Devonshire House Hotel 293-297 Edge Lane, Liverpool, L7 9LD 12pm – 2pm Tuesday 31st August 2010

4 of the 5 candidates have produced statements on health

Andy Burnham, Diane Abbott and Ed Miliband attended in person. Barbara Keeley MP represented Ed Balls

Transcript of the event

MARTIN RATHFELDER: Right everybody, we are nearly time to begin we are just rounding up a few stray politicians who are on their mobile telephones as usual. Despite all saying we have to start dead quick they are the people to delay us.  Can I start by asking you to turn your mobile phone off please even if you are a politician.  And while we are gathering the troops, right, would the candidates like to come and have a seat on the platform?

In case you have not noticed we do not have a public address system. We have to shout.  We have 2 thorns between the roses (laughter).  I am Martin Rathfelder director, in fact the entire paid staff, of the Socialist Health Association.  We were set up in 1930 to campaign for the establishment of a free National Health Service and we are affiliated to the Labour Party in the same way a Trade Union is. We don’t necessarily agree with everything it does, but we think the Labour Party is a better bet than the other buggers. (laughter) For the last 13 years we have been offering advice to successive ministers in health, most of whom have not taken much notice of what we  said (laughter) and clearly in opposition it’s a different game. We think we need to do a lot more in health politically because we think it’s an area where the coalition government are vulnerable and we need to support local Labour Party’s councillors and activists in getting involved in debates about health and this is the start of that process.

We have 3 candidates who I am sure you have seen before and Barbara Keeley who has gallantly volunteered to be Ed Ball’s representative on earth (laughter) and Barbara is a member of the health team.  I am a little worried from the point of view of running a hustings that Andy here has an unfair advantage having done the job for real whereas some of the other candidates have never been that intimately involved in health and health is a hard area for a politician. People come and ask you obscure questions about respiratory physiology and expect you know all about it.  I think we should give Andy a penalty of about 10 points (laughter).

ANDY BURNHAM:  Make it 20.

MARTIN RATHFELDER:  So we have had a ballot for the questions that are put. Some of the people who asked the questions are here present. Some I will have to ask because they are not with us today.  The first question is going to be “What do you think is the best thing Labour did in health over the last 13 years and the worst thing we did – or possibly something we should have done and didn’t do?” Can I ask Barbara to kick off, we will say a minute?  Shall we do a minute per question?

BARBARA KEELEY:  The best thing about the NHS for me is how we transformed the outcomes for our investment in the NHS. I thought today of 2 campaigning stories campaigning in 97 we came across, the Labour team came across, somebody who was waiting for heart surgery and had been told he had a 2 year wait and was worrying about dying whilst on the waiting list. This time in my constituency I met somebody who had been to the GP on a Monday, blood test Tuesday, found a tumour on Wednesday, and was treated on Thursday. We all know remarkable stories like that and we know in cardiac surgery life can be saved through triple heart bypass, quadruple bypass, so those are (inaudible) stories and they became (inaudible) moving towards the patient.  The worst we did not do enough soon enough to tackle health inequalities in my constituency and many others. All we need (inaudible) all how it should be funded and also (inaudible).

ED MILIBAND:  Well.

MARTIN RATHFELDER:  Can I say you are allowed to say I agree with the last speaker if you want to (laughter).

ED MILIBAND:  I agree with the last speaker (laughter).  Can I thank everyone for coming along today.  It’s the first day back at school for many people after the Bank Holiday. We feel as though we have been at school for much of August. Let me say a couple of things in answer to the question. I echo what Barbara said about the great achievements. In a way we saw at the general election those achievements whether they are in health or not seem to be banked and taken for granted and people forget what the world was like.  The way Barbara  - in my own constituency I would say NHS LIFT centres are making a big difference. Having somewhere for primary care which is not a falling down building, not somewhere which doesn’t have disabled access and somewhere which is a clean nice place to go – maybe has a local library and other facilities there as well makes an enormous difference and shows what capital spending can do.

The biggest mistake? I think it’s that we didn’t take people with us, particularly members of staff with us in the changes we made in the Health Service.  Andy did a work shadowing thing when he was the health minister, I remember reading at the time, and it showed the way we had alienated a lot of people. I think one of the ways we alienated the people was by sometimes making it appear as though it was “Public bad – Private good” when it came to health and we should have been prouder of a publicly run NHS as a public service. It’s an important lesson we learn, and the only other thing I say is we were right to have entitlements and targets for people. I think like all good ideas they can become a bad idea. My sense is that the culture of target and audit went somewhat too far and is one of the reasons people felt actually this is a service that or changes that I don’t feel part of.

ANDY BURNHAM:  Well I do agree with the last speaker on the messages we sent out.  I did change policy on the use of private sector in the NHS because I did feel when we came into government we alienated staff rather than saying NHS staff are its resource. We almost set ourselves up in opposition to NHS staff rather than getting them with us on that journey to improvement. It’s something I changed when I changed the policy to make the NHS the preferred provider. Thoughts on the bad side? The GP contract was a mistake in 2004, and we should acknowledge that. I also look to a chequered history in the government of public participation. The abolition of Community Health Councils in the early days of the government was again a mistake. We never articulated a strong successor to Community Health Councils. But perhaps the biggest on the negative side I point to would be whether or not we gave enough priority, I believe we didn’t, to mental health. People’s lives have changed in the last 20 years a lot. Not just in this part of the country, all over, people have traded very secure employment and secure family life for a much more insecure existence with much more stress and everybody has felt the pace of life. I don’t think the NHS yet has ever undergone real service change to reflect that great emphasis we need on mental well-being as opposed to physical well being. That probably for me is the biggest failure. We didn’t sufficiently prioritise mental health services.

On the plus side we said we will save the NHS. We did. We re-built it in primary care and also largely the secondary care estate.  We invested in its people, in its workforce. We brought down waiting times. Barbara mentioned Ian McCartney. My Dad had a heart bypass at Broadgreen a year ago.  He waited six weeks for the appointment,  not because he was my Dad,  - because that was the waiting time from Warrington general. I checked as Health Secretary what the waiting time was at Broadgreen in the mid-90s: 2 years 1 month.  That tells you everything about the transformation that Labour made in the NHS. How many of those poor sods on the waiting lists never made it off the waiting list? We made a major effort. Blood sweat and tears brought down those waiting lists. I find if the 18 week maximum waiting list has gone people are facing that old choice – wait longer or go private – and it breaks my heart.

DIANE ABBOTT:  Well it’s good to be in Liverpool. I agree with almost everything my colleagues have said about the successes and the great things we did both in the saving the National Health Service and pouring investment in. I was a Member of Parliament under a Tory government. I know better than anyone on the platform what it was like for Health Service and GPs and practitioners under Tory years and I have seen my general hospital in Hackney and GP surgery and services commissioned by the PCT increase by leaps and bounds. Millions were poured in.  If you have to ask me the single best thing we did I would say the targets for cancer treatment I don’t think there is anybody who doesn’t know someone affected. However negative they might be about this issue will not be able to point to somebody they know or somebody in their family who has benefited from those targets. That’s certainly my experience and the worst thing we did? – I believe it goes to the heart of why I am standing this election – is to assume that the market had answers to some issues in health care provision when it patently didn’t. We have had some brilliant new hospitals built under PFI and the problem is PFI is going to leave a huge debt overhang going forward for our children. There is about 1.1 billion pounds worth of hospitals built under PFI and the latest calculation there will be several times that debt being paid for years to come. That runs a risk of shaping services and job cuts. I think the structural changes we brought in to PCTs encouraged them not to provide services directly and to go out to tender, often to private sector contractors, tragically have created a structure which makes it easier for the Tories to drive forward which is what is their agenda which is opening up the Health Service to private contractors some from America and elsewhere.  The Health Service more than anything else proves the market was not and is not the answer to every issue in public sector provision thank you (applause)

MARTIN RATHFELDER:  First 2 questions are about inequality. We have taken the view for a long time that inequality in society is damaging to health and can I ask Dr Alex Scott-Samuels to ask his question.

DR ALEX SCOTT-SAMUELS:  Thank you Martin. Can I say having been a Labour Party member for nearly 35 years how sad it was for me to campaign for Labour to get elected in 97 then spend most of the last 10 years actively opposing Labour’s health policies.

So this is my question: In the last government at least 2 cabinet ministers, Peter Mandelson and John Hutton, openly boasted about Labour’s success in widening income inequalities.  From the work of Richard Wilkinson and Kate Pickett amongst others we know income inequality is the key indicator of health and many other social inequalities. If elected how would you deal with policy in this area?

MARTIN RATHFELDER:  Can we ask Ed to start off.

ED MILIBAND:  Thank you for your question. I think this does go to the heart of the challenge we face as a political party going forward and I think the change we need to make from what we talked about and the way we talk to the government. I think our whole society is scarred by the fact that the gap between rich and poor is so wide. I think if you look round the world at those countries that are healthiest, happiest, most secure, it is the more equal societies. I think narrowing the gap has to be a central objective of the policy of the future Labour government. I think under my leadership as to the issues you talk about in relation to health and the specific story there I would say a couple of things. First of all I think that we have to understand that actually the changes we made in the Health Service and the improvements provided the platform, if we had stayed in government, for a much greater drive on health inequalities.  Actually it is by stopping the Health Service being cuts and crisis you can then move on to what people have always talked – about making the National Health Service a health service and not a sickness service but wellness service and reaching out to people in relation to health inequalities.  That’s the first point I make to you and the second point I make to you is this: is that you can’t divorce issues of health inequality from wider inequality in your society and of course you need the right health policies to deal with these issues and also need the right policies when it comes to a living wage, housing, people on the top of the society in their responsibilities they owe to the rest. So we do need to drive forward back in government on health inequality and a whole range of different ways, whether it’s on smoking nutrition and so on but I think we also need to recognise the wider issues in which health inequalities are embedded and we have to deal with those issues if we are to successfully tackle not just health inequality but inequality more generally.

DIANE ABBOTT:  I know about the health inequality. I represent the East End. You can look from the top window of my house and see the spires of the City of London one of the wealthiest areas in London.  In Hackney we still have some of the worst health outcomes in Europe particularly among refugees asylum seekers and minorities.  In terms of narrowing health inequalities we have to, as Ed said, narrow inequalities generally. First of all strengthen and support trade unions. It’s a little repeated fact this country was most equal in the 70s when the Trade Union level was high. One of the most important levers of reducing inequality is a vibrant Trade Union. Agency workers and the rise of casualisation of labour helps employers force wages and conditions down and we still need housing.  It’s a big issue. It’s very related – poor housing, damp housing, overcrowded housing is very related to health issues. In the East End it’s no good health managers saying we are going to get you out of hospital in a day, we are going to do the operation for the afternoon and send you home in my constituency. Home to what?  You cannot take the issue of poor housing or non-existent housing away from health outcomes. So the Labour Party I would lead would address issues of inequality. I would support the trade unions particularly in health. My mother was a nurse and a very loyal COHSE Member but it would also understand issues between housing and health inequality.  (Applause)

MARTIN RATHFELDER:  Can you shout a bit the microphones are for the benefit of the cameras not the audience.

BARBARA KEELEY:  I want to talk about income inequality. We clearly made a start as was said with rising minimum wealth and the national minimum wage improved things particularly for women. We have through the minimum wage really helped with women and the pay gap but the key issues remain as the other candidates have said. Really Ken Livingstone established a living wage for unions and people living in London and Ed Balls introduced that living wage in his government department for all staff and (inaudible) as has been said there is more to it. The living wage is not in itself the answer. We need to raise the national minimum wage every year in line with average earnings (inaudible) can’t model on the old idea. We need to keep up enforcement of the national minimum wage and as Diane certainly just said we need to strengthen (inaudible) and make sure they have access to Trade Union organisations.  One key thing is what we did was the Equality Act. We need to ensure the public sector leads the way on this directly out of procurement. We fought in Parliament to get the Equality Act through before the general election and have procurement there so we can improve equality and income equality. So now we must monitor the implementation of the measures we brought in in the act and keep the Tories to that legislation. Ed Balls has written about his alternatives to the government plan and cuts and what he is now calling his more credible plan for reducing deficit fair tax rises including starting start rate of tax at (inaudible).

ANDY BURNHAM:  Thanks Martin.  I joined Labour 25 years ago in this region as a young person. I wanted a fairer spread of health wealth and life chances in this country and 25 years on it’s why I am still Labour and standing for our party. I believe there is much, much, more for us to do to create a fairer spread of health wealth and life chances in this country. For all of the great things we have done down the decades as a party it’s still the case the postcode of the bed you are born in will pretty much determine where you end up in life, how much you earn, what opportunities you will have and how healthy you will be. It is very true of people who live close by to where we are now the postcode here will determine what I have just said.  If we are not in this Labour Party to change that and in many ways what was wrong with our time in government was that Official doctrine Mandelson edict we were supposed to believe in be more relaxed about differential economic differential in society which leads to a gap in health and in life chances and I believe that is, where any Labour person, is the reason we join Labour is because we are worried about the gap in society. It brings us into the party in the first place and going forward to capture ourselves and our identity we need to talk about that much more and move away from the idea if only people at the bottom are moving up it doesn’t matter no we are about much more.  Health inequalities was a banned term in health before we came in.  We set up the Aitcheson report, ground-breaking, and towards end of our time in government had the Marmot report. Though they were very good reports there are much bigger things determine inequality in our society and sometimes we shied away from those things.  In this campaign I have spoken of a fairer system of property taxation to bring that equality into the heart of our taxation system and also think we need a debate when are looking at ageing society. There is lots of talk how we are going to need to raise the retirement age for everybody to 68 or even higher.  Let’s think about that. That is unfair on the people who have done hard physical manual work all of their life and find they reach their 60s and find they are physically worn out. That then drives more inequality in society as people are working longer having been physically worn out throughout their life. We have to stand up and say No. We are not having people putting forward policies like that without the Labour Party pointing (inaudible). We have got to find our voice on this issue. We can’t be a Labour Party intensely relaxed about these things. We have to worry about these things.  As your leader I can give you my word that is precisely what I will do.  (Applause).

MARTIN RATHFELDER:  Should we have retirement pension linked to the postcode of your birth so people in poor parts of Liverpool can retire early and people born in Kensington have to work ’til they are 80 (laughter)?  Next question about public health. Should breast feeding be compulsory? Should inflicting cigarette smoke on children be a crime? Put it another way how can we maintain Labour values and avoid paternalism and have people do more for their own health? Diane.

DIANE ABBOTT:  Many of the things about new Labour which some of us found problematic were driven by the tabloid press and the tabloid press has driven this agenda about the nanny state and many of the excellent things we in government have done to help or encourage people to take care of their health have been held up to derision in the newspapers.

But I believe there are things the state can do in the public health arena which can be successful. I think the incidence of smoking is a case in point. When I was a child smoking was extremely common. People smoked in meetings. People smoked at work. People smoked everywhere. It’s 20 odd years later people are reduced to smoking huddled outside in the street. It has become something which people understand is wrong and it is become something which has been driven out of public places. You can, by a combination of information, and the right legislation and the right drive from government, you can change the practise of the public over time but the smoking issue took over 20 years.  We don’t have that amount of time to wait to deal with things like childhood obesity for instance. So we have to educate people, we have to stand up to the vested commercial interests which don’t want us to educate people.

One of the first things Tories did is drop traffic light system saying what the calorie count on food was.  Even the most hurried Mum can pick up a packet and see red yellow green. Oh take the green. That’s why within weeks Tories gave way to corporate paymasters and refused to implement it.  We can stand up to corporate interests who want to make money selling people the worst food generally and we can make legislation as we did it in the case of smoking to shape over time public practise.  Some things will take a long time but some things can’t wait.  I go into schools in Hackney very regularly. At the beginning of the year I made a point of visiting every primary school in Hackney in the space of a few weeks. It is shocking to see those primary school children and how many of them even ages 5, 6, 7 are obese and how many have all the signs of poor nutrition and poor health.  We can not wait for those children to grow up and start making decisions for themselves. We have to intervene. It’s not just the cost – the obesity brings diabetes, blood pressure ,and so on. It’s not just the people involved but also the right thing to do. At the end of the day we are socialists. Not just about the market or what will get us through the next election and not just what the latest opinion poll said. Not just yesterday’s focus group or today’s Daily Mail editorial. We are about what’s right for the community. (Applause)

MARTIN RATHFELDER:  Barbara:

BARBARA KEELEY:  I don’t think we can have breast-feeding made compulsory but we need to remove barriers. We now have bus companies telling us how good their policies are on this rather than throwing people off the buses. And smoking  - I don’t believe we can criminalise but there are some massive challenges. It’s a tightrope to walk between seeming to tell people what to do and helping them help themselves.  It won’t be achieved, I don’t think, improving health by the laissez-faire policies we have seen from the government. From cutting school milk, from having GPs call people fat instead of obese. Some ridiculous gimmicks we have seen in Parliament from the health team so far.  It is achieved through solid hard work.  In the North West there has been great results in Knowsley and Salford through innovative ways of getting out into communities and helping people stop smoking. Citing people as community heroes. It’s heroic (inaudible) if you smoked all through your life.  Good diet is not just about.  There are 2 things to it.  Having income, enough income to pay for a good diet in the knowledge and Jamie Oliver not just did a great job in terms of putting better school meals. He highlighted some families did not know how to cook at all and the reason they live off fast food is that they don’t know how to cook anything. Don’t know how to use a cooker. We were right to take up that challenge with him and to focus on nutritional standards.  Schools will never ever do it on their own and there are many campaigns in Parliament MPs take up. There has  been one in the North West nationally to get more young girls and women to take part in sport it drops off with girls when they are 11, 12.

NEW SPEAKER:  I am awfully sorry can you lift your mic up I thought it was only me it not we can’t hear over here.

BARBARA KEELEY:  More women and girls to take part in sport.  It’s something we have done across the North West. I talked to a young woman. The head told me she was very good at football.  She had to give up. Her Mum was a single Mum and couldn’t afford the kit, travel, subs and things. So cost is a barrier to participation in activity. We have to take that into account.  You think with girls and young women they don’t want to do it. In many cases they can’t afford to do it and the final aspect is we have got to remember people need an adequate income if they are going to live healthily and need it for their diet and need to take part and housing comes into it as I said earlier.  It’s not easy but we need to take all those factors into account.

ED MILIBAND:  I think the question – and I am certainly not in favour of compulsory breast-feeding, I would be in big trouble if I was, for good reason.  I think the reality here is that you need a combination of things to make a difference. You first of all need action by the state because we shouldn’t succumb to, as Diane says, Daily Mail notions or the idea somehow state action is interference with the individual.  The reason I voted for the smoking ban you had 2 rights colliding. The right of someone to smoke and the right of employees to work in a safe environment. For me that’s more important, right, and I think the smoking ban is now something that’s been accepted and it shows the way taking the right action can change people’s minds and the culture and the second point is about markets. The traffic light system is a good example of the way that actually markets can have a devastating effect on public health.  That traffic light system was a very good system brought in and has now been abandoned and it’s completely wrong it was abandoned. I think we should see as the next Labour government if we can bring it back in. It’s a basic fundamental of giving people transparent information on what’s healthy or not healthy.

The final thing about another newspaper, it’s about the Guardian not the Daily Mail. You know how the people say “oh well all those Guardian adverts about the 5 a day coordinator smoking cessation. All non-jobs.” actually that is complete nonsense because the best thing we can do as a political party and as a government is offer to have people within communities, some being paid, some not, making a difference to public health. I was in Scotland recently with Margaret Curran one of our new members of Parliament and a local housing association run the housing and community centre.  I met a guy there, a walking coordinator. If you listen to the Daily Mail they say “oh walking coordinator, ridiculous”. He was making an enormous difference on that estate.  He was leading adults and young people for walks twice a week. I think that shows how the combination of action by government and communities have made a difference we need to make to public health in this country.

ANDY BURNHAM:  Ed makes a very powerful point, the last point. But I was setting my last operating framework at the Department of Health as Health Secretary I said explicitly history should not repeat itself for the NHS to go first for health promotion when it comes to saving money.  I think, as Ed indicated ,the evidence is already there, that’s why precisely what is happening, as we are looking at the way the NHS is facing up to the financial challenge. It’s a great shame from our point of view. We have lots to be proud of and took bold action on tobacco and on a whole range of public health measures we should feel proud of.  If we have a criticism it should be more on presentation than on policy.  We allowed this fear of Nanny State to be built, perhaps because we didn’t articulate precisely enough the limits of state action. We should have always said we should consider public health intervention where they meet 2 criteria. Where it affects children. We have an obligation to protect the health of children particularly when they are in care of the state, when they are at school, or elsewhere and secondly we should always act where one person’s actions affects the health of another person. Again if we have clearer criteria I think we can build more support for the Nanny State. The Guardian said recently people support it more than people think. There was a poll said support for the banning of smoking in cars with children ran at 60 or 70%. It was a finding that surprised me. Maybe the public is running ahead of politicians at times.  Let’s see.  The last couple of points we have to look back and say we took bold action on tobacco. Too much ambivalence in our response to the rising levels of alcohol abuse and rising levels of public concern on the effects of alcohol abuse. We have to reflect on that as a party. The public were ahead of us on the issue and we were behind the debate and the last point I make is this. When people talk about public health people think of finger-wagging approach – “don’t do this that or the other” and Change for Life tried to break that and come forward with a more positive approach to health promotion, promoting physical activity and good diet and I think there was something very important in what Change for Life was trying to do and the policies we brought forward for it such as free swimming. It’s a positive encouragement to say we will help you to lead the healthiest life you can and I have had moving letters from young people. Given scrapping of free swimming they can only go once a week instead of 4 or 5 times a week.  If we are serious about tackling an obese society we need to get policy putting investment into promoting good health. Too often politicians on all sides are guilty of paying lip service to it rather than funding the services that help people live a healthier life.

MARTIN RATHFELDER:  Is Tony Carr here.  Would you like to ask your question about PFI.

Tony Carr:  The question is a 2 parter, first part is straight yes or no are you in favour of PFI to re-build Royal Liverpool Hospital when PFI debt has dragged down local health economies in Manchester and around England and the second part is moving forward do you have a policy or potential remedy to secure future costs of PFIs are limited or possibly secure them in shareholdings we have in UK banks thus achieving practical and workable interest rates.

MARTIN RATHFELDER: We will ask Andy to answer first.

ANDY BURNHAM:  Given I approved the new hospital for the Royal I better say yes in answer to your first question.  Actually it brings home the argument for PFI, because we would not have a new hospital being built in Liverpool without the PFI route. Quite frankly there is not public capital available to build a new hospital for the Royal. So I took that decision before the election. I know in taking that decision we have the prospect of a new hospital for the city which it badly needs.  To go to the second part I am not going to defend every PFI deal that was done. Some did represent questionable deals in the rush to get all of the deals done.  Clearly those in the early days of the government what I can say to you is that every time a PFI comes forward there is a very strict test of a 30 year lifespan of that deal. Department of Health were subjected to a public capital test which is value for money way offer approving that hospital and the PFI often does represent better value for money. It’s a different way of building hospitals. Without it we would not have built many of the 120 hospitals we built under our time in government and renewed the fabric of the NHS and to give further backing to what I am saying the National Audit Office recently looked at PFI in health and it concluded that on balance that most contracts are well managed and deliver value for money.  There is room for improvement and other ways it can be looked at bringing down the interest rates in PFI deals by perhaps using NHS as a guarantor of the contracts. I am open to those ideas. It may not be popular to say it to this audience.  I could not have given new hospitals to many towns, communities, cities without PFI. The  real strength of it, it allowed more areas to have a new hospital simultaneously. I can look you in the eye and say it wasn’t at the cost of value for money in the National Health Service and I am not going to apologise for it. (Applause)

ED MILIBAND:  I agree with Andy on this. Let me put it in personal terms. My Dad ended his life in a hospital in London which was a dilapidated broken down hospital, bad for patients and bad for staff. My son was born in a hospital nearby 15 years later which was a brand new hospital built under the private finance initiative – UCH hospital. I know because of demands on the public purse that that hospital wouldn’t have been there if we weren’t willing to use PFI. I understand the concerns people have in the audience on the costs of debt that are going to be paid back in the future,  about inflexbilities of some of the contracts which aren’t just an issue in PFI hospitals but in PFI schools as well. We have to look how we can better regulate costs going forward and deal with some of those inflexibilities. In the end you have got to make fundamental choice and answer the fundamental question which is that have we improved people’s quality of life both people who use the Health Service and work in there by use of PFI. It’s my view, not popular with everyone in this audience, the answer is unquestionably yes. It’s a massive abdication of responsibility if we said we won’t use PFI. My son wouldn’t have been born in the new hospital, thousands and millions of people around the country would have still been treated in old broken down hospitals which existed under the last Tory government (applause)

BARBARA KEELEY:  If Ed Balls were here he would have agreed with a lot too. He was in favour of PFI.  For him, thinking back 30 years ago, his father moved in the 70s to a newly built hospital in Nottingham which started to develop structural faults – peeling walls, problems in the building months after it was built and his view was that it had to change. The private sector could take the money and run.  In his view he was appalled, and it was a point Andy made also, involved in building the building and also 30 years maintenance and Ed feels that not just the private sector now has to build a building and think about maintenance of the building.  PFI contracts stopped that and PFI has helped Labour to have more schools and hospitals as Ed and Andy said and I think almost every MP would speak about the transformation that new hospital or the in the case of my constituency new schools (inaudible) it has transformed entirely transformed conditions at that school. I won’t take that away from the young people (inaudible) for anything.  (Applause)

DIANE ABBOTT:  I wouldn’t scrap the Liverpool Royal Infirmary. I think expectations in the region were built up so high about it, brand new hospital, wonderful landscaping. People wouldn’t understand if it was scrapped. At this point however I hate to disagree with my colleagues. They after all were top new Labour advisers when I was knocking around as a backbench MP. PFI is never better value for money. Never (applause).  The reason for that is something you don’t have to be a top economist to understand. It’s always cheaper for the government to borrow money than for the private sector and it was initiated by the Tories. I was an MP at the time. Why we took that and expanded that? It had a technical, a technical merit in that it took expenditure off the public balance sheet and put it on to the private balance sheet and that helped us in presenting what we were doing in accountancy terms.  The truth is, as I said earlier, we have spent 11.3billion on PFI hospitals but our children and possibly our grandchildren have to pay back 65billion in payments for the PFI.  It is, and people my age understand this – a glorified form of hire purchase. As we all know and can remember hire-purchase is always more expensive than putting your hand in your pocket and paying for it with cash.  The problem with PFI though is not just the big debt over hang. Remember £11.3 billion expenditure £65 billion in payments to be made. You are locked into the contracts. You say they can be changed. It’s very hard. These are contracts and you have to re-negotiate that – all of them in their entirety. I think those private sector contractors are not willing to do that. We are locked into contracts with huge debt overhang and the cost of repaying those debts must mean over time that it bears down on our ability to maintain staffing levels. It bears down on our ability to provide services.  PFI was one of those ideas that looked clever at the time, but we have left our children in the staff in those Health Service institutions to pay the cost going forward (applause)

MARTIN RATHFELDER:  I want to turn now to look forward, I suppose is the word, towards what the coalition are proposing to do about health.  First question is from Amy Mercer Bailey – and shout.

AMY MERCER-BAILEY:  Would you like your doctor to think about you or his budget when arranging your treatment?

NEW SPEAKER:  Hear hear.

BARBARA KEELEY:  I think it’s a good question. It’s a really key issue. It could undermine the relationship between the patient and the GP and the issue of rationing of treatment is not as transparent as it needs to be. At present a row has happened, with the Primary Care Trust and GPs it seems are very uncomfortable indeed on taking on these rationing measures.  Besides concerns about rationing, charity after charity working in the medical field is coming up and saying about their concerns on GPs taking on commissioning. We have had in the last few days the muscular dystrophy campaign saying GPs on the whole with that condition don’t have enough experience. There is 50% of the people in the survey by the campaign had complained of misdiagnosis. 70,000 people in the country have muscular dystrophy or related condition. That’s a very serious thing. If commissioning services for those people falter and fail if you like and there is also a question very much so about GPs commissioning mental health services. The charity Re-think said 2 thirds of GPs are uncomfortable or don’t think they have ability to commission mental health services for people with those issues.

One of the questions for this husting, we scanned through when Martin sent them, there are 6,000 rare conditions in this country and so GP commissioning for those conditions and mental health is of great concern. We have really got to continue to challenge the Conservatives and Lib Dems on this. People will suffer with all those conditions.  It’s not just GPs being uncomfortable making decisions. People will suffer if we let it happen.

MARTIN RATHFELDER:   Andy next.

ANDY BURNHAM:  Well you have put your finger on what is deeply damaging about this white paper. I point to 2 problems in terms of the GP patient relationship. First there is the GPs traditional role as champion of the patient. That is compromised somewhat when the GP is also the budget holder and they are not popular.  PCTs perform an important function in taking that pressure out of the consulting room and a secondary problem at the heart of the NHS. A conflict of interest where GP is both provider and commissioner, and the GPs need neither have the desire nor expertise to commission population wide health services and they will have to bring in others to help them do that and I believe we are looking really at a fundamental change to the character of our National Health Service and it’s privatisation of the commissioning function in NHS which leads to great fragmentation of services – a postcode lottery writ large and when you put all that alongside the effect on patients. They are removing the 18 week national waiting standard and lifting the private patients cap on NHS trusts. The effect of those two – hospitals can devote more theatre time to private patients they no longer have a private waiting time for NHS patients.  They will let NHS patients pay the price. It brings back the old choice in the NHS of wait longer or pay to go private. The whole package of reforms threatens to unpick the fabric of our National Health Service and it is an attack in the end to. NHS services will be so fragmented from one GP commissioning group to another it will no longer have a character of an NHS and, the greatest irony of all, I have great respect for GPs and general practitioners there may be many in the audience today, the very people who decided not to come into NHS at the outset are now being handed the entire budget for the National Health Service and that is what is being promoted here.  (Applause) I think these reforms are ill-conceived on practically every level.  I don’t believe it is right now to subject the NHS to the biggest ever re-organisation in its history. It’s currently facing the biggest ever financial challenge in its history. To combine those 2 things together is a recipe to turn the order we have in the NHS today into chaos in a few weeks time.  The coalition agreement said no further top down re-organisation of the NHS. How can they possibly defend a white paper a few weeks later that gives NHS the biggest and most dangerous re-organisation in its history? I don’t see any democratic legitimacy or mandate for these proposals or any of the 7m people who voted Lib Dem voted for the break up of the NHS. I ask all Lib Dem MPs to show some courage and stand up to the government and say “we were not elected on the back of this promise therefore we will vote against this Bill when it comes to House of Commons”.  If we pull together and launch a ground war against these plans we can stop them. They threaten our NHS like nothing else before. I believe if we expose risk to patients we can bring this home to the public and stop this Bill. At the moment it will forever change the character of our NHS and will unlock a reform in the NHS that is very hard to put back.  Even though we are fighting a leadership campaign we are all united in saying Labour will defend with everything it’s got it’s proudest achievement from this attack (applause)

DIANE ABBOTT:  To answer your question I would prefer my GP thinking about me and not about his budget. The thing about GPs, all very nice people, they are not saints. I mean the BMA to its credit is one of the last old-fashioned hard-nosed Trade Union negotiators in the land. When they negotiated responsibility to visit patients at home it was like, for them it must have been like taking candy from a baby.  The problem with this new form of GP fund holding is two-fold actually, actually, most GPs won’t want to get involved in the practicality accountancy business side of it. They will bring in people from the private sector to do that management function.  But the more profound problem you see there in some parts of America where they have this GPs (inaudible) there is a conflict of interest and interest and there is pressures on them. Even if they don’t feel them, there are pressures on GPs going forward to commission treatment not because it is absolutely the best and most appropriate treatment for you but because it is treatment that will help their balance sheet or perhaps it is the treatment that they have been softened up or encouraged to commission and that essential conflict of in desk between somebody deciding what is best for you and somebody who is responding to other external pressures nothing to do with your health. That is the problem with GP fundholding.  As Andy said this is really an attempt to open up the NHS to private contractors to private health companies, possibly from America. As I say it is regrettable that some of the structural changes we made opened the door to this.

ED MILIBAND:  It’s a case of everything has been said but not everybody has said it. I will be as brief as I can be. There is an issue about waste. It will cost 3 billion pounds to do these changes at a time, as Andy said, the NHS is under massive pressure. There is an issue of accountability. Whatever problems we had with PCTs at least public money was in some sense accountable. I don’t think it was the greatest form of accountability but people employed by the public sector were responsible for how the money was spent.  It’s a market philosophy brought to the heart of the NHS with the decision around GPs commissioning.  I don’t want those decisions to be made on a free market basis. I want some sense of accountability on the way that money is spent. The question is not are these bad reforms, they obviously are, how do we fight them? I make a point to colleagues from the Socialist Health Association and all the health professionals in the room. It’s great for Andy to lead the campaign and great for Diane myself and Barbara to be part of the campaign and the way this campaign succeeds is led by health professionals and we need GPs and nurses and midwives, people across NHS to campaign on this issue along with UNISON. Actually there is a job of persuading that we have to do to win the argument.  Health Service re-organisation is a set of words that make most people’s eyes glaze over. For reasons we understand we have to hone our arguments and in every GP surgery people to be told “these are the changes proposed this is the impact it will have on you”. These are the dangers of the changes. You should contact your local MP to fight the changes.  Unless we have that kind of effective campaigning we will protest and say these changes are bad and make ourselves feel good about opposing the changes and won’t defeat them. We have got to have a proper mass mobilization against the changes in order to defeat them (applause)

Jacob Stewart:  I wanted to ask, having heard your criticisms of the white paper I was wondering if there is anything in the white paper you agreed with. Much as there are many bad things, I look at it and consider there may be positive outcomes to it. I wondered what you thought of that.

ED MILIBAND:  As a person who has read it I think Andy should answer the question (laughter)

ANDY BURNHAM:  Not much (laughter) really not much.  I have re-read it and re-read it to ensure the reaction is proportionate to what is being proposed. If I was looking for something perhaps the abolition of GP boundaries, as something I proposed myself as Health Secretary, because I think that more choice in primary care was a good thing so people can choose to stay with a GP who was their family doctor when growing up or move to one nearer to work. I thought that was a good thing but ultimately you have to look at the combination of proposals here and look at them all together and say do these proposals together add up to a reform that will change the character of our NHS and is that reform desirable? I don’t think you can pick one off or another. It’s when you set them all alongside each other. There is a proposal in the white paper of no bail-outs for any NHS organisation. That essentially takes hospitals, as Diane said before, that takes hospitals off the public sector balance sheet. They will not be guaranteed by the Department of Health or Treasury anymore and when you think about the lifting cap on private patients and all of what comes with that this will change the behaviour and mindset of people working there. They are no longer protected by the government. Then they will have to compete in the market place and adopt a very competitive approach to health care. It’s no coincidence that the duty of Monitor the foundation trust regulator is changed so promoting competition is the primary objective of that regulator. So what I would say to you. It’s looking at the whole package together. I don’t think you can just take out one thing or another.

There is lots of warm words in the white paper about the patient being in charge and the expert patient.  I agree with that. We want to move more towards the notion of expert patient and see lots of clinical leadership. That was the great theme of Lord Darzi’s next stage review. Those things I could say “yes we agree with those in principle”. It’s when you come to put them into practice.  GP fundholding in the early 90s – at least there was a framework of public accountability behind it with the health authority. Ed mentioned accountability. That is one of the gravest dangers of the white paper. It hands over the budget to the people who didn’t want to come into the NHS and wipes away the whole infrastructure that represents public accountability for that. It’s saying to NHS managers, PCTs you are expendable. I know those PCTs are staffed by decent hard working committed people who helped put NHS back on its feet and it’s a terrible message for the government to send to those people.  What happens there is no expertise in population wide health commissioning in general practitioners.  Who is going to be the voice for the voiceless and people who never come over the threshold of GP surgery? Complex mental health needs or HIV aids, homeless or travelling community, who is going to commission for that whole population going forward in the future? That’s why it’s an 18 billion pound gamble.  Primary Care Trust it’s not perfect. It commissions services for everybody and ensures there is a safety net for everybody. To simply take it away and take a huge step into the unknown when there is no evidence is appalling.

Let me finish on this point.  They are ruthless aren’t they the Tories? it’s unbelievable to see you forget until you see them back in government. Announcements are being made that come from nowhere just drop that affect the public fabric of our country. Friday afternoon for a bank holiday weekend Health Secretary visits a hospital and casually let’s it slip he is minded to abolish NHS Direct. 3,000 or more people work for them. The public values NHS direct for the support it gives to families with children and it saves 100m pounds for the NHS every year in preventing trips to the accident and emergency department. To say it’s being scrapped on the day of a Bank Holiday with no proven alternative in its place is no way to treat NHS staff who have served NHS loyally for years. It’s no way to run National Health Service and if you do one thing today sign John Prescott’s petition saying Save NHS direct.  It sends a direct message to the Health Secretary that he cannot go on acting in this high-handed arrogant manner in dealing with our Health Service.

MARTIN RATHFELDER:  Anybody want to add anything to that.

DIANE ABBOTT:  Well actually I have read it. (laughter) Not much to like, I am particularly concerned amongst many other things about the stuff about the expert patient. I represent, I know, lots of inexpert patients. They are elderly and don’t have access to computers to go on line and sift through information.  I want a Health Service gives best possible treatment and secures best possible outcomes for all patients not just expert patients and there was one thing in it.  I was quite interested when they talked about having public health officers actually sit within Local Authorities. You have to see what the budget was, you would have to see how the powers were and see how that interacts with GP fundholders whatever. I think there is something to be said for having more of a Local Authority role in public health matters. Public health was one of the key roles of Local Authorities in the 19th century, fighting cholera and typhoid, putting in proper sewers, and housing. It was public health which was one of the big drivers behind the setting up of municipal authorities in Victorian times. I think some of the issues I touched on today like housing again if you had public health sitting in the Local Authority it would be much easier to have this coordination. I say that tentative tentatively – knowing the Tories it’s lip service  - nonetheless I think a greater role for Local Authorities and for elected local people in public health provision in principle. (Applause)

BARBARA KEELEY:  To say I wanted to emphasise what I think comes out in every area the risks and uncertainties  Andy touched on. He has touched on all the risks in the NHS white paper and the reasons we should fight against it. People staff in Primary Care Trusts that work on important areas like improving treatment for people with learning disabilities. Those organisations will be paralysed in the next two or three years while people worry about their job. It’s a good move to (….as read….) moving across. Everyone is worried will they get the job, won’t they get the job, what are the terms and conditions? People getting rid of our targets, bringing in private medicine and abolition of organisations like Food Standards Agency, Health Protection Agency, National Treatment Agency. This morning we heard about abolition of the Health and Fertilization and Embryology authority. It actually deals not just with IVF which is important but some other agency could deal with but stem cell research and is a leader in the world in that area of work. To be fair, in the light of this question I had a look back to see if there are aspirations. It has an opening paragraph on the NHS being a great national institution, requires hospitals to be open about mistakes and making the system focus on personal care. It talks about focusing on carers, and strengthening the collective voice of patient in the role of the Care Quality Commission and the key thing is really the risks and uncertainties. When this paper was published a letter went out from David Nicholson saying there was a real risk of loss of quality and when we thought about that in Parliament, what does it mean? A time of budget cuts and loss of quality in the NHS? Loss of quality can mean these things – errors, misdiagnosis, treatment that goes wrong and unnecessary death and unfortunately that’s what we face and why we have to all fight to defend our NHS.

MARTIN RATHFELDER:  Can we move to social care, seamlessly? What should we do about the division between health and social care? Should we move to the principle that social care should be free at the point of need and paid for out of general taxation.  Andy.

ANDY BURNHAM:  Thanks Martin.  Well, I think the biggest public policy challenge facing this country in this century is the ageing society, and unless we find as a society a better way of funding care and support for older people and people with disabilities then we face a very bleak prospect. Indeed where we look to a century where people will live longer but what kind of lives? More anxious lives as they face cost of care and don’t have peace of mind, don’t have the independence to live a long happy and fulfilled life. I believe unless we find a solution then really we are going to fail a generation of older people. Figures show in every local area numbers of people who are over 85 in any Local Authority – these numbers are doubling very quickly and the challenge gets bigger every year. It’s an indictment of us all. When you look at the social care system in England 80% of the people work in it work at or close to the national minimum wage. What message are we as a society sending to people who work within our care system on how importantly we value them and what they do on our behalf in caring for our loved ones? We have to do better. The system in England is malnourished and underfunded. If we leave it as it is it’s struggling to fund an ever (….as read….) I was accused before the election of wanting to introduce a death tax. My answer is we have something far worse right here right now in this country and that is a dementia tax where the people who faced the hardest circumstances in life, people who have got Alzheimer’s or Parkinson’s or severe dementia, they are not just wiped out physically by those terrible conditions around them. The family is wiped out emotionally. More than that they are utterly cleaned out financially. How can any member of the Labour Party look at that and feel we don’t need urgent reform? We criticised American health care system in such superior way from our vantage point and the same injustices are present in our system of social care. We let people fend for themselves and the most unfortunate pay most and lose everything they have worked for their homes and savings.  In this leadership campaign I have put on the table what I believe is the biggest idea any candidate has put forward. A national care service free at the point of use available for each funded by a 10% levy on all estates. I believe it is the only solution to the challenges that we face in this century and I also believe it could give empowerment to all older people as they face a longer life and give them piece of mind and the ability to protect everything they have worked for. For those reasons this change could be for Labour in this century what the National Health Service was for us in the last century. It’s ideas on this scale that will re-connect Labour to the people out there. They will say I know what this Labour Party is all about now again. They are trying to build a fairer society for everybody.  For me it’s a reform it’s time has come. I wouldn’t pay for it from general taxation. I don’t think that’s fair to the working age population today to give them another thing to pay for. If we create it right now, after the war it should have been included, it never was included in the post war settlement. I do think it’s fair to ask today’s pensioners to pay 10% levy on their estate to pay for a free at the point of use National Care Service and I think it gives people peace of mind and ability to protect everything they have worked for.

ED MILIBAND:  I am very sympathetic to the National Care Service proposal we talked about before the general election. I am afraid we didn’t get to including it formally in our proposals at the election.  Let’s understand what the injustices are here. I think the biggest and first injustice we have to tackle is the injustice of people in their own home and not getting care they need.  We know for many people the best solution is to stay in their own home. It is the situation of people up and down the country finding they are not being properly helped at home that are worst of all. In my own constituency I had a man come to see me in the surgery. He made an appointment, came a couple of weeks later. He said, I came anyway my wife died last week after I made the appointment. She waited a year to get a stairlift at home and it never came. Up and down this country we know there are these stories and the first thing we have to do is improving that care people are getting in the home so people aren’t cruelly left without that care as they are at the moment.  Secondly we have to deal with injustice Andy talks about because the truth about social care it should be following the same principle as the NHS. It’s a catastrophic cost over which you have no control as a person and it’s random who it hits.  Principle should be those costs are borne across society and we pool the risk and that’s why we have got to find a funding system. It could be Andy’s. It could be another funding system.  Thirdly and finally let me say something about people working in the care sector. It’s really important and the work place and what happened to people at the work place is something that was left out of what new Labour talked about and wrongly in my view. I was at a care home in Durham, a Southern Cross care home. People are paid just above £5.80 minimum wage doing one of the most important jobs in our society.  15 p an extra for getting NVQ level 2. I said to a worker in the care home what do you think is a fair wage? She said I get paid 7 pounds an hour to work at Tesco’s. There is a deeper debate we have to have in our society and use the leadership discussion on what our values and priorities are and if we think what the market will bear is a fair wage for someone working a care home or follow different values that’s why we have to change. Unless we do that we will find we still leave people doing most important jobs in our society getting paid the least. It’s wrong and it has to change.  (Applause)

DIANE ABBOTT:  I agree with what Ed said about people who work in care homes, many of whom are women and are from marginalized groups in society and yet when they could work in Tesco’s give the people they are working with and for a level of dedication that would put the average merchant banker to shame. It is really what does society value.  On the question of social care people will have forgotten we had a Royal Commission, one of the few Royal Commissions this country instituted right at the beginning of the administration in 2000. It took an extensive amount of research, it had a huge amount of submissions, it was top heavy for experts and the Royal Commission said clearly it was their main recommendation that social care should be funded out of general taxation but, poor people that did the Royal Commission ,it was dead on arrival. Before it was accepted formally the government made it clear it was not going to accept its conclusions. I recently re-read it and the arguments it made were funding social care out of general taxation are as strong now as they were then. It’s quite tragic they say. This was in 2000. The system is a mess. There is unfairness.  There is a bias against people from the social care because of Alzheimer’s or need care because of cancer. It said all of this.  I say to Andy who has a fantastic record as Health Secretary when he said that people who are not old should not have to pay for old people who need social care what he is actually doing is questioning the underlying principle of the Welfare State. The point about the Welfare State it’s for those who don’t have children contribute to those who do have children. I am not yet retired pay something to help people who retire, it’s about putting the actuarial and accountancy issue it’s pooling the cost but the philosophical issue is – I am my brother’s keeper. I think it was a great underlying principle of the Welfare State moving away from saying I don’t have children I am not paying. That more than anything else undermines the values and principles of the Welfare State. As it happens the Royal Commission proposals were taken up in Scotland. People say huge amount of cost. The cost of social care in Scotland was about 3% and if you provide social care free at the point of use you can actually stop many more people going into homes and save costs at that end and so it you can’t just look at the net cost of providing social care. Taxation you have to look at the money you save of people not going into homes. It’s hugely popular in Scotland. It’s proved to be effective. It isn’t a huge burden on the exchequer. Scotland is not going to abandon this any time soon and the problem with elderly people that need social care is that they are often marginalized and voiceless. The people trying to help them, immediate family are often so caught up in struggling with the Health Service or the money and struggling with banks they can’t be a voice. Now you know if we in the Labour Party in 2010 cannot be a voice for the voiceless what is the Labour Party for?  That is why I am running this election. That is why I am running this election because it’s not just burying inconvenient Royal Commission reports. It’s not what is prudent or what is a good headline in the Express or Mail. It’s about what’s right and I return to the view for all sorts of practical reasons and also for reasons that go to the core of why we are in the Labour Party we need to look again at care for funding social care from general taxation.  (Applause)

BARBARA KEELEY:  I agree we need to look again at this and that’s one of the most important things Andy detailed our proposals on the health care service.  On Scotland those who campaigned in (inaudible) found that they were actually real concerns in Scotland. The personal care budget is rationed. You get to a certain point in the year and you stop. It’s like the same thing Tories are going to do with the new cancer drugs fund and one of the reasons we won the bye-election apart from having an excellent candidate local?  In Scotland had increased other public care costs at home.  The main thing about this question I think it’s very important to take on board. We must have more discussions. It’s a difficult argument (inaudible) Andy did a great job in bringing forward a National Care Service and launching it.  Before a general election it’s a great time indeed (inaudible) difficult policy options. We have got really and thinking back it was the case I think MPs find it’s a shock to constituents when they come to you and talk about this and they find they are going to have to pay for social care. It is a shock people weren’t expecting it. If we think back as recently as the 80s much more service was provided to people in their homes. There was shopping and gardening and that sort of thing and of course the fact is services have shrunk to the point where as Ed said one of the issues most disturbing are people living at home with no service whatsoever.  Something like 300,000 people with complex care needs not receiving any support and not even receiving support in their families (inaudible) also not receiving any support. Of course we get these awful cases where people are in terrible circumstances and not (inaudible)

What it seems is that with the cuts in (inaudible) Conservatives and Liberal Democrats it may be we have to do what we propose to do in the general election and have building blocks as Andy said. The building block we should get to is the one we were trying to do with our Bill to provide free personal care at home for people with dementia. If we can achieve this in building blocks instead of trying to do everything we were trying to do then that’s the way forward.

MARTIN RATHFELDER:  I think we have just got time for the candidates to sum up in a minute, is that okay? Who shall be first? Ed.

ED MILIBAND:  Thank you to everyone for coming. You have a heavy responsibility in the coming few days you get to choose who the next leader of the Labour Party is.  I am standing in this election because I believe I am the person who has the values to take our party forward and I am also the person I believe can win the next election for us and I want to say to you very clearly I am the head and heart candidate at this election.  Unless we change from some of the things new Labour got wrong we are not going to win the next election. Unless we reach out to working class support as well as middle class support we will not win the next election. Unless we are willing to change on issues of privatisation, ID cards we won’t win the next election or unless we move forward on Iraq we won’t win the next election. Unless we move our party in a different way we won’t win the next election.  The way we win is we have a party in Parliament of course and a party in Parliament connected to our party in the country and our Trade Union movement. I am pleased I had the backing of UNISON and a number of other trade unions in this campaign. That’s because of my message on the way Labour needs to stand up for working people in this country. Let me end on this point. Some people will tell you when Labour loses an election it always has to move to the right, but we did not lose the last general election because we were too left wing. I believe we lost it because too many people thought they didn’t know what we stood for and there was no difference between the parties. We have got to have confidence that if we stand up for values we believe in and stand up for a fairer more equal just society we increase our chances of winning the next election.  If we speak to our values we can create a party we are proud of, a movement we are proud of, and a country we are proud of too.  Thank you very much (applause)

Bashir Chaudry:  (Inaudible) Afghanistan can you give us your views.

ANDY BURNHAM:  Thanks Martin.  As a minister and as a backbencher in Parliament I was 100% loyal to Tony Blair and Gordon Brown.  Why? I wanted to sustain a Labour government for as long as I possibly could and I gave them that loyalty they needed. Not everybody in our party can say that. I can.  Coming forward to stand for leadership it takes loyal members of the Labour Party to tell home truths and that is this. Labour became dangerously disconnected from ordinary people during our time in government. New Labour was formed out of a distrust of its own party members, its grass roots and wider Trade Union movement and developed a controlling top down elitist Londoncentric approach to party management.  It alienated people up and down the country. It told us we have to be relaxed about the gaps in society. I wasn’t. I bet you weren’t. It took us away from who we were, what we were all about. It took the heart and soul out of the people’s party. That’s what we have to put back in as part of the leadership election. That’s what I can offer. A candidate who can give Labour back its heart and soul and re-connect Labour with people we need to win back. I talk about a National Care Service and free at the point of use. That is how Labour re-connects – brings forward big inspiring ideas. It can shape this century in the way the best of our values shaped the last century. That’s how Labour puts itself back in touch with the people we need to put us back. I don’t have support of the media establishment in this election or the union establishment or Labour establishment. I am not seeking their support. I am seeking your support. Things need to change in our party. People want things to stay as they are, have more of the same. We can’t have that. If we do Labour will be on a path to irrelevance and in slow decline and we need to re-build this people’s party of ours from the bottom up. There are those out there now trying to re-run battles of the past and make the leadership contest a battle of new and old Labour. That’s to entrench the factions. Party members have to say we want to move beyond that era and want a united Labour Party to unite around true Labour. Values that speak to us. I say I am not old Labour or new Labour I am true Labour. I speak and always have done for the mainstream majority opinion in the Labour party. Right now that’s the opinion people need to hear and the way old labour didn’t represent (….as read….) nor did new Labour and the voice we need to hear in this election now is the voice of mainstream majority members that were and Labour Party focused on the concerns of ordinary people. That’s what I can offer you in these final stages of the leadership campaign. Think of the kind of party we need. How we will re-build the party from the bottom up true to Labour principles? Let’s together make sure Labour values shape this century in the way our values shape the best of the last. Thank you very much. (Applause)

DIANE ABBOTT:  I am standing for the Labour Party because I believe I bring specific attributes to the leadership question which no other candidate on the hustings does. I am the only candidate that was a city councillor.  That’s why I take the role of Local Authorities and  locally elect representatives far more seriously than other candidates. I am the only candidate saying we need to re-visit the Thatcher and Trade Union laws and create a level playing field between trade unions and bosses and I am the only candidate who served on the National Executive party in the 90s and going forward and therefore I am the candidate who was not parachuted into a safe seat. I am the candidate who is not the darling of the Westminster media. I am the grass roots candidate and if the immediate task ahead of us is to re-build a party from the grass roots I say to you as someone who has worked their way as a party from collecting subs as a young woman to serving on the council to serving as a Member of Parliament for 23 years is perhaps someone you should look at to perform that task and I also bring a life experience no other candidate did. I brought up a son on my own for 18 years. I lived and represented some of the poorest areas in this country all my life, as a member of the Labour Party and there are issues we need to discuss and haven’t discussed about what’s happening in our societies and what’s happening amongst our young people and happening in relation to family and gang culture which I can come to and I can speak about from personal experience and personal knowledge which no other candidate can do and you know with our inner cities it’s not just about the money. The money is vital but there are other issues as well. I am a working class girl brought up in a working class community. I know about stuff that drops off the back of lorries. Some of the things I see gang members doing now are things unthinkable when I was a girl growing up. I think we need to challenge as a party what is really going on in some of our communities.  I also bring to the leadership the fact I am a reasonable communicator – a reasonable communicator. I do a show on BBC late at night. It’s the most popular politics show on the BBC. When you ask those people, people say would Lyndon vote for this. When you ask my viewers what is your next most favourite programme they say Mid-Summer Murders. I am a candidate that can speak to and engage with Mid-Summer Murders viewers (laughter).  And I bring to this context a clarity of vision. All of the other candidates are willing to will the ends and not necessarily willing to will the means. We have to examine the way we regarded the market and divert to market mechanisms and thought they were answer when they were not.  We have to examine the way we deferred to bankers and the very wealthy and thought they had magic knowledge particularly people in trade unions did not have.  We have to examine the presidential model of new Labour for 30 years. The other candidates are trying on the presidential mantle for size. I am saying to you I would lead a democratic open party that would listen and learn from its own members and listen to the public also.  I am it’s well and good to say you might consider putting up taxes. How can you say to anybody even a banker that you put up their taxes when we are proposing, or at least my colleagues are proposing, to waste billions on the Trident nuclear weapon system. (applause) We are wasting billions keeping our troops in Afghanistan, the endless war which no Western army has won in 2 centuries. How can we put up anybody’s taxes, even a bankers taxes ,when we spend disproportionate amounts of money on defence spending? I am the candidate that will signal to the public the Labour Party has moved on from the new Labour years.  Don’t let the papers tell you it’s a battle between two Milibands. I am not a Miliband but I am the candidate you should be voting for in this election.  (Applause)

BARBARA KEELEY:  I have an impossible task. Now I think we have 5 excellent candidates running for leadership that is very good for our party.  I want to say quickly a few quick things about Ed Balls and why I nominate him. He has qualities I think are important. I had a look at what his other supporters in his team of people supporting him said about him. They said he gets things done. He is strong and decisive and also inclusive with his colleagues, intelligent and driven to achieve Labour goals. His commitment to children and family makes a massive difference (inaudible) in cutting buildings schools for the future.  Supporters said he has hunger and drive gets the big judgement right. People find him focused attentive and he really listens. People said Ed is the best candidate to take the fight to the Tories. He understands how (inaudible) had to fight the difficult campaign to hold that seat. People say he is the candidate best placed to set out (inaudible) and has a burning desire to (inaudible) to fight against to do the best for ordinary working people. That’s a set of views (inaudible) Ed wanted to be here today and also wanted to talk about affordable housing.  I think given what’s been said in this session today it’s clear that is another issue which perhaps we didn’t tackle and should be tackling. Ed wanted to say he believes the NHS is one of the things makes him most proud to be British.  Under Labour it was not about ability to pay it’s about need that’s why Ed will fight to defend our NHS thank you.  (Applause)

MARTIN RATHFELDER:  Can I thank the candidates. I think they have got an impossible job. They are all probably short of sleep. We have asked them to abandon their holidays and children and I understand most politicians go to Italy every August for a month (laughter). they have come to Liverpool instead and have had a better time. Can I also thank Billy and the staff at the Devonshire House hotel. I know the candidates are anxious to run away to further meetings. Ssome of  us are going to hang around. The Socialist Health Association is a membership organisation and you can join us if you want us to do a bit more to raise the profile of health in the Labour Party and politics generally please take one of our membership forms.  Thank you very much for coming.  Thank you.

Questions for the candidates

There was a vote to choose the most popular questions. Thanks to everyone who sent in questions – far more than we could use. I have amalgamated or shortened quite a lot of them. Apologies if I have distorted what you meant.

Questions about equality

  1. The rich got richer under Labour both in income and in capital wealth. Labour has done much to help those at the bottom of the pile but those at the top have taken off and gone into orbit. The effects of this inequality far outweigh anything the NHS can do. How can we do something about this? Dr Katy Gardner
  2. In the last government at least two cabinet ministers – Peter Mandelson and John Hutton – openly boasted about widening income inequalities. From the work of Professors Richard Wilkinsoin and Kate Pickett among others, we know that income inequality is the key indicator of health and many other social inequalities. If elected, how would you deal with policy in this area? Dr Alex Scott-Samuel
  3. The Marmot review highlights that truly reducing health inequalities can only be done through a more integrated approach to health. How would you see this begin to be translated into policy and practice? Isla Dowds & Shiela Sweeney
  4. Do you think the equity goal of the NHS should be to provide equality of access according to need (where need is defined as the ability of the NHS to improve health) or to use health care to try to achieve equality of health? Jacob Stewart
  5. Do you think Asylum seekers should be less entitled to health & social care than the rest of us?  Ruth Appleton

Questions about Health

  1. How would you surmount corporate, logistic and cultural barriers to realise the cost, healthcare and environmental benefits of cycling and walking for transport? Derek Gould
  2. Should the Government have a food policy? Hazel Andrews
  3. Can we afford to continue the war on drugs? Dr Paul Walker
  4. If you were leader would you tell the public whether your children had been vaccinated? Lucy Crocker
  5. Should breast feeding be compulsory? Should inflicting cigarette smoke on children be a crime? Dr Innes Pearse
  6. How can we maintain Labour values, avoid paternalism and have people do more for their own health? Susan Haworth
  7. What would you do to campaign or develop policy to enhance the life expectancy of people with mental health diagnosis in the UK?. Currently, people with a mental health diagnosis have an on average 15 year lesser life expectancy that the rest of the UKs population. Catherine Harris

Questions about health and the NHS

  1. Labour used Private Hospitals to carry out operations on some patients from the NHS waiting list. Was that justifed? Should we continue with that policy? Jannette Turner & Anne Gorton
  2. Scotland and Wales have abandoned the purchaser/provider split. Should England do the same? Irwin Brown
  3. For the past 50 years the NHS has relied on imported black staff to do the low status jobs. Can we carry on doing the same for another 50 years? Jasmine Edwards
  4. Will you consider abolishing the life time ban on men who have sex with men from donating blood? Lewis Webster
  5. What are your views about free fertility treatment for all women, including lesbians and on the upper age limit for abortions? Cllr Louise Baldock
  6. EU Health Ministers have adopted a European Council Recommendation that calls on Member States to develop and implement plans and or strategies for the treatment of rare diseases. What will UK health ministers be doing to develop a UK strategy for rare diseases, bearing in mind that there are over 6000 rare diseases affecting over 3.5 million people (1 in 17) in the UK? Liz Glenister/ Stewart Kirk
  7. Are you in favour of the use of PFI to rebuild the Royal Liverpool hospital, when PFI debt has dragged down local health economies in Manchester and around England? Do you have a policy or potential remedy to secure future costs of PFI’s are limited, or possibly secured against shareholdings we have in UK banks thus achieving practical and workable interest rates? Greg Dropkin & Tony Carr
  8. The role of Stigma in mental illness is crucial in determining optimal access to services. What will candidates do to bring mental illness out of the shadows so that it may enjoy a reaction amongst sufferers, carers, planners and the public that is mature and on a par with say, heart disease or cancer? Steven Hawkins
  9. Medical Royal Colleges in the UK advocate a centralisation of many secondary care services. Do the candidates agree with the clinicians that a shift away from the ‘district general hospital model’ is needed to achieve better clinical outcomes? Declan Harte
  10. How will you exert leverage to ensure that the current government follow through on their promise to put 4,200 more new health visitors into the NHS? Angela Roberts
  11. Will you be prepared to explore the notion that for many people, choice among health care providers is an unwelcome burden when they are sick, anxious and/or mentally frail? Who gains most from a consumerist approach to health care? Brenda Weston
  12. What role shouild markets and contestability  have in our health service? Margie Jaffe
  13. The NHS already rations treatment, through access to certain treatments and drugs, but this is never openly discussed. It is inevitable that demand for healthcare will outstrip supply in the face of higher expectations, improved treatments and an ageing population. How would you enable an honest debate about priorities and what the NHS can and can’t deliver? Marion Saunders
  14. Will you use the unique buying power of the NHS to keep prices down and not be dictated to by the Drug Companies? Anne Gorton

Questions about public involvement and democracy

  1. How will you ensure proper consultation about and influence on services with dignity and respect for the over 50s? Lydia Meryll
  2. Was it a mistake to abolish Community Health Councils in England? Malcolm Alexander
  3. Should we elect people to the boards which decide how NHS money is spent, or how else should we involve service users in the future planning and development of social and health care services? Mike Young
  4. In the 1997 election manifesto, the then leader of our party, Tony Blair, gave the following explicit promise to the electorate and the party: “Our fundamental purpose is simple but hugely important: to restore the NHS as a public service working cooperatively for patients not a commercial business driven by competition.” So my question is, how can you, would-be next leader, guarantee that you will not pursue policies exactly contrary to what you have promised? Dr Julian Tudor Hart
  5. Should we make it easier to close hospitals? John Taylor
  6. Would you make elected representatives responsible for allocating health resources or leave it with quangos or worse still businesses? Richard Bourne
  7. What ought we to be arguing for to ensure public acccountability for the decisions made by GP consortia? Lord Phil Hunt.
  8. I believe that local people especially in deprived areas should be closely involved with decisions about how services should be delivered especially in respect of cultures and social marketing especially prevention – obesity, alcohol, smoking, Teenage pregnancy. etc. Commissioners in health are too far away from the people and usually don’t live locally and do not understand the local culture/attitudes. How are you going to achieve this massive challenge? Ann Gerrard
  9. How are you proposing to challenge the government on accountability and democratic legitimacy in their propopals in the White Paper? How is there going to be any control over GPs spending decisions in relation to health needs which will be within the local authority?   There is is only the suggestion in the White Paper that the GP consortia might be represented on the Health & Well-being boards. Cllr Lilias Gilles
  10. How would a Labour government ensure the delivery of high quality health and social care for people of all ages with disability irrespective of post code and what weights and measures would be put in place to make delivery of this answerable to the end users? Dr Andrew Curran

Questions about social and long term care

  1. Will you introduce the National Care Service and if so how will it be funded? Jonathan Hurley
  2. With the elderly now being given the option to die at home, how would you guarantee 24/7 full medical care in this situation? Ellen Cargill
  3. What will you do to make sure carers needs are met to ensure their emotional and physical wellbeing and to ease their worries about those they care for if they need respite or take ill especially if the person they care for is solely dependent upon their carer and receives no other support? Lisa James
  4. Given the large numbers of people in prison with mental health problems, what ideas do you have about improving the mental health of the population who are most likely to turn to crime; and increasing opportunities for people to improve their mental health and well-being, whilst in the criminal justice system? What level of commitment do you have to the principles of the ‘New Horizons’ mental health strategy of the former Government, that sees improving mental health and well-being as not just the business of the NHS but of all departments? Tricia Hagan
  5. What is your vision for social care, particularly for people with disabilities? Duncan Enright
  6. What should we do about the divsion between health and social care? Will you commit to the principle that all care (including adult social care) should be free at the point of need and paid for out of general taxation? Irwin Brown & Mike Young
  7. When are politicians going to realise that Carers Allowance is too low and an insult to Carers everywhere? Clive Arnold

Questions about the Coalition’s plans

  1. What will you do to recreate our NATIONAL and free at the point of delivery health service after this government’s devastations? Val Hudson
  2. What exactly do you intend to do in order to stop the privatisation of the NHS? Teresa Holland & Jacob Stewart
  3. Are locally run social enterprises the future of the NHS? Tim Carter
  4. Would you like your doctor to be thinking about you or about his budget when he arranges your treatment? Martin Rathfelder
  5. Should there be a special fund to pay for drugs for cancer treatment? Liz Lawrence
  6. Do you want to hear the sound of bedpans dropping in hospitals resounding in the corridors of Whitehall? Dr Charles Brook
  7. If other European countries can manage without a nationalised health service, why do we need one? Julfried Kleinbach
  8. The Coalition is proposing a model of NHS universal outsourcing very similar to the model used by the Tories to privatize the railways, a public service delivered by private companies, which has turned out to be twice as expensive. So will you bring back NHS service delivery and direction back into public ownership where private sector delivery has increased costs and reduced efficiency, bearing in mind that Labour in office failed to return the railways to public ownership? Dr Jim Ford
  9. Where is there evidence of an alternative to established New Labour and Coalition policies for the systematic erosion of public audit,  the outsourcing,  privatisation (and offshoring) of public services (incl. health!), plus the consolidation of party political hegemony and the personal enrichment of political leadership? Des McConaghy
  10. Which parts of the health white paper do you agree with? And which parts do you disagree with? And why? Jacob Stewart
  11. Are you committed to removing the ‘market’ from health? Are you committed to ‘planning’ a quality health service? Tina MacKay
  12. The Tories are removing waiting time targets. I believe that the public will be forced to wait longer for treatment and that will make the private sector more attractive. What should we be doing about this? Lord Phil Hunt

What do you think?

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