When is an NHS reorganisation not an NHS reorganisation?

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.

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