Shadow Health Secretary Andy Burnham may not have his own policy commitment sewn up yet but that doesn’t stop him being emphatic about what he doesn’t want in his vision of a future NHS.
Speaking in his office at Portcullis House, Westminster on a balmy summers day, Burnham – who managed to look relaxed in a shirt and tie – showed signs of recovery after the hammer blow that was the Health and Social Care Act.
But while he is mostly consistent in his criticisms of the legislation, one area stands out. GP commissioning.
Shadow Health Secretary Andy Burnham may not have his own policy commitment sewn up yet but that doesn’t stop him being emphatic about what he doesn’t want in his vision of a future NHS.
Speaking in his office at Portcullis House, Westminster on a balmy summers day, Burnham – who managed to look relaxed in a shirt and tie – showed signs of recovery after the hammer blow that was the Health and Social Care Act.
But while he is mostly consistent in his criticisms of the legislation, one area stands out. GP commissioning.
Back in February 2012, in a bid to get the government to scrap the then beleaguered Health Bill, Burnham led the Labour offering of an olive branch, in which the party pledged to support GP-led commissioning.
The government, of course, declined the offer and fast forward a couple of months and Burnham appears to have changed his mind.
He now claims the new clinical commissioning groups (CCGs) could potentially damage the GP profession as a whole, thanks to the reforms “reblurring” the lines between the commissioning and provision of services.
“It is not healthy for people who have a stake in the provision of services to have control over the commissioning of services,” he says.
“GPs should absolutely have a central role in shaping commissioning decisions but not a controlling one.”
The risk to the doctor-patient relationship is never more evident than when it comes to the introduction of the controversial quality premium. He predicts while the policy may deliver short-term wins, by mixing financial incentives with clinical incentives, it will cause long-term “devastating defeats for everybody”.
Rather more worryingly, he also warns that a loss of “grip” over the locally focused CCGs will result in the government missing its self-imposed £20bn efficiency savings target through the QIPP (Quality, Innovation, Productivity and Prevention) programme.
Thanks to a perceived “downer” on nationally-led initiatives and targets being seemingly “out of fashion”, the Act has a undeniably strong localism mantra.
However, Burnham says the promise that the headquarters of the NHS will be in every consulting room in the country post 2013 is a “recipe for utter chaos”.
“The government’s localism agenda is not a national health service,” he says.
“The N in NHS is important because it brings clarity and control – and that is something you give up very lightly.”
The Conservative-Liberal Democrat coalition government has undoubtedly suffered at the hands of the Health and Social Care Act.
It bruised most easily amid claims the legislation seeks to open the NHS up to market forces and start the wheels in motion for the privitisation of the service.
Such claims were heard the most frequently from Labour benches.
But many in the health profession have accused the very politicians who shouted the loudest of being hypocrites in their opposition to the Health and Social Care Bill for seemingly opening the doors to the private sector in the first place.
Burnham refutes the hypocrite accusation without hesitation and without question.
While he resoundingly believes in a public NHS, Burnham says he has never been closed minded about the potential for the private sector supporting the health service.
“Can the private sector support and supplement the NHS? Of course it can.”
He makes the claim that Labour fundamentally changed the relationship between public healthcare and private healthcare by “eroding” the business case for the latter.
“When we came to government in 1997, the private healthcare industry traded on the back of the failings in the NHS,” he says.
“As we slowly improved the NHS, we eroded the business case for private healthcare. As waiting lists came down and as facilities improved, people had less and less reasons to go private.
“The private sector then had to make its capacity available as it became subordinated to the NHS.”
Clearly, Burnham is very proud of Labour’s record with the NHS in recent times, but admits delivering 18 week waiting time targets had to be “dragged along a bit”.
The involvement of the private sector, he claims, forced the NHS to produce improvements “that were not on the table before” and served to “change mindsets” among NHS workers.
Despite his defence, Burnham has called upon his critics upset with Labour’s stance on the private sector to join with all opponents of the government’s health reforms and with the pro NHS majority he believes exists to help him devise a new vision for the NHS.
Quite a task.
While he was reluctant to say too much about the details of Labour’s planned health policy, should the party come in power in 2015, Burnham has pledged to restore the 2006 legal basis of the NHS or in his words, “the free for all enshrined in the part three of the bill”, but remains non-committal on how this can be achieved.
“I want to repeal the spirit and whole intellectual basis of the Act,” he says.
“Whether that means completely taking [the legislation] off and putting another on, or how you best do it without throwing the NHS into another top down reorganisation is something I am working through at the moment.”
Rather than spend his time agonising over whether PCTs stay or go, Burnham intends to build his idea of a future NHS around the concept of ‘whole person care’, a policy in which mental health comes centre stage.
He claims it is clear the future of the NHS depends on whether it can look at the whole person and deal with a person’s physical, mental and social needs together.
Burnham is adamant he doesn’t want to develop his policy within the confines of Westminster and dump a telephone directory of ideas on people’s desks at the end of it.
He has promised to publish information to inform people how they can contribute to the “big alternative policy” and the ways in which the party will make the process “as inclusive as possible” shortly.
For now, Burnham is busy working on “exposing the reality” of the government’s legislation through an already popular ‘NHS Check’ process, whereby his health team will sift through thousands of reports written by both staff and patients at the frontline of the reforms.
He also is working hard to ensure Labour councillors who opposed the reforms continue to work with commissioners and providers “to keep the NHS together”.
A former Health Minister in 2009 – 2010, Burnham often jokily refers to himself as a “shadow of his former self”.
He has already had a wide and varied career in politics but it is the protection of the NHS that is his passion.
Promising he has no intension of going anywhere, he knows uniting and re-energising the bill’s opponents will be a big ask.
But with the challenge comes opportunity and this marks the first time a Labour politician has had the time to properly step back and devise a health and social care service fit for the 21st century in 20 years.
One thing is clear – Burnham is determined not to waste it.
