that with some feeling. But obviously as part of training medical professionals, that is where the changes of attitude can be brought about.

News Online Host:

OK, let's go to one more question, that's from Jenny Carling in London, she says many NHS hospitals are filthy. Is it not time to scrap outside contractors who seem to do such a bad job in keeping the wards clean?

Caroline Spelman:

Well it may not be outside contractors. The nub of the problem has to do with line management and whether or nor the ward sister can require the cleaner to clean up that puddle under the bed, or get to, and get the toilets clean on the ward. And the problem is at the moment that contractors don't see their line manager as the ward sister and by changing the line management so that the ward sister does have the say as to where the cleaning power goes in will make a difference on the ward. The other thing that will help will be trying to run the NHS at a capacity, 100 per cent capacity, results in what is known as hot-bedding. In other words, patients are in and out of their beds so fast there's not a chance to really get the place clean. And I think if the capacity, bringing in capacity from the private sector to ease the pressure on the NHS, it should be possible to get better standards of hygiene in our NHS hospitals.

News Online Host:

Isn't there a problem that contractors from outside the NHS are paid ever lower wages, so the people they are employing don't have the commitment to the NHS that many employed directly would have?

Caroline Spelman:

I think that's, Jeremy, that's really a sub-issue and that has to do with local rates of pay. It is difficult enough in some parts of the country to get people to work in the NHS because there are competing jobs. I mean certainly nurses sometimes leave health care because they can get better paid at the check-out of the local supermarket. I mean that's a situation that is wholly undesirable. But that is a wider issue about whether or not rates of pay should be better adapted to local circumstances where there's competition for these jobs.

News Online Host:

OK, we'll have to leave it there I'm afraid. Sorry we couldn't get through all the questions but Caroline Spelman, shadow health minister, thanks for being with News Online.

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