The Andrew Neil Interview

Conference in Manchester where we This is the Andrew Neil interview

live live from the Conservative Party Conference in Manchester. My

guest is the Health Secretary, Andrew Lansley. Welcome to our

programme. . APPLAUSE

You have known David Cameron and George Osborne for years. You were

their boss... 20 years ago. How have they changed? David

Cameron, of course, if you recall back to the 1992 general election,

in the midst of that general election, each morning the Prime

Minister then John Major came to Conservative research department

and was briefed each morning by the brightest and best of the research

department. You can guess who that was, David Cameron.

Not George Osborne? George Osborne joined the research department

after the 1992 general election and he followed David in being

responsible for the political department. Have they changed? Well,

I would say David hasn't changed in terms of great abilities, the

ability to see a strategy and to pursue T George Osborne I would say

like wise, but we were in troubled times after the 92 election when he

was at the research department and he was up against it and we didn't

have the opportunity to fight and win a general election as we did

and David played a central part actually in fighting that and

winning that general election back then.

They are now your boss so what went wrong?

LAUGHTER Nothing went wrong. What went right

for the country is we have David Cameron as leader of the

Conservative Party and as Prime Minister. That's the right thing.

You suffered a stroke at one stage. Way back nearly 20 years ago.

have that any influence, did it shape your attitude to the NHS?

really. I think for a number of reasons I was a supporter of the

NHS and somebody who was particularly wanted to see the NHS

prosper and that was actually going back to when my father was running

the pathology laboratory at Eastham Memorial Hospital, but as a patient

in 1992, I did realise if you wanted to get the best treatment

you had to in effect negotiate your way through the NHS. It is 20 years

ago, but it is true today that we have to concentrate on ensuring

that what is called in the NHS the inverse care law, that the people

who are most in need, are the people who are least likely to get

access to carement I was looking at some of the new data that we are

generating. Across this country, actually, the people who have the

poorest performance in terms of needs -- knees, are the people in

the parts of the country that have the least access to knee surgery.

So that inverse care law still applies. One of the things I want

to see happen across the NHS is for people to have much better

information, access to the NHS, and the ability to get the services

that they need. Explain how the Tory position went

from no top down reform of the NHS when you were in Opposition to the

biggest organisational reforms ever when you were in Government?

said it needed to be modernised and it needed change. We said we were

going to devolve decision making in the NHS close to the front-line. We

said we would give patients more choice and information. We said we

would have a new patient voice. What we didn't say before the

election that we would needily abolish Primary Care Trusts and

Strategic Health Authorities, but we brought together both our

priorities for health and the Liberal Democrats priorities for

health. The Liberal Democrat priority was

to give - no, let me complete the thought.

Are you saying you wanted major organisational change? Yes.

Hatch your party didn't -- half your party didn't? If you look at

the manifesto. It is not a top down structure, it is a devolved

structure and it is a more independent autonomous structure

for its NHS. You can go back to the 2007 white paper and see the

structure of what we are setting for the NHS then.

A question from Barbara, in this audience. Where are the health

reforms going, she wants to know? In the direction of giving patients

greater information and say in their care. The patient should feel

through the NHS that it is literally no decision about me,

without me. Secondly, we are putting in place devolved decision

making so the doctors and nurses in whom we put our trust to make

clinical decisions are also in a position collectively to be able to

decide what services they need for the best interests of their

patients. Thirdly, we are putting in place serious information about

the outcomes that we achieve, not just the processes and the targets

and fourthly, we are going to build a stronger public health structure,

not least bringing Local Government across England into a place where

it can lead health him prosmt plans -- improvement plans.

Can you explain the principles? That patients should have no

decision about me without me and the decisions should be made by the

doctors and nurses whom we trust and they should be accountable for

the results they achieve. I hope that's two sentences.

That's three, or two, but a very long one. In the changes that

you've been making to this legislation, have the fundamental

principles change snd. No, the fundamental principles haven't

changed, but we have change add number of things in order to

improve and reassure people. But these are changes of detail or

cosmetic? No, they are not cosmetic, they are significant. There are

substantive changes. People wanted reassurance in the legislation that

the sect of state would be responsible for education and

training in the NHS and we've put that in. They wanted to be clear

that competition in the NHS was competition on quality and not on

price and we amended the legislation so that is clear.

People wanted to be confident that the private sector wouldn't be

given advantages compared to NHS services and we've put that in. So

we can't go down the path of future secretaries of states, can't go

down the bath the Labour Party did which is giving the private sector

a higher price for what they were offering to the NHS and they were

willing to pay to NHS providers. I could go on, but there are a range

of changes. Why didn't you put that in from the

start? Some of it, we heard interest people and we said "yes,

we can give you that reassurance so we changed the Bill." A grown-up

approach is to be willing to listen, reflect and improve.

When David Cameron and Nick Clegg, when they signed this white paper

in July 2010, they wrote the introduction along with you. When

they signed that introduction, do you think they understood the

implications of your white paper? am sure they did. Not only did they

sign the forward, but we had obviously Cabinet and Cabinet

committee discussions to approve the policy.

Why did they start demanding changes a year later? For the same

same reason I looked for changes. So they hadn't fully understood it?

People wanted reassurance and we wanted to give them reassurance.

Some people said, "You tell us this is going to be true, but we we

can't see it in the legislation." Other things people came forward

with good responses because remember between July 2010 and

about March 2011, we moved from a place where most of the doctors and

nurses across the NHS weren't really engaged with this. We got

them to a place, the same is true for local authorities actually, by

the spring of this year, we got them to a place where they were

mostly engaged. The Pathfinder Consortia were nearly all signed up

by the spring of this year and they are focused then and they have been

focused on what their job will be in the future and they wanted to

know for example, how it would work. How the hospital consultants and

specialists were going to be co- ordinating with GPs in designing

services better. So we had through the legislation we've put

additional duties to integrate services.

But back in January, Mr Clegg was boosting to the BBC that the NHS

reforms had been part of the Lib Dem manifesto. But by May of this

year, his spindoctors were briefing the media that he was leading the

charge for major changes to your legislation. You suspect he was

opposing the reforms to bolster his position within his own party?

I don't. I mean... Why was he doing it? A minute ago Andrew I was

explaining why for example we reached the decision collectively

after the election that we should abolish Strategic Health

Authorities and Primary Care Trusts and it was because the Liberal

Democrats in their manifesto and their policies were in favour of

democratic accountability rather than unaccountable quangos. Why did

he feel he to lead the charge for major changes? Well, because we

were all in the spring of this year clear that we weren't taking people

across the NHS with us to the extent that we wanted. They don't

trust you? No, no, I don't think that's true.

The polls show they don't trust you? That is not fair. If you go

back and look, actually we took over ap number of years because I

have been health spobes man for the Conservative Party for eight years,

we took the Conservative Party from a place where the public and people

in the NHS did not trust the Conservative Party to a place where

they did, but trusting us was not the same thing as when we were in

Government understanding and necessarily understanding the

changes we were looking for because people don't like change and where

they see change they question it and they want reassurance and it

was responsible on our part to stop, to listen, to improve and to take

people with us and that's what we did. Tens of thousands of people

engaging with the process and actually saying we agree with the

principles. We want the changes that the future Forum suggested.

Have the Liberal Democrats been a help or a hindrance in this

process? A help... LAUGHTER

You are glad to have them on board? Think. Think. Look me in the eye...

LAUGHTER Let me explain why.

APPLAUSE A help because number one, I think

if we hadn't taken the decision early on in writing the white paper

that we needed to abolish Primary Care Trusts and Strategic Health

Authorities we might not have done and we would have ended up not

being able to save the extent of costs that we are going to be able

to do because we're going to reduce the admin costs to the NHS by by

45% and that's a great deal and it is not possible without taking out

tiers of management. Secondly, the Liberal Democrats said and we've

taken on board in the legislation bringing Local Government right

into the heart of strategy for health commissioning and for health

improvement locally. If you ask the question, what has the biggest

impact on people's health? The answer generally isn't how many

beds there are in the local local hospital. The answer is, what

educational opportunity do they have? What kind of parenting do

they have? What are their economic opportunities? What is their

environment, transport and housing like? Local authorities, Local

Government is often right at the heart of those issues in local

communities that will the biggest impact on long-term health.

All right. Is the legislation as it is now, is that it? There will be

no further further major changes as far as you are concerned? Well, as

far as the Lords are concerned they have an opportunity as they always

I understand that. But as far as you are concerned do you want

anymore changes? I am not seeking additional changes.

All right. Sorry, with the exception there is,

I think, one change that we signalled in the Commons which we

have to make in the Lords. All right. Unlike unlike you, for

obvious reasons, I was at the Liberal Democrat Conference in

Birmingham and and Shirley Williams and others made it clear that they

are they are after more changes in the Lords. Are you up for that? Do

you have red lines through which you will not pass? I said at report

stage, for example, that if there is any further way in which we can

give further assurance that the Secretary of State will continue to

have a legal as well as a political accountability for the continuation

of a comprehensive NHS service available to all, based on need and

not ability to pay, if we, if there is any additional way which we can

provide that reassurance we will do Have you spoken to Shirley

Williams? I had a meeting with her in the year.

Recently? Not since... She will have the support of Labour to do so.

This Bill could be mauled in the Lords?

The Lords, it is their job to revise, but as far as... But will

you make it clear that look you can revise, but this far and no

We are very clear - we are reaching a stage now where there are

particular issues that clearly Shirley has discussed with us,

raised with us, doesn't appear to be wholly reassured. As far as I'm

concerned, I have looked, along with my colleagues - including

right across Government - and we have looked at the question of can

we make it absolutely watertight that the Secretary of State in

future has a legal responsibility to ensure the provision of a

comprehensive Health Service in the way I described? Yes, we do.

Abgskhully, on the basis of the -- actually, on the basis of the

evidence and how the legislation is framed, Shirley should be reassured.

Ron Forest thinks insurance-based Health Services give much better

outcomes than a state monopoly NHS. Did you ever consider a switch to

that system? The Conservative Party thought about this nearly a decade

ago now. I think when I was first our spokesman for health, these are

one of the issues that I looked at, along with others. The conclusion

is that I don't think it is possible to deliver the kind of

equal access to healthcare that you wish through an insurance system. I

think as you look at insurance systems across the world, what you

tend to see is that the transaction cost, the cost as it were of people

being part of a healthcare system are very high. And people across

the world - you can look at the Obama healthcare reforms - and what

they are trying to do at the moment is to arrive at a place where

through an insurance system they have universal coverage. We have

got universal coverage. We have, through the NHS, universal

membership of a health insurance system. So I don't think there is

any intrinsic benefit of moving away from that. What I want to do

is look at other healthcare systems and there are comparisons we need

to make in terms of the outcomes. Last week, the Royal College of

Surgeons published a report on high-risk emergency surgery. They

said we look at our results here and we look at a research study

that looked at the same kind of patients, older patients with

abdominal surgery in America. The death rate here was four times that

in America. That wasn't about the way in which the healthcare system

was funded. It was about the way in which hospitals organised

themselves to deliver the best possible care. That is what I want

to focus on. I don't think there is any merit in changing the way we

fund the NHS. I want to deliver the pwhest possible care. I understand

that. -- The best possible care. understand that. We need to get

through this quite quickly. Is it still coalition policy to ringfence

health spending so that spending rises every year in real terms?

Does that promise take into account the fact that inflation is now

higher than anticipated when you made that promise? That promise

takes into account the normal Government method of calculating

inflation is by reference to the GDP deflator. If you take the

latest index, the latest calculation of the GDP deflator -

technical but it's a way of measuring the impact of inflation

on public spending. That measure is not rising? That is not true. It is

rising this year as compared to last year in real terms. Let me

give you the latest figures. The new one taking into account that

inflation is higher now, considerably higher. In the last

financial year, 2010-2011, health spending was �103 billion, a little

up on 2009-10. The next financial year, it would be �102 billion. By

2012-13, it would be below �102 billion. So taking account the

latest measures of inflation, on these figures, issued by the

Treasury in August, you are not increasing spending in real terms?

That is not true. I could have brought the figures... I have given

you them. No, you haven't taken any account of the outturn data on

expenditure in 2010-11. What does that mean? It means the amount

spend by the NHS, the amount that is available to the NHS provided to

the NHS this year and under the Spending Review through to 2014-15

rises by a small amount in real terms. I'm going to post these

figures on our website. I will arrange for us to post ours. I want

you to comment on them. Applying these latest figures you are not

increasing spending? I went through this. The King's Fund published an

analysis which, as you have done, suggested it was going down a small

amount. We have written, the Department on my behalf has written

to the King's Fund giving them the data relative to the spend in 2010-

11. When did you write? One of my officials would have written I

think about six weeks' ago. Might not have had the latest figures?

The OBR has not changed the GDP deflator figure since then.

Treasury has looked at new ones. That is what I have done. We will

decide that and people can go to the website. I will put up the data.

Is it not a sign that inflation is not keeping pace and waiting lists

have gone up? From G DP referral, the average waiting time was eight

weeks. The latest data show the average waiting time for 8.2 weeks.

It went down. You can take figures the way you want them. Let's take

those who had to wait over 18 weeks for treatment in a hospital. In the

last 15 months of a Labour Government, it was 316,000 people

had to do that. In the first 15 months of your Government, it was

380,000, a rise of 20%. That's not what you just said. The first point

you made was waiting lists in fact... The point I'm putting to

you, you said more people are waiting more than 18 weeks. Agreed?

Well, it went up and now it's come down again. The operational

standard in the NHS set from before the election was that 90% of

patients should be seen and treated within 18 weeks. We are meeting

that operational standard. In the latest data, the numbers seen

within 18 weeks, the proportion seen went up compared to the

previous month. In the last 15 months of the Labour Government,

393,000 people had to wait more than four hours for A&E treatment.

In the first 15 months of your Government, that's risen to 679,000.

That is a 73% rise. But the point is that takes into account a period

over a winter where we had an exceptional level of flu activity

and we had an exceptionally severe winter. We had as a consequence...

The last winter of a Labour Government was seriously cold as

well. 2009-10, the country came to a halt. It was the wrong kind of

snow. LAUGHTER The critical difference was how many patients

went into high dependency or critical care units. We had many

patients filling those units to the point where hospitals were not able

to admit patients for routine surgery because they could not be

confident that they would have critical care beds available.

However you count it, the average... Let's go back to the point, the

average time that patients on the latest data, the average time that

patients waited for their operations is lower than it was at

the last election and we are meeting and the NHS overall is

meeting the operational standard, that is 90% of patients. Have you

been to Wales? I go to Wales almost every month. Have you checked the

figures in Wales? I know what you are saying because that is a

Labour-run area. If we were in Wales we would talk about it. You

don't have responsibility for Wales. Let me ask you this... One, two,

three - it is seven out of ten patients in Wales get seen within

18 weeks. Nine out of ten... What is your excuse for the following

figure... APPLAUSE In July 2010, 3,75 5 people waited over six weeks

for a test including a cancer test. In July of this year, it was 10,734.

That is a rise of 186%. What is your excuse for that? We are

continuing to meet all the targets that the Labour Party set... Your

target was... You haven't moved on - we are meeting all the

standards... I thought you were getting rid of targets? We are

setting operational standards and we are continuing to meet them. We

are doing more. What about hospital infections? 25% reduction in MRSA,

17% reduction in C-diff in the last year. You didn't mention that one,

did you? APPLAUSE What about patients who have been admitted

into mixed-sex accommodation when they ought to be in single sex

accommodation breaching the rules? Labour said they had abolished it.

Untrue. We have calculated it. We asked for data for the first time,

and we published it in December. It was 11,800 times in that month. We

have brought it down 90% since then. APPLAUSE All right. Viewers and

voters will decide if I have put one set of figures where it is not

going well, you answer by another set. I don't agree with you at all.

We are meeting the standard for our cancer waits. While we are talking

about cancer... No, no. I'm sorry, Minister. You can't - I have

another question. GPs earn over �100,000 a year, much more than an

MP, four times more than the average wage. Are they worth it?

GPs are worth more than MPs. right. APPLAUSE I don't think that

is what can be regarded as controversial, Minister. You did

ask the question. If they are being paid so much... GPs pay has not

gone up since the contract came in in 2005. If they are being paid so

much and you think they are worth it, why can you take your pet dog

to see a vet at any time of the day or night, but you have to take time

off work or wait days to see your GP? Because - it is interesting.

Just yesterday David Cameron and I set out how we are going - we are

going to bring GPs back to taking responsibility collectively for the

service that is provided. By April 2013, we will have everywhere in

England a 111 telephone system and online and I hope a mobile phone