With thanks again to a Health Policy Insight reader for their work, here is the transcript of Health Secretary Andrew Lansley’s appearance on BBC Newsnight from Tuesday 14 June..
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A couple of quick observations.
Firstly, if Labour's shadow health secretary John Healey wanted to return the 'being misquotes and quoted out of context' favour of both Lansley and PM David Cameron, he might avail himself of the former's line "I literally have no plan". What's sauce for the goose ...
Secondly, this gives us a new nickname for The Artist Formerly Known As Secretary Of State For The Time Being. The famous 18th-century English landscape gardener Lancelot Brown earned himself the nickname 'Capability' Brown for his catchphrase that his client's estates had "capability" for improvement. In such a vein, Our Saviour And Liberator admonishes Paxo that "even you, Jeremy, are capable of improvement. I'm certainly capable of improvement".
Thirdly, have a look at this wordle of 'Capability' Lansley's language. "Actually" is very big - this is a man who wants people to know they have misunderstood what was going on (and so are "completely wrong", presumably).
Oh, and "choice" and "competition" are pretty much the same size. Which tells us something.
Transcript of Andrew Lansley interview, Newsnight, Tuesday 14 June 2011
Lansley: "The result of the changes that we’re making will actually probably mean that competition and choice will be extended but will be extended probably over a more phased timetable"
Jeremy Paxman: Andrew Lansley, after these changes take effect, will there be more or less competition in the NHS than there was previously?
Andrew Lansley: Well, the decision about that essentially will be for the NHS commissioners, you know, the local Commissioning Groups and so on – because what drives it is, in order to deliver the best care for patients, how much patient choice do they want – because that’s really the essence of this. The competition, the extent of competition, is directly the result of how much patient choice you want to give in the service.
JP: That’s an opaque answer to a pretty straightforward question. You said previously that competition was the way to improve efficiency – correct?
AL: Well, competition is actually a way to increase quality and I think there are various ways of delivering greater efficiency – through redesign of services and developing the pricing system in the NHS.
JP: But there may be no more competition, or there may be more competition, after this rewrite of the legislation?
AL: Oh, I think it’s fair to say we are clear that patients over time will get access to more choice. I mean they have, at the moment, for example, choice for when they go for planned surgery – we are looking for that – but it’s going to be phased over time, so that will lead to –
JP: And by comparison with the previous draft of the legislation, will there be more or less choice?
AL: Well, the result of the changes that we’re making will actually probably mean that competition and choice will be extended but will be extended probably over a more phased timetable.
JP: What about the involvement of the private sector? It’s about – what one pound in twenty now is spent – NHS money is spent in the private sector? What do you think it ought to be in about, say, 10 years’ time?
AL: Oh, I have no plan for that.
JP: What about an ambition?
AL: No, I don’t have an ambition for that.
JP: Would you like to see it above a pound?
AL: No. My ambition is very straightforward – it is to deliver the best possible care for patients. And if that involves the NHS having an opportunity to provide services rather than the private sector, that’s fine too.
JP: You don’t – you really, literally, honestly do not have –
AL: I literally have no plan.
JP: – a view? So it could be less than one pound in twenty?
AL: Could be less, could be more. It’s going to be the result not of decisions made by me. So why would I want to have an ambition of a kind like that if I am not intending to make the decisions that will result in that outcome?
JP: Well, because you presumably have a vision for how the NHS can be made to work better.
AL: Yes, absolutely, and it’s not about transferring services to the private sector, it’s about giving everybody in the NHS, through reform, the opportunity to deliver improving services for patients.
JP: What about these Commissioning Groups of GPs? They were supposed to be formed by 2013. By when do you hope Commissioning Groups now to be formed?
AL: Well, they’ll be established in 2013, but they will only take on the commissioning responsibility, the actual budgetary responsibility, when they’re ready to do so. Now, some –
JP: When is that?
AL: Well, some may want to do so before then, and we’ll help and support them to do that. Many will be ready in 2013 – but if they’re not ready, and they’re not willing and able to do this job at that point, the NHS Commissioning Board will step in and take the responsibility and then support them to take those responsibilities at a later stage.
JP: Why did you previously have a deadline?
AL: Well, we had a deadline becau – on the basis that we knew we had to transfer the responsibility into the hands of clinicians. We were always clear that if they weren’t actually able to do so, we wouldn’t authorise them to do so. So we’re making it clear –
JP: Why didn’t you ask them that before you produced the White Paper?
AL: Well, we did ask them when we produced the White Paper and one of the messages that came back was they did want to set up the GP Commissioning Groups, but one of the messages that came back was – once the Pathfinders started to establish themselves this year – one of the messages some of them sent was “we want to do this, but we don’t think we’ll necessarily be ready in 2013”.
JP: Is this pattern of producing White Papers and then producing legislation and then withdrawing it and rewriting it, one that you’re going to continue with?
AL: Well, I personally don’t intend to. But I think it’s been – perfectly reasonable process. You set out in the White Paper –
JP: Of course, you’re not really the one who counts in all of this, are you?
AL: Well, I think for this purpose I am.
JP: The one who counts is David Cameron –
AL: What really –
JP: – who says he can be held personally responsible! Where does that leave you?
AL: The issue is – you asked the question – setting out in the White Paper what the principles are is what you do in a White Paper and, actually, the vision and the principles were supported. When we’ve actually introduced the legislation this year, of course – when you actually produce the legislation it actually brings forward a lot of questions and concerns – and what would you do? Would you say, under those circumstances, “well, look, the implementation of this – people have got concerns about this – well, we’ll just ignore those”? Or do you say “well, OK, if people have got concerns, let’s stop, let’s listen and, if we can, let’s improve.”
JP: Some people might say that if it – the rewriting, the redrafting, the recommendations, the consultation – can be accomplished in two months, what on earth were you doing during the seven years you’ve held this brief?
AL: Oh, I’ve been actually arriving at the point where we know we can reform the NHS to make it much better in the future.
JP: But you produced a duff piece of legislation!
AL: No. I don’t see – and actually, to be fair, the NHS Future Forum didn’t say that. They said they can improve it. And, of course, even – Many things are capable of improvement.
JP: Why didn’t you get it right first time? You had seven years!
AL: Even you, Jeremy, are capable of improvement. I know I’m certainly capable of improvement.
JP: We’re all capable of improvement –
AL: Absolutely –
JP: – certainly.
AL: – and legislation is capable of improvement as well.
JP: Sure, but, generally, the improvement takes place before you introduce it into Parliament.
AL: No, no, no, it doesn’t actually. Actually, there are many – most pieces of legislation are improved in the process of scrutiny in Parliament. What I think was particularly important here, however, is that it wasn’t that Parliamentarians should simply engage, although many of them did with the legislation. And there was an awful lot in the legislation which, to be frank – I know – and I take this on my shoulders – was, basically, creating a permissive structure – saying, for example, to the GP Consortia, “well, you know, you will have to set out in future how you are going to structure your patient and public involvement, how you’re going to structure your relationship with other professions locally, how you’re going to do these things”, and a lot of people said “we don’t want to leave it to them, we want to get it set out now”.
JP: Are you saying you were taking a piece of legislation through Parliament that you knew to be defective?
AL: No, I’m not saying that.
JP: Well, thank heavens for the Liberal Democrats, then!
AL: No, I’m not saying that. I’m saying what is very clear is that people had concerns –
AL: – some of them were, you know, on the basis of people who were making misrepresentations or misunderstanding – but some of them were genuine concerns. And people who were coming together – Pathfinder Consortia around the country, local authorities, people who were in Foundation Trusts – and saying “actually, some of these concerns, we think we can improve the legislation, we think we can put more clarity into how we’re going to do these things in future, if you engage with us now and respond to this”. So we did.
JP: But if this had been a majority Conservative government, this legislation would not have been changed, would it?
AL: Well, we’re not in that position.
AL: I actually think – you know, what we’ve demonstrated is a good process of government.
JP: So thanks –
AL: I happen to think good government is about listening to people, coming together –
JP: But when Paddy Ashdown says this is an occasion for the Liberal Democrats to celebrate an achievement in getting this legislation rewritten, he’s right, isn’t he?
AL: Well, it’s not about anybody winning or losing or celebrating or otherwise, it’s about the Government – Coalition Government – getting plans for the NHS, modernisation of the NHS that delivers improving services for patients. It’s all about delivering quality for patients. And if I can –
JP: I just wonder why you didn’t plan it like that in the first place.
AL: If I can do anything that will help in the process of delivering the best care for patients, I will certainly do it. I mean, I will, of course, take on my shoulders that there were things we could have done earlier and things we should have changed earlier but, actually, what is very important is to focus on getting the principles, the strategy actually into implementation for the NHS, because that moves us from a place where the NHS was really at risk for the future – everybody knows change is required, everybody knows the pressures that are coming on the NHS. To do nothing was clearly not an option. But to modernise the NHS in this way, by engaging the staff in increasing the quality and effectiveness of what they do, by putting them right at the heart of commissioning services and responding to patients – that’s absolutely critical to make that happen.
JP: Andrew Lansley, thank you.
AL: Thank you.