ANY QUOTES USED MUST BE ATTRIBUTED TO MURNAGHAN, SKY NEWS

DERMOT MURNAGHAN: Now it goes without saying that the NHS will be a key battleground in this year’s general election but is it being used as a political football once again and is there a way it could be depoliticised?  Well Frank Dobson is a former Labour Health Secretary, Lord Warner was a civil servant and Health Minister in Tony Blair’s government and Mary Riddell is a Daily Telegraph columnist and has just been writing about the National Health Service, a very good morning to you all.  I want to start with you Frank Dobson as a former Health Secretary and I talk about it being used as a political football but the charge is when it comes to Labour during this election campaign, which of course has already started, is it has gone beyond that, Labour have quote-unquote ‘weaponised’ it.  

FRANK DOBSON: Well it’s always been a political issue but I think what people in the National Health Service want is basically to be left alone.  The first telephone call I received from a human being after I was appointed Health Secretary was from a very close friend, Professor Richard Madeley from the Medical School at Nottingham, who sadly died a couple of years ago and I’ll Bowdlerise what he said, he said for God’s sake let us alone, keep reorganisation to a minimum and I did try to do that and the changes that I made had a two-thirds majority in favour of them at the BMA’s annual conference.  But I think it is the constant changing that people don’t want.  

DM: So Lord Warner, just leave it alone and it will heal itself, it’s gone beyond that hasn’t it?

LORD WARNER: Yes and it was never in that position that it would heal itself, there has to be some degree of central direction.  I think what we’ve done though is we’ve gone in for massive attempts of command and control far too much and there is a beginning of a realisation, particularly by Simon Stevens, that we’ve got to let local people have more flexibility about how they solve their healthcare problems.  

DM: That’s the head of the NHS.  

LORD WARNER: Yes and I think that’s the route that we have to take but even last week Jeremy Hunt was saying, he was accepting responsibility for everything which goes on in the NHS and it is a fantasy that any Health Secretary, however brilliant, can actually control everything from ….

DM: Well that’s the point, Mary Riddell.  I say you’ve been writing about it, Lord Warner uses the term fantasy, we want some reality in this debate don’t we?  Everyone uses it, everyone has some access to the National Health Service, do they recognise the way that all politicians characterise it, particularly when we come to a general election campaign?

MARY RIDDELL: Well I don't think there is any harm in the NHS being used, political football is an unfortunate term but obviously debate is going to be politicised, what it relies on is politicians making the correct decisions and gathering enough of a consensus I think to drive through the sorts of changes that will be needed.  I mean obviously the NHS needs more money and Simon Stevens has said a minimum of eight billion a year by 2020.  No political party has quite said how that money will be found but it also needs I think a complete restructuring.  You have got somehow to bring health and social care together in a way that hasn’t been done before, ring-fence the budgets and you are going really to need cross party agreement and very strong political …

DM: But that brings us back to the political football.  You need this pause, you need this consensus and don’t politicians just  over-exaggerate the threat?  Frank Dobson, you became Health Secretary after we had a campaign in 1997 didn’t we, 24 hours to save the National Health Service – it’s still here.  

FRANK DOBSON: And we did.  

DM: Oh I see, it’s because of you, here we go.  

FRANK DOBSON: But you see Mary is straight into we need a massive reorganisation and the last thing that people want is a massive reorganisation.  It is possible, it would be possible to make the integrationist changes, bringing social care and healthcare together without a lot of basic structural change.  

DM: So where do you stand on … I mean there is heavy criticism from Andy Burnham, from Ed Miliband about what Lansley did, the Lansley reforms, which of course he would have liked to have gone further, the state it’s left the NHS in now.  Would you just say okay, wherever it is, let’s just leave it alone and tinker at the edges?  

FRANK DOBSON: I think we do need just to make some modifications but one of the problems is that – and I’m not getting at Sky particularly but people in the news media are constantly demanding new initiatives and changes and dramatic improvements and this, that and the other and really if a Minister came on and said look, forget about dramatic changes, forget about reorganisation, what I’m going to try to do is just make the existing system work as it was intended to and to …

DM: But you talk about dramatizing, it’s the politicians standing up at Prime Minister’s Questions knocking ten bells out of each other on it.  If we all agree, we’ve all agreed that it needs some kind of gentle reorganisation, particularly this integration of social care with clinical care, then perhaps this might be able to take place.

FRANK DOBSON: Well nobody has been advocating the bringing together of social care and the NHS more than Andy Burnham over the last couple of years so there is that consensus but we don’t want dramatic reorganisation.

DM: One of the great things, Lord Warner, that is never allowed to be talked about is getting more money for the NHS from people who can afford it who use it, particularly when it comes to the crisis in or the pressure on, I should say, on A&E departments.  Some people are saying, Rachel Johnson is writing about it in the papers today, okay she is only a columnist, saying I know what, charge those who can afford it a fiver for turning up there and that will soon make them think twice about whether they should go there for their bunions.  

LORD WARNER: Well I think the idea that it is a wise thing to put a financial impediment in place of people seeking care would be not a very sensible thing to do.  I  mean we already have problems in this country with failure to early find out about cancer so we’ve got people putting off going for healthcare when they need it.  

DM: But people point out that a lot of people get charged for teeth and eyes, what’s the difference with your feet?  

LORD WARNER: I am not against some degree of charging and indeed the reality is that we have got different systems in the UK, we’ve got free prescriptions in some parts of the UK and not in other parts of the UK.  My point essentially is that we should be much more restricted in the things we try to control from the centre and we should stop trying to pretend that we can control in detail what is going on locally and that is the great fantasy.  We do need to integrate health and social care, we do need to actually ensure that everyone has access to a GP but we don’t have to control everything in Penzance and try to pretend it’s the same as what goes on in Newcastle.  

DM: That’s an interesting point, wasn’t that the direction of travel, that was the direction of travel of the Blair reforms, devolving powers there, remember Patient Choice, you could go anywhere in the country, you  could go across to Europe to get your operation done if you wanted to.  

MARY RIDDELL: It was, it was …

FRANK DOBSON: It was actually wrong.  Until the changes were introduced, first of all by Ken Clark, any GP could refer any patient to any hospital in the whole of the United Kingdom.  It was only when contracts came in and this idea of commissioning that people were restricted.  

MARY RIDDELL: I think this issue of choice though is rather misleading.  At the moment people have no choice, they turn up in A&E, they are not treated, they are stuck in beds because if they are old and infirm there is no way they can go home because there is nobody to help them survive and live a normal life at home so I think really choice has been completely eroded and I think what you need now, as well as an amalgamation of health and social care, at some point we are going to have to bite the bullet and stump up more money, whether that’s on a tax …

DM: Could it be about charging them?   

MARY RIDDELL: Andy Burnham has come up and revived several times actually the idea of a death tax or an estate levy which I think would be a fair way of doing it, if it is wealthier older people who are going to benefit from these services  to pay a little more.  I doubt that the mansion tax will quite do it, it may not raise enough …

DM: Then it will all go to Scotland won’t it?  

MARY RIDDELL: Well yes but in a way why not?  That would be fair.  With the NHS you have got a service that is partly the glue of the nation, it attracts widespread support and if you have quite a divisive tax that’s going somehow to bankroll that service then I think you run into problems culturally as well as practically so I think they are probably going to have to improve on that at some stage.  And one last thing, although Frank no doubt did save the NHS in 24 hours in 1997, Blair as I recall has to rephrase it some time later when he was told by one of his peers that the NHS was not as good, the health service was not as good as Poland’s, he then had to …

DM: But it was Mr Blair’s promise wasn’t to match EU levels of spending?

MARY RIDDELL: Indeed.  

FRANK DOBSON: Probably one of the most important things I did when I was Health Secretary was I sent him, Tony Blair, a personal two page memo saying if you want a first class healthcare system you are going to have to pay a first class fare and about two years later, long after I’d ceased to be Health Secretary, he sent me a note saying it was your note to me that provoked us into finding the extra money.

DM: So what’s your idea, Frank, on getting more money into it?  Mary Riddell saying a death tax as the Conservatives would term it, get more money out of inheritance tax on richer people.

FRANK DOBSON: Well one way or another it needs more money but there is also this …

DM: You dodged that, how?

FRANK DOBSON:  I don’t mind where it comes from but it needs more money.

DM: But higher taxes on the rich?

FRANK DOBSON: It may be higher taxes on the rich, yes.  As I say, I don’t mind where it comes from but pretending that it doesn’t need more money, we’re still spending a lot less than the French do, we’re still spending a lot less than the Germans do and one of the results of that is we have three hospital beds per thousand people.   The French have six beds per thousand people and the Germans have eight or the other way round.  

DM: Lord Warner, the overall introduction here was more or less to say are we overdoing it?  It can be bad but we’ve all got our personal anecdotes, my daughter, my 17 year old, fell down the stairs God love her, she was all right but hurt her ankle and it didn’t go after a week.  We didn’t bother A&E but after a week she thought I’d better go and get an X-ray and she was treated within the hour, it was fine.

LORD WARNER: It is very easy to be star-struck by what goes on on the ten o’clock news, it really is and I think what we need to face up to is simply giving the NHS more money would be a mistake because many of their ways of delivering care are inappropriate.  We don’t need the number of 85 year old frail and confused elderly people sitting in A&E departments and then sitting in acute hospital beds.  People in the NHS have to change the way they do business.  They may need some more money but they also need to change the way they look after patients.  

DM: You’d go along with that, Mary, as well wouldn’t you?  It’s those twin pressures isn’t it on A&E departments, many of those people are elderly and what do you do with them once you’ve got them in the hospital?

MARY RIDDELL: That’s right and that’s why I talked earlier about some sort of reorganisation.  I agree of course with Frank that we don’t want to throw everything up in the air and start again but I do think there need to be some structural changes to get over that and Frank’s quite right, we don’t have parity with Europe but also we don’t treat people in the same way.  In Europe they are much more focused on diagnostic tests at a much earlier stage before people even get to hospital, good cancer testing, the sort of poly-clinics that Lord Darzi brought in and fell from favour.

DM: I’m sorry, we are out of time and we haven’t solved the NHS crisis in the fifteen minutes we had available, oh dearie me.  Frank Dobson, thank you very much indeed, Lord Warner and Mary Riddell, very good to have all your thoughts.