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A tidal wave to solve an earthquake


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Friday, 25 January 2013

A tidal wave to solve an earthquake

The shadow health secretary Andy Burnham made a speech to the King’s Fund yesterday in which he mooted proposals to hand the running of the NHS over to local government.

There was more to it than that, but that’s what the plan boils down to.

The point of being in opposition is not to propose new policies but to rubbish the existing ones.

This is very safe territory to operate in, particularly in a recession and in the wake of the most radical reforms since Henry VIII decided to decommission the monasteries.

Andy Burnham has several assets on which he has traded very successfully so far. He has authentic working man roots. He is liked for his frequent allusions to football and his former job as minister of sport.

He had a short stint as a health minister in 2006 and was briefly secretary of state for health in the dying months of the Brown government, giving him the further advantage of an unblotted copybook.

Mr Burnham couldn’t miss against the architect of the reforms, the uncharismatic technocrat Mr Lansley, nor did he waste much time getting stuck in to his new opponent, right of centre forward Mr Hunt.

On 5 September, the day after the new secretary of state took office, Mr Burnham wrote to Mr Hunt demanding to know if he stood by proposals to denationalise the NHS and replace it with an insurance system, which appeared in a document co-authored by Mr Hunt in 2005.

The following month, in his speech to the Labour party conference, Mr Burnham made easy work of the new health secretary’s low profile calling Mr Hunt “the invisible man” and “lightweight Jeremy”.

Ten days ago during health questions in the House of Commons, doubly blessed with the prospect of cold weather and figures showing missed targets for NHS A&E departments, Mr Burnham went in with both feet. Fellow minister Jamie Reed was right behind him bemoaning the “parlous state” of ambulance services “as a result of this government’s wasteful and expensive reorganisation”.

In yesterday’s speech Mr Burnham abandoned the safety of the sidelines and launched a spectacular flying tackle on existing policy, proposing nothing less than the full integration of health and social care – the only way, he argued, to cope with the financial pressures on both systems, co-ordinate services, address the determinants of health and keep grubby privatising paws off the NHS. 

Mr Burnham was careful to frame his speech as “a green paper moment, the start of a conversation” not as a manifesto pledge. But he did make one promise:  “nothing I have said today requires a top-down structural reorganisation”. We heard something very similar two and a half years ago.

Mr Burnham’s proposals raise huge questions about who would direct spending on health and how priorities would be decided. Will local politicians be bolder and wiser than existing NHS commissioners or the GPs about to replace them?  With a single budget under the control of local government, will care pathways trump highway repairs?

In his welcome letter to Mr Hunt, Mr Burnham wrote: “We repeatedly warned your predecessor that he was making a disastrous mistake by reorganising the NHS at a time of financial stress. This has led to two lost years for the NHS. It has been distracted from the efficiency challenge and patient care has been put at risk.”

Now that the NHS has been reorganised it is difficult to see how a future government could pull off so radical a change without straying into the same dangerous territory. It’s as if Mr Burnham were proposing a tidal wave to solve an earthquake.

With more than two years to go before the next general election, Mr Burnham can afford to be bold. There is plenty of time to water down the proposals and retreat to the sidelines.

d.macintyre66@gmail.com says:
Jan 25, 2013 11:57 AM
Will the funny man be back next week?
jpatterson says:
Jan 25, 2013 12:13 PM
No, I'm afraid we can't feature Mr Burnham twice.
mmundey says:
Jan 25, 2013 01:32 PM
Five star review for this post...incisive comment as always! It's terrifying to see yet another politician lining up to give the NHS football a good punt.
janerubidge@hotmail.com says:
Jan 25, 2013 01:46 PM
Mr Burnham seems to have taken his eye off this particular ball - LAs are currently being quietly reduced to zero under the Dick & Nave Show's agenda so nothing to hand the NHS to. Unless of course doing this would stop the demise of local government -oh hang on, giving the NHS to local government would finish the job much more quickly - euthanasia so much kinder than starving to death! Central Government 1, Local Government 0. Result. You heard it here first Messrs Cameron and Clegg.
robinr says:
Jan 25, 2013 02:32 PM
Perhaps we'd better hang on a bit to read the transcipts; but on the face of it, this sounds like a return to where Labour left off. For many years - long before Andy arrived - the direction of travel under Labout had been towards integration, and at local authority level, simply shorn of Brown's customary timidity. Perhaps Andy feels they no longer need to worry about alienating all the medical profession.
jpatterson says:
Jan 25, 2013 02:58 PM
robinr says:
Jan 25, 2013 05:16 PM
Ah, some times you do just think, isn't the internet rather good......
t.eynon@nhs.net says:
Jan 25, 2013 05:36 PM
The Francis Report is about to disperse any lingering illusions about NHS accountability. The HSCA, rather than reducing the layers of bureaucracy, has multiplied them beyond all reason. The addition of toothless Quality Surveillance Groups to the mix only reinforces duplication and redundancy.

The one bright star in Lansley's legacy has to be Health and Wellbeing Boards. Comprised by local representatives of service users and providers, they are, in more functional councils, being led by public health.

Surrounded as they are by the bastions of unaccountable bureaucracy, they are likely to fail. In control of an integrated health and social care budget, they could have the huge advantage of having local politicians on board.

Why do I say that? Not because I think politicians are especially bright or clever. Neither are they always terribly representative. The good thing about politicians, compared to public sector CEOs is this: You can embarrass a politician with the truth and, with a little help from the electorate, end their career forever with no golden handshake.

If we'd had that kind of accountability, we might not have waited so long for Mid-Staffs.