:00:44. > :00:49.Here in the east, as the controversial health bill clears a
:00:49. > :00:55.crucial hurdle in the Lords, we ask the Health Secretary about his
:00:55. > :01:05.plans for a service where GPs control 80 % of its �108 billion
:01:05. > :01:05.
:01:05. > :25:46.Apology for the loss of subtitles for 1481 seconds
:25:46. > :25:51.budget, and competition is Welcome to the part of the
:25:51. > :25:55.programme for us in the east. Andrew Lansley is here with us, and
:25:55. > :26:00.later we will be hearing from some of the people working in the health
:26:00. > :26:04.service he would like to ask him a question. We are concerned with
:26:04. > :26:11.their health bill the Government is proposing. We believe we already
:26:11. > :26:16.provide exceptional and efficient services.
:26:16. > :26:19.After a pause for thought between April and June, the Health and
:26:20. > :26:25.Social Welfare Bill is back on track. The Bill has been described
:26:26. > :26:31.as the biggest shake-up of the NHS since it began in 1948. Primary
:26:31. > :26:36.Care Trusts used to buy treatment for patients, but in future, GPs
:26:36. > :26:42.consortia will hold the purse- strings, spending 80 % of the
:26:42. > :26:48.Budget. We can reveal that in the East, only 12 practices are not yet
:26:48. > :26:53.in a consortium. 749 surgeries have already joined the 36 newly formed
:26:53. > :26:58.consortia. As part of the changes, this month has seen the merger of
:26:58. > :27:05.the East of England strategic health authority which oversees the
:27:05. > :27:11.PCTs, too become the NHS Midlands and East S h a. Both will be
:27:11. > :27:15.scrapped in 23rd April -- 2013. One of the first pilots is underway in
:27:15. > :27:23.Cambridgeshire. We have been back to see how they are getting on.
:27:23. > :27:27.Other surgeries remain sceptical about the reforms.
:27:27. > :27:32.Two GPs, both based in Peterborough, both of their surgeries have
:27:32. > :27:36.already joined up with other practices Duke create clusters. Dr
:27:37. > :27:41.Richard Withers is leading the pilot. It is the way forward. The
:27:41. > :27:44.government has decided this is the strategy, and we are trying to make,
:27:44. > :27:51.too implement some of the recommendations which have come out
:27:51. > :27:57.from the review and make it work, on the ground. This doctor feels he
:27:57. > :28:02.has been forced to join. We were all made to fill it would happen
:28:02. > :28:10.whether we like it or not. Withers does not agree entirely,
:28:10. > :28:15.but is prepared to make it work. For GPs are in a pivotal place to
:28:15. > :28:20.understand. But it is not without its difficulties. No more so,
:28:20. > :28:25.perhaps, because of the financial challenge facing the NHS pub --. It
:28:25. > :28:29.is probably the worst time to pick up the reins. I cannot see any
:28:29. > :28:34.extra benefit for the patients, unless we make extraordinary
:28:34. > :28:40.savings. And I do believe that the whole recommendation is about
:28:40. > :28:44.saving money. He is concerned there will be a conflict of interest.
:28:44. > :28:48.when a patient is sitting in this chair, I do not want them to feel,
:28:48. > :28:54.is the doctor thinking about my welfare or his Budget? These
:28:54. > :28:58.decisions are not made by just GPs. A lot of time and effort is going
:28:58. > :29:03.into the government's arrangements, so these conflicts of interest are
:29:03. > :29:08.minimised. In the last year, changes have been made on the
:29:08. > :29:12.ground, even though the legislation has not been passed. Dr Withers'
:29:12. > :29:19.surgery offers a wider range of tests, and he no longer works as a
:29:19. > :29:25.GP full time. Two days a week, he is organising the consortium.
:29:25. > :29:27.a doctor. But I have a duty to help contribute, too utilise the
:29:27. > :29:36.experience I have gained over the years of organising health care
:29:36. > :29:40.services. This doctor has not made changes in the last year. He thinks
:29:40. > :29:44.the government has made enough. Every time we have a different
:29:44. > :29:50.political party ruling, we have another minister coming a long.
:29:50. > :29:54.That needs to be stop. Both of them want the best for their patients.
:29:54. > :30:00.Dr Withers believes the future is challenging, Dr Prasad once the
:30:00. > :30:05.legislation scrapped. A number of issues raised in that
:30:05. > :30:09.report. Let's talk about Dr Prasad. He has been made to join a
:30:09. > :30:14.consortium. We understood there was to be no more top-down
:30:14. > :30:19.reorganisation. This is top-down reorganisation. This is in order to
:30:19. > :30:24.deliver better services to patients. He saw Dr Weather is in that report,
:30:24. > :30:30.who captured exactly the important point. If we are to deliver the
:30:30. > :30:34.best services for patients, general practices are uniquely well placed
:30:34. > :30:39.to achieve that. They see not only their relationship they have with
:30:39. > :30:44.patients and their families as individuals, they also see the
:30:44. > :30:49.population health needs. I would say to Dr Prasad, I guess, you have
:30:49. > :30:53.to be part of a group of your GP practices working together. But in
:30:53. > :30:57.order from your point of view to be clear about what services you want
:30:57. > :31:01.for your patients. I do not think that is anything other than
:31:01. > :31:05.absolutely part of the role of the general practice. We put ourselves
:31:05. > :31:08.in their hands of doctors and nurses to deliver our care. It is a
:31:08. > :31:14.reasonable extension from that that we should expect them to be clear
:31:14. > :31:18.about what services they will need to look after us. You said yourself
:31:18. > :31:22.that we put ourselves in the hands of doctors and nurses. And yet we
:31:22. > :31:29.saw that Dr taking a leading role, not very enthusiastically, and
:31:29. > :31:34.saying he is losing two days a week to admin. It is not bad men.
:31:34. > :31:40.Clinical leadership in the NHS, it is all very well to add menace --
:31:40. > :31:45.dismiss it as administration. It is about clinical leadership. What he
:31:45. > :31:49.will be doing in those two days is helping to decide and design what
:31:49. > :31:54.services should be provided for his patients around Peterborough. That
:31:54. > :31:57.is part of the clinical decision- making process. If you are a doctor
:31:57. > :32:02.or a senior nurse and you are trying to decide how you should
:32:02. > :32:07.refer your patients, what services should be available and where, you
:32:07. > :32:13.have to be part of designing that process. What about the issue of
:32:13. > :32:16.conflicts of interest? Willett not happen in such a way that patients
:32:16. > :32:22.will at least perceives that decisions are being made on a
:32:22. > :32:26.financial basis rather than on what is best for them? No. At the moment,
:32:26. > :32:30.there is a greater risk that they are being made on a financial basis.
:32:30. > :32:35.If you go to somewhere like Peterborough, the Primary Care
:32:35. > :32:40.Trust, who were supposed to run the NHS there, in the early part of
:32:40. > :32:44.last year they lost financial control. So a lot of decisions were
:32:45. > :32:49.made on financial grounds. And it was GPs who were concerned about
:32:49. > :32:54.the availability of services, but they have no control about how
:32:54. > :33:00.services were going to be designed to deliver that. So actually, too
:33:00. > :33:05.be fair, Dr Withers, who is responsible for their developing
:33:05. > :33:09.commissioning group, he put it fairly. He said, we are putting it
:33:09. > :33:14.in place of those conflicts of interest do not arise. It has been
:33:14. > :33:19.a rocky road for the bill. How do you view that personally? It is a
:33:19. > :33:24.personal blow to you, isn't it? I am only interested in an NHS
:33:24. > :33:28.which is stronger, able to improve the outcomes that achieves for
:33:28. > :33:32.patients, and where people in the NHS Bill that although they had
:33:32. > :33:37.been a prose -- been through a process of having to build their
:33:37. > :33:41.own structures, that gives them a sense of ownership and stability.
:33:42. > :33:47.You cannot deny there has not been a backlash -- there has been a
:33:47. > :33:52.backlash. One occasion, tell me an occasion in the life of the NHS
:33:52. > :33:57.when anything changed and there was not a big argument. When it was
:33:57. > :34:01.born there was opposition to it. In the early 1990s, the BMA used to
:34:01. > :34:08.put up big posters saying, what do you call a man who does not listen
:34:08. > :34:12.to Kent -- medical advice? Ken Clarke. In 2003, the legislation
:34:12. > :34:18.was practically lost in the House of Commons on a vote that was very
:34:18. > :34:22.nearly tied. People oppose change. Nevertheless, this particular
:34:22. > :34:29.backlash has put you under pressure. The whole thing was stalled from
:34:29. > :34:33.April to June. Stalled? That is pejorative, isn't it? We decided,
:34:33. > :34:39.we said we were going to take an opportunity, not least because we
:34:39. > :34:43.have got the GPs and others coming together in commissioning groups.
:34:43. > :34:48.Last year, we had a full consultation on the White Paper. In
:34:49. > :34:53.the intervening months we got these organisations coming together. We
:34:53. > :34:57.had an opportunity to pause the Bill, put out there and opportunity,
:34:57. > :35:03.a team of experts, hundreds of meetings and thousands of
:35:03. > :35:06.contributions. Let's meet some NHS staff. We have been to the Norfolk
:35:06. > :35:12.and Norwich University Hospital to speak to those working on the front
:35:12. > :35:15.line of the national health service. Each of these people, a doctor, a
:35:15. > :35:21.radiographer and union representatives who has worked in
:35:21. > :35:25.accident and emergency, they each have a specific question. I am a
:35:25. > :35:32.consultant anaesthetist by trade, I have worked in the National Health
:35:32. > :35:36.Service since 1982. I have been a consultant here since 1994. My
:35:36. > :35:40.question for the Secretary of State for Health is how he is going to
:35:40. > :35:43.ensure that, with increased competition for health services in
:35:43. > :35:47.England, their health services people rely on are not pulled apart
:35:47. > :35:53.by the drive for competitive business to secure financial
:35:53. > :35:59.advantage for itself? What do you make of that? First, because many
:35:59. > :36:03.services will not be in that sense open to competition. He works in
:36:03. > :36:06.emergency services. Clearly we are not expecting there to be
:36:06. > :36:10.competition in accident and emergency, we are expecting them to
:36:10. > :36:14.be commissioned to provide a service and continue to do so.
:36:14. > :36:18.Second, there is already competition. It happens already.
:36:18. > :36:24.The problem is that at the moment, it happens on the basis of price,
:36:24. > :36:27.because people do competitive tenders for services. What we want
:36:27. > :36:32.to do in future is extend a system that will set tariff prices,
:36:32. > :36:36.uniform prices, and then there is competition on quality. But people
:36:36. > :36:41.will make money out of those prices, will they not? There is a strong
:36:41. > :36:44.body of opinion that finds that repellent, making money out of sick
:36:44. > :36:51.people. If so you would like to arrive at a place where nobody
:36:51. > :36:54.makes any money out of providing services to the NHS? No pharmacy?
:36:54. > :37:04.General practice mostly consists of independent contractors who are
:37:04. > :37:08.funded out of the profit they make. Let's be realistic. Hospitals
:37:08. > :37:14.generate profit. They call it a surplus but they generate profit.
:37:14. > :37:19.Why? Because they need to invest. They are a public service. Across
:37:19. > :37:25.the NHS at the moment, the great majority of services make a profit.
:37:25. > :37:29.That will be true in the future. How about this whole issue of NHS
:37:29. > :37:35.patients been pushed to the back of the queue by private patients?
:37:35. > :37:40.Because they cap the amount the hospital scan and... Know, it will
:37:40. > :37:44.not happen, the legislation does not permit that. It only permits
:37:44. > :37:49.Foundation Trusts to secure private income in order to meet their
:37:49. > :37:53.principal purpose, which is to provide services to the NHS. None
:37:53. > :37:58.of them will be treating private patients in any way that
:37:58. > :38:05.disadvantages NHS patients why then has there been a concern issued
:38:05. > :38:08.saying the decision to lift the cap mean that most of our finest
:38:08. > :38:14.hospitals would become private and foundation hospitals would be
:38:14. > :38:19.subject to competition. The latter is completely untrue.
:38:19. > :38:25.The legislation does not change anything. For with respect to her,
:38:25. > :38:29.she is completely wrong. There are 112 hospitals and trusts in our
:38:29. > :38:34.region. You could go to bed for good or Harlow or Ipswich, or to
:38:34. > :38:37.King's Lynn, they are all NHS hospitals. They are allowed under
:38:37. > :38:43.existing legislation to have as much private patient income as they
:38:43. > :38:50.like. The effect she describes does not happen. Privatisation is
:38:50. > :38:54.clearly at the forefront of people's minds. I am an advanced
:38:54. > :38:59.radiographer and work in the radiotherapy department. I spend my
:38:59. > :39:03.time along with my colleagues caring for and treating patients
:39:03. > :39:06.who are suffering from cancer. We are concerned with their health
:39:06. > :39:12.bill that the government is proposing, as we believe we already
:39:12. > :39:16.provide exceptional and efficient services. And we feel the
:39:16. > :39:20.introduction of competition from the private sector will cause a
:39:20. > :39:25.problem with this, and that they will not be able to cope with the
:39:25. > :39:29.work like we can. My question to a Andrew Lansley is, do you think
:39:29. > :39:34.that introducing more private sector provision will actually
:39:34. > :39:39.improve the quality of care? What do you make of that? The bill does
:39:39. > :39:42.not introduce more private sector provision. It places a
:39:42. > :39:47.responsibility on the commissioning groups, which is like the GPs that
:39:47. > :39:51.we saw in the earlier report. It gives them and their colleagues
:39:51. > :39:55.their responsibility to commission the best possible services they can.
:39:55. > :39:59.But if the cheapest option is from the private sector... You have
:39:59. > :40:03.lapsed into precisely the fallacy, that it is competition on price.
:40:03. > :40:11.There will be a uniform price established, the competition is
:40:11. > :40:15.only on quality. Led's talk about added-value. What is to stop GPs
:40:15. > :40:19.offering secondary services to their patients, something they have
:40:19. > :40:24.a financial interest in? They can do that now a. What they have to do
:40:24. > :40:28.is make sure there is no conflict of interest. Say there was a
:40:28. > :40:31.physiotherapy service, and a GP practice wanted to offer a
:40:31. > :40:35.physiotherapy service. There is nothing to stop them doing that, it
:40:35. > :40:39.is just that the contract would be with the commissioning group, and
:40:39. > :40:44.they would have to do it on the basis that patients could choose
:40:44. > :40:51.that service or other services. Patient choice would be extended.
:40:51. > :40:55.Finally, too the health workers' union. Harry has worked in accident
:40:55. > :41:02.and emergency at the hospital. Here is his question. I have worked at
:41:02. > :41:07.the Norwich and Norfolk hospital for over 12 years. I am now a union
:41:07. > :41:11.representative. My question is based on what a lot of commentators
:41:11. > :41:17.think the bill is going to do. They think it will restrict and ration
:41:18. > :41:20.health care, privatise large chunks of the health service. And they
:41:20. > :41:25.think it will destabilise the finances of many large general
:41:25. > :41:30.hospitals. Is this why you were so keen to wriggle out of the
:41:30. > :41:35.responsibility of this to provide a comprehensive health care system to
:41:35. > :41:39.the people of this country? What about that responsibility? That was
:41:39. > :41:43.interesting. That was a question constructed around four
:41:43. > :41:48.propositions from Unison, all of which are totally wrong. The deal
:41:48. > :41:52.is very clear that my responsibility and my successor's
:41:52. > :41:57.responsibility is providing an securing the provision of a
:41:57. > :42:02.comprehensive felt -- health service, free and based --
:42:02. > :42:06.available to all. It does not permit or promote any privatisation.
:42:06. > :42:11.It does not lead to any fragmentation. Indeed for the first
:42:11. > :42:16.time in legislation for the NHS, there will be specific duties to
:42:16. > :42:23.integrate services around the need of patients so there is no change
:42:23. > :42:26.in the responsibilities? Either yourself or any successor?
:42:26. > :42:35.practice, it strengthens the accountability. All the legislation
:42:35. > :42:37.actually does is bring the bill in line with reality. I want to quote
:42:37. > :42:41.line with reality. I want to quote Baroness Williams, quite she
:42:41. > :42:45.fighting for the legal duties of the Secretary of State for Health?
:42:45. > :42:50.the Secretary of State for Health? We have had very long conversations.
:42:50. > :42:54.The position now have, we understand that the position is
:42:54. > :43:01.this. Our I can deal with complicated -- I can deal with
:43:01. > :43:06.complicated. I am apologising for being long-winded. For a long time,
:43:06. > :43:11.the legislation was constructed around the proposition that the
:43:11. > :43:16.Secretary of State would provide or secure services. The legislation
:43:16. > :43:21.League side that provide bit. Why? Because the Secretary of State has
:43:21. > :43:26.never provided, the Secretary of State has delegated that two other
:43:26. > :43:30.bodies. And if we relieving that word in the legislation, up we
:43:30. > :43:35.would have to have a mechanism. Instead, we are having a mechanism
:43:35. > :43:39.for commissioning services. But the accountability to provide the
:43:39. > :43:44.service is absolutely there. Would it not have been simpler to reduce
:43:44. > :43:50.the number of primary care trusts to 50, change the boards so that
:43:50. > :43:55.you put doctors in the driving seat and cap management costs? Job done,
:43:55. > :44:00.simplification, not 329 pages. And something most members of the
:44:00. > :44:04.public would find easier to grasp than this. A if you had gone out
:44:04. > :44:09.and said to the public, do you know what a Primary Care Trust is, do
:44:09. > :44:13.you think they could have answered? But they should be able to. They
:44:13. > :44:19.should be able to. We are talking about patient choice. How can they
:44:19. > :44:23.make a choice if they do not understand the system? To they did
:44:23. > :44:26.not understand the system. They did not have choice. They will be more
:44:27. > :44:31.empowered in future. There is nothing simpler than the
:44:31. > :44:34.proposition that, if patients are registered with their general
:44:34. > :44:40.practice, three their general practice in the area where they
:44:40. > :44:45.live, and it might be as big as a whole of Northamptonshire, when
:44:45. > :44:49.they do that, that they know that through their general practice,
:44:49. > :44:53.their doctors, nurses and clinicians to look after them
:44:53. > :44:57.equally have a responsibility for insuring that resources in the NHS
:44:57. > :45:01.are used to deliver the services they are looking for. That is not
:45:01. > :45:04.very complicated. In the past, we had this appalling system where
:45:04. > :45:08.they were registered with the general practice, and they were
:45:08. > :45:12.seen by consultants at the hospital, and when things were not right or
:45:12. > :45:16.available or when decisions were made they did not agree with,
:45:16. > :45:21.everybody pointed at the PCT and said they were doing it. And the
:45:21. > :45:26.PCT said, we are accountable to the Secretary of State, and the
:45:26. > :45:32.Secretary of State said, no, it is a local decision. So there was no