29/02/2012 Newsnight


29/02/2012

Jeremy Paxman challenges the health secretary over the government's contentious NHS reform plans. Plus, James Murdoch quits News International.


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Transcript


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It affects all of us, and we will all have to live with the

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consequences of the most contentious piece of legislation of

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the entire Cameron Government. Tonight, the plan to reform the

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National Health Service. The legislation is far bigger than

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the law which created an institution all parties profess to

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love and protect. Does the system have to stay the same forever and

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ever? The Health Secretary tells us,

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there is nothing wrong with the reforms, it is all about

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perceptions. You could say blame me as a communicator, but if people

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are literally distorting and misrepresenting what the bill does,

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I just literally have to fight back against that.

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These people have to make the health service work, they will be

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putting their anxieties and hopes directly to the Health Minister,

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who thinks the whole reform is solely about making the system work

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better for patients. And one sunrises as another departs.

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How long before News Corporation gets out of British newspapers for

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good, as James Murdoch quits. Another day, another pile of

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argument about the Government's attempts to reform the healthcare

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system, Labour claim tonight that the Government was trying to rush

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its now very knocked about bill through parliament, by the time of

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the budget next month. Rubbish said the Government. The plan described

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by a senior NHS boss, as so big you can see it from space, has had a

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very checkered history. Promoted by the Liberal Democrats, and amended

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by them. Introduced into parliament in January last year, then

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suspended for a while, now approaching final votes. It is not

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what the Government had hoped for. Away from Whitehall and Westminster,

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to Worthing. A beach on the south coast. The Government's health

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reforms look set to make it on to dry land, what exactly do they

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change, how and when? What we have here is a charity that

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is part of, in effect, the NHS. asked the Health Secretary to take

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us to somewhere that exsemplified the reforms they are trying to get

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going, he has brought us to Action For Deafness. This charity is being

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billed as the best provider of help for those who are hard of hearing.

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It isn't strictly the NHS, as it stands it is asked by the health

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service to cater for patients' needs. Lansley's bill is supposed

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to give help to give suppliers like this, who want the best for their

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patients, the work. In 60 seconds, Josie clearly isn't fully aware of

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what is going on, explain it? we are setting out to do, it comes

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down to, firstly, making sure that you as a patient, everything that

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happens to you, you should get really good information, and

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wherever possible you should have some choice about the service that

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is provided to you, including where it is provided from. Secondly, you

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are registered with a GPs' surgery, your GP locally, and doctors and

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nurses around locally in Worthing, they should be in a position where

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they are able to design the services that you need locally, and

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use the NHS resources to make sure those services are here for you.

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Days ago Nick Clegg urged his party to take pride in the fact that they

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had saved the NHS from privatisation. It strikes a bit of

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fear with privatisation. Because, just explain to me what is it? From

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my point of view, we are not going to do privatisation, explain to me

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what it is you think privatisation means as a problem? It will just go

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out to various people, are those people going to care like the

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National Health Service cares now. I have had a lot of dealings with

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the National Health Service regarding my father, he died a

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couple of years ago, to try to bring all those bits and pieces

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together was one long fight, but we got there in the end. Because we

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all worked together. If it is going to be put out to privatisation, is

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it all going to work. The sort of thing I have been saying, actually

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it is going to be NHS care, like this is NHS. It doesn't have a big

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sign saying it, but this is NHS care. The political peril of this

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bill is clear, while the Health Secretary is down south, at Prime

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Minister's Questions, Labour's leader goes on the attack for yet

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another week. Let me refresh his memory as to who opposes his bill.

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There is no good the Deputy Prime Minister smirking, I don't know

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whether he opposes or supports the bill, which day of the week. Oh he

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supports it, oh, he supports it, Mr Speaker. What you are saying is the

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critics don't really understand the bill? I have to say, there are a

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lot of things that I have seen said about the bill that appear to

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suggest they haven't even bothered to read it. That includes coalition

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partners, doesn't it? No. Of course it does? To be fair, Shirley

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Williams, actually, that is the point. We have spent some

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considerable time working with Shirley and others in the Lords, to

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get to a point where, yes, we are going to make some amendments, but

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they are amendments that give us, and them, a sense of actually,

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finally putting precise reassurance in. Health Minister Mr Bef van cuts

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the turf. Lansley's predecessors include the founding fathers of the

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NHS. Is it up there with Beveridge these reforms? I wouldn't say.

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they are going to last for a long time? The character is very

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different. If you go back to 1950, Bevan said there is the tension

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between the centralised funding system and decentralised

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administration. And actually, over the years, the fact that the centre

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has provided all the money, has meant the centre has had all the

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control. Andrew Lansley was so trusted by the Prime Minister, that

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years out of forming Government, he was the only one of David Cameron's

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team to be promised he would make the grade, and go from Shadow

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Health Secretary to the Government job. The idea was no major reform

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change, reorganisation, steady as she goes, the public was to trust

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the Conservatives on the NHS. But now, because of these reforms, it

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is almost certain the NHS will be a battleground at the next legs, that

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was never part of their plan. -- next election, that was never

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part of their plan. It is one thing to get a bill through parliament

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against opposition, many have done it. But verdicts on policy come

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later, in the real world of people's experience. The challenge

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for this Government is, while they may will it to work, it is probably,

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very soon, out of their hands. As you heard there, the Health

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Secretary was at a centre for the hard of hearing in Worthing earlier

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today, by happy chance, it is also the town where Oscar Wilde wrote

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the Importance of Being Ernest. Did you anticipate the sort of trouble

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that you have run into on this bill? Yes, I always knew there

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would be, there is always noise, the NHS matters, so people make a

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lot of passionate remarks about it. You could go back, 2003, do you

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remember, it is only less than a decade ago, Alan Milburn put

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forward foundation Trusts, over 100 members of his own parliament

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rebelled against him, The Royal College of Nursing came out against

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it, others said it would be the end of the NHS. You are the person who

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said in 2006 you would build consensus on the need for change?

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You failed? On the need for change, absolutely we have, and on the

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principles of the bill. If you look at it, not only amongst

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organisations, but last year, when the Future Forum went to thousands

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of NHS staff, at hundreds of meetings across the country, they

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established there was a consensus on the principles. Would the bill

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have been any different if you had not been in coalition? If it had

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just been a Conservative Government, we would have started now the a

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different place. The bill is better as a result of the coalition coming

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together to shape it. Actually, I think, the central point, from the

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Liberal Democrats' point of view, has been democratic, local,

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democratic accountability. Local Government, in the new health and

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well being boards, bringing together health, social care,

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public health, into a combined forum, where local voices, and

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local views can be added to professional views from the health

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service. Actually it is stronger, as a consequence of being a

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coalition bill. If you can't take cabinet colleagues with you, on a

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profoundly important piece? We have taken cabinet colleagues with us.

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They sign off on one thing and then they try to amend it? I'm sorry, we,

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as a Government, as a coalition Government together, designed the

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legislation. As a coalition together, Nick Clegg, David Cameron

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and I, we want to improve the bill, we want to respond to people's

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concerns, we did that last year. I think we did that very successfully.

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Are you also going to maintain that this rigmarole we have been through,

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the legislation being introduce, paused for consultation, and

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amendments introduced many of which you accept, that was all

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anticipated too was it? No, I thought when we published the White

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Paper, which we did in 2010, and we had 6,000 consultation responses,

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that actually most of the concerns would be there. It turned out it

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didn't happen that way. That, it wasn't until the bill was in the

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Commons, that many people said, we're worried about this and that.

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Actually it was important to pause the bill, to listen, and to respond.

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We did that. I think, actually, what that demonstrated was the

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support, in principle, for the bill, across the service. It gave us a

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lot of recommendations, and we were able to accept them. Which is why,

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actually, I think, across the NHS, there is an understanding among

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many staff that this is actually, in a sense, the bill they helped

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shape. Doesn't it also demonstrate that however well you may be on top

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of your brief, you are a hopeless communicator? No, I don't think

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that at all. You didn't take people with you? Then that didn't happen

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to any a second on health legislation at any time in the past.

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Patricia Hewitt stood up in front of the Royal College of Nursing and

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they booed her. Ken Clark, a fabulous communicator, he tried

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reform in the early 1990s, and the BMA said it was the end of the

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world as we know it, they put up posters with a picture of Ken Clark

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asking what do you call a man who doesn't take medical advice. There

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is no way of undertaking major reform, important reform, and

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imagining that you are going not to be misrepresented, distorted or the

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subject of argument, not going to be the subject of genuine concerns,

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and genuine issues, that you have to genuinely respond to. I think we

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have pretty much reached the stage where quite a lot of the

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disinformation out there is a problem too. People are saying

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things that are literally not true. The list of organisations,

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organisations that ought to know about the NHS, as well as you know

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about the NHS, the Faculty of Public Health, BMA, nurse, midwives

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and all the rest of it? The Family Doctor Association, and the

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representatives of Trusts and Hospitals. Are you saying they are

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ignorant, have they fallen for propaganda? They are engaged in

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various campaigns for various purposes. When you actually get to

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it, take The Royal College of Nursing, for example. When do you

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think they opposed the bill? January, up until that point they

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had been literally with us. They said they supported the bill. What

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changed? They fell victim to some piece of propaganda or something?

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You tell me. Maybe they read the bill? I tried to find out what

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change caused them to change their minds. What is your theory? I think

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they were angry with the Government because there was a continuation of

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pay restraint and the pensions issues, frankly, I find it...These

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Organisations if they are against the bill, they have a right to be?

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How can it be we introduce the bill in January 2011, for a year The

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Royal College of Nursing work with us, say they support the bill. The

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general secretary sits in my office on more than one occasion, saying

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they support the bill. We make the amendments they looked for in the

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course of the discussions we had with them last year, and suddenly

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they say they are against it, well, because actually, other things were

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going on. Can you guarantee, finally, that if this bill goes

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through, and it is now much improved, you claim, that it will

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be the last reform of the NHS, that you can foresee for the next ten

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years? Yeah. I think it is a major piece of legislation. Why? Because

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we are dealing with issues that haven't been dealt with in the past.

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The reason we need the legislation is to effect a transfer of

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responsibility and power, to local authorities and local health

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organisations. It doesn't deal with the fundamental problem, that the

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NHS, for not much longer, can be afforded? It does very much help

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with that. What it does is it puts the decision making responsibility,

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increasingly, in the hands of people who can use resources better.

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Rationing is inconceivable, in your view? Proirt setting is necessary,

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and should be done by -- priority setting is necessary and should be

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done by the doctors and nurses with the care of the patients. That is

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rationing? It is not, that is depriving people access to services,

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getting people the right care, at the right time, in the right place,

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is what it's about. Thank you. With us is the Shadow Health Secretary,

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Andy Burnham. Apart from taking �20 billion out, what is your policy on

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the NHS? We had a successful NHS when this Government came in,

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judged by the Commonwealth fund to be one of, if not the best

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healthcare system in the world. What they have done in the 18

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months in power, is take the self- confident NHS, destablise it, and

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demoralise it, and turn it into an organisation fearful for the if you

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are tue. We will be the judge of what -- Future. We will be the

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judge of what they turned it into, what is your policy? We have a

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planned National Health Service that for 60 years delivered care.

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You haven't a policy other than what exists? I have a policy, a

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National Health Service that is planned and provides care to a

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whole population, not legislation for a market in healthcare, that

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basically, breaks all of that apart. No change? No, and one of the

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arguments I would make, one of the problems with this bill, it is a

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distraction from the real reform the NHS needs. It needs service

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reform, not back office structural reform. It needs reform? It needs

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more care in the patients' homes in the community, changes to service

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on the ground. The whole debate about the structures of the NHS s a

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massive distraction to the change of services we need on the ground.

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In policy terms, what are you advocating? I have just explained,

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we need service change. You have asserted people need more care in

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their homes? In the ageing society, we need to bring together health

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and social care. It was an argument I made as Health Secretary.

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would you do that? We needed to reform the social care system to

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provide more prevention in people's homes, better integration with the

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health service. This bill is a recipe for fragmentation, and a

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move away from the integrated care we need to see. I'm interested in

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what you want to do. Is it just coincidence, that when you are in

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Government, Tony Blair boasts about the scars on his back, that come,

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he said, from taking on vests interests in the public sector, and

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that when you are in opposition, you basic clo dance to the vested

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interests -- basically dance to the vests interests tune? I don't agree

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with that. The it is not opportunism, what they did was make

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a catastrophic mistake, by combining the biggest-ever

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financial challenge in the NHS, with the biggest-ever top-down

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reorganisation. They would do well now, at this late stage, to give

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the NHS the stability it needs to face the financial challenge. That

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is what I will be doing now. I will be giving the NHS the ability to

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focus on changing services, make them more sustainable so, they can

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face the future. Will there be any detail in what you will do, should

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you be elected? I was part of Government that took the NHS, that

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was on its knees in 1997, and turned it into one of the best

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healthcare systems in the world. needs changing? It needs service

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change. I have always argued for that. We made some difficult change

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to skefrss in Government. We made changes to stroke services in

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London, maternity services in Greater Manchester. These are the

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difficult changes the NHS needs. That is the nettle all politicians

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need to grasp. If we are in the position where we are always using

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the NHS as a political football we will never get there. That is what

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the bill should focus on, this bill is a massive distraction from it.

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With us now is the Minister of State for Health Simon Burns, and

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an ensemble of healthcare professionals, between them they

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represent thousands of nurses, doctors and patients across England,

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and listen to those who have been patients of the NHS. Some agree

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with Government reforms, others are sceptical. Let's start with this

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accusation about The Royal College of Nursing. Did you sit in Andrew

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Lansley's office and tell him you believed in the bill? Sat in Andrew

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Lansley's office many times, telling him we had severe anxieties

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and concerns about this bill, but we were committed to try to work

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with it, and we worked with it for a year, and we didn't get anywhere,

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we made the decision that we would now withdraw our support, because

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while there was a lot of listening, there wasn't much action. So you

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did tell him you supported the bill in one sense, but when it came to

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it you decided you couldn't? thought it was the responsible

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thing to do, with the elected Government of the day, to try to

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work with this, to see if we could change it, and we didn't succeed.

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This is a very, very significant difference of emphasis, what is

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your recollection? I was at some of the meetings, not all, my

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recollection is similar to Andrew Lansley's. We did listen, we have

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made changes that responded to what The Royal College of Nurse iting

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was asking for. For example, they wanted a nurse on all -- The Royal

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College of Nursing was asking for. They wanted a nurse on all the

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clinical boards, following the Future Forum review, we have sed

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that, and that is now happening. We have accepted that and that is

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now happening. Is your recollection about the British Medical

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Association in any sense similar? With all reforms there will be

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people who are for it, within an organisation, and people who aren't.

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What we found with the responses to the consultation document, that the

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BMA were supportive of some things, but less happy with others. When

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the Future Forum reported its recommendations, which we accepted

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last June, they warmly welcomed that, because they were taking on

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board ideas to improve and strengthen the bill. So Dr Hamish

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Meldrum, did you also initially support the bill? No. You have

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never supported it? Never supported the bill. When the White Paper came

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out, the headlines, which are about better clinical involvement, better

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patient engagment quality, of course you support that, when you

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read beneath the headlines, no, we didn't support it. We engaged in

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the consultation process, three months after the bill came out, we

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had a special representative meeting, asking for the bill to be

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withdrawn. So to say we have supported the bill, I'm sorry, is a

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travesty of the truth. You also opposed the setting up of the NHS?

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No we didn't, that is another long and oft repeated myth. The doctors

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and the BMA proposed, don't look so surprised. Did he not say, I will

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get their agreement, by stuffing their mouths with gold? That is

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about the contractual arrangements within the NHS. Exactly? It wasn't

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about the NHS itself, doctors didn't want to be state employees

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and actually not to...You Don't like change, that is your problem?

:21:38.:21:43.

That is not true, I have been a GP for over 30 years, I have seen

:21:43.:21:48.

massive change. It has been evolutionary change not structural.

:21:48.:21:53.

I have seen nine structural organisations that have made the

:21:53.:21:58.

NHS worse in many respects, they have been hugely distracting and

:21:58.:22:01.

costly, and taking the eye off the real things. Do you think those

:22:01.:22:05.

with a vested interest in the National Health Service are really

:22:05.:22:12.

adaptable? I would hope they have the best interests of improving the

:22:12.:22:17.

NHS. I want you to talk about your experience rather than your hopes?

:22:17.:22:23.

In my experience I have found they have been prepared to engage, but

:22:23.:22:27.

they have come to conclusions that are not in the interests of moving

:22:27.:22:33.

the NHS to move forward. What is disappoint beg the BMA is they have

:22:33.:22:38.

-- disappointing about the BMA, is they have been for the bill, but

:22:38.:22:42.

they voted for one of the core parts of the bill, clinical

:22:42.:22:46.

commissioning groups. Dr Alessi you are a GP, you support the bill?

:22:46.:22:53.

am a GP. You are singing from an entire different hymn sheet from

:22:53.:22:56.

the BMA? I am looking it on the basis of consultation with patients.

:22:56.:23:00.

I can think of the way things will change in the future. Things won't

:23:00.:23:04.

happen quick low, change won't happen rapidly. We will -- quickly,

:23:04.:23:07.

change won't happen rapidly. We will come to the bit soon where we

:23:07.:23:11.

will manage the interfaces, and we will have more control over what

:23:11.:23:14.

happens to patients than we have at the moment, that is what all this

:23:14.:23:17.

about. You think it gives you freedom? I think the change has

:23:17.:23:21.

been palpable, the discussions I'm having now with my colleagues in

:23:21.:23:24.

hospital is completely different to what it used to be before. They

:23:24.:23:28.

have been liberated as well. They are able to speak to me, before

:23:28.:23:35.

they just, it just didn't work. doctors' trades unions angry?

:23:35.:23:38.

fact it is happening before the bill has passed, shows you don't

:23:38.:23:42.

need a bill to make that happen. That is the whole point. You can't

:23:42.:23:46.

say it is due to the bill, the bill isn't in law yet, these things are

:23:46.:23:50.

and were happening. The fact that doctors want to do the best for

:23:51.:23:57.

their patients, Assam, who sat on a platform with -- as Sam, who sat on

:23:57.:24:00.

a platform with Andrew Lansley a year ago. He said just because we

:24:00.:24:04.

want to do the best four patients, doesn't mean we support this bill

:24:04.:24:08.

and we don't. You are a GP, you also think there

:24:08.:24:13.

is a lot to be said for the reforms? I do, I think while I have

:24:13.:24:17.

some mixed views about the bill, there are some parts I'm not

:24:17.:24:21.

supportive of actually, there is no doubt in my mind, as a GP involved

:24:21.:24:24.

in commissioning, it has made a huge difference to the influence

:24:24.:24:28.

that I have been able to exert. the changes have already been

:24:28.:24:31.

implemented, why do you need another piece of legislation?

:24:31.:24:39.

have been trying to change things for better for about 15 years. Up

:24:39.:24:43.

until this legislation, which attracted everybody's attention, I

:24:43.:24:46.

haven't been able to get the traction I needed to effect change.

:24:46.:24:51.

You have got the traction, you are making the changes, as Dr Alessi

:24:51.:24:56.

has been saying? Absolutely, it is because of the bill, the scope,

:24:56.:25:00.

scale and sheer audacity, has hit the radar of absolutely everybody,

:25:00.:25:04.

and people have started to behave, I agrie, as if it is in lepblgs --

:25:04.:25:09.

I agree, as if it is in legislation, but before this happened under the

:25:09.:25:12.

previous administration it was not possible. The clear indication is

:25:12.:25:17.

you didn't need to do much of this? We do, that is a false myth, put

:25:17.:25:22.

around, sadly, mostly by politicians. The reason we have to

:25:22.:25:25.

have the legislation is because they are moving in pathfinder form

:25:25.:25:28.

at the moment. But there is nothing in law to make the clinical

:25:29.:25:33.

commissioning groups accountable, so you need legislation, and also,

:25:33.:25:39.

you have got to abolish the PCTs and the SHAs, you cannot do that

:25:39.:25:44.

without primary legislation. That is why it needs the legislation to

:25:44.:25:54.
:25:54.:25:57.

actually make it work. Angela Coulter, you speak for a number of

:25:57.:26:03.

organisations, I understand in your judgment can it deliver better

:26:03.:26:07.

patient care? There are 160 organisations representing patients

:26:07.:26:10.

and carers, and they are, on the whole, very unhappy about the bill.

:26:10.:26:13.

They have done a lot of lobbying, and are very pleased that the

:26:13.:26:17.

Government has listened in some cases, and the bill includes more

:26:17.:26:20.

power for patients, more involvement in decisions about

:26:20.:26:25.

their care, and so on. But, it is a real distraction from the major

:26:25.:26:28.

issue, which faces our health system and everybody else's, which

:26:28.:26:33.

is people with long-term conditions who want joined-up care. The

:26:33.:26:38.

problem is, that this bill seems to represent, or certainly the concern

:26:38.:26:43.

of our members is, is it will make care more disjointed, not more

:26:43.:26:46.

joined up. It is not just a distraction, it is a positive

:26:47.:26:50.

impediment? Nobody really knows, because the bill is incredibly

:26:50.:26:54.

complex. There is a real fear. feel similar? It is one of the

:26:54.:26:58.

major concerns, this emphasis on competition, what we should be

:26:58.:27:01.

doing is getting the component parts to work with each other, to

:27:01.:27:05.

collaberate with each other, the Hackneyed, joined up thinking, this

:27:05.:27:10.

bill will stop that happening. is, I'm afraid. Factually incorrect.

:27:10.:27:14.

The whole ethos of the bill is putting patients at the centre of

:27:14.:27:20.

care, and...Built Around the idea of competition? Competition has

:27:20.:27:25.

always been in the NHS and will continue to be. Competition, based

:27:25.:27:30.

on quality, can be a force for good. Let me give you a brief example.

:27:30.:27:35.

Two NHS hospitals within five miles of each other, one of them has a

:27:35.:27:38.

reputation, through surgeries, for hip replacements, they have short

:27:38.:27:43.

waiting times for it. There may be other peripheral things, their MRS

:27:43.:27:50.

A-levels are very low, their mixed sex ward accommodation is very low,

:27:50.:27:56.

and the hospital five miles away, an NHS one, has a poor record,

:27:56.:28:01.

clinically, on hip replacements, longer waiting times, with patients

:28:01.:28:04.

empowered with choice, you will see, probably, many more patients going

:28:04.:28:08.

to the hospital that is performing better, that will be a spur for the

:28:09.:28:13.

less performing one, to ask why. That is open it to patients now, we

:28:13.:28:20.

don't need the bill for that. is a good thing. You can already do

:28:20.:28:23.

this? You can already do that, if you can find the information about

:28:23.:28:26.

the quality of the hospitals you can choose to go to the best. We

:28:26.:28:36.
:28:36.:28:38.

didn't need a bill for that. have some experience of how

:28:38.:28:43.

competition works, Kresimir Zubak? I find the debate of -- Stephen

:28:43.:28:49.

Bubb? I find the debate of are we for the bill origins frustrating.

:28:49.:28:53.

The majority of people in hospital beds are over 65, long-term

:28:53.:28:56.

conditions, taking 70% of the health budget, and there are

:28:56.:29:00.

charities and social enterprises, who want to do more to provide

:29:00.:29:06.

those services. We want competition to enable that to happen.

:29:06.:29:10.

You, presumably, you are heavily involved in charities that would

:29:10.:29:14.

like to do more? I run a social enterprise. I presume you welcome

:29:14.:29:18.

this, don't you? It is not case of welcome or not welcome. We are

:29:18.:29:24.

where we are, the fact of the matter is the competition issue is

:29:24.:29:27.

largely irrelevant, we have had competition in the NHS for a long

:29:27.:29:32.

time, the question is management of the markets. What worries me is

:29:32.:29:34.

noft-for-profit organisations, social enterprises, aren't in a

:29:34.:29:39.

place where they can compete with some of the highly capitalised

:29:39.:29:42.

private sector organisations. Just giving you an example, if you look

:29:42.:29:46.

at the provision of community health services in Surrey, that

:29:46.:29:51.

contract, which was worth �90 million a year, went to a private

:29:51.:29:55.

sector organisation, when, actually, the best performer, in terms of

:29:55.:29:59.

delivering community healthcare services was a social enterprise.

:29:59.:30:04.

But it simply could not compete. I raised this matter with the Prime

:30:04.:30:08.

Minister. You can't just talk about competition without saying

:30:08.:30:12.

something about how you manage the market. Just one other thing, it is

:30:12.:30:18.

the case that where you have limited resource, and we do have

:30:18.:30:20.

limited resources, unfettered competition can waste those

:30:20.:30:24.

resources. There are lots of issues about the market and how we manage

:30:24.:30:29.

the market. Your experience, Ali Parsa, of letting different kinds

:30:29.:30:33.

of disciplines get to work, is actually rather different, isn't

:30:33.:30:39.

it? Absolutely. Just explain what you do? We are, I guess, now

:30:39.:30:43.

Europe's largest partnership of doctors, nurses, healthcare

:30:43.:30:46.

professionals, who think we should be able to run hospitals, exactly

:30:46.:30:51.

in the same way that GPs can run GP practices, they are a partnership

:30:51.:30:53.

of people who have come together and contracted back to the

:30:53.:30:56.

Government to deliver to them the services the Government want. Why

:30:56.:31:00.

can we not do that in hospitals. Where we were given the opportunity

:31:00.:31:05.

to do it, for instance, in Bath, from scratch, without any

:31:05.:31:10.

Government grant or support, we built a building that won the award

:31:10.:31:18.

for the best building, globally, we brought people who design luxury

:31:18.:31:24.

hotels to design the building, and Michelin-starred chef to cook every

:31:24.:31:29.

day. It can be done. Makes you want to be ill? When you are ill you are

:31:29.:31:35.

welcome. It can be done. Why do you oppose it? You don't need a bill to

:31:35.:31:41.

do that, as demonstrated. That is a fair point? To take the Simon's

:31:41.:31:45.

point, the hospital that is poor needs to be sorted out, patients

:31:45.:31:52.

still have to go there, you need to sort out bad, inequality of service,

:31:52.:31:56.

competition won't help that. Actually this bill is costing �3

:31:56.:32:00.

billion. No it is not. It is taking a huge amount of people's minds off

:32:00.:32:04.

the care of patients. What do you mean it is costing, the

:32:04.:32:11.

implementation of the bill? implementation. Can we put it right.

:32:11.:32:16.

The cost of it, as the impact assessment shows is up to �1.3

:32:16.:32:19.

billion, a one-off cost, as a result of that, between now and

:32:19.:32:24.

2015, the savings will be �4.5 billion, to reinvest in the health

:32:24.:32:30.

service. For the rest of the decade �1.5 billion, per an number, all to

:32:30.:32:35.

be reinvested in the -- peran number, all to be reinvested in the

:32:35.:32:40.

health service. You are changing the subject now? This is the risk

:32:40.:32:43.

of this legislation. You asked about money, he told you about

:32:44.:32:49.

money, now you are talking about the risk register? I think if you

:32:49.:32:52.

put clinicians in the driving seat of reorganising healthcare, we

:32:52.:32:55.

understand the product of healthcare in a way professional

:32:56.:33:01.

managers don't always. I'm abs lout low certain that my colleagues, and

:33:01.:33:05.

-- absolutely certain that my colleagues, and a lot of young

:33:05.:33:09.

doctors are coming forward with solutions for improving services

:33:09.:33:12.

for patients. The NHS is not perfect, there are areas where we

:33:12.:33:16.

can do better, and we know where they are. We don't need a lot of

:33:16.:33:20.

data, we speak to patients on daily basis, we understand what needs to

:33:20.:33:26.

be fixed. We are the best placed people, clinicians working in

:33:26.:33:31.

partnership with hospitals and colleagues to do this best. We have

:33:31.:33:35.

to remind ourselves this is the NHS and social care bill, it is not

:33:35.:33:41.

just about clinicians deciding what populations want. What it should be

:33:41.:33:46.

about is commissions and populations deciding how they

:33:46.:33:51.

provide an integrated health and social care system. Hang on, let me

:33:51.:33:54.

finish, which is about commissioning. And so far, just a

:33:54.:33:59.

point I'm making, I'm not saying I disagree with any of you, I'm

:33:59.:34:02.

making the point that we have talked about the NHS as though it

:34:02.:34:07.

is about hospitals and clinical interventions, the NHS and social

:34:07.:34:11.

care bill. We're not going to save �20 billion unless we integrate

:34:11.:34:16.

health and social care. Are all of these a conspiracy against the

:34:16.:34:21.

public, the NHS should be about patients? That is my point, it is

:34:21.:34:25.

the NHS and social care bill. also about citizens. It is the

:34:25.:34:30.

citizens in charge. It is care, well co-ordinates and meets their

:34:30.:34:36.

need. Absolutely. That is the challenge. This shake-up of the NHS

:34:36.:34:39.

is putting organisation against organisation, it is dividing

:34:39.:34:43.

professionals, it is actually not helping. It is going to take about

:34:43.:34:46.

four years before the commissioning groups really learn how to do it.

:34:46.:34:52.

It will take some time to settle in. All major change takes time? A lot

:34:52.:34:56.

of people will be ill and need better co-ordinated care. You look

:34:56.:35:01.

at countries according to the OACD, have the best healthcare quality in

:35:01.:35:06.

the world, France, Germany, Switzerland. And the UK. They are a

:35:06.:35:09.

co-operation between the private sector, public sector, private

:35:09.:35:13.

sector in Germany runs more hospitals, more healthcare

:35:13.:35:17.

provisions than the public sector does T does it in a regulated

:35:17.:35:20.

market, in which people can't "cherrypick", in which people need

:35:20.:35:25.

to focus on the patients. That is what we need to focus on. The

:35:25.:35:29.

British public is not concerned on whether the service is provided by

:35:29.:35:32.

public sector, private sector, the Government, it is concerned about

:35:32.:35:35.

whether it is fair, it is accessible, it is free at the point

:35:35.:35:39.

of delivery. We should focus on making sure that happens, and when

:35:39.:35:42.

that happens, when that happens everything will be fine. By the way,

:35:42.:35:46.

for those who think that the private sector, or the social

:35:46.:35:51.

enterprises just take the cherry, let me say it here and now, please,

:35:51.:35:55.

give us all your potatoes, keep the Cheries, we love to have what you

:35:55.:36:05.

don't want. France and Germany spend 2% more of GDP on healthcare.

:36:05.:36:10.

The British healthcare system is the most cost effective service in

:36:11.:36:16.

the world. But not the best. haven't had much of a shout. Can we

:36:16.:36:20.

have an opportunity perhaps, now we are in this state where we are

:36:20.:36:24.

starting to have a dialogue with our local authorities. This is

:36:24.:36:28.

starting now. Let's give us the oxygen we need to make it happen.

:36:28.:36:34.

We need the space, the time to make this happen. I wonder if you feel,

:36:34.:36:37.

as a practising GP, that, in a sense, this is rather missing a

:36:37.:36:40.

point. We can have the organisational changes, but there

:36:40.:36:44.

is a real crisis in this country about how on earth we carry on

:36:44.:36:47.

paying for healthcare, giving the increasing demand? Unless we change

:36:48.:36:52.

what we are doing, we will get into difficulty. I believe only by laifg

:36:52.:36:58.

the dialogues at this level and in- - having these dialogues and at

:36:58.:37:01.

this level and intensity can we find our way out of where we are at

:37:01.:37:05.

the moment. A lot of this debate is often dominated by a professional

:37:05.:37:09.

view. There is nothing wrong with that, but the citizen view doesn't

:37:09.:37:16.

often get in. To give you an example of this, we want more

:37:16.:37:21.

choice in the NHS. The NHS institution guarantees choice, but

:37:22.:37:25.

doesn't deliver it. If at the end of your life you want to die at

:37:25.:37:28.

home or in a hospice, you are often denied that choice. The majority of

:37:29.:37:33.

people who want to die in a hospice or at home, they die in a hospital

:37:33.:37:37.

bed. There are charities out there, hospices that would love to provide

:37:37.:37:40.

that care, they are not commissioned, and the system needs

:37:40.:37:44.

to be opened up, so that those organisations can be commissioned

:37:44.:37:48.

and provide that choice to people. That's what people want. That will

:37:48.:37:54.

happen under your bill, will it? is already happening. It is already

:37:54.:37:57.

happening. It isn't, because the majority of people at the end of

:37:57.:38:01.

their life are dying in a hospital bed, they wish to die in a hospice

:38:01.:38:06.

or home. Let's support charities that provide that for them.

:38:06.:38:10.

going to have to stop you, I'm afraid, we have to get on to

:38:10.:38:15.

something else. Thank you very much. Now, it's perhaps one of the least

:38:15.:38:19.

surprising bits of corporate news this year, James Murdoch, the man

:38:19.:38:22.

whose father gave him a media empire, is quitting ASBOS of News

:38:22.:38:29.

of the World. He hopes there by to step out -- quitting as boss of the

:38:29.:38:35.

News of the World. He hopes to step out and set up somewhere Aspel a

:38:36.:38:40.

television executive. Whether that will be -- Where as a television

:38:40.:38:43.

executive. Whether that will be enough, we will see.

:38:43.:38:53.
:38:53.:38:58.

On a week where one Murdoch Sun went, another rose.

:38:58.:39:02.

James Murdoch was nowhere near his father's corporation when the

:39:02.:39:07.

hacking went on at News of the World, why do many believe it was

:39:07.:39:12.

he have table he would step down. Some say he was in charge when he

:39:12.:39:17.

tried to limit the damage. Some say he either tried to cover up how far

:39:17.:39:22.

hacking went, in that case he had to go, or on the other hand, he had

:39:22.:39:26.

no idea what was going on in the company, in which case, he had to

:39:26.:39:30.

go. There has been criminal wrongdoing on a large scale in this

:39:30.:39:33.

company for many years. Now the police investigation is beginning

:39:33.:39:36.

to unearth those networks and Leveson is beginning to show the

:39:36.:39:39.

methods deployed by some of the journalists working for the company.

:39:39.:39:46.

Not all of them. And yes, I think the day of judgment is coming for

:39:46.:39:50.

James and Rupert Murdoch. Until very recently, News International

:39:50.:39:53.

maintained hacking was the work of one rogue journalist, the royal

:39:53.:39:58.

editor of the News of the World, Clive Goodman. But the company had

:39:58.:40:03.

information that the practice was far more widespread. Just this week

:40:03.:40:08.

the Leveson Inquiry into practices, saw an internal e-mail showing 110

:40:08.:40:12.

victims could have been involved. James Murdoch agreed a huge pay-off

:40:12.:40:20.

to one of the victims, �700,000 to gord dond Taylor, then of the

:40:20.:40:23.

professional Football Association. If he had read the paperwork that

:40:23.:40:27.

accompanied the pay-off, he would have known many more victims were

:40:27.:40:32.

involved. Although he was sent e- mails, he maintains he didn't read

:40:32.:40:38.

them. You embarked on a sustained cover-up, the accusation against

:40:38.:40:40.

you, because you know how widespread it was and you didn't

:40:40.:40:44.

want it to come out? There was a particular settlement I authorised,

:40:44.:40:47.

and I have said was made with information that was incomplete.

:40:47.:40:51.

James Murdoch has been dogged by this question ever since. Did you

:40:51.:40:57.

see, or were you made aware of the "for Neville" e-mail, the

:40:57.:41:03.

transcript of the apt voicemail message? No, I was not aware of

:41:03.:41:11.

that at the time. But Mr Murdoch has been contradicted by two of his

:41:11.:41:16.

former executives. Although he quits as chief of News of the World,

:41:16.:41:23.

he remains CEO of News Corporation based in New York. Many there say

:41:23.:41:29.

he's no longer credible. Does it worry you that his explains in all

:41:29.:41:34.

of this was, sorry, I didn't read my e-mail? That is at best, that is

:41:34.:41:39.

if nothing else, if he is found incompetent to read his e-mails,

:41:39.:41:43.

that doesn't make him fit to be chief executive of any company we

:41:43.:41:48.

are investing in. You can't have people like this. 100 years ago it

:41:48.:41:53.

would be a cluby person on the board, they have to be high-

:41:53.:41:56.

performing individuals. How do we read the departure, is it evidence,

:41:56.:42:01.

as some believe, a victory for News Corporation shareholders, who don't

:42:01.:42:06.

like the messy, low tech, newspaper business, and particularly the

:42:06.:42:10.

reputational damage it is doing to their interests. Or is it evidence

:42:10.:42:13.

that Rupert Murdoch has decided to take personal charge of the

:42:13.:42:17.

operation here in Britain. Just like he did in the old days.

:42:17.:42:21.

It was, afterall, Rupert, not James Murdoch, who launched the Sun on

:42:21.:42:25.

Sunday this week. However, the big news of the week, that you wouldn't

:42:25.:42:31.

necessarily have read about in the Sun, was the revelation at the

:42:32.:42:36.

Leveson Inquiry, that the Sun was running a network of corrupt public

:42:36.:42:39.

officials, including the police, spending tens of thousands of

:42:39.:42:43.

pounds on bribes. There also appears to be a culture at the Sun

:42:43.:42:48.

of illegal payments, and systems have been create today facilitate

:42:48.:42:52.

these payments, while hiding the identity of the officials receiving

:42:52.:42:56.

the money. Some believe this is a game changer, opening News

:42:56.:43:03.

Corporation in America, to poosable, federal investigation under the

:43:03.:43:06.

Foreign and Corrupt Practices Act. Some believe it is all about

:43:06.:43:11.

isolating and limiting this damage. Joining us now from New York, the

:43:11.:43:18.

former editor of the Sunday Times and Times, Sir Harold Evans, whose

:43:18.:43:22.

book about working for Murdoch, is about to be reissued, including the

:43:22.:43:28.

events of last year. Did he jump or was he pushed, James Murdoch?

:43:28.:43:32.

think we shouldn't spent too much time on James Murdoch, actually, he

:43:32.:43:40.

was a very able executive of Sky. I think he's blundered awfully, I'm

:43:40.:43:43.

not absolutely convinced he orchestrated the cover-up. That may

:43:43.:43:49.

have been the work of sloppyness and negligence of him. I'm not sure

:43:49.:43:54.

he did. I think more important, other than the faith of James

:43:54.:43:58.

Murdoch, is the faith of the Murdoch empire given the very

:43:58.:44:02.

serious charges of bribery, not just by one journalist, buying a

:44:02.:44:09.

cop a drink. But by a whole series of systematic payments. I think,

:44:09.:44:13.

myself, don't forget Rupert Murdoch and I parted, not on the best of

:44:13.:44:17.

terms, he pushed me out of the Times, you have to bear in mind I'm

:44:17.:44:22.

some what prejudiced. I'm also prejudiced for decent reporting,

:44:22.:44:27.

honesty, and not invading people's minds. What is running through the

:44:27.:44:30.

whole thing from beginning to end is the rotten smell of corruption.

:44:30.:44:35.

It has been there for years, and only encouraged by slack and

:44:35.:44:39.

corrupt politicians who wanted favours from him. It is really an

:44:39.:44:43.

indictment, not just of James Murdoch, which is actually small

:44:43.:44:51.

fry in many ways, but the whole Murdoch corporation, of the cosines

:44:51.:44:58.

between slack politicians, and Rupert, who knew how to manipulate

:44:58.:45:02.

them. It raises the question of how the owners of these properties here

:45:02.:45:08.

will regard their investment? a terrific investment in terms of

:45:08.:45:12.

cashflow. You have to look at the News Corporation businesses, they

:45:12.:45:15.

are extremely well run, highly profitable, and the question is how

:45:15.:45:20.

big is a shareholder's soul. If he cares about integrity in the news,

:45:20.:45:26.

he will care a lot. On the other hand, if the Murdoch corporation

:45:26.:45:29.

faces a prosecution under the corrupt practices act in the United

:45:29.:45:35.

States, that is very serious trouble. Because it was that the

:45:35.:45:39.

Murdoch corporation would have to lose, if they were indicted and

:45:39.:45:42.

convicted, they would have to lose control of very valuable

:45:43.:45:46.

investments, that depend on Government licenses, cable

:45:46.:45:50.

television and the like. That is the really serious issue here. Also

:45:50.:45:54.

bear in mind the other serious issue is the terrible blow that

:45:54.:45:59.

these activities have done to the reputation of journalism generally.

:45:59.:46:02.

Just leaving that to one side, the question of the reputation of

:46:02.:46:08.

journalism as a whole, the future of the Murdoch empire, Rupert

:46:08.:46:12.

Murdoch, a man who, whatever his failings, believed in newspapers.

:46:12.:46:15.

James Murdoch, a man who doesn't believe so much in newspapers, but

:46:15.:46:20.

clearly blofs in other forms of media. Why -- believes in other

:46:20.:46:24.

forms of media. Why Hong on to newspapers here? It is a good

:46:24.:46:27.

question. A little bit of my heart goes out to him, I'm a romantic

:46:27.:46:31.

newspaper man myself. But the rest of my heart, and most of my head

:46:31.:46:37.

said, I would rather he had nothing to do with newspapers, he does not

:46:37.:46:41.

bring enough to them, apart from money. He doesn't thing integrity

:46:41.:46:45.

to them. In some sense, as I say, I'm personally slightly torn about

:46:45.:46:50.

it. I think it would be a good idea if he devested himself from the

:46:50.:46:54.

newspapers, it would be good for the shareholders, and in the end,

:46:54.:46:58.

for journalism. The smell now is so intense, I don't think it can be

:46:58.:47:03.

eradicated by any more apologies, revelations keep coming out and

:47:03.:47:06.

coming out. The public, I think, is sick to death of it.

:47:06.:47:12.

Thank you very much for joining us. Tomorrow morning's front pages,

:47:12.:47:15.

James Murdoch is on most of them. There he is on the front page of

:47:15.:47:20.

the Guardian. Also he's on the front page of the Independent and

:47:20.:47:24.

the Financial Times. On the front page of the Telegraph

:47:24.:47:34.
:47:34.:47:46.

is a picture of Davey Jones of the That's all from Newsnight tonight.

:47:46.:47:52.

A man in a chip shop in Worthing gave me a free gherkin today. There

:47:52.:47:58.

will be all manner of pickles and preserves on tomorrow night,

:47:58.:48:05.

preserves on tomorrow night, overseen by Mr Gavin Esler.

:48:05.:48:11.

Good evening, a cooler start to tomorrow than the last few days.

:48:11.:48:15.

Misty and foggy towards the south. Most brightening up through the day.

:48:15.:48:22.

Sunny spells developing in plane areas. Holding on to a lot of cloud

:48:22.:48:25.

across southern areas. To the east of the Pennines, to the Midlands

:48:25.:48:29.

and the south, the morning cloud and mist, it clears, the cloud

:48:29.:48:33.

breaks, sunny spells developing. It will be a mild day under light

:48:33.:48:38.

winds. Temperatures peaking at around 14.15. Sunny spells in the

:48:38.:48:43.

south west and through many parts of Wales.

:48:43.:48:49.

On the west we could see one or two showery bursts of rain. In the

:48:49.:48:53.

south-east of Northern Ireland, holding on to bright, if not

:48:53.:48:57.

sunnier weather. After a wet start across the Highlands in Northern

:48:57.:49:01.

Ireland, brighter and dryer, some of the patchy rain pushing into

:49:01.:49:05.

other parts of Scotland with a drop in temperature. That rain fizzling

:49:05.:49:10.

out. Cloud on Friday, with temperatures dropping a degree or

:49:10.:49:13.

so down. Across England and Wales a lot more cloud for the end of the

:49:13.:49:18.

week. Again, temperatures down a notch. Still above average for the

:49:18.:49:22.