Editor’s blog Tuesday 12 April 2011: Questions about the Downfall of Andrew 'Transport' Lansley

I have seen a vote of confidence in Sectretary Of State For The Time Being Andrew Lansley's political future.

The Kings Fund, think-tank par excellence, is advertising his presence on 18 May at their NHS leadership summit.

They obviously don't foresee his Downfall, unlike the makers of this brilliant viral spoof taken from the movie Downfall. "I could do transport".

Truly, he is viral-prone.

Anyway, once again, our thanks to a good friend of Health Policy Insight who transcribed Our Saviour And Liberator's appearance on BBC Radio 4's PM last week.

PM, BBC Radio 4, Wednesday 6 April 2011

Eddie Mair: … Andrew Lansley joins us live on PM once again. Welcome back.

Andrew Lansley: Good afternoon.

Mair: We know from the week that we spent talking about these changes that people are very, very interested and I think people listening will want to know what are the parameters of this listening exercise? Is it possible for any of the central tenets of your changes to be changed? I’ve got some specific points to put to you just to test that, if I may. For example –

Lansley: Yeah, well first would it be helpful for me to explain what the parameters are?

Mair: Well, let me ask you a direct question: can Primary Care Trusts be saved from abolition?

Lansley: Well, let me be clear what the parameters are, because –

Mair: Yes or no?

Lansley: No, no. Let me explain, ’cause if you ask a question I’ll be very happy to explain, ’cause we set it out today and I’m sure listeners would want to hear this. We’ve been very clear that we wanted to bring forward the changes and the reason in the NHS we needed to change is very straightforward, it’s because we want to have a sevice that is literally world class –

Mair: Mr Lansley, forgive me for interrupting your first answer, which I wouldn’t normally do, but we spoke about this for a week.

Lansley: We did.

'Lansley: No, it’s my fault if I haven’t explained it (the legislation).'

Mair: I don’t want to hear all that again. Things have changed.

Lansley: OK. You don’t want to hear all that.

Mair: No. Things have changed and I’ve got specific questions about the changes, because I think listeners will want to hear the answers.

Lansley: OK. Well, let me –

Mair: My first question to you is this: under the listening exercise, will people power be able to stop the abolition of Primary Care Trusts?

Lansley: Well, we are listening to what people have to say, engaging with them and responding and we are going to improve the Bill.

Mair: Can they stop the abolition of Primary Care Trusts?

Lansley: We’re very clear that we are doing it in the context of a devolution of responsibility to front-line staff. We have asked General Practitioners – that General Practices across the country, would they come forward, do they want to be Pathfinders. We were talking in January about those who were responding, we’ve now reached the point where 88% of GP surgeries across England have responded and said yes.

Mair: Again, Mr Lansley, that’s well worn ground. What people will want to know is –

Lansley: Yeah, but it answers your question, Eddie, because –

Mair: Well, it doesn’t, it doesn’t.

Lansley: It does, because we are basing the legislation –

Mair: Can people stop this legislation in its tracks?

Lansley: No. We are not going to stop the legislation.

Mair: Right.

Lansley: We are not withdrawing the legislation. We are setting out to listen. People have sometimes misplaced and I think misunderstood the nature of what we’re proposing. In other places –

Mair: It’s their fault?

Lansley: No, it’s my fault if I haven’t explained it. I’ve tried. I spent a week with you for – expressly for that purpose. But I don’t suppose I can explain everything and people have got everything that I would like them to know in their minds. So, what I need to do is to make sure that through this listening and engagement – not only do we correct misapprehensions and misunderstandings, but where there are legitimate concerns – and you heard Nigel Edwards there, for example, saying we’ve got to make sure that competition and purchasing in the NHS works really more effectively, but also in a way that really supports joined-up working across the NHS and we have to do that.

Mair: And people will want to know –

Lansley: Just going back to the question you asked –

Mair: Well, will you answer it now?

Lansley: We are basing commissioning, in the legislation and in the overall reforms, on the basis of clinically-led commissioning, doctors and nurses leading commissioning. Primary Care Trusts – the intention is to continue to abolish Primary Care Trusts –

Mair: Right.

Lansley: – and the reason is very straightforward –

Mair: And people can’t stop that?

Lansley: No. We’re intending to go ahead with legislation and that is part of the legislation.

Mair: Well, come on, Mr Lansley, you know what I’m asking you. People are entitled to know the parameters of this listening exercise and whether –

Lansley: I also know, Eddie, precisely what you’re setting out to do, which is to find one or two things and say “well, you’re continuing with that, therefore you’re not listening”. We are listening; we formally consulted.

Mair: No. Forgive me, Mr Lansley, I’m trying to establish the parameters.

Lansley: We are listening in the areas where people have clearly put forward legitimate concerns. That is that choice and competition in the NHS should support the best interests of patients and the need for delivering joined up care.

Mair: Understood. Would you abolish the practice of putting GPs in charge of commissioning services? Is that up for grabs?

Lansley: We are intending to have, not just GPs, but clinicians – an area that we are intending to listen and make whatever necessary changes we have to is precisely in the area of ensuring that, while commissioning should be General Practice-led, because General Practice has not only an individual responsibility for us as patients but a long-term responsibility for us and for a population – a whole population perspective on this – but it must be clinical commissioning across the professions.

Mair: Alright.

Lansley: So it’s involving the whole range of professions because multi-disciplinary work in the NHS is at the heart of designing services better.

Mair: You’re suddenly pausing and listening to criticism of legislation, even though it’s had its first and second reading in the Commons, it’s gone though the Committee Stage with all those amendments that Norman [Smith] talked about. I’d like to give you the opportunity, here live on PM, to take a deep breath and tell us the full and candid truth about the reasons for this listening exercise.

Lansley: Oh gladly – because as we’ve taken the legislation through, people have supported the principles of what we’re trying to do, which you stopped me explaining, which is about putting patients first, improving outcomes, delivering –

Mair: Because we’ve heard it before.

Lansley: Well, not everybody who listens to your programme listens to every programme, Eddie, so they may not have heard it before – and involving local authorities much more effectively. And, actually, what has really been, I think, at the heart of what we need now to do is – people have said “we agree with those principles” – like you heard Mark Porter from the BMA say – “we’re in favour of GPs and doctors being more responsible for commissioning, but I worry about the private sector being able to cherry pick”. Those sorts of concerns have come back. We have to make sure that, where those concerns come forward, we can deal with them in the legislation.

Mair: People were telling you that last summer when there was a huge consultation exercise and you went ahead with your plans anyway!

Lansley: Well, I actually think what we need – I mean, if I were to carry on with the legislation and you were to say “well, look, people are worried about cherry-picking” and I said “look, I think we’ve dealt with it”, people would say “no, no, no, it could still happen because, because –”. What we’re going to do –

Mair: Instead of responding to imaginary conversations, why don’t you ’fess up? You made a mess of this!

Lansley: No – well, and abuse won’t get you anywhere, Eddie, to be perfectly honest! Frankly, we’re in the middle of legislation; we have a point at which it is perfectly normal for legislation to be delayed, between Committee Stage and Report. We are going to use that time to engage with people, to listen to what they have to say, to reflect on that and to improve the legislation. If I were not willing to listen and improve the legislation, you would accuse me of arrogance and pushing on ahead regardless.

Mair: On the Prime Minister’s handling of this –

Lansley: We’re clear about the principles, we’re clear about what the objectives are –

Mair: OK, you’ve made that point.

Lansley: The public and the professions are very supportive of that –

Mair: On the Prime Minister’s handling of this –

Lansley: – but they have concerns and we’re very willing to listen and respond to those.

Mair: On the Prime Minister’s handling of this: do you sometimes wish he spent less time making speeches, reminding everyone that he knows what it’s like to rely on the NHS and more time getting across the detail of important legislation in a timely fashion?

Lansley: No, I think that’s completely unfair. Actually, what is absolutely at the heart – and the Prime Minister has always done – is made absolutely clear our commitment to the NHS, his personal commitment to the NHS. If that were not true, we would not be in the process of now seeking to modernize the NHS so that in circumstances where, for example, 20% – er the number of people who are erm 85 years old over the next 20 years is going to double, where costs are rising in the NHS, where there’s additional treatments and obligations that the NHS will have to meet in future –

Mair: Is the Prime Minister still listening to you?

Lansley: We talk to each other all the time about this.

Mair: Is he listening to you?

Lansley: Today, we, the Prime Minister, the Deputy Prime Minister and I, set out very clearly why we need to modernise the NHS.

Mair: People say he’s stopped listening to you. Is he still listening to you?

Lansley: – why we need to modernise the NHS and how we are going to listen, engage, reflect and respond to people in improving the NHS.

Mair: Why can’t he say he’s listening to you?

Lansley: Of course! We listen to each other. We’re in government together. We make collective decisions together. And part of that is that the NHS is so important that we protected it when the spending review took place, we put additional resources in the NHS but we – equally we know that the demands on the NHS are rising even faster, so we actually have to modernize in order to continue to improve the quality of the service that we provide and the best way of doing that is to do so with the professionals and the staff in the NHS, with patients, with those who are directly responsible for the care that’s provided to patients. He understands that, I understand that, the Deputy Prime Minister understands that, and we’re working together to make that happen.

Mair: Have you considered your position?

Lansley: My position is that I am committed to the National Health Service. It is absolutely my mission – you know, you know –

Mair: Did you think about resigning?

Lansley: You know from our conversations over several years, I think, that I have been absolutely committed to my mission, which is to ensure that we deliver a healthcare service that is amongst the best in the world.

Mair: I know and you’ve had to rethink this important legislation, which has been seven years in preparation, after three months. My question to you is have you considered resigning?

Lansley: When you say “rethink”, what I’m absolutely willing to do – always been willing to do – made it clear last year when we had a formal consultation – again in the New Year when we continued other consultation on things like the information supporting patients –

Mair: Mr Lansley, I know you don’t like the question, but I wonder if you’d address it: have you considered resigning?

Lansley; No, because, actually, as a government, we are pursuing the principles that we collectively have sought public support for and, indeed, received public support for and professional support for, and it isn’t actually about the principles of the policy or the essentials of the policy, it’s actually about how we can ensure that people’s concerns, legitimate concerns in how this is implemented, are met by listening to them, engaging and responding.

Mair: Andrew Lansley, thank you.