Andy Burnham made an important speech to Conference about the Labour Party’s policy on health services. In doing so demonstrated why it’s important for opposition parties not to announce policy specifics 30 months before the election. What he has discovered is that when you announce one big thing it leads to a whole host of questions about everything else. .
He announced a number of things that will now be probed in great detail.
First there is the important question of whether the next Labour Government will launch a top down reorganisation of the NHS. On Wednesday he restated his February policy to repeal the Coalition’s Health and Social Care Act.
Last Sunday his boss, Ed Miliband, was asked on the Andrew Marr programme why he was arguing for a reorganisation of the health service in 2015 when it was such a bad idea in 2012. The toxic question for Labour politicians in the next election campaign will be, “Why do you want to put the NHS through another reorganisation?” As Ed Miliband pointed out to Andrew Marr the current reorganisation is a big upheaval that is happening to the NHS at a time when money is very tight and it has a lot to do.
Ed Miliband argued with some force that 2012 is a crazy time for a reorganisation of the NHS.
But the problem with that argument is that in the run up to the election this will leave Ed Miliband being asked “Given the money is still tight, and given that the NHS still has so much to do, why do you want another complete reorganisation? You said it was a diversion for the NHS in 2012, so why won’t it be a diversion in 2015?”
On Wednesday Andy Burnham’s defence against this was that the repeal of the NHS Act is not a reorganisation of the Health Service.
But if you repeal the Act you don’t have any structure and you will need a new one. His speech did seem to say that he wanted to transfer power to the local commissioning of NHS services – from the new NHS Clinical Commissioning Groups to Local Government Health and Well Being Boards.
I don’t know what the abolition of CCGs looks like from the podium in Manchester but out here in the NHS it looks a lot like a top down reorganisation of the NHS. An Act in 2016 that abolished CCGs and gave the power of NHS commissioning to Health and Well Being Boards is a top down reorganisation of the NHS.
In another part of his speech he wisely said that if he were to become Secretary of State for Health he will ask the existing organisation to act differently – with more cooperation – and will therefore not need a new organisation. That’s a really good idea but CCGs can’t act differently if you abolish them. And repealing the 2012 Act will abolish them.
The problem here is the way in which he sees power. Andy Burnham is making the same mistake as Andrew Lansley. They both see the answer to their problem as coming from legislation.
A clever alternative which Lansley rejected and Burnham looks as if he might also reject is to keep the legislation you have already and make the structures work differently.
But you don’t do that by repealing the Act.
The second policy issue that Andy Burnham addressed was the development of greater power for the ‘N’ in the National Health Service. As he will know New Labour had a really good track record of creating much greater strength for the ‘N’ in the NHS. The creation of NICE is probably the single most powerful addition to the national infrastructure in any of the 60+ years since the creation of the NHS.
At the same time New Labour created the National Frameworks for certain conditions and diseases. I have said before that the national Tsars for Cancer and Coronary Heart Disease, backed up by the Government did more to create a single national clinical approach to these killers than has ever happened before. They have saved thousands of lives through creating this more national approach
So the ‘N’ in the NHS really matters – and since he wants to make this stronger I am really puzzled as to why he wants to give power over local NHS Commissioning to local government.
Local Government, through the election of local councillors, has an essential role to increase the power of locality. Councillors in Walsall get elected on a political platform that argues strongly that Walsall is different from Wolverhampton. This is what local government is. It essentially differentiates locality from locality.
What it isn’t and what it can’t be is something that strengthens a national approach to any service.
It may be a good thing to give the NHS to local government but it won’t make it more national – it will fragment it around locality.
The third policy issue was the role of the private and the voluntary sector as providers. It was interesting to read that he saw that there was a role for the private and the voluntary sector in supporting a publicly accountable NHS. Obviously not a big role, but a role.
I remember in March 2006 there was an enormous fuss about the role of the private sector in providing operations to NHS patients through Independent Sector Treatment Centres. In that month ISTCs carried out 1% of all of the operations carried out on NHS patients
In proportion this was obviously very small. But in impact it was very large. A few percentage points of support from the voluntary and private sectors can have a very big impact.
But there was a further puzzle in the speech. As I say he was in favour of the voluntary and private sector having a supporting role for the NHS, but he was against competition.
This led me to wonder how the voluntary and private sector could get to play that supporting role. Could he be suggesting that NHS commissioners simply give the contracts to private and voluntary providers without any competition? Just giving the private sector contracts without competition would bring a very large storm down upon his head.
(And would in any case be illegal)
So to get what he wants – voluntary and private sectors providing support to the NHS he has to use competition.
Three issues then from this speech:
1 If you abolish the current Act you will carry out a top down reorganisation in the NHS in 2016.
2 If you give local commissioning power to local government you fragment the ‘N’ in the NHS.
3 If you say you want a supporting role for private and voluntary providers for the NHS, then you need competition to get them that role.