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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?
It is absolutely astonishing that we have allowed the Tories to establish a lead on health. We need to raise our game.
As a first step, we need a moratorium on structural change and reorganisation in the NHS. The health service doesn’t need to be in a state of permanent revolution in order to deliver. It’s time to let the health service settle down and time to let NHS staff get on with the job.
Secondly, we need to set out a clear and unambiguous vision for the role and limits of private sector provision within the NHS. As a very basic general principle, I believe public services should be publicly provided unless there’s a very good reason why not. For instance, in Northern Ireland, I used the private sector to clear a massive waiting list backlog and that was absolutely the right thing to do because it delivered such huge improvements for patients. But there should be a general presumption for public provision.
Finally, we need a new deal with NHS staff. For example, the two-tier workforce in the NHS is a major cause of insecurity among staff in the health service. That is why, in Northern Ireland, I exempted catering and cleaning staff from PFI contracts in the NHS, because I believe that, while there is a role for private finance, it should not be at the expense of the terms and conditions of workers.
2. Why do you think health reforms have produced such a strong reaction from NHS staff?
NHS staff feel that the health service is in a state of permanent revolution, with wave after wave of reorganisation. NHS staff aren’t opposed to reform, but they don’t feel we’ve made the case. First and foremost, NHS staff want to get on with treating patients.
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?
As I explained above, I believe public services should be publicly provided unless there’s a very good reason why not. In Northern Ireland, I used the private sector to clear a massive waiting list backlog, which we brought down from as long as four years to a matter of weeks.
There is a role for the private sector in delivering health services, but where we have failed is being clearer about what the scope and limits of private sector involvement should be. There should be a general presumption for public provision, but with a role for the private sector when we can show clearly there is benefit for patients.
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?
We need to be pragmatic and we need to be prepared to admit when we have made mistakes.
There was a clear case for introducing payment by results – namely, that patients benefit if hospitals that perform well and treat more patients are able to do so without being financially penalised.
But clearly, we need to learn from experience, and only proceed with such reforms if the evidence shows that they are working.
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?
The NHS must remain free at the point of use, and I am opposed to any extension of charges for NHS services.
6. Does the public really value choice in the NHS?
Yes. Patients want to be in control of their own treatment.
Choice must not be a dirty word for the left, and we need to nail the Tory lie that choice equates to marketisation or vouchers.
We must make the case for choice for patients within a publicly funded NHS, free at the point of use.