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 | You and Yours - Transcript BBC Radio 4 |
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| TX: 21.09.06 - Charities and the NHS PRESENTER: CAROLYN ATKINSON |
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| Downloaded from www.bbc.co.uk/radio4 THE ATTACHED TRANSCRIPT WAS TYPED FROM A RECORDING AND NOT COPIED FROM AN ORIGINAL SCRIPT. BECAUSE OF THE RISK OF MISHEARING AND THE DIFFICULTY IN SOME CASES OF IDENTIFYING INDIVIDUAL SPEAKERS, THE BBC CANNOT VOUCH FOR ITS COMPLETE ACCURACY. ATKINSON Now four years ago the MS Society and the NHS signed a revolutionary agreement which was designed to improve the provision of drugs and specialist nurses for patients with multiple sclerosis. Well Simon Gillespie is the chief executive of the MS Society. Simon, tell us how this was all supposed to work. GILLESPIE Yes certainly. Well it was a ground breaking scheme basically. The National Institute for Clinical Excellence who basically assess therapies and drug treatment for patients in England had rejected these beta interferon therapiesas the treatment for MS, on the basis they were not seen to be cost effective. Nevertheless people with MS have a need for therapy and actually what we were able to do was to get the Department of Health to direct primary care trusts across England to provide these therapies with an agreement there'd be an assessment of their effectiveness further on in the future and if they were not living up to the manufacturer's claims then there'd be a refund of the money back into the NHS. ATKINSON And for your part - that was their side of the deal - for your side of the deal you put up a lot of money to fund MS nurses. GILLESPIE Yes well we followed on with the MS nurses as well, some of them directly related to the provision of these therapies but actually particularly looking at the specialist needs of people with MS across the country. And this has worked to varying degrees, it's something that's applied across all four nations of the UK and in some of the four countries it's working very well, in others there are difficulties - funding is running out, for example. ATKINSON But overall as a society you were very happy and willing to take part? GILLESPIE Absolutely right, absolutely good idea and we indeed have put £4 million worth of the charity's money into supporting the MS nurses scheme. ATKINSON So four years on you're very concerned about how things are working out, so what's going wrong? GILLESPIE Well there's a couple of things that are happening that are really of concern to us and of course primarily to people with MS. And the first thing is that there appear to be some waiting lists for the therapies when in fact the funding is there and a direction from the Department of Health to PCTs in England to provide it but there are also issues there across the four nations to one degree or another. The other thing about MS nurses is we're seeing that now the funding is beginning to get very tight after our initial funding efforts have been put in. We're seeing the threats of redundancies, we're seeing recruitment of vacant posts being held up and the like. ATKINSON So you're saying PCTs aren't really doing their side of the deal? GILLESPIE Some are doing very well, some are not and ... ATKINSON But 25% is your figure. GILLESPIE Absolutely right, 25% of the PCTs across England don't appear to be fulfilling their commitments. ATKINSON So has this undermined your confidence in this whole principle of charities taking over work which has traditionally been done solely by the NHS? GILLESPIE I think it's given us cause for concern. At the moment we're having to put in additional amounts of the charity's money to maintain services and I don't think that can be right, these are services that people with MS are entitled to, they should be having and in the case of England, for example, the Department of Health has directed PCTs to provide. ATKINSON Okay Simon Gillespie of the MS Society stay with us if you will. Let's hear the view of someone who's had first hand experience of this new service. Neil Thomas is a 38-year-old lorry driver from Pontypool. He was diagnosed with MS in 1999 but he's had two relapses this year, he's ended up in hospital and he has been judged as totally eligible for having these beta interferon drugs but he finds himself ninth on a waiting list of 25 people in his area. THOMAS I initially went, after the first relapse, in February and saw the consultant. They sent me a letter out saying that I did meet the criteria for these beta interferons. And then in March I received a letter saying that unfortunately there's no funding for these drugs, so that was a bit of a body blow. And it's gone from there really - I'm still waiting, I'm still number nine on a waiting list. When I spoke to my consultant this week he said it may - may be a year, 18 months still to wait to go on to these drugs. But obviously the biggest worry for myself is that my condition deteriorates in that time and then I'm going not going to meet the criteria to go on to these drugs, so it's a bit of a Catch 22, you know, you're waiting to go on to these drugs, yet if you deteriorate in the time that you're waiting to go on to these drugs you're not going to be eligible to go on the drugs anyway. I would say I've lost 70% of the strength down my right hand side. I use one walking stick, my mobility has suffered quite a bit. My quality of life is - it's deteriorating by the month really, there's no fun living with MS, that's for sure. ATKINSON Neil Thomas who has MS. And because of the way waiting lists are working for MS patients, as he hinted there, he fears he may never actually get the medication. Simon Gillespie, why is that? GILLESPIE Well it's very concerning. I mean we have seen a written commitment from the Welsh Assembly government to fund and provide therapies - the beta interferons - when somebody is eligible and as Neil's just very eloquently said the reality of the situation is it may be too late for him by the time he gets it. ATKINSON Misses this window of opportunity. GILLESPIE Absolutely right. ATKINSON You've got to go for it at a key point. GILLESPIE Yes absolutely and all of the indications are that the sooner the therapy is instituted, once somebody is eligible, the more effective it is. And what we're seeing is a picture of avoidable pain, avoidable disability and avoidable suffering because government, in its various forms, the health service is not living up to its commitments. ATKINSON But he's worried by the time his number comes up he'll not fit the criteria. GILLESPIE Yes, and I think that may be the reality. ATKINSON Okay. Paul Farmer is the chief executive of the mental health charity MIND, he's also with us. Paul, what's MIND's position been on this third sector, if you like, involvement - charities and voluntary bodies? FARMER Well MIND's and our 200 local associations provide around about well over a thousand services to people with mental health problems and the reason why we do it is because it completely conforms with our mission of supporting people who have mental health problems. And people themselves tell us that they really like the fact that we as a charity provide that service. We're more flexible, we're often more innovative, we're able to be a little bit more person centred in terms of the response we're able to make and I think we also help to dispel some of the stigma and discrimination that's often associated with going to a statutory provider. So it's a win/win. ATKINSON But this big idea that the government has of more involvement of organisations like yourselves, I mean what would you like to get more involved with? FARMER Well MIND's particular interest is in talking treatments, in particularly accessing what we hope will be significant new funds for much needed talking treatments, people really want them and yet at the same time they don't seem to be particularly widely available. MIND currently runs at a local level through our local associations a number of counselling services - for example in Bexley GPs refer patients to our local MIND association who are then able to offer people a choice of three different types of talking treatments. Now we would really like to be a more significant provider of this and I think the opportunity is there. ATKINSON But why if the NHS can't provide these talking therapies can you? FARMER Well partly because more therapists would prefer to work for MIND than would necessarily prefer to work in the statutory sector. ATKINSON So you'd arguably mop up sort of capacity that isn't being fully used? FARMER That's right, there is unquestionably capacity available, which we could work with. We also are able to be able to provide a more flexible environment and we're able to provide a more cost effective solution. ATKINSON But the MS Society, we've just heard, putting up £4 million for those specialist nurses, arguably some PCTs aren't sticking to the contract, how would you be sure that if you were providing talking therapies that they would be properly funded, you know? FARMER Well I think this is the kind of litmus test for true government commitment around voluntary sector service provision. Charities shouldn't be seen as a quick fix, charities actually provide these services with a very - on the whole a good degree of quality in terms of the service that is provided. We need to make sure that we have what's called full cost recovery, whereby where the charities are commissioned to provide a particular service that the costs that they incur are fully recovered from the statutory commissioner. ATKINSON But I mean as an organisation as relatively small as you how would you be able to sort of fight for those big tenders, how would you compete, how can you actually come up with the goods? FARMER And I think that's where the commissioning answer is very key. We provide local services for local people and we feel that that is very responsive to local communities. It's therefore quite important that those services are commissioned in a local way so that the local voluntary sector that understands the issues within communities is able to be able to provide a quality service, often under the umbrella of a larger national organisation to ensure the quality. ATKINSON Paul Farmer thank you. Simon, from the MS Society, you're already providing respite services for example and you claim that you're already subsidising those, so social services are getting a helping hand from you, NHS is getting a helping hand - is the third sector always going to find itself short changed when it comes to getting involved? GILLESPIE I think it's always going to be difficult for third sector organisations unless they happen to be particularly big ones. We provide respite care services, we subsidise that to the tune of about one and a half million a year. But we also like MIND, as Paul has said, provide a range of services locally through our branch network of 350 branches across the UK and 9,000 volunteers and that's specifically trying to meet the needs of people locally. And those services are high quality, they're much in demand. ATKINSON But the government - if the government doesn't keep the pressure on, as you would put it at the moment, to make the PCTs fulfil their obligations how can you make that happen because you've already had a directive from the DOH saying hello, please can you fund the beta interferons and in some places it just isn't happening? GILLESPIE Yes, I mean I think the obvious answer would be let's have another directive but the issue is actually making the first directive stick. These are issues of, if you like, trust and confidence between people that would I think like to see themselves as partners within provision of care. The most important thing, I think, is that people with MS or people with mental health problems are not the ones that suffer from a difficulty that the independent sector, the NHS, and statutory bodies, and the commercial sector may have in sorting out the arrangements to help them. ATKINSON Okay, well given that the government has a minister now for the third sector - Ed Milliband - and only four months ago the Prime Minister himself publicly endorsed this much bigger role for the third sector - that's charities and voluntary bodies - for providing public services, is this the way forward or is it merely a cheap fix which will not sustain? Well we don't have Ed Miliband with us but we do have the health minister, Ivan Lewis, who joins us from our Bristol studio. Minister, the role of the third sector is never going to work if you let the PCTs get away with what they're getting away with at the moment, as we've just been hearing. LEWIS Well good afternoon first of all. I think what we've got to recognise is that most of these issues have to be resolved at a local level, by local commissioners working with partners to purchase services which are focused on the needs of users and carers. And sometimes those services will be better provided by voluntary organisations, community based organisations than by traditional statutory services. Now this isn't a new phenomena or a new concept, it's been going on since the health service was created, it's been massively part of the social care system in this country for as long as we can remember. But what we are determined as a government to do is to recognise that in the real world, in reality, sometimes that relationship between statutory bodies and voluntary organisations doesn't work in the way it ought to, in terms of a genuine partnership approach and in terms of honouring commitments that have been made. At the moment the Treasury is conducting a massive - one of the largest ever consultations of the third sector in this country, to address many of these issues. As we look at how we spend public money over the next few years in public services and make sure that we do get the relationship right between the state and voluntary organisations. And we shouldn't forget it's not just about providing services, although we believe the voluntary sector's got a major role to play in that, it's also about their traditional role as campaigners, champions and advocates, particularly for vulnerable people. ATKINSON But back in the real world we've got people like Neil Thomas on a waiting list that shouldn't even be there, there should not be a waiting list. So you can do directives and you can tell local - local people to do things but it's not happening on the ground. LEWIS Well on this question of access to drugs I entirely agree with you, it's absolutely clear what's expected of primary care trusts and the message is that they should be putting that into practice. Equally there are many other decisions that are made that you can't have it both ways, we get criticised for trying to run things from offices in Westminster and Whitehall, not being close to local communities, then when we devolve and say it's really for local decision makers to make decisions about what's in the best interests of their local community people want the government to come in, in a heavy handed way and interfere. Now on this specific question, however, of access to drugs the message is clear - PCTs do have a duty and a responsibility to ensure that patients are having access to these drugs, that is absolutely clear. ATKINSON And overall you're still endorsing the role of the third sector because we had the Prime Minister a few months ago sort of taking a platform with a number of cabinet ministers saying this is the way we want to do it? LEWIS Let's be absolutely clear, I mean I spent my entire working life before entering parliament, from the age of 16, working in the voluntary sector, so I personally am very passionate about the distinctive unique contribution the voluntary sector can make to the delivery of high quality responsive public services. But let me be clear, this is not about ideology, this is about saying what is in the best interests of users, and in this case carers, up and down the country in terms of services that genuinely meet their needs and are not a group of professionals telling people what's best for them. And sometimes that will mean that locally based voluntary organisations and community based organisations are best placed to provide those quality friendly accessible sensitive services. On other occasions it may well be that statutory agencies are best placed to do that. So it's not about saying an ideologically driven - these services must be provided by the following structure or the following agency like the voluntary, state or private sectors, it's about saying what's in the best interests of users and carers. And also saying to statutory agencies sometimes you only look for the solution within your own organisation and on occasions you may actually achieve more by supporting and enabling voluntary organisations or independent sector organisations to provide the service. ATKINSON But it does get quite confusing, doesn't it, because yesterday we had the third sector minister, Ed Miliband, actually sort of quoted in the Guardian newspaper saying the role of the third sector is actually being overplayed. What is the position because that's very confusing for people like MIND or the MS Society when they hear something like that, they don't know on the one hand the Prime Minister's saying yes let's go for it and on the other hand you've got the minister saying it's all being overplayed? LEWIS No. What Ed is saying is quite straightforward, it's exactly what I have just said - let's not be driven by ideology or by sectoral interests, let's be driven by the best interests of those who are vulnerable and depend on public services of one kind or another and their families. And on occasions it means that the best service can be provided by voluntary organisations, on other occasions it will be the statutory agencies that are best placed to provide it. So what he's saying is when he's talking about it being overplayed he's saying let's not get into a situation where we say voluntary sector good, public sector bad, or indeed vice versa, let's focus on what's in the best interests of those who need our services. ATKINSON And let's focus on the cost, the idea that it can turn into a cheap fix, that you're passing the buck to the charities because we've got the MS Society here feeling slightly out of pocket in some cases for example. LEWIS Sure, one of the issues that the Treasury review's looking at is full cost recovery, it's three year contractual or partnership arrangements, it's some of the grievances that often - that the voluntary sector will articulate. So of course we expect statutory agencies not actually to see the voluntary sector and voluntary organisations as a cheap option. Equally however there is some evidence that in some cases some of the larger voluntary organisations perhaps are incredibly expensive. So it has to be about value for money, it has to be about cost effectiveness but we do expect statutory agencies to treat their voluntary sector partners, whether it's a contractual, a commissioning or a partnership arrangement fairly and properly. In a lot of cases that happens, frankly in some cases it doesn't. And I would argue that actually the great dividing line on this issue is when the Conservative Party under Mr Cameron talk about the use of the voluntary sector they in fact do it as - see it as a cheap option, we don't see the voluntary sector in that way at all, we see them as major partners in the improvement of society, particularly for some of our most vulnerable citizens. ATKINSON Okay Ivan Lewis thank you very much indeed, the health minister and thank you too to Simon Gillespie from the MS Society and Paul Farmer from MIND. ATKINSON Now four years ago the MS Society and the NHS signed a revolutionary agreement which was designed to improve the provision of drugs and specialist nurses for patients with multiple sclerosis. Well Simon Gillespie is the chief executive of the MS Society. Simon, tell us how this was all supposed to work. GILLESPIE Yes certainly. Well it was a ground breaking scheme basically. The National Institute for Clinical Excellence who basically assess therapies and drug treatment for patients in England had rejected these beta interferon therapiesas the treatment for MS, on the basis they were not seen to be cost effective. Nevertheless people with MS have a need for therapy and actually what we were able to do was to get the Department of Health to direct primary care trusts across England to provide these therapies with an agreement there'd be an assessment of their effectiveness further on in the future and if they were not living up to the manufacturer's claims then there'd be a refund of the money back into the NHS. ATKINSON And for your part - that was their side of the deal - for your side of the deal you put up a lot of money to fund MS nurses. GILLESPIE Yes well we followed on with the MS nurses as well, some of them directly related to the provision of these therapies but actually particularly looking at the specialist needs of people with MS across the country. And this has worked to varying degrees, it's something that's applied across all four nations of the UK and in some of the four countries it's working very well, in others there are difficulties - funding is running out, for example. ATKINSON But overall as a society you were very happy and willing to take part? GILLESPIE Absolutely right, absolutely good idea and we indeed have put £4 million worth of the charity's money into supporting the MS nurses scheme. ATKINSON So four years on you're very concerned about how things are working out, so what's going wrong? GILLESPIE Well there's a couple of things that are happening that are really of concern to us and of course primarily to people with MS. And the first thing is that there appear to be some waiting lists for the therapies when in fact the funding is there and a direction from the Department of Health to PCTs in England to provide it but there are also issues there across the four nations to one degree or another. The other thing about MS nurses is we're seeing that now the funding is beginning to get very tight after our initial funding efforts have been put in. We're seeing the threats of redundancies, we're seeing recruitment of vacant posts being held up and the like. ATKINSON So you're saying PCTs aren't really doing their side of the deal? GILLESPIE Some are doing very well, some are not and ... ATKINSON But 25% is your figure. GILLESPIE Absolutely right, 25% of the PCTs across England don't appear to be fulfilling their commitments. ATKINSON So has this undermined your confidence in this whole principle of charities taking over work which has traditionally been done solely by the NHS? GILLESPIE I think it's given us cause for concern. At the moment we're having to put in additional amounts of the charity's money to maintain services and I don't think that can be right, these are services that people with MS are entitled to, they should be having and in the case of England, for example, the Department of Health has directed PCTs to provide. ATKINSON Okay Simon Gillespie of the MS Society stay with us if you will. Let's hear the view of someone who's had first hand experience of this new service. Neil Thomas is a 38-year-old lorry driver from Pontypool. He was diagnosed with MS in 1999 but he's had two relapses this year, he's ended up in hospital and he has been judged as totally eligible for having these beta interferon drugs but he finds himself ninth on a waiting list of 25 people in his area. THOMAS I initially went, after the first relapse, in February and saw the consultant. They sent me a letter out saying that I did meet the criteria for these beta interferons. And then in March I received a letter saying that unfortunately there's no funding for these drugs, so that was a bit of a body blow. And it's gone from there really - I'm still waiting, I'm still number nine on a waiting list. When I spoke to my consultant this week he said it may - may be a year, 18 months still to wait to go on to these drugs. But obviously the biggest worry for myself is that my condition deteriorates in that time and then I'm going not going to meet the criteria to go on to these drugs, so it's a bit of a Catch 22, you know, you're waiting to go on to these drugs, yet if you deteriorate in the time that you're waiting to go on to these drugs you're not going to be eligible to go on the drugs anyway. I would say I've lost 70% of the strength down my right hand side. I use one walking stick, my mobility has suffered quite a bit. My quality of life is - it's deteriorating by the month really, there's no fun living with MS, that's for sure. ATKINSON Neil Thomas who has MS. And because of the way waiting lists are working for MS patients, as he hinted there, he fears he may never actually get the medication. Simon Gillespie, why is that? GILLESPIE Well it's very concerning. I mean we have seen a written commitment from the Welsh Assembly government to fund and provide therapies - the beta interferons - when somebody is eligible and as Neil's just very eloquently said the reality of the situation is it may be too late for him by the time he gets it. ATKINSON Misses this window of opportunity. GILLESPIE Absolutely right. ATKINSON You've got to go for it at a key point. GILLESPIE Yes absolutely and all of the indications are that the sooner the therapy is instituted, once somebody is eligible, the more effective it is. And what we're seeing is a picture of avoidable pain, avoidable disability and avoidable suffering because government, in its various forms, the health service is not living up to its commitments. ATKINSON But he's worried by the time his number comes up he'll not fit the criteria. GILLESPIE Yes, and I think that may be the reality. ATKINSON Okay. Paul Farmer is the chief executive of the mental health charity MIND, he's also with us. Paul, what's MIND's position been on this third sector, if you like, involvement - charities and voluntary bodies? FARMER Well MIND's and our 200 local associations provide around about well over a thousand services to people with mental health problems and the reason why we do it is because it completely conforms with our mission of supporting people who have mental health problems. And people themselves tell us that they really like the fact that we as a charity provide that service. We're more flexible, we're often more innovative, we're able to be a little bit more person centred in terms of the response we're able to make and I think we also help to dispel some of the stigma and discrimination that's often associated with going to a statutory provider. So it's a win/win. ATKINSON But this big idea that the government has of more involvement of organisations like yourselves, I mean what would you like to get more involved with? FARMER Well MIND's particular interest is in talking treatments, in particularly accessing what we hope will be significant new funds for much needed talking treatments, people really want them and yet at the same time they don't seem to be particularly widely available. MIND currently runs at a local level through our local associations a number of counselling services - for example in Bexley GPs refer patients to our local MIND association who are then able to offer people a choice of three different types of talking treatments. Now we would really like to be a more significant provider of this and I think the opportunity is there. ATKINSON But why if the NHS can't provide these talking therapies can you? FARMER Well partly because more therapists would prefer to work for MIND than would necessarily prefer to work in the statutory sector. ATKINSON So you'd arguably mop up sort of capacity that isn't being fully used? FARMER That's right, there is unquestionably capacity available, which we could work with. We also are able to be able to provide a more flexible environment and we're able to provide a more cost effective solution. ATKINSON But the MS Society, we've just heard, putting up £4 million for those specialist nurses, arguably some PCTs aren't sticking to the contract, how would you be sure that if you were providing talking therapies that they would be properly funded, you know? FARMER Well I think this is the kind of litmus test for true government commitment around voluntary sector service provision. Charities shouldn't be seen as a quick fix, charities actually provide these services with a very - on the whole a good degree of quality in terms of the service that is provided. We need to make sure that we have what's called full cost recovery, whereby where the charities are commissioned to provide a particular service that the costs that they incur are fully recovered from the statutory commissioner. ATKINSON But I mean as an organisation as relatively small as you how would you be able to sort of fight for those big tenders, how would you compete, how can you actually come up with the goods? FARMER And I think that's where the commissioning answer is very key. We provide local services for local people and we feel that that is very responsive to local communities. It's therefore quite important that those services are commissioned in a local way so that the local voluntary sector that understands the issues within communities is able to be able to provide a quality service, often under the umbrella of a larger national organisation to ensure the quality. ATKINSON Paul Farmer thank you. Simon, from the MS Society, you're already providing respite services for example and you claim that you're already subsidising those, so social services are getting a helping hand from you, NHS is getting a helping hand - is the third sector always going to find itself short changed when it comes to getting involved? GILLESPIE I think it's always going to be difficult for third sector organisations unless they happen to be particularly big ones. We provide respite care services, we subsidise that to the tune of about one and a half million a year. But we also like MIND, as Paul has said, provide a range of services locally through our branch network of 350 branches across the UK and 9,000 volunteers and that's specifically trying to meet the needs of people locally. And those services are high quality, they're much in demand. ATKINSON But the government - if the government doesn't keep the pressure on, as you would put it at the moment, to make the PCTs fulfil their obligations how can you make that happen because you've already had a directive from the DOH saying hello, please can you fund the beta interferons and in some places it just isn't happening? GILLESPIE Yes, I mean I think the obvious answer would be let's have another directive but the issue is actually making the first directive stick. These are issues of, if you like, trust and confidence between people that would I think like to see themselves as partners within provision of care. The most important thing, I think, is that people with MS or people with mental health problems are not the ones that suffer from a difficulty that the independent sector, the NHS, and statutory bodies, and the commercial sector may have in sorting out the arrangements to help them. ATKINSON Okay, well given that the government has a minister now for the third sector - Ed Milliband - and only four months ago the Prime Minister himself publicly endorsed this much bigger role for the third sector - that's charities and voluntary bodies - for providing public services, is this the way forward or is it merely a cheap fix which will not sustain? Well we don't have Ed Miliband with us but we do have the health minister, Ivan Lewis, who joins us from our Bristol studio. Minister, the role of the third sector is never going to work if you let the PCTs get away with what they're getting away with at the moment, as we've just been hearing. LEWIS Well good afternoon first of all. I think what we've got to recognise is that most of these issues have to be resolved at a local level, by local commissioners working with partners to purchase services which are focused on the needs of users and carers. And sometimes those services will be better provided by voluntary organisations, community based organisations than by traditional statutory services. Now this isn't a new phenomena or a new concept, it's been going on since the health service was created, it's been massively part of the social care system in this country for as long as we can remember. But what we are determined as a government to do is to recognise that in the real world, in reality, sometimes that relationship between statutory bodies and voluntary organisations doesn't work in the way it ought to, in terms of a genuine partnership approach and in terms of honouring commitments that have been made. At the moment the Treasury is conducting a massive - one of the largest ever consultations of the third sector in this country, to address many of these issues. As we look at how we spend public money over the next few years in public services and make sure that we do get the relationship right between the state and voluntary organisations. And we shouldn't forget it's not just about providing services, although we believe the voluntary sector's got a major role to play in that, it's also about their traditional role as campaigners, champions and advocates, particularly for vulnerable people. ATKINSON But back in the real world we've got people like Neil Thomas on a waiting list that shouldn't even be there, there should not be a waiting list. So you can do directives and you can tell local - local people to do things but it's not happening on the ground. LEWIS Well on this question of access to drugs I entirely agree with you, it's absolutely clear what's expected of primary care trusts and the message is that they should be putting that into practice. Equally there are many other decisions that are made that you can't have it both ways, we get criticised for trying to run things from offices in Westminster and Whitehall, not being close to local communities, then when we devolve and say it's really for local decision makers to make decisions about what's in the best interests of their local community people want the government to come in, in a heavy handed way and interfere. Now on this specific question, however, of access to drugs the message is clear - PCTs do have a duty and a responsibility to ensure that patients are having access to these drugs, that is absolutely clear. ATKINSON And overall you're still endorsing the role of the third sector because we had the Prime Minister a few months ago sort of taking a platform with a number of cabinet ministers saying this is the way we want to do it? LEWIS Let's be absolutely clear, I mean I spent my entire working life before entering parliament, from the age of 16, working in the voluntary sector, so I personally am very passionate about the distinctive unique contribution the voluntary sector can make to the delivery of high quality responsive public services. But let me be clear, this is not about ideology, this is about saying what is in the best interests of users, and in this case carers, up and down the country in terms of services that genuinely meet their needs and are not a group of professionals telling people what's best for them. And sometimes that will mean that locally based voluntary organisations and community based organisations are best placed to provide those quality friendly accessible sensitive services. On other occasions it may well be that statutory agencies are best placed to do that. So it's not about saying an ideologically driven - these services must be provided by the following structure or the following agency like the voluntary, state or private sectors, it's about saying what's in the best interests of users and carers. And also saying to statutory agencies sometimes you only look for the solution within your own organisation and on occasions you may actually achieve more by supporting and enabling voluntary organisations or independent sector organisations to provide the service. ATKINSON But it does get quite confusing, doesn't it, because yesterday we had the third sector minister, Ed Miliband, actually sort of quoted in the Guardian newspaper saying the role of the third sector is actually being overplayed. What is the position because that's very confusing for people like MIND or the MS Society when they hear something like that, they don't know on the one hand the Prime Minister's saying yes let's go for it and on the other hand you've got the minister saying it's all being overplayed? LEWIS No. What Ed is saying is quite straightforward, it's exactly what I have just said - let's not be driven by ideology or by sectoral interests, let's be driven by the best interests of those who are vulnerable and depend on public services of one kind or another and their families. And on occasions it means that the best service can be provided by voluntary organisations, on other occasions it will be the statutory agencies that are best placed to provide it. So what he's saying is when he's talking about it being overplayed he's saying let's not get into a situation where we say voluntary sector good, public sector bad, or indeed vice versa, let's focus on what's in the best interests of those who need our services. ATKINSON And let's focus on the cost, the idea that it can turn into a cheap fix, that you're passing the buck to the charities because we've got the MS Society here feeling slightly out of pocket in some cases for example. LEWIS Sure, one of the issues that the Treasury review's looking at is full cost recovery, it's three year contractual or partnership arrangements, it's some of the grievances that often - that the voluntary sector will articulate. So of course we expect statutory agencies not actually to see the voluntary sector and voluntary organisations as a cheap option. Equally however there is some evidence that in some cases some of the larger voluntary organisations perhaps are incredibly expensive. So it has to be about value for money, it has to be about cost effectiveness but we do expect statutory agencies to treat their voluntary sector partners, whether it's a contractual, a commissioning or a partnership arrangement fairly and properly. In a lot of cases that happens, frankly in some cases it doesn't. And I would argue that actually the great dividing line on this issue is when the Conservative Party under Mr Cameron talk about the use of the voluntary sector they in fact do it as - see it as a cheap option, we don't see the voluntary sector in that way at all, we see them as major partners in the improvement of society, particularly for some of our most vulnerable citizens. ATKINSON Okay Ivan Lewis thank you very much indeed, the health minister and thank you too to Simon Gillespie from the MS Society and Paul Farmer from MIND. Back to the You and Yours homepage The BBC is not responsible for external websites |
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