ON THE RECORD ANN WIDDECOMBE INTERVIEW RECORDED FROM TRANSMISSION: BBC ONE DATE: 23.5.99
.................................................................................... JOHN HUMPHRYS: Ann Widdecombe, you say the NHS cannot do everything, even if you spend a bit more. So you want more of us to pay spend more towards our treatment. That¹s it in essence. ANN WIDDECOMBE: In essence what I am saying is that the NHS has never been able to do everything but with the increasing amount of new medicine, new drugs, new surgery coming on stream there is an ever growing gap between what is demanded and what it can actually supply. And what I am saying is that even though of course, of course any future Conservative Government will go on increasing spending, in real terms year on year of course we will do that, there¹s no doubt about that at all. Yet, even that will not be enough and even if there were to be under any government a substantial tax increase, that still would not be enough. Now, once you¹ve accepted that and the evidence screams at you that that is so with people not being able to get Beta Interferon and so on. Once you have accepted that that is so, then you really have a choice, you either accept increase rationing because you are so committed to doing things the way we¹ve always done them, that you¹d rather accept increase rationing than do anything new. Or, you say, we¹ve got to look at new ways to get money in on top of that extra spending which the Government will put in. So it¹s not a substitute. You are not saying farm out what you do, you are saying let¹s look at ways at getting additional monies in so that we can do more. HUMPHRYS: Which means more of us paying more out of our own pockets. WIDDECOMBE: That is one option, if by that what you mean is more people taking out individual medical insurance. There are other options, for example employers insuring, maybe even self-insuring their workforce. Getting money in from the private sector itself through the private finance initiative or through partnerships. HUMPHRYS: In addition to buildings that is, we¹re not talking about just putting up. WIDDECOMBE: We already do buildings.. HUMPHRYS: Precisely. WIDDECOMBE: In addition to buildings, getting the private sector to put its own money in. For example, in one or two places but not enough, the private sector has supplied a scanner, it has paid for the scanner, both sectors use it. Now, the NHS quite clearly is using a scanner that it hasn¹t paid for, it¹s that sort of plus. If you have, as everybody knows, take one that everybody¹s familiar with, if you have a private ward in an NHS hospital that actually brings income in to the Health Service, which the Health Service can then use and spend. So there are all sorts of ways. I think there is a danger and I think we saw that in just looking at those vox pops that you¹ve just done - or experts that you¹ve just done. I think there is a danger because it¹s the way we¹ve always done it in this country, and we can¹t look wider of simply saying that private medicine equals Bloggs taking out an insurance premium. That is a part of it, but it¹s not the whole of it and above all, I can¹t stress enough, this is additional, it¹s not substitute. HUMPHRYS: Those medical savings accounts that we heard about. You¹ve got another expression for that. WIDDECOMBE: We¹re looking at what we call Health Tessas. I stress again we¹re only looking at them. We haven¹t, you know, it¹s certainly not policy at the moment. We¹re looking at a whole range of things. HUMPHRYS: What do you mean a Health Tessa. WIDDECOMBE: Well everybody knows how a Tessa works. I mean one of the nice things is trying to get something that is familiar to people and the idea would be, might be, it¹s not policy, might be. But you save and the savings are dedicated specifically towards medical care and services as and when you need then. The beauty of it of course is that if you don¹t need them, then you can take the money at the end of it. So, that is just one of umpteen and I stress umpteen possibilities. I don¹t want everybody to run away and say this is what the Tory Party is going to do. We are still looking. HUMPHRYS: But why should we do that for instance, when we¹re paying our taxes, we expect the NHS to provide. WIDDECOMBE: Well of course all the examples of trying to get to people to take more responsibility for their own health, probably involves some measure of tax relief other than actually getting private sector money into the NHS, which I am very keen on as quite a big block way of getting money in. The question is simply this. If you accept that the NHS can¹t do it all, then you¹ve got to accept that we must have proper partnerships, we must have other ways of doing things. If the NHS were doing it all, nobody at the moment would be taking out any form of private medical insurance because you would say, well it doesn¹t matter. The NHS does the whole thing. It never has been able to and everybody out there knows that there is a huge gap between demand and supply that is not going to be bridged just by carrying on the way we are. HUMPHRYS: But we¹d have to have, as you say, they¹d have
to be incentives to encourage us to take more responsibility for our own health care. WIDDECOMBE: I think it would be very difficult to persuade people to just simply to go and take more responsibility without offering them incentives and what we have to look at is what those incentives will deliver. It¹s no good saying vaguely let¹s have an incentive. I want to know the likely result of that incentive. What it¹s going to cost, how many extra people it¹s going to bring in, bearing in mind that it might only otherwise benefit people who are already taking out private medical insurance. No point in that. There¹s got to be an incentive that has a real and measurable effect and that is why, although everybody is clamouring to know what we are going to do, we¹re examining so many different options, trying to crunch the figures, trying to come up with what is effective. HUMPHRYS: Because at the moment people want (a funny noise somewhere round there - we¹ll assume the whole set isn¹t going to blow up). At the moment people will buy the insurance, private insurance because they want a better service. They want to go in to be treated when they want to be treated, they want to have a nice fancy private ward or champagne for dinner, or whatever it happens to be. I mean that is itself an incentive. Now it¹s difficult to see, apart from a very substantial and serious tax incentive, why unless that¹s what they are after, people should bother with it. WIDDECOMBE: The very fact that at the moment they do bother with it, the very fact that at the moment the NHS does use the private sector, it does it on a very limited scale but if you take the waiting lists initiative, a lot of the waiting lists initiative at the moment is being delivered by the private sector for the NHS under contract. Now one of the things, you see, we do get very tied up, as I have just said, on Bloggs taking out an insurance policy, that¹s just one portion. HUMPHRYS: A big one though. r
WIDDECOMBE: Not necessaily. I mean, I think the single biggest improvement we could bring about is actually getting private sector money in by contracting at favourable rates, now fundholding was doing that. Fundholding was doing a very great deal of buying services from the private sector at very favourable rates and therefore releasing money that can be spent to treat more patients. HUMPHRYS: That¹s not real money is it, I mean if a fundholder saysŠ WIDDECOMBE: But it¹s getting more for it. That is the point. HUMPHRYS: He might be getting a bit more for it. Yes. It¹s not actually new money for ŠŠ WIDDECOMBE: But gross that up. If you gross that up and people are getting more for the money which the NHS is spending, that makes a substantial contribution, but you are right, that again, like Bloggs and his insurance premium is only a part. But if you get a very large partnership going, whereby the private sector is committing quite substantial funds into that partnership, then you are starting to make progress. We are looking at such a range but at the core of this always, and I must stress, that at the core of this always, is that we will go on expanding the public sector at the same time, there is no question of hiving off responsibilities onto the private sector. HUMPHRYS: But at the moment, just to go back to the private insurance rather, at the moment it¹s what, six-and-a-half million people or thereabouts covered by private insurance. You would be happy to see that spread, that figure to grow. WIDDECOMBE: They already do for example, twenty per cent of all acute elective surgery, that¹s things like hips, cataracts, those sorts of things, they already do twenty per cent of that, I am quite happy to see that grow, because what we know is that they do that well, that they do it so well that the NHS itself contracts with them, and what I would like to see is a growth there, because, to put it very crudely, the more the private sector does, the more free the NHS is to do the things that it does not do at this moment, because what is being ignored in this discussion we are having, we talk about rationing as though it is some great theoretical thingŠ.. HUMPHRYS: Politicians are normally terrified to talk about rationing. WIDDECOME: Well I¹m not. HUMPHRYS: They won¹t use the word. WIDDECOME: Well I¹m not, I use it all the time. HUMPHRYS: I have never yet met a NHS Secretary of State for Health that even uses the word. WIDDECOMBE: Well you¹re looking at a Shadow one that¹s used it ever since her appointment. But can I just put rationing in context. What rationing means is that we have a three-tier Health Service in this country and on the top tier are those who get their NHS treatment or who choose to go private quite voluntary. On the next tier down are those who can¹t get their NHS treatment, either because the operations or the drugs aren¹t available, or the delays are too enormous, and they don¹t choose to go private, but they can often at huge personal cost, I mean we have got people in this country selling houses in order to buy Beta-Interferon. But on the third tier, are people who don¹t get their NHS treatment and they couldn¹t go private if they didn¹t eat. Now those people are totally dispossessed under this system, and what I¹m saying is that if we can share the burden more, the NHS can reach out towards those dispossessed people and do more than it is doing at the moment. HUMPHRYS: But this, that clearly Š.. WIDDECOMBE: That¹s what¹s happening. HUMPHRYS: Well, yeah. But the danger in more people going private, and ultimately, there is no reason according to your logic, there is no reason why half the population for instance shouldn¹t take out some sort of private medical insurance, you wouldn¹t have a problem with that would you? WIDDECOMBE: I think it¹s a somewhat exaggerated aim, but let¹s take it from theoretical purposes. Let¹s take it from theoretical ŠŠŠŠ. HUMPHRYS: Š.You would then end up with the NHS in danger of becoming a kind of safety net service for those who couldn¹t afford it. WIDDECOMBE: No, and I see exactly why you¹re saying that. And that is why I have said right from the start that we don¹t want to hive off responsibilities, we want to share, but we want to go on expanding in the public sector, we want to go on expanding year on year, what I am saying is, that itself won¹t be enough, but it will always be there, a big thriving National Health Service that can do ever more and more. I don¹t want it to become a safety net service, I know that there are some theorists who say that will be a good idea. I think actually it would be a very bad idea. What I want is a true partnership. It¹s both sectors doing most things. I think there are some things that at the moment the private sector cannot do. HUMPHRYS: But the danger of what you¹re suggesting, you may not want this to happen, but the danger is, let¹s assume you do have half, not necessarily half the entire populationŠ.. WIDDECOMBE: ThenŠŠ. HUMPHRYS: OK, but let¹s say, half the middle class, or sixty per cent of the middle class, entirely possible, that is, because an awful lot of them already do private health insurance, they will stop, forgive me for using the word, because it¹s what your political opponents used to use, stakeholders, they will stop becoming stakeholders in the NHS, then you have a real problem on your hands. WIDDECOMBE: They won¹t. We¹re all stakeholders. HUMPHRYS: If you¹re paying privately. WIDDECOMBE: Yes. ŒA¹ because we all still pay our taxes, even if you get some relief, you will still pay a large ŠŠ HUMPHRYS: Š.and they¹ll resent it. WIDDECOMBE: Šbut ŒB¹ we all use the NHS because the fact is that we all depend very heavily on the NHS indeed for accident and emergency services, most people still use the NHS at primary care level. If you actually look at where the private sector has developed, it does twenty per cent of the sort of elective surgery I was discussing, hips, eyes, things like that. It does a third of all mental health care, it does eighty-five per cent of all elderly care. So it¹s developed in specific areas, and there are other areas where we assume that the NHS is the first port of call and where it must be excellent, for example, we will be in a very bad way indeed if we don¹t have an excellent and expandingly excellent accident and emergency service which you and I use. It doesn¹t matter how insured we are, if we go out there and drop down with a heart attack, you and I have a stake in the NHS having a first class excellent service. HUMPHRYS: No reason though why if we have a sufficiently expanded private sector they shouldn¹t do that sort of stuff as well, and then it would expand to the extent where you know, we drop down in the street or something or get knocked down by a car, because you¹ve got your private health thing you just get taken to a private hospital. WIDDECOMBE : No, these are fantasies because this is not what I¹m working towards. That would be so if what I had said right at the start was: I want the private sector to take more and more of what the NHS does and to shrink the NHS. In fact what I¹ve said is the exact opposite. I¹ve said I want to go on expanding the NHS, but that won¹t be enough and I need an addition, an addition on top of that, and it¹s to private monies, whether it be from an individual, an employer, or the private sector itself that I¹m looking for the addition. I still have a vision of a huge and expanding Health Service. HUMPHRYS: Right, but the question is how much expanding. Why don¹t you instead of saying private partnership and all that, why don¹t you say: let¹s do what the Germans and the French do. Let¹s spend substantially more, not just another penny in the pound or tuppence of thruppence on the pound - a third more as they do. They spend a third more than we do on their National Health. Let¹s do that. WIDDECOMBE: Have you analysed it.? When you look - and you¹ve now hit, I think inadvertently, the whole nub of the problem, because when you look across OECD, even if you exclude America which has a huge private model, in case you think I¹m pulling a fast one, let¹s exclude America. - if you look across the developed world what you actually see is that yes, there is a difference between what we spend and they spend, but nearly all of that difference is made up not by public spending, but by private spending. That is the essence of our problem. HUMPHRYS: I¹d love to argue that with you. WIDDECOMBE: No it¹s there. It¹s there in all the independent OECD statistics. That is the essence of our problem. They do spend more GDP and the difference is the private addition. HUMPHRYS: Ann Widdecombe, must end it there. Thank you very much indeed. Š.oooOOOoooŠ. ŠoooOoooŠ 4 FoLdEd