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Minister sets out his case and draws dividing lines with Tories

In an exclusive interview with Pulse, health minister Mike O'Brien talks about private providers, Tory commissioning plans - and the looming general election.

By Gareth Iacobucci

In an exclusive interview with Pulse, health minister Mike O'Brien talks about private providers, Tory commissioning plans - and the looming general election.

Health minister Mike O'Brien is unlike any of his recent predecessors. It's not so much his personality or his policies that distinguish him from the likes of Ben Bradshaw or John Hutton. It's more his situation, as a member of a Government coming towards the end of its term in office and facing an uphill battle for survival.

So when Pulse meets him, it is a different kind of minister on show. It's not just that he is more conciliatory, and considered, than some of those of have come before. It is also that, with one eye on the election, he is just as focused on attacking the Conservatives' plans for general practice as he is on promoting his own.

He has his work cut out, with a Pulse poll earlier this month finding fewer than one in 10 GPs planned to vote Labour in the next election, with support for the Tories topping 50%. So what can O'Brien, who replaced Bradshaw in the Prime Minister's latest reshuffle in June, pull out of the hat to alter such tough odds? Well, what better place to begin than with what for many GPs is the most controversial of all primary care political issues – the involvement of the private sector in the NHS?

O'Brien highlights health secretary Andy Burnham's recent – and controversial - policy announcement that under-performing NHS providers would be given ‘at least two chances' to improve before turning to alternative providers. ‘As far as we are concerned, this is a clear difference between ourselves and the Conservatives,' he says. ‘We want to see the NHS deliver and to work with it to deliver. The Conservatives would rather privatise it.'

Not that this is a U-turn. ‘We're not a rowing back on the reform agenda,' he insists. But many observers, the Government is doing just that. After years of encouraging PCTs to stimulate the market and create competition, Labour now appears keen to put clear blue water between its polices and those of the Tories, who have remained ominously quiet about their plans to involve private firms in primary care.

‘When we thought we needed to bring in the private sector, as with independent sector treatment centres, we did,' says O'Brien, ‘We paid a premium because we wanted to take waiting lists down. Money is tighter now. We were able to use the good times to fix the roof while the sun shined. We're now in a much stronger position, but the NHS is the preferred provider.'

That apparent policy change is so marked it has been panned from the right of the Labour party by those including former health secretary Alan Milburn, who argues the NHS needs more, not less, competition to remain financially sustainable. But O'Brien says the days of throwing big money at private providers are over, and that, unlike the Tories, the Government doesn't have an ‘ideological disposition' towards the private sector.

The minister must have been doing some serious reading over the last few months – he talks authoritatively on primary care despite his inexperience in the role. Indeed, he is sufficiently sure-footed to go on the offensive against Conservatives plans to place GPs at the heart of a new primary care NHS marketplace.

The Tories have pledged to write commissioning responsibility into the GP contract and give all GPs budget-holding responsibility. Mr O'Brien, though, criticises the move, claiming it will endanger the existence of small practices by placing too much administrative responsibility on their shoulders.

‘Particularly if it's a small or single-handed practice, dumping a whole load of administration on them they do not want, for an ideological reason, which is the Conservative position, could drive some of them out of business.'

Labour's plan, he insists, would not force GPs to take on responsibility, but would instead give real budgets only to those who ‘really want to do it' under practice-based commissioning. ‘If they feel they can, and if groups of practices are prepared to come together to commission jointly, that is something we really want to encourage.'

Budgets on an even bigger scale will be the main talking point whoever wins the election. The thorny issue of NHS cuts, and the extent to which they will infringe on frontline services, is another battleground on which the Government is attempting to seize the initiative. Shadow health secretary Andrew Lansley wants to reduce NHS budgets back to 2004 levels, claiming the party could recoup 1.5 billion in efficiency savings by scaling back on management costs, scrapping SHAs and abolishing central targets. But O'Brien has marked out a starkly different approach, insisting he will ‘name and shame' PCTs that impose ‘slash and burn' hacks on budgets.

The Government is claiming findings by the Commonwealth Fund, concluding UK GPs were ‘among the best in the world', vindicate its reforms, investment and targets. The results showed UK GPs ranked highly in a range of areas, including low waiting times for patients referred for specialist care. O'Brien claims Tory plans to scrap targets such as 18 weeks for operations, two-week wait for cancer patients and four-hour waits for A&E, would force patients to wait longer for treatment and operations, and would effectively amount to frontline cuts.

‘Andrew Lansley said he was going to save money by abolishing targets. But that cannot happen without cutting frontline services. The only way they will save money is by not delivering the targets - making people with cancer wait more than two weeks. We've put a lot of extra money into the NHS, but we've held it to account. The Conservatives left the NHS on its knees. And if they ever return to Government, it will be back on its knees.'

But Mr O'Brien's enthusiasm for Government targets is not always shared by GPs. The blanket rollout of Darzi centres in particular has not gone down well, with Pulse's recent investigation showing many – particularly in areas that are not under-doctored – are set to miss their patient registration targets.

The minister seems to concede the primary purpose of the centres may have to change, to reflect their use instead as walk-in centres, and that their funding model may therefore have to change too.

‘On the face of it, GP-led health centres appear to be successful. One of the concerns we've had is that we've seen an increase in people going to A&E. What we are likely to see is, instead of going to A&E, people will start going to GP-led health centres. The question then becomes how you deal with that in funding terms.'

O'Brien offers little succour for GPs in another area where the Government has made itself popular with the profession – the issue of pay. He does though offer honesty, admitting he understands why GPs have felt disgruntled over recent years, and conceding the Government has indeed been clawing cash back.

‘We gave GPs the biggest rise they've ever had in 04/05. Some have felt they've been playing catch up since. It is true, and in a sense, I can understand that,' he says.

GP pay is one area in which Labour and the Tories largely sing the same tune, with neither partly promising things will get better any time soon. Indeed the Government has called for a pay freeze for the coming financial year, while the Tories are planning another, for most of the public sector, the year after. That could make it five pay freezes in six years.

O'Brien says the Government acknowledges GPs' expenses are increasing, but that with all sectors facing a pay squeeze in the next few years, they must accept ‘the pay rises of the last decade are not going to be the pay rises of the future'.

Despite that note of caution, the Government is hoping to galvanise support from GPs by drawing its battle-lines in the sand and putting Tory policy under the microscope. With an election just a few months away, and Pulse's recent poll showing a gaping gulf in support for the main parties, it is a last throw of the dice.

Mike O'Brien: the NHS is the Government's preferred provider Mike O'Brien: the NHS is the Government's preferred provider

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