PLEASE NOTE "THE ANDREW MARR SHOW" MUST BE CREDITED IF ANY PART OF THIS TRANSCRIPT IS USED Andrew Marr interviewed Andrew Lansley MP, Secretary of State for Health on July 3rd 2011. ANDREW MARR: And so how we're going to pay for better care for elderly people. We're talking about very basic things here. We're talking about help with washing, getting dressed, eating, people in their own homes or in care homes. Almost everybody seems to agree with Age UK's damning assessment that our system is crumbling and close to collapse. Not enough money's being spent. Local authorities finance it for some people. Many others have to sell their houses, or fear they're going to have to sell their houses to pay for basic care. Tomorrow a major report's going to be published calling for fundamental changes. Today the Labour Leader suggests he wants to work with the government to help, and right now Andrew Lansley, the Health Secretary, joins us from Cambridgeshire. Mr Lansley, welcome and thank you for joining us this morning. Can I start right away … ANDREW LANSLEY: Good morning, Andrew. ANDREW MARR: … by asking whether you also agree with Age UK that the system that we've got at the moment to care for elderly people in their homes or in residential homes is crumbling, is close to collapse and needs to be radically changed? ANDREW LANSLEY: Well we know we need change in order for it to be sustainable in the future, and, more to the point, for us to deliver quality care. I think we knew last year when we came into office that the system of supporting people with care at home and in residential homes, as you say, was in great difficulty. It's why in the Spending Review at the end of last year, we made substantial additional provision. It's a total of seven … over £7 billion over 4 years additionally through the grant to local authorities and also directly through the NHS. You know this year, we're providing an extra £650 million through the NHS directly to support some of that help at home … ANDREW MARR: Sure. ANDREW LANSLEY: … things like home adaptations, community equipment and so on. But the point that Age UK make is a fair one. It will not be a… We will not be able to give people the quality of care and support and the sense of security that they need in the future unless we have change, which is why last July as a government we asked Andrew Dilnot and his colleagues to consider these issues of how we fund care in the future. ANDREW MARR: Now this report says in essence that most people are going to have to get out some kind of new insurance ultimately to pay for their care; that people with a bit of savings are going to have to pay through insurance. But the big debate seems to be whether or not the government will accept that there should be a cap on how much people have to pay for their own care at around £50,000. Can you help us on that? Is that going to happen? ANDREW LANSLEY: Well of course Andrew Dilnot, his colleagues Joe Williams and Norman Warner will produce their report tomorrow, and I will of course first give the government's response to that to parliament tomorrow. But I think Andrew Dilnot has set out very clearly some of the shape of what he's going to say and I think we are going to give it a very positive response; we're going to treat it as the basis for engagement. But of course it is part of the overall questions that need to be answered. I think Andrew Dilnot's commission themselves make clear that there's a range of issues within their own report that need to be resolved and on which it's fair for people to be able to express their view - where a cap should be set, how it is to be paid for; issues of the thresholds, for example, on means test and how the means test should be applied to people in the future, so they contribute to the cost of their care. And of course if people are in residential homes, they raise the question of the extent to which they should pay for their accommodation costs, their as it were "hotel" costs in residential homes. ANDREW MARR: Yes because … ANDREW LANSLEY: So there's a range of issues inside Andrew Dilnot's report. And the big question of course, questions beyond it of how we deliver quality care, how we give people proper protection, and of course how these issues are to be paid for. ANDREW MARR: Because quite a lot of people watching might think that if they get into terrible trouble in their old age with, as I say, very basic things like cleaning and feeding and so on, somehow the state will provide. But that's not the case and that cannot be the case, can it, simply because of the cost to the taxpayer of doing a sort of NHS style universal service? ANDREW LANSLEY: (over) Well one of … Yeah, I think you raise an important question, you see, because what Andrew Dilnot's research for his commission has shown very clearly is that people are very confused about what it is that is provided through care and support. Of course for those who have no income or no assets of their own, the state does provide. But increasingly of course with the pressures, the financial pressures, we're seeing that it's not at moderate levels of need; it's only when they really have substantial need. So if we carry on as we are, we're going to have increasingly large numbers of people who are not supported to be independent and to live comfortably at home, and they are tending to fall into greater need and more cost to the state later on. (AM tries to interject) But I think it's important for people to remember, this is … You know if one has no assets, the state is currently providing. If one needs healthcare, the state is providing. If people's primary need is a health need, there will continue to be healthcare support, which meets all of people's needs. And indeed just last … on Friday, Tom Hughes-Hallet and Alan Craft produced a report for me and my colleagues on palliative care - that is end of life care - and one of their recommendations, which we'll also be now taking forward, is that where people are right at the end of life, in order to join up health and social care better, there should be a … the government should take responsibility, the NHS effectively should take responsibility for the whole of their care. ANDREW MARR: When it comes to the social care issue that we were talking about before, where do you stand on essentially the moral question of whether people who have got assets which are substantial - houses, generally speaking - in the end should have to sell those houses to pay for their care rather than pass the value of that house down to their family? ANDREW LANSLEY: Well of course at the moment we're in a situation where it's a terrible lottery. You know people, one quarter of people have effectively no substantial care costs; whereas there's another quarter where the costs exceed £50,000, and for 1 in 10 it's over £100,000. So it's effectively a lottery, and some people end up through just what is in effect chance events - they happen to have dementia in old age, for example - they end up losing everything that they worked for in life. And of course if you don't have any assets, the state will pay. If people are very rich, they can afford to pay. So the focus of the question of paying for care and support in old age does come down to people who have assets. Not necessarily very large amounts of assets, but these are the things that they've worked for and saved for all through their lives. And what we want to do, and which Andrew Dilnot makes very clear he wants to do, is to make it possible for people to prepare for their contribution to costs in old age … ANDREW MARR: Right. ANDREW LANSLEY: … and, through a partnership between the state and families and individuals, for that preparation for old age to mean that people don't have a catastrophic loss of everything they've worked for in their lives. ANDREW MARR: But you're not going to tell us about whether there's going to be a cap or where the cap's going to be today. Let me therefore press you a little bit further on exactly the timing of all of this and how you're going to approach it politically because people will be worried about whether they're going to have to pay more in the short-term and they'll also see today that the Labour Leader, Ed Miliband, wants to work with you to do a cross-party consensus. Their ideas, the Labour ideas, you guys had a really tough go at before the election - called them "death taxes" and so on. But is this something where you think you can now all get round the table, produce something quite quickly that will give people more certainty than they've got at the moment? ANDREW LANSLEY: Well I think the first thing to say is it is important … I mean the reason why I can't … You know I haven't received Andrew Dilnot's report and I'll tell parliament how we're going to proceed tomorrow. But I think it's important to recognise that there are issues in Andrew Dilnot's report that the public and indeed political parties together have a responsibility to consider what are the decisions that need to be made in relation to many of those issues. There is the wider decision on which Andrew Dilnot and his colleagues do not make recommendations about how those … what the extent of cost is and how those costs are to be met … ANDREW MARR: Alright, let's … ANDREW LANSLEY: .. and there's important questions there. And we need to set it in a wider context. ANDREW MARR: Okay. ANDREW LANSLEY: But you come to the point … I mean last month David Cameron made it very clear that we would work with other parties. But of course we've got to work beyond political parties. ANDREW MARR: Okay. ANDREW LANSLEY: There's the representatives of all of those people, older people and their carers organisations, who have a legitimate part themselves to play in all this. ANDREW MARR: Let's move onto the National Health Service u-turn. Do you now think that you got your original plans wrong? ANDREW LANSLEY: I don't think … See I don't think we got them wrong necessarily or that there's a u-turn, but I think what was absolutely clear in March and April was that many people had concerns. Some of them may have been misplaced, but others were genuine concerns, and there were issues where people felt very strongly that there was scope to improve what we were setting out to do in the NHS and give people greater confidence about how it was going to work to deliver benefits in the future. ANDREW MARR: This improvement has produced … ANDREW LANSLEY: (over) I'll gladly explain I mean because … ANDREW MARR: Sure, well let me just put to you the case that was being made in the House of Commons, which is that this improvement has come at the cost of a vast increase in bureaucracy - shadow commissioning groups, authorised commissioning groups, PCT clusters, SHA clusters, clinical networks, clinical senates, HealthWatch England, Public Health England; and, according to the Royal College of GPs, the number of statutory organisations in your changes is going to rise from 163 to 521 organisations. ANDREW LANSLEY: Yeah, well the latter point simply isn't true. But, look … ANDREW MARR: Well what is the figure? ANDREW LANSLEY: … if you try to explain, I'd invite you Andrew to explain how complicated the current NHS system is; and as part of what we're proposing to do, which actually people have agreed with, is to take two whole tiers of management out. But of course in the process what we are going to do is we're going to use many of the existing organisations because clinical networks exist. The cancer networks currently exist. There are clinical senates already, for example, in the East Midlands and in the south of England … ANDREW MARR: (over) So can you give us the current figure of the … ANDREW LANSLEY: (over) … but we're going to use them and make them part of the system. ANDREW MARR: Can you tell us how many new … ANDREW LANSLEY: I'm sorry? ANDREW MARR: … how many statutory organisations there are going to be in the NHS after your changes? ANDREW LANSLEY: No I can't because the clinical commissioning groups that will be established across England will only be determined, the number will only be determined when the local groups have come together in order to determine what is the best geography for their delivering services to patients in their area. So it may be 200 or it may be 250, I don't know. The point is that they will determine that geography themselves. But we're going to take whole tiers of management out. And let's be frank about it … ANDREW MARR: (over) Okay. ANDREW LANSLEY: … everybody knows we need to cut the costs of administration in the NHS. We're going to cut it by more than a third in real terms. And since the election, we have reduced the number of managers in the NHS by over 4,000 and increased the number of doctors by over 2,000. ANDREW MARR: Let me ask you about another story getting a lot of coverage today, which is this government drive against obesity. We've seen some fairly disgusting pictures of livers and other inner organs on our television screens already this morning. Do you think it's the government's job to tell people what they should be eating? ANDREW LANSLEY: No, I think it's the government's job to help people to lead healthier lives. That's why, for example, just in the weeks coming up we're going through Change4Life, which I think people recognise is about supporting them, not lecturing them; through Change4Life giving families the opportunity with their children to have a lot of additional physical activity during the course of the summer. And it's National Obesity Week in the week coming up, and I think what is important - and it's one of the things that my colleagues are highlighting just now - is that people may not realise the nature of the risks that people run if children, in particular, become seriously overweight. So, for example, people think of liver disease, fatty liver disease in particular, as something which is a consequence of abuse of alcohol, but actually there are 60,000 10 year olds who could be at risk of developing fatty liver disease themselves if they are too obese in the years to come. ANDREW MARR: Alright. Andrew Lansley, thank you very much indeed for joining us this morning. INTERVIEW ENDS
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