Published: 11/12/2003, Volume II3, No. 5885 Page 26 27
Having been described as 'naturally combative' and a 'star performer' by his peers, junior health minister Lord Warner was the ideal man to chaperone the foundation hospitals bill as it was batted to and from the House of Lords
As soon as he was appointed junior health minister in the House of Lords in June, following prime minister Tony Blair's cabinet reshuffle and former health secretary Alan Milburn's departure, Lord Warner of Brockley was faced with a small mountain of work labelled 'foundation hospitals'.
Given that his main task so far has been to secure the safe passage of the Health and Social Care (Community Health and Standards) Bill through the Lords, while retaining the key government policy on foundation trusts, he must be feeling rather pleased with himself.
However, Lord Warner has the assured air of someone who is well seasoned in the rough and tumble of political life.And he is confident enough to hold this interview on the eve of last month's crucial vote on foundation trusts in the Commons.
Yet achieving the passage of the bill through the upper house has been no mean feat. He has had to battle the likes of Liberal Democrat health spokesman Lord Clement-Jones and the Conservatives' Earl Howe to secure victory. However, he has won praise from his peers in the past; Lord Clement-Jones has described him as 'loyal government minister' who has a 'naturally combative and feisty style', and his predecessor Lord Hunt has said he is both a 'sharp performer' and a 'high flier'.
He seems slightly bashful with accolades. 'I do not want to blow my own trumpet, but I like to get things done, ' he says. 'I think I have a reasonable political antenna and I am a negotiator.'
He tells me there is no substitute for listening, something he thinks was of utmost importance when the Liberal Democrats and the Conservatives formed an alliance in the Lords to block foundation trusts.
Lord Warner thinks it was his willingness to listen which meant the government agreed several compromises to the bill and helped guide it through the Lords.
'It is part of normal human intercourse to have discussion and debate, ' he says.
On the Friday before our interview, the Lords voted to remove foundation trusts from the bill entirely, so Lord Warner awaited a Commons vote to see whether the policy would be put back in before returning it to the Lords yet again. The process of a bill going back and forth between the two Houses is known as ping-pong - it must have been a tiring game for Lord Warner.
So would potential defeat of the policy weigh on him? 'I do not lie awake worrying, if That is what you mean, ' he assures me. And he was right not to have worried unduly that the foundation trust section of the bill would not go through.
'I am a traditional constitutionalist, ' he asserts. 'It is for the House of Commons to decide, but there is always scope for fine-tuning on government policy.'
Despite the outward appearance of calm, you can't help but wonder whether he did experience some nervousness when waiting for the vote. In fact, the government narrowly scraped the policy through the Commons by 17 votes before it was again rejected by the Lords. It was accepted only after a series of compromises.
Is he happy with the way the amendments have been shaped for foundation hospitals?
'We have made concessions on what I believe to be technical points of the bill.We have agreed 150 technical amendments and there are no more to be made in the Lords, ' he says.
'I am not worried if things go sour. If the government has to reconsider its position, then it will have to, 'he insists. 'The issue of giving freedom [to the NHS] will not go away; we have to make a change.'
As expected, he is very on-message about foundation trusts. 'It is important we run the NHS in a decentralised way. We have to have the debate, whether it is through foundation trusts or not.
Foundation trusts are a practical way of dealing more freedom and autonomy to people at a local level... we need to take the shackles off, ' he says.
He seems irritated when talking about the Lords debate, saying critics of foundation trust proposals have not come up with an alternative viable 'game plan'.
'I agree that on some areas around governance, patient forums and patient confidentiality, our critics had a fair point.
But they do not go to the heart of foundation trusts or the detailed legislation about the way you do this.'
He believes that no-one has yet come up with an effective policy to alter the principle shape of foundation trusts or the way in which they will be run.
Since taking up the role, Lord Warner has had to compete with the legacy of Lord Hunt, who resigned as junior health minister earlier this year in protest over war with Iraq. A minister for five years, Lord Hunt brought with him experience as a health manager and as chief executive of the NHS Confederation.
But Lord Warner, too, has much to offer in his background and is, in fact, an old hand at the Department of Health, having joined the then Ministry of Health back in 1959 as a junior civil servant.
He is also no stranger to controversy, resigning the party whip when he applied unsuccessfully to become chair of the Audit Commission two years ago.
So how does he respond to claims that he only became an independent peer because he failed to land the Audit Commission job? He laughs it off.
'I applied to become chair and resigned the whip because I thought it was important not to be seen as part of any party.
'I was recommended to Stephen Byers [then trade and industry secretary] as the best person for the job; I was in front running for the job. I went on holiday for a few weeks and I had already resigned the party whip. When I came back, I found Mr Byers had changed his mind, but I moved over to the cross-benches anyway.'
Lord Warner seems unruffled by the incident and rejoined the government a year later. But where does he see the future role of the Audit Commission within the health service?
'[Audit Commission chair] James Strachan and [Commission for Healthcare Audit and Inspection shadow chair Professor Sir] Ian Kennedy are working together on the transition [to CHAI]. I can see the Audit Commission may not have wanted the work to go to CHAI but [the commission] continues as arbiter for the normal auditing of health and financial management, but it doesn't have the remit to audit value-for-money services.'
Lord Warner says he is confident CHAI will be fully operational from 1 April, though he concedes 'it will take time to put in place a new set of NHS standards and criteria.'
'We will need time to make a new set of arrangements. We do not want to rush this.We have to adapt the performance ratings for the NHS as it changes, and we have to have an orderly transition.'
He says the government wants to see the NHS 'raise its game extensively' and that 'CHAI needs to measure how it is doing this'.
He believes it is critical that 'reasonable' ways of measuring national standards are developed and that with the amount of investment going into the NHS this is not an unreasonable request. Otherwise, he asks, 'why have an NHS free at the point of need if it can't deliver?'
Does he think, then, that the Department of Health needs to be downsized for the 21st century?
'Shifting the Balance of Power made it clear that we do not need as many people at the centre; the DoH needs to downsize.' And what of the government health agencies? There has been talk of slimming down, or even merger, for the National Patient Safety Agency and the National Clinical Assessment Authority.
On this point, Lord Warner is candid. 'We can expect efficiency gains; we have to look at whether they are still fit for purpose and still doing a good enough job, and we need to look at whether roles are overlapping.'
Lord Warner looks extremely comfortable in his office at Richmond House, with one major victory under his belt. 'I have enjoyed coming back to the DoH, ' he says proudly. 'I hope I am seen as a proper politician.'
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