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DERMOT MURNAGHAN: David Cameron has said he is at one with his Health Secretary, Andrew Lansley, amid speculation about Mr Lansley’s position and the controversial NHS Bill itself. Writing in the Sunday Times, the Prime Minister said there was no alternative to the Bill. It is expected to face another difficult day in the House of Lords tomorrow when the government expects to suffer a series of defeats. Well joining me is Deputy Chairman of the Conservative Party, Michael Fallon, Baroness Tonge who is a Liberal Democrat peer and former spokesperson for the party on health who voted against the government and former Health Minister under Tony Blair, Lord Warner, a very good morning to you all. If I could start with you, Michael Fallon, this article the Prime Minister has written today nailing his colours to the mast. If I can mix my metaphors, after you’ve got a headache after banging your head against a brick wall isn’t the answer to stop?

MICHAEL FALLON: No, this isn’t a brick wall, this is a very important reform bill. Just as we’re reforming welfare, just as we’re reforming education, so we’re continuing the reforms of the health service that actually the last Labour government started, giving patients more choice, putting doctors not bureaucrats in charge of shaping local services and for the first time, integrating social care with the rest of the health service. These are very important reforms and we are sticking with it.

DERMOT MURNAGHAN: Let’s just put that straight to Lord Warner, the point there and it’s oft made that this is really a continuation of the Blair health reforms?

LORD WARNER: Well it is a continuation of the Blair reforms but anyone who has managed a big organisation wouldn’t have chosen to do these reforms this way. You don’t throw your top management cadre up in the air when you have got £20 billion of savings to make and I think the issue is, is this the right way of doing the reforms not whether we need reforms.

DERMOT MURNAGHAN: Jenny Tonge, right way to do it? I think you all agree there needs to be some change in the way the health service is run.

BARONESS TONGE: It is totally the wrong way to do it because, as Lord Warner says, we have got to make huge savings in the health service – and I did work in it for a long time. We have got to make huge savings and you can’t do that against a background of total reorganisation and reorganisation that both parties promised specifically that we would not do before the general election. It’s not in the coalition agreement, it is a real betrayal of people in the health service and their patients and it is simply not going to work. You talk about putting doctors in charge and giving patients more choice – I don’t see that happening because doctors aren’t going to go home in the evenings and say, oh I’ll do a bit of commissioning now. Of course they’re not, they haven’t got time.

DERMOT MURNAGHAN: Well a lot say that they are already doing that.

BARONESS TONGE: Doctors want to be clinicians, most of them.

MICHAEL FALLON: Let me just answer that, it was in both our manifestos, the Liberal Democrat and the Conservative manifestos at the last election that we would give doctors more control over shaping local services. Now I’ve never heard anybody in the whole of this …

BARONESS TONGE: What about the PCTs …?

MICHAEL FALLON: The PCTs are bureaucrats. I have never heard anybody in the whole of this debate and do as Lord Warner has done and say let’s defend the top management cadre. The problem with the NHS is that we have got Strategic Health Authorities, Primary Care Trusts, bureaucrats. What we need to do is get the clinicians more involved in shaping local …

DERMOT MURNAGHAN: I’ll get back to you on the no top-down reorganisation but Lord Warner, that issue of, I mean they are derided bureaucrats, the Primary Care Trusts, whatever other layers in there, it’s an easy hit isn’t it? With an organisation this size of course it needs where its money goes to be carefully managed and accounted for.

LORD WARNER: It is a cheap shot to call every manager in the NHS a bureaucrat.

BARONESS TONGE: Yes, I agree.

LORD WARNER: It is a very cheap shot indeed. The Conservative party used to be in favour of good management, they did some good work in the 80s in bringing general managers into the NHS. The NHS is a big business and it’s a joint enterprise between doctors, nurses, scientists and actually managers and you need all four of them singing from the same hymn sheet. We haven’t got them singing from the same hymn sheet.

DERMOT MURNAGHAN: So staying with the PCTs?

LORD WARNER: I would reduce the number of PCTs to about 50. The NHS does need reform, Labour were actually putting GPs more in charge through practice based commissioning but what has happened here is that the Conservatives started well, the Bill when it started was in better shape than where it is now. If you believe in choice and competition, you really have got to have the courage of your convictions and not water it all down.

DERMOT MURNAGHAN: Baroness Tonge, it’s your fault in the Lords then, all these amendments have watered down and changed, have altered a Bill that was better when it started?

BARONESS TONGE: The Liberal Democrats, after their spring conference last year called a halt to the Bill and it was looked at again but I don't think it’s made much difference. In fact I think it has made the Bill much more complicated and difficult to implement but I want to take up something that Michael said, that management is bad and managers are bad and bureaucracy is bad but what the Conservatives, the coalition government is doing is replacing the present structure with private companies because it’s private companies and private managers and private bureaucrats that will be doing the commissioning for the GPs and that frightens me more than anything else.

DERMOT MURNAGHAN: I have heard that and read that, that a lot of people working for the PCTs saying well our job is to abolish ourselves and get ourselves rehired in the private sector.

MICHAEL FALLON: The NHS shouldn’t be about managers and bureaucrats, it should be about delivering good service to patients – just let me finish. GPs by the way are private people, they are self-employed businessmen inside the NHS delivering a service. The whole point of this reform is to bring decisions about the budgets, shaping local services, much closer to people in the community to understand this stuff, who are clinicians, who are doctors and nurses, who will be on the commissioning groups, who will run the commissioning groups, instead of the bureaucrats that Lord Warner has been in favour of who have been running them up to now. Now that’s good.

BARONESS TONGE: But nobody tells me why you couldn’t have done that by putting doctors and nurses and clinicians on the Primary Care Trusts.

MICHAEL FALLON: I can answer that very directly, it would have needed legislation to do that. You still need legislation to do that, you need a Bill, you need a Bill to make this change.

DERMOT MURNAGHAN: The point is, Lord Warner, and it has been made by David Davies on the Conservative side amongst others, that we didn’t need a Bill to see these kind of changes, that it could have been done organically through existing Bills and indeed through the way PCTs and other organisations are run.

LORD WARNER: I got rid of over 150 Primary Care Trusts by secondary legislation. You could have done what Lansley wants by using secondary legislation to actually get rid of 100 PCTs and pack the 50 that are left with more GPs on the Primary Care Trusts. You could have put doctors in charge of commissioning at the local level with fewer Primary Care Trusts using secondary legislation and nobody would have ….

DERMOT MURNAGHAN: I just want to ask you, Michael Fallon, we have mentioned him twice now, the Health Secretary Andrew Lansley. There has been a lot of discussion about his position and we know that he knows the NHS inside out, he has been on this brief for many, many years in opposition before he became Health Secretary but the charge is that he is not explaining these changes. Where is he this weekend when all the discussion is about his Health Bill it’s others who are defending it for him?

MICHAEL FALLON: Well the rest of the Cabinet voted for this Bill, supports this Bill and they’ve been out there this morning and yesterday defending this Bill. He’s been defending it right round the country, the Prime Minister has …

DERMOT MURNAGHAN: He’s the man who knows it best.

MICHAEL FALLON: Yes but he’s been defending it, he’s been out there visiting hospitals defending it. He’s been doing this for two years solid. I want answer Lord Warner’s point, do you really think we would have embarked on this Bill if it hadn’t been legally necessary? This Bill does lots of good things by the way, it bring social care and health care together, that needed legislation. To change the PCTs into commissioning groups needed legislation. To promote equality in the NHS you needed … to put a duty on the Secretary of State, you needed a Bill.

DERMOT MURNAGHAN: You did say no top-down reorganisation, that is a charge that will be hung round your neck, going into the election no top down reorganisation – well what on earth is this?

MICHAEL FALLON: It is getting rid of the top-down, it’s getting rid of the department, the Strategic Health Authority, the Primary Care Trust and it is putting all the focus on local doctors shaping their own services.

BARONESS TONGE: But when they have got to find a way of saving £20 billion …

MICHAEL FALLON: They have to do that anyway.

BARONESS TONGE: Yes, but it would be much easier done and change and reform and reorganisation may have come as a result of making those savings but to actually impose from above a top-down reorganisation at the same time as clinicians have got to look to make those savings is totally wrong. I’m sorry, I’ve worked there, I’ve been a manage, I’ve tried to implement these things. You cannot do it and it is going to be chaotic.

DERMOT MURNAGHAN: Do you have a view on Andrew Lansley, do you think he’s messed this up, certainly explaining it?

BARONESS TONGE: I think he was given his head, I think one of Cameron’s faults is that he seems to say oh get on with it, chaps, and then has to pick up the pieces afterwards. I actually now feel quite sorry for Andrew Lansley but then I’m quite a kind lady.

DERMOT MURNAGHAN: Lord Warner, do you think the Health Secretary has handled this in any way well?

LORD WARNER: No, and I think the trouble is if you are going to engage in the reform of something as iconic as the NHS, you’d better have a pretty good political narrative as to why you’re doing it and you have to take with you a significant chunk of the people who deliver services. He’s failed both those tests, political narrative and taking enough doctors and nurses with him.

DERMOT MURNAGHAN: Well this is it Michael Fallon, isn’t it? You spent a long time in opposition trying to so-called, quote unquote, ‘detoxify’ the brand when it came to the Conservatives in the NHS, that seemed to have been achieved and now all the good work has been undone, the latest poll saying 62% of the British public do not trust the Conservatives with the NHS any more.

MICHAEL FALLON: Well I don’t accept that. The NHS has to be reformed, it is facing an ageing population, increasing costs with new medical technologies becoming available and the need to integrate healthcare and social care and to save money of course, it has to be more efficient. These are huge challenges, it can’t be done any more by a vast bureaucratic organisation. The best people to make decisions about these changes are the doctors themselves and they’re going to be in the driving seat.

DERMOT MURNAGHAN: Do you think the Bill, very briefly, should be dropped, Baroness Tonge?

BARONESS TONGE: I think the Bill should be dropped, I think it a recipe for ditching the N out of the NHS. We no longer have a National Health Service, it’s gone already because some of these changes have been implemented already. We shall have health services that will differ in different parts of the country and it is certainly not addressing the things that Michael Fallon has been saying before.

DERMOT MURNAGHAN: So Lord Warner, do we need to scrap this Bill in your view and start again?

LORD WARNER: I wouldn’t scrap the Bill now, it’s got some good things in it on public health and the role of local authorities, I think it is too far down the track in reality on the ground and I think we will create chaos if we don’t carry on trying to make the Bill better than it is at the moment, hold our nose and get on with it.

DERMOT MURNAGHAN: All right, interesting times ahead. Lord Warner, Baroness Tonge, Michael Fallon, thank you all very much indeed for your views there on the NHS Health and Social Care Bill.