ANY QUOTES USED MUST BE ATTRIBUTED TO MURNAGHAN, SKY NEWS

DERMOT MURNAGHAN: Now one Tuesday junior doctors are going to stage the first of a series of strikes over proposed changes to their contracts, about 45,000 are expected to walk out after talks with the government reached a stalemate.  This morning the Health Secretary, Jeremy Hunt, has warned that some accident and emergency departments could be forced to close because of the added pressure he says it will put on hospitals.  I am joined now by Lord Warner, the former Health Minister and by Norman Lamb, the Lib Dems Health spokesman who was the Care Minister in the coalition government of course, he’s in Norwich.  A very good morning to you both, staying with you Norman Lamb there in Norwich, your thoughts on the Junior doctors actually striking.  It will affect, it’s got to affect patients in some way.

NORMAN LAMB: Well I fear that it will and that’s why I think it’s critically important that we find a solution to this as a matter of self-evidently acute urgency.  I think this is a bit of a misplaced fight to pick on the part of the government, when I talk to hospital leaders they tell me that they don’t have particular problems with staffing hospitals so far as junior doctors are concerned and I don't think the government has quite properly worked out what it is they are actually seeking to achieve with this idea of seven day working.  Obviously we want to ensure that a patient is just as safe any day of the week and that we can safely discharge patients seven days a week but I don't think they have properly and clearly worked out what they are seeking to achieve and I think therefore this is a damaging dispute which has massively damaged morale and it has created a loss of trust between government and junior doctors and that has to be repaired very quickly.

DM: Okay, Lord Warner, your thoughts, do you agree with Norman Lamb that the government have picked the wrong fight?  

LORD WARNER: I think they have.  It is very difficult to win a fight with doctors in my experience and I have been negotiating with the BMA on and off for 50 years and I think the trouble is that the government has got itself committed to seven day working without fully understanding what the cost of that was going to be.  They are now in a situation where they can’t go back on the commitment, which is a good commitment and in the interests of patients, but they are struggling to find the money at a time of really historically cutting back the level of funding increases year on year for the NHS so they’ve got to do the cheapest deal they possibly can on getting more doctors working on Saturdays and Sundays.

DM: So you are saying within the current budgets, and we are going to talk much more in a moment or two about the overall strains on the NHS’s budgets, this kind of aspiration is pie in the sky?  

LORD WARNER: Well I don't think it is pie in the sky but you have got to be prepared to take this at a pace which is commensurate with the money you’ve got available and at the moment … at the end of the day this is all about money, most disputes in my experience with the BMA are usually about money and they are a trade union and they do the best they can for their members.  

DM: That’s the point, isn’t it, Norman Lamb?  A trade union, some say vested interests, they are one of the most difficult organisations to try and beat if that’s what you want to do?

NORMAN LAMB: Well certainly that’s true but I’ve met with many junior doctors who are completely committed to the NHS and to patient care and appear to be completely genuine about their concerns about what the government is negotiating and I think Norman Warner is absolutely right, at the end of the day you have got to be prepared to invest in doing this properly and the danger is the government is taking away safeguards against excessive working hours and actually reducing the pay of junior doctors who do work long hours.  As I said at the start, they haven’t got this right and in a way it is another symptom, as Norman Warner has said, of the overall existential challenge that the NHS faces and we’ve got to get to grips with this.  The longer we leave it, we will just sleep walk into a disaster and that’s my real concern.   

DM: Well, let’s stay with that, an existential challenge, the future of the NHS then at stake, is it all just about money or do we need another reorganisation?

NORMAN LAMB: It’s not just about money.  As Lib Dem Health Minister I was always totally committed to trying to make the system work more effectively, more efficiently and one of the things that I’ve argued very consistently for is bringing together the health and care system, it’s crazy the way it works in silos, so we can spend the money more effectively but just think about this: in the period up to 2020 the government is actually planning to spend a reducing percentage of our national income on health at a time when demand is increasing dramatically because we’re all living longer, we’re living with chronic conditions, that seems to me to be completely irrational.  

DM: All right, so you’re measuring it by proportion of national income but of course the government will say that at the general election they pledged, Lord Warner, to put more in than Labour.  

LORD WARNER: Well I’m not a member of the Labour party anymore so I’m not going to justify Labour and what Labour are doing.  What I would say historically is the NHS had got used, until about five or six years ago, to getting 3-4% real terms increase each year and for the last five or six years it has had, give or take, about a 1% increase and it is going to have roughly the same up to 2020.  Something has to give, however much you reform, however much you improve the productivity of the NHs you have to be prepared to make change, radical change but also in a managed way and there is a man in charge of the NHS, Simon Stevens, who has got a good plan but you have actually got to fund some of the changes themselves and we’ve got to do, as Norman Lamb did very courageously in government, try to bind social care and the NHS together in a more integrated way but what’s happening as we’re sitting here is publicly funded social care is going down the swanny and we are in very grave danger of a lot of the private providers of publicly funded residential and domiciliary care actually throwing in the towel and moving out and that will do tremendous damage …

DM: So we have got to join social care into the acute care as well.  Norman Lamb, radical solutions required as Norman Warner is saying there, should it involve bringing in more insurance based products to the NHS, charging those who can afford it for certain services, as they do for eye care or dental care?

NORMAN LAMB: Look, I’m a great believing in the founding principles of the NHS, free at the point of need regardless of your ability to pay and actually the Commonwealth Fund in 2014 found it to be the best performing health system globally so we shouldn’t throw the baby out with the bathwater but you cannot actually carry on like this.  As Norman has said, this has been the toughest funding settlement over the last five years and through to 2020 that the NHS has ever known.  You mentioned that the government is providing an extra ten billion but the gap experts say will be 30 billion and in social care the Health Foundation reckon the gap in 2020 will be six billion and there will be consequences to not providing sufficient funding.  We will get to a point in social care where if you have money you will get access to great care, if you don’t have money you’ll get nothing or something very substandard and in a civilised society I don't think you can justify that and that’s why I have called, together with Stephen Dorrell and also Alan Milburn, the former Labour secretary of state, for a cross party non-partisan commission to create a new settlement, a new long term settlement for the NHS and care and in my view part of that is bringing together health and social care.

DM: Lord Warner, the practical solution is putting more money in, you are both agreeing about that, to the NHS.  Either take it from other departments, put up taxes or, as you’ve suggested, in some areas to charge.  

LORD WARNER: Well I think we may have to move to some form of charging but I agree broadly speaking that …

DM: But where, what in?

LORD WARNER: Well I think for example the French have always had pretty much, if you go to see a GP you get charged a fee.  You don’t get charged a fee before you see the GP but you pick up the tab, some tab, afterwards and there is a management of demand issue as well as just raising the money, so there is a management of demand issue.  Basically the NHS is always going to be largely tax funded, we’re not going to get away from that.  What we haven’t had in this country is the public debate on what can you expect to get from the NHS for what you are prepared to pay in taxes and that debate has to take place. I support the idea of an independent cross party review but it has got to be one that operates in the public arena.  People cannot go on pretending they can get the all singing NHS that they want and love without putting their hands in their pockets more either through taxes or through some other means to pay for it.  

DM: Okay and let’s end on the doctors again.  Norman Lamb, you think the government should back down entirely?  

NORMAN LAMB: I just think it is a dangerous step that they are taking, taking on the doctors over a dispute that I think ultimately won’t achieve much of an objective in itself so I think the government just needs to settle this, move on and rebuild trust.  

DM: Okay, thank you very much indeed Norman Lamb there in Norwich and with me in the studio, Lord Warner.  Very good to see you both, thanks a lot.  

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