Burnham fills in the blanks on 'reform without reorganisation'

If Labour triumph at the general election it may well be concluded that it was “Andy wot won it”.

Labour trail the conservatives on the economy and are broadly head to head on all other issues, expect health – where they are streets ahead. Tory polling guru Lord Ashcroft’s latest survey placed “improving the NHS” as the voter’s number one priority – overtaking the economy and immigration.

‘Andy Burnham wants to know how the service believes he can best achieve his desired outcome of “whole person care”’

Yes, Labour shadow health secretary Andy Burnham has the considerable advantage of the Lansley reforms to work with, but Jeremy Hunt is perhaps the most politically skillful health secretary of modern times and has fought a fierce rearguard action.

Given his success, it is perhaps not surprising that Mr Burnham is now prepared to be a lot more forthcoming about the plans he would implement should he be the first person to become health secretary for a second time.

Healthcare leaders, while warming to the Leigh MP’s rhetoric, have become increasingly frustrated at Labour’s “reform without reorganisation” message, knowing that nothing when it comes to the NHS is that simple.

Embrace considerable change

In his lengthy interview with HSJ, Mr Burnham makes it very clear that he is still in listening mode – wanting to know how the service believes he can best achieve his desired outcome of “whole person care”. But he is beginning to colour in-between the lines of his proposals for NHS organisations to become “preferred providers” and for health and wellbeing boards becoming the pre-eminent commissioning power within a health economy.

‘No private healthcare firm of any significance is going to queer its pitch with a potential new government’

On the former he says “it reflects what I feel about the NHS… that people matter, not profits. I think for too long too many politicians have been quite casual with that principle. Saying, you know, oh it doesn’t matter, we’re all neutral about who can provide services. I’m not and I don’t think most people in the NHS or the public are either.” Yet, it is also clear from his comments that he also has no attention of declaring war on non-NHS providers.  

He claims the introduction of a preferred provider regime, first proposed during his time in charge at Richmond House, would be “pro-reform”. It would allow the NHS to meet efficiency and integration challenges without the alleged straightjacket of competition regulations. The impression is that he wants to roll back some of the internal market/New Labour/Lansley reforms – but not all the way to 1979.

He explains: “You can carry on driving change into the system by almost saying everything is up for grabs, to be openly tendered, [so that] no one’s got any certainty any more… or you can do a cleverer thing and say the NHS organisations are not facing an existential threat [and that by] providing that security about the provider landscape, the deal is that people are going to have embrace considerable change in the way that services are provided.”

Rising sceptism levels

Mr Burnham is unlikely to get too much challenge on the preferred provider front – no private healthcare firm of any significance is going to queer its pitch with a potential new government and it is not a battle the Conservatives will choose to fight. The idea made the third sector nervous in 2009-10, but most are natural Labour supporters and will not want to rock the boat.

‘Mr Burnham is inclined, like Mr Hunt, to keep a tight grip on the variability of outcomes from centre’

The level of potential objection will be different when it comes to the developing role of HWBs. Here, scepticism levels in the NHS are high and the Daily Mail’s “Now Labour gives councilors the power of life and death” headline lurks just around the corner.

In his interview Mr Burnham fills in some important blanks, but stresses he wants to take the NHS on a “10 year journey” and that “people should embrace [integration] at a pace that feels right given the nature of the arrangements that they have at a local level”. He added: “The message I will send out is the quicker you embrace the notion of a single service and single budget, the quicker you will be placing your health economy on a path to sustainability. The longer people stick in the silos, and argue, I would guess that will increase not diminish the funding problem.”

All this talk of devolution notwithstanding, it is clear that Mr Burnham is inclined, like Mr Hunt, to keep a tight grip on the variability of outcomes from centre. “I can imagine being more insistent or tougher when it comes to the N in NHS,” he says before raising the challenging issue of compliance with recommendations made by the National Institute of Health and Care Excellence.

Miliband’s silence

System management and regulation are likely to play as significant a role in a Burnham run NHS as they have in a Hunt one. Monitor – that harbinger of market economics to the NHS – may even be transformed into the policeman of effective health and social care integration. It is also clear the financial incentives such as the Year of Care tariff will be as much to the fore as payment by results was when New Labour set about clearing acute waiting lists.

‘The biggest healthcare row post-election for a Labour government could yet be with the unions, rather than the private sector’

Mr Burnham claims the difference with the current administration is that Labour would be working with the grain of what the NHS and social care system wants to deliver. HSJ suspects he will have to continue to work hard to suggest his “evolutionary” approach will not create confusion or, perhaps as a result, morph into a full blown reorganisation.

The shadow health secretary’s stance on NHS staff pay is significant, given the scale of the efficiency challenges ahead. He says his intention to work with unions, but makes a point of using the line favoured by those running NHS trusts that “there is always a trade-off between what you can pay and job numbers”. The biggest healthcare row post-election for a Labour government could yet be with the unions, rather than any private sector group.  

One big question remains, but it is not one Mr Burnham can answer. Will he be in a position to see through his ideas? At the same time in the last electoral cycle, David Cameron had already confirmed that Andrew Lansley would be the Conservatives’ health secretary. No such word from Mr Miliband – and might Mr Burnham demand a greater reward for delivering electoral success?