Examination of Witness (Questions 20-39)
RT HON
TONY BLAIR
MP
22 NOVEMBER 2005
Q20 Dr Wright: The Government makes
much of the fact that it operates on the basis of what it calls
evidence-based policy and yet often policies seem to descend from
the blue skies of Lord Birt or somewhere and we wonder where the
evidence base is. We are now told that the essence of the public
service reform that is going on at the moment is to do with choice,
contestability and competition. If I said to you where is the
Government document that sets out the intellectual case for these
propositions, where is the evidence amassed, where is the international
examples assembled, I would suggest to you that there is not such
a document, so that when the particular proposals come in certain
areas they look as though they have dropped out of that clear
blue sky.
Mr Blair: I am afraid I would
profoundly disagree with that. I think you can see in the five-year
programmes that were published before the last election where
the evidence is set out. Look, for example, at cardiac care and
how that has been helped by people having the choice to go elsewhere
if they have to wait too long or look at the independent treatment
centres and how they have opened up choice for people waiting
for cataract operations. When we came to power people used to
wait for as much as two years for their cataract operation and
they now wait a maximum of three months. If you look at the schools
system, I do not think there is any doubt that specialist schools
and City Academies are succeeding and are improving.
Q21 Dr Wright: I am not talking about
the particular policy areas. I am saying there is a particular
approach to public service reform going on at the moment. If someone
said, "Show me the basis of this. Show me all the evidence
that has been assembled to show that choice, competition and contestability
is the golden key to reforming public services," I am putting
to you there is not such a place that people can go.
Mr Blair: I think they can. They
can go to any of the White Papers that we have published on it
or the five-year programmes and you will see it set out there.
What I would also say to you is that if you look at any of the
published polling evidence, for example, on choice, there is a
very clear desire on people to have a choice, for example if they
cannot get their operation done within a specified time, to be
able to go elsewhere and get it. Incidentally, I would put choice
and contestability within a broader framework. It is about public
services being responsive to the user. I believe, and I may be
wrong in this, there is a fundamental social, economic and political
shift going on which, as I have said before, I think is very similar
to the debates about, for example, trade union reform back in
the 1960s or council house sales back in the 1970s and 1980s and
that shift I would describe as follows. The public believed that
the previous Government underinvested in our public services.
They wanted us to put more money in. We have put more money in
and we are going to continue to put more money in, but at the
same time what the public is saying is if you put more money in
to those services then we want them more responsive to us as consumers
of those services. That is what I think is going on underneath
the surface as a major social, economic and political shift. My
point, very simply, is that we should respond to that as a Government
and do it in a way that is fair. The evidence base is there in
the stuff that has already been done, in the choice in the National
Health Service, in contestability and also, of course, with the
schools.
Dr Wright: We have colleagues who want
to explore this in relation to particular areas.
Q22 Mr Barron: Prime Minister, in
relation to NHS reform particularly, on 28 July Primary Care Trusts
were told that by the year 2008 they had to divest themselves
of being providers. That timetable has been withdrawn. It does
not look as though it has been very well thought through in terms
of policy in this particular area. What do you say to that?
Mr Blair: This is a very particular
issue where what the Department of Health wants is for the PCTs
to concentrate more on the providing side because that is the
system that we are moving to, but it caused a lot of concern because
the PCTs were being told, for example, they had to sell off their
community hospitals and so on and then the staff worried who they
were going to be employed by. Patricia then clarified the Department
of Health guidance and it has been made clear that people will
continue to be employed by the PCTs unless and until the PCTs
change it. There are PCTs that are getting out of the commissioning
side of it. It is a process that I think has to happen over time
and it should happen because that is what people locally want.
Q23 Mr Barron: Given the turmoil
that it has created for the people who are employed directly by
Primary Care Trusts, would this not have been better done through
a White Paper or after the consultation process that the Department
has been having about where patients believe that they should
be rather than brought in on the 28 July timetable that was withdrawn
when Parliament came back in October?
Mr Blair: As Patricia has made
clear, we are now able to do this on a proper timescale and with
proper local consultation. There is another issue which is that
we need to reduce the number of PCTs and that is partly to fulfil
a manifesto commitment to reduce the management costs, but I think
it is important that is done by way of local consultation. I do
not see this myself as absolutely central to the key question,
which is how you introduce a system within the NHS where patients
can use spare capacity by moving around the country, if there
is spare capacity available, to make sure that an operation can
be done sooner for them.
Q24 Mr Barron: It created turmoil
and people are unsure. What do you think about the issue of National
Health Service pensions if somebody moves into the independent
sector, will they retain that if they still work in community
care but have moved over to the independent sector?
Mr Blair: I will have to get back
to you on the precise detail of that.
Q25 Mr Barron: That is what Lord
Warner said when we took evidence from him two weeks ago.
Mr Blair: Is that good or bad
that I am saying the same?
Q26 Mr Barron: It seems to me that
this should have been known about before the letter of 28 July
went out.
Mr Blair: Would they not be covered
by the TUPE arrangements and so on?
Q27 Mr Barron: I am not sure whether
pensions are.
Mr Blair: I will come back to
you on that.[2]
The basic point is that they are not going to be employed by anybody
else unless and until the PCT decide it.
Q28 Mr Barron: I accept that. We heard
in the papers on Friday that a large selection of primary care
workers in Surrey are going to form their own company and instead
of having a statement on primary care you are going to have another
monopoly that is going to retain their contract of employment
and they are going to employ themselves. What is it about if we
move from one monopoly to another, what is the aim of it all?
Mr Blair: The aim of it is to
get the PCTs to focus on the commissioning role, which is obviously
very important for them. As I understand it community hospitals
were not always provided for by the PCT; that has been a process
of change over a number of years. I think the important thing
is that this decision can be taken locally. I do not myself regard
it as central to the issue of the overall NHS reform. That is
why, as a result of representations that were made, not least
by our own Members of Parliament, Patricia gave the clarification
she did.
Q29 Mr Barron: When John Hutton gave
evidence to the Public Administration Committee on 1 November
he said that this is still the general direction of travel as
far the Government is concerned. What you are saying is that the
PCTs can decide not to move that way if they want.
Mr Blair: In any event what is
important for the PCTs is to focus on their commissioning role.
That does not mean to say that they have to come out of provision.
I forget which report it was now, but there was a report by one
of the independent bodies that said some time ago that it is important
for the PCTs to focus on having that commissioning capability
because that will be one essential part of the system whereby
the patient can transfer right round the NHS. The purpose of the
NHS reforms all in all is to have payment by results going through
the system so that the money genuinely follows the patient according
to an agreed tariff. You then get the GP-based commissioning which
enables the GP to try and get the best deal for their patient.
You then have a situation where you are opening up, in circumstances
where it is necessary to do so, contestability so that if we cannot,
for example, get the right amount of diagnostic capability within
the NHS we can have someone in the independent sector provide
it for us. The whole purpose of it is to make sure we get to the
pledge that we have made for an 18 week maximum as an outpatient
by the end of 2008, which will effectively end the concept of
waiting. Tony was asking me earlier about the foundations of reform.
In my view the purpose of it is to get to a point—that is
the issue of waiting which has fundamentally altered from the
situation we took over in 1997, where you had an 18-month wait
just on the inpatient list without looking at the outpatient wait
that people had to undergo—where the patient gets a better
deal.
Q30 Mr Sheerman: Prime Minister,
I want to take you back to popularity and difficult policies that
Tony Wright addressed. Some years ago you had a minister and,
I understand, government policy that said energy from waste using
the incineration of towns and cities rubbish was a good source
of heating and power and 150 incinerators were going to be built.
Then Greenpeace or Friends of the Earth or someone seemed to trigger
a panic button and you all retreated. Some of us would agree with
you on nuclear power, but what happened to that policy that you
were going to use the rubbish in our towns' and cities' as an
alternative method of energy?
Mr Blair: I think what happened
was that there was huge local concern not just from NGOs but huge
local concern about incineration plants. Some of that is somewhat
misguided but nonetheless it causes enormous difficulties within
the planning system. However, I would not say that it is an either/or
between incineration and nuclear power. I think nuclear power
is of a different order of magnitude as a decision. The reason
why we are coming back to that in the context of the energy review
that we will announce shortly is because the facts have changed
over the past couple of years.
Q31 Mr Sheerman: Prime Minister,
we can understand that you are keen to reform public services
and you are keen, as you have just said, to put that money in
to invest in public services if the vested interests could give
way and if you could get the reform you want. I have never seen
a White Paper on education that has so divided people. 50% of
the people I talk to think it is a truly radical document and
50% seem to think it is a deeply conservative document. Why do
you think you have split opinion on this particular White Paper?
Mr Blair: I think when you do
these types of things opinion does get divided. When we first
introduced specialist schools I think there were those who I remember
at our own party conference who said this was going to bring back
selection and it was the end of comprehensive schooling as we
knew it. I think if we want to get a better deal, particularly
for kids from lower income backgrounds, we have to make the changes
necessary to raise the standards of the schools. We have made
great progress, it is true. In the last eight years standards
in GCSE have risen considerably and literacy and numeracy have
risen considerably.
Q32 Mr Sheerman: Prime Minister,
you know that you and I agree on that. If you put so much emphasis
in a White Paper on parent power, what do you say to those people
who say the parents who always have the power seem to be the articulate,
professional middle classes, those people who are the "haves"
already? Is it really harassing parent power? Is this next wave
going to help working class families? There is no real history
of great involvement in education from working class homes.
Mr Blair: You obviously know a
lot about this with your position, too. There is a tendency for
people to say, "The middle class are here and the working
class are there," when I see a far greater spectrum than
that. I think there are lots of people from lower income families
who are desperate to get the best for their kids and who are very
happy to work hard to make sure that their school is better. What
we will be doing is giving them real help in order to achieve
that. The City Academy programme is one example where it is possible
to go into areas where the intake is from a lower income background
and the parents are absolutely up for the change.
Q33 Mr Sheerman: Why do you think
the White Paper will enhance that? Why do you think that this
is such a fundamental reform in a progressive way?
Mr Blair: What it will allow schools
to do is to get the benefit of having an external partner, it
could be a charitable foundation, a voluntary sector, it could
be a business foundation, and it will enable them on a far bigger
scale than they do presently with specialist schools to have that
external partner to drive the ethos and the purpose of the school
forward in a way that is not constrained in the same way by central
or local government. We are also putting in additional help, for
example, with transport costs for lower income families and we
are going to focus as much help as we can in getting that strong
external partner and sponsorship on the schools in the most disadvantaged
areas.
Q34 Mr Sheerman: There are no new
resources in this White Paper. You more or less say very clearly
in the White Paper that this can be done by greater economy and
greater use. Everybody knows that if you allow successful schools
to expand, even a small number of them, the cost to the Exchequer
is going to be something like £1.5 billion, that is just
with 100 schools expanding.
Mr Blair: It is not as though
we are not putting enough money into education because we are
putting in a massive amount of money into education. The capital
budget when we came in was £700 million and it is now over
£5 billion. There is a massive amount of money going in.
It is not always about the money, it is also about schools turning
themselves round.
Q35 Mr Sheerman: These proposals
will cost something, Prime Minister. You have recently made a
number of very interesting, exciting speeches about education
and you made some others running up to the election and many of
us thought that your constant theme about the low staying on rate
at 16 was going to be addressed in this White Paper. In fact,
I think you gave a commitment that we would not allow any 16-
to 18-year-olds not to be in anything, either training or education
or work, yet we do not have that in the White Paper, it is missed
out. We still have not delivered to these 16-year-olds. There
are still 16-year-olds doing nothing with their lives. Why is
that so?
Mr Blair: What we do have is the
educational maintenance allowance that obviously can help kids
from lower income backgrounds stay on at school. The single biggest
factor as to whether children stay on at school or not is whether
the school that they are in is giving them a high quality education,
that is the thing that makes the difference. This is about the
powers for local authorities to intervene far earlier in failing
schools and it is about going into those schools which are either
coasting or failing their children because not nearly enough of
them are getting the right results and turning those schools round.
Q36 Mr Sheerman: So we cannot give
a guarantee to every 16- to 18-year-old that they will have something?
Mr Blair: Because of the apprenticeships
which we have also trebled or quadrupled the number of, because
we are introducing over time at least a better vocational route
inside the school and because of the New Deal for the young people
then I think we can guarantee that to them, but in the end they
have got to stay on at school by a decision that they are making
and my view is that they will far more easily make that decision
if the school is good. It is not just about schools expanding,
you can have federations of schools as well. I was looking at
the Haberdashers' School recently, which is a school that is not
in a very wealthy part of London. There was a school just along
the road from it that they have now entered into federation with.
Within two years they have gone from a situation where the school
that they went into federation with had falling rolls to one in
which it is over-subscribed. There is a lot more that can happen
there. If you take the Sedgefield Community College that five
years ago was getting 30% five good GCSEs, it has become a specialist
school, it has got good external links now, it was over 60% on
the latest figures and it is going places. The result of that—and
that is what is so important for educational opportunity—is
you have now got middle class parents who, frankly, were on occasions
staying away from that school locally, even though Sedgefield
is by no means a very poor part of my constituency at all, coming
back into the school again and that is what it is all about to
my mind.
Q37 Mr Willis: The biggest accusation
I think most people make against you is you just do not listen
and you do not listen to the evidence and you do not appraise
the evidence. If you take the 14 academies that we have got in
this issue of choice, eight out of those 14 academies are now
taking fewer pupils with free school meals than when they started.
If you look at the Sutton Trust's evidence, it says that in terms
of the top 200 schools, in fact they take four times fewer the
number of students with free school meals that are in their area.
If you look at the evidence from the Bristol University study,
that is independent research which indicates that when you have
choice in an area what you get is choice which is concentrated
in the hands of the middle classes. Why are you not listening
to that evidence and actually doing something about the very children
who need this Government most and that is those that are at the
bottom of the pile, who have no one to advocate for themselves
other than what we are going to get, which is a choice adviser
or perhaps fashion advisers such as Susannah and Trinny coming
in to deal with them?
Mr Blair: What they are getting
in the areas where there are City Academies is the chance to go
to a decent school for the first time in their lives.
Q38 Mr Willis: They are being driven
out. In Walsall 60% of children with free school meals are attending.
Mr Blair: There are actually larger
numbers of children getting free school meals. The percentage
on free school meals has fallen. What does that tell you? It tells
you that more people are trying to get into the school. That is
a good thing for those children, not a bad thing. The worst thing
you can have in an area is where all the kids from the poor backgrounds
and on free school meals are in one school and the middle class
kids in another. The way of changing that is not to leave the
system as it is, because if the system as it is had worked it
would have worked for those children, but to get those schools
to have a mix of the middle class and poorer families and that
is what City Academies are doing. Before you criticise them, go
and visit them. I have been in City Academies and I have been
taken round by exactly the same kids who were in the old school
where they were getting lousy results and no one wanted to go
there. One young girl showing me round a City Academy said to
me—and these kids are not scripted or put up to say things
like this—"I never thought a school like this was for
a child like me". That is worth having.
Q39 Mr Willis: I could take you to
hundreds of schools across the country where children would say
exactly the same thing and they do not have to be in an academy
to do that. Could I agree with you that in many areas, leaving
out the poorest areas, academies do offer new hope. My issue is
to do with getting access to those. The Secretary of State recently
said, as far as this White Paper is concerned, that there will
be no selection by the front door, the back door, the trap door
or the green door, whatever that meant, but there is going to
be selection by the side door through parental interviews, as
happens in The Oratory and elsewhere. Will you rule that out?
It is the most sinister form of selection because it is so covert.
Mr Blair: First of all, the admissions
procedure is not changing. I do not think there is evidence that
that admissions procedure is faulty.
2 See Ev 26 Back
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