Published: 07/04/2005, Volume II5, No. 5949 Page 18 19
The shadow health secretary wants 'good management...strong management', but he admits that 'administrators' are bound to be targets during the election campaign
Speak to NHS managers and they will say one of two things about shadow health secretary Andrew Lansley. Either they ask, 'who's that?' or they will respond surprisingly positively, saying he listens to their concerns and understands the issues.
Mr Lansley has certainly gone out of his way to curry favour, visiting one-fifth of all English acute trusts in the year since his appointment.
'I want people to understand how hard I've tried to get to grips with this issue, ' he says. 'I've never worked in the NHS, but my father did from 1948 until he retired. He was a medial laboratory technologist and became chair of the Institute of Medical Laboratory Science.' Mr Lansley has a harder job than most of his shadow cabinet colleagues: no subject is seen as more of a core Labour issue than the NHS and every Conservative health spokesperson since 1948 had had to insist the service was safe with them.
But the present incumbent believes he is making some headway. Private polling has shown that Labour's lead on the issue has fallen from almost 30 per cent in the late 1990s to 'within 5 per cent' now.
'I personally believe in the NHS. I rely on it. I do not think there is any objective information that supports the proposition that Labour is the party of the NHS. In the mid-1970s I joined in marches in London as a student against health cuts under a Labour government - there have been points in the past when both parties have failed to give the NHS the resource backing it needs.' He says his party now understands you cannot get NHS improvement and reform 'on the cheap' - which is why Mr Lansley says he has committed the party to£34bn extra over the next four years.
But, speaking a week before rightwing Tory deputy co-chair Howard Flight made his damaging comments that the party was planning deeper cuts to public services than it had admitted, he concedes: 'I have a whole flank of people that I am guarding against, who want to move to co-payments systems, social insurance systems and so on, on the basis that the NHS can't work. I do not believe that. I want a system of delivery which protects the values of equity of access for the population while at the same time introducing genuine competition and choice to energise and incentivise the NHS as a whole.
'All I can see in the social insurance model is that it is going to segment the population. Some people will get better services than others and some would end up with some people having to pay more.' Mr Lansley says he is pleased that health secretary John Reid has returned to what he believes are, at heart, Conservative policies following Labour's first term of slash and burn on Tory health reforms. He claims credit on behalf of the party for the introduction of competition, plurality of provision - including the greater user of the independent sector - and the decentralisation of budgets to GPs.
With a grin he adds: 'If the government is saying it wants to deliver Conservative policies, That is fine by me. But I just think the electorate and the people working in the NHS would probably think it was sensible to have Conservatives delivering Conservative policies.
'Managers will not see a lot of things they have been working on being junked [if the Conservatives win the general election]. We will not be junking any of the work that has been put in on the extension of choice, on practice-based commissioning or payment by results. But there are improvements that can be made.' There are still clear difference between the parties, he says. One is the way the Tories want to subsidise those patients who wish to use the private sector. 'It is not a voucher scheme because patients do not see the money - It is a reimbursement for their providers, ' he claims.
'We are trying to get to the point where waiting lists come down. If at the same time we have got 350,000 extra patients [who had previously used the private sector] returning to the NHS for operations every year, it will be very hard. So the practical solution is to say we will help people stay in the private sector. The one thing it doesn't do is cause any harm for people who have NHS treatment - they do not have to pay anything, and their treatment will be faster.' Mr Lansley insists the Conservative party is not against good managers.
'If you look in our manifesto, it says in place of Labour's bureaucracy we will enable hospitals to be managed effectively - leadership and strong management will thrive if bureaucracy doesn't get in the way. I believe in good management - I believe in strong management.' But: 'If you talk to hospitals and if we give you a greater degree of independence, would you need the strategic health authorities to tell you what to do? Answer: no.
'So obviously there is a bureaucracy that you do not need. Outside health provision, whether It is outside GP practices or outside hospitals, There is an awful lot of structure that needs to be slimmed down.' In the past year, he alleges, the number of 'administrators' has risen by 7.8 per cent while the number of doctors and nurses has risen by 3.9 per cent. 'I think even people working in the NHS think those figures are wrong, ' he claims.
'If We are increasing the number of doctors and nurses so rapidly, there is on the face of it no reason why the number of managers needs to rise faster.
'I am not setting a target for how many managers there are to be in the NHS; hospitals are going to have their budgets and a greater degree of independence. So are GPs, and the number of practice staff engaged is something GPs will have to determine.
'But I think there will be fewer administrators in hospitals because the requirements of reporting back to all those inspectorates will be reduced.
If we do all that the hospitals will employ fewer administrators, and good managers want that.' He goes on: 'We have arrived at the point - and I am sorry It is a numbers game but I am afraid it illustrates the point very clearly - [where] there are 39,000 administrators in primary care trusts; there are 33,000 GPs. This is absurd; this is the wrong way round. If GPs have their budgets they will employ administrative staff; good practices have practice managers - they may well in future have local contract staff working for them. But I do not think that if you give them their budgets they are going to end up with 39,000.
'There is a balance to be struck.
They key to it in my view is minimise the extent to which people are engaged in essentially unproductive tasks of checking and collecting data and pushing it around.' So will managers have to endure a lot of bashing in the election? Mr Lansley is not reassuring. 'You will hear a lot [about managers] because the public are rightly concerned that they have paid a lot in taxes and they feel that insufficient of that money reaches the front line.' And negative case studies will also feature. The Tories' use of Margaret Dixon's repeatedly cancelled shoulder operation was criticised by those who questioned whether individual cases revealed anything about the state of the NHS.
'I do not think one should use individual cases to make all your points, but it came at a moment when we had just had statistics on cancelled operations, ' he says.
'Margaret's operation being cancelled several times was quite clearly linked to systemic failures.' North Cheshire trust was at fault for not providing enough critical care beds when emergency wards were transferred to Warrington Hospital from its other site at Halton, alleges Mr Lansley.
'It tells you something about the way the NHS is managing itself.
[Though] It is not entirely a criticism of the trust because their ability to provide those critical care beds depended upon their grant from the SHA.' He does not rule out more individual cases being brought in to the election campaign. But he says: 'If someone [like Ms Dixon] comes to us - and many people do - we will seek to resolve their cases; we'll try to help them and not exploit them. But Margaret asked Michael [Howard] to raise it because no one was listening.
'What are elected representatives for except to make the bureaucracy listen to them?'
1984: private secretary to Norman Tebbit (his political hero) at the Department of Trade and Industry.
1990: ran the Conservatives' research department; key role in the party's unexpected election victory in 1992.
1997: entered the Commons as MP for the safe seat of Cambridgeshire South.
Appointed vice-president of the party.
1999: appointed to shadow cabinet.
2001: left the shadow cabinet when Iain Duncan Smith took over as party leader.
2004: appointed shadow health secretary by Michael Howard.