Harriet Harman

Red Pepper / Keep Our NHS Public survey of Labour deputy leadership candidates views on the NHS

1. The government has put massive investment into the NHS, yet polls suggest the Tories are now more trusted to run it. What would be the first three steps that you would like to see to improve the NHS?

The idea that the Tories can be trusted with the NHS is absurd. Whatever they are saying is designed to achieve one thing -- to get them into power. If that happens we would see how little they really care about the NHS. For all the undoubted importance of issues such as hospital waiting times, our overriding health policy priority has to be to tackle the wide disparity in health outcomes that still exists in Britain today between people from different regions and social backgrounds.

We know these inequalities have economic costs both to the NHS itself and in terms of the number of working days lost. So, it makes economic sense to tackle them - but the most powerful reason for putting this issue at the heart of our party's policy agenda is the social and human cost of these inequalities.

Consider for example the gap in birth weight between babies born to families in the lowest and highest incomes groups, which is perhaps the most glaring example of health inequality that we face. Babies born underweight are statistically far more likely to die before their first birthday. They are also much more likely to develop behavioural problems, have a low IQ, and suffer from chronic ill health later in life. Moreover, there is strong likelihood that they themselves will then grow up to have babies of their own, who are also of a low birth weight; thus perpetuating the cycle of inequality.

In the last ten years we have done a great deal to address health inequalities. Maternal health and well being for example is an issue that receives more attention in Whitehall today than it has ever done in the past. We now need to address the human cost of these inequalities. As a party and a Government we need to become more vocal on the issue of health inequalities. We need to highlight their pernicious effect on society and to try to put them at the forefront of the debate on health, rather than on the margins.

2. Why do you think health reforms have produced such a strong reaction from NHS staff?

Whatever the reasons for the hostility shown by some - although certainly not all NHS staff -- we do need to demonstrate a new willingness to listen and take staff with us as we carry out future reforms.

3. Should extensive private sector involvement in the health service be continued or curtailed and why? Do you favour the expansion of private involvement into primary care, with companies running GP surgeries and PCT services being outsourced?

With power and resources now being devolved from Whitehall to local health care providers, we need to strengthen the way in which these local organisations are held accountable to the public. The freedom of PCTs for example to commission services and to set health care priorities to suit the needs of the local population, is one that I welcome, but these decisions shouldn't be taken in a political vacuum. Each community should be able to hold their local trust to account for the decisions that they take. There is a strong case for having directly elected officials on each primary care trust board, making local decision-making more open and transparent, and helping to restore public trust in NHS management

We need to be careful that in addressing this democratic deficit in the NHS, we do not undermine the progress that has been made since 1997 in ensuring that all patients, wherever they live, receive a consistent level of care in key clinical areas based on national targets. We would also need to make sure that in deciding what their priorities should be, trusts do not sideline some of the strategically important, but less politically sensitive services such as public health and health promotion activities.

4. Aside from private sector involvement, reforms have aimed to create a quasi-market with NHS hospitals competing with each other and earning their 'payments by results'. Has this been wise and should it continue to be the direction of travel?

Outside providers have undoubtedly helped the NHS to cut waiting times for elective surgery and reduce pressure on NHS hospitals. It is clear, however, that independent sector treatment centres have not always proved to be more efficient or innovative that NHS-run elective centres. When we consider bringing in outside agencies, we must make sure we do not jeopardise one of the important developments in the NHS - the very welcome shift towards greater multi-disciplinary working. Fundamentally the NHS must remain a public service within the public sector.

5. There has been talk recently of charges for health services - Charles Clarke said the NHS should provide core services for free but demand a fee for peripheral treatments. What would your policy be on NHS charges?

I'm against the extension of charges. They can be very expensive and bureaucratic to collect.

6. Does the public really value choice in the NHS?

Yes, if it means the service is shaped for their benefit but what really matters is getting the best possible treatment in the shortest possible time.