The big NHS speech by Burnham the media ignored

10:24 am - January 25th 2013

by Sunny Hundal    

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Yesterday, the shadow health secretary Andy Burnham gave a very important speech on the Labour’s party vision for health and social care in the future.

You can’t say Labour is failing to develop important policy, but it is obvious that they find it difficult to get heard. The national media barely paid attention to it.

The speech, titled ‘Whole Person Care‘ was to open Labour’s health and care policy review.

Burnham said that historically there had been three systems to deal with differing aspects of health and care: physical health in hospitals, mental health often in separate services on the fringes of the NHS, and social care led by council run services.

He said the consultation would look at full integration of health and social care within a single pooled budget.

Provision for the barriers between mental and physical health would be tackled by giving them equal priority, families would have a single point of contact when seeking care, and streamlining resources will allow the NHS to invest in more preventative measures.

In his speech he reiterated that Labour was committed to repealing the NHS Bill as far as possible, without pushing the NHs through another costly and time-consuming re-organisation.

Health and Well-Being Boards could come to the fore, with CCGs supporting them with technical advice. While we retain the organisations, we will repeal the Health and Social Care Act 2012 and the rules of the market.

It is a confused, sub-optimal piece of legislation not worthy of the NHS and which fails to give the clarity respective bodies need about their role.

Dan Holden at Shifting Grounds says of the speech:

Throughout his speech Burnham took care to describe the financial benefits of his plans, as well as the health benefits. Specifically, with elderly care, he described how the facilitation of care at home and an increase of social care workers on wards would both decrease costs, free up hospital beds and provide more comfortable care for many frail and unwell elderly patients.

You can read the whole speech here.

It’s about time Labour came out with some bold new ideas on health and social care, and this was a good start. Burnham deserves a lot of credit for continually pounding the government’s failures on the NHS; it’s just a shame not more attention* was paid to the speech.

[* the Telegraph wrote it up briefly as ‘reviving the spectre of a death tax‘, though they have published a more favourable editorial.

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About the author
Sunny Hundal is editor of LC. Also: on Twitter, at Pickled Politics and Guardian CIF.
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Reader comments

I think what you meant to say was “Minister stupidly chooses to give speech on day when he knew everyone would be looking at Davos”

Fair play to Andy Burnham on this – he’s clearly thought long and hard about the NHS and how it fits into the wider context of social care and public health. I think we can now expect a radical health and care policy, with wide support from medical professionals, to be a flagship of the next Labour manifesto.

The Holy Grail, for me, would be an integrated National Health and Care Service funded through general taxation – but for now I just hope we can have a grown-up debate about care funding that isn’t characterized by stupid ‘tombstone’ posters and the like.

`In his speech he reiterated that Labour was committed to repealing the NHS Bill as far as possible, without pushing the NHs through another costly and time-consuming re-organisation.’

So not at all then. Private companies will continue to deliver NHS care whilst at the same time sloughing off 20% of our National Insurance Contributions to pay fat cat excutive salaries to the shysters that run them and undeserved dividends to the absent shareholders that own them. Add that to cuts in spending and you’ve got a huge reduction in the amount of money going to front line services. The NHS remains in name only because the care and treatment available free at the point of delivery will soon be so poor that unless you have private insurance don’t bother.

4. Alisdair Cameron

I’m sorry but while this has some promising elements, overall there’s not that much to get excited about.
Pooling of health and social care budgets has been a “holy grail” for nearly 60 years, and every darn politico sooner or later believes they’re a genius for proposing it. Everyone in health and social care knows it makes sense…
BUT…healthcare in the form of the NHS is free (broadly speaking) at the point of use. Social care is means-tested, and often requires contributions by the recipient.
What our politicians can’t face up to is deciding whether to integrate health so that it then ceases to be free, or integrate soc care so that it’s no longer means-tested. The first is political dynamite (but Tories and Blairites alike want it) and the second unaffordable.
We talk all we like about integration, but when the funding mechanisms are at odds with one another, we’ll always see cost-shunting. Until this is resolved,there’s little difference between a dispute between health and social care bodies, and an internal dispute within a merged health and social care set-up.
It’s a plain issue. Just one that keeps being ducked, fudged or people try umpteen sophisticated attempts to triangulate it away, or pretend it’s not there..

@ David Ellis

“So not at all then.”

The idea is that we can keep the institutions we inherit from the Tories – CCGs and the rest – but change the way they operate. That makes a good deal more sense than trying to push through a second top-to-bottom structural re-organisation in the space of five years.

It’s not the existence of the institutions themselves that’s responsible for increasing privatisation, after all – it’s the way the healthcare market operates under the rules those institutions are required to follow. By repealing the Bill, you can get rid of those rules and fundamentally change that market.

Go and read the speech. To give you a flavour:

“NHS hospitals need the security to embrace change and that change will happen more quickly in an NHS Preferred Provider world rather than an Any Qualified Provider world, where every change is an open tender.
I don’t shy away from saying this.
I believe passionately in the public NHS and what it represents.
I think a majority of the public share this sentiment.
They are uncomfortable with mixing medicine with the money motive. They support what the NHS represents – people before profits – as memorably celebrated by Danny Boyle at the opening ceremony of the Olympic Games.
Over time, allowing the advance of a market with no limits will undermine the core, emergency, public provision that people hold dear.
So I challenge those who say that the continued advance of competition and the market into the NHS is the answer to the challenges of this century.
The evidence simply doesn’t support it – financially or on quality grounds.
If we look around the world, market-based health systems cost more per person not less than the NHS. The planned nature of our system, under attack from the current Government’s reforms, is its most precious strength in facing a century when demand will ratchet up.
Rather than allowing the NHS model to be gradually eroded, we should be protecting it and extending it as the most efficient way of meeting this century’s pressures.
The AQP approach will not deliver what people want either.
Families are demanding integration. Markets deliver fragmentation.”

Alasdair: So what you are saying then is that not only will New Labour be keeping private provision of national health services but they will be introducing means testing for those seeking it. No wonder they wanted the media to ignore it.

Not only will New Labour keep the private provision of health services but it will introduce means testing for those wanting to use those services and it will get rid of the internal market so that the private providers have a guaranteed monopoly. That way they can screw the National Insurance Contributor not once, through fat cat salaries, not twice, through shareholder dividends, but thrice, through monopoly prices.

There will be no democratic control over these providers who will be able to dictate terms and refuse to provide services that cost them money.

@ David Ellis

Where are you getting this stuff from, exactly? They’re talking about weighting the market towards the NHS (Preferred Provider), not private companies (Any Qualified Provider). There’s been no suggestion of means testing for health care. And a key proposal is to put democratically accountable Health and Well-Being Boards in charge of commissioning services.

Read the speech. Failing that, read some responses to the speech by healthcare experts.

@4 – true, but there are several stepping stones that would help:

– National Governments publishing health and social care as one line in the budget rather than the absurd position we are in where the tories claim to be protecting the health budget and at the same time slashing local authorities which means slashing social care.
– This means social care needs to be taken out of the control of local authorities (I’ll assume I don’t have to make the case against doing this the other way and making health the responsibility of local authorities).
– Seperating administration of primary and secondary care (not sure if you already do this in England – but we don’t in Wales..).
– Social care and primary care are similar enough that they can be merged – it isn’t that difficult to start means testing and introducing charges in primary care.
– Admistrative body for secondary care should then have power to fund treatment in primary/social care settings.

What we are then left with is secondary care free at the point of delivery, and primary/social care with charges and means testing. Administrators can then fund primary/social care in specific cases when doing so makes sense.

Budgets wise, when further finance is available, we then prioritise the reduction of means testing in social care/primary care, perhaps by implementing Dilnot and then reducing the thresholds so that we can incrementally move towards universal system.

10. David Ellis

`And a key proposal is to put democratically accountable Health and Well-Being Boards in charge of commissioning services.’

Quangos held to ransom by private health service providers with a monopoly.

The Coalition basing itself on the foundations laid by New Labour have turned the NHS into a massive ATM machine for their carpet bagging private sector friends. The least a workers’ government could do is drive these carpet baggers out, restore the publicly-owned and democratically accountable NHS as the provider of these services and have its management elected by its workforce instead of imposed by political patronage, the Old School Tie Network or absent shareholders.

Whatever we may believe Mr Burnham said in his speech, can we all remember it was just a speech.
I am yet to be convinced that I should believe a single word that any politician says.
Whether in power or opposition they all have considerable form for being economical with the truth.

Seeing how relaxed Labour M.P.s were sitting alongside their hero and arch manipulator, Mr Blair could have decided to re-launch New Labour as The Conservative and Unionist Party or even The Nationalsozialistische Deutsche Arbeiterpartei, as long as the expenses kept coming and their property portfolios continued to grow they wouldn’t have given a toss.
Please, let us move away from tribal politics, you can’t put an atomic particle between the three main Parties and their corporate paymasters.
Can we try and bring this shamocracy to an end and just stop voting for them. Please.

@ David Ellis

“The Health and Social Care Bill mandates a minimum membership of:

– one local elected representative

– a representative of local Healthwatch organisation

– a representative of each local clinical commissioning group

– the local authority director for adult social services

– the local authority director for children’s services

– the director of public health for the local authority

Local boards will be free to expand their membership to include a wide range of perspectives and expertise, such as representatives from the charity or voluntary sectors.”

These are publicly owned, democratically accountable bodies. No shareholders, no Old School Tie Networks, no political patronage: just NHS staff, local authority staff, elected representatives and members of the public.

Under Any Qualified Provider, it’s probably true that these groups can be held to ransom by powerful private companies. Hence the proposal to scrap those rules and give Preferred Provider status to the NHS.

13. the a&e charge nurse

I’m reminded of this – ‘The government is to press ahead with massive structural changes to the NHS because this time it is obviously going to work. Health secretary Andrew Lansley insisted all the previous massive reforms had missed out something really simple and that all he had to do was to make sure that did not happen again. And he stressed that this time it would definitely work because the government had asked a lot of doctors what they think’.

Yes, more NHS reform with everything being prioritised exactly the same,and enough cash for everybody; what is there not to like?

“In his speech he reiterated that Labour was committed to repealing the NHS Bill as far as possible, without pushing the NHs through another costly and time-consuming re-organisation.”

This is exactly what Labour said about the Railways Act 1993. I call bullshit.

Obviously a lot of thought has gone into this. but he missed one very important point and that it, later this year clinical commissioning groups that take over from PCT’s via local doctors surgeries and thier involvement, will be responsible for buying all types of care from that in hospital to care homes. I have not heard quite how the budget side of things are going to work particualry when the CCG’S run out of money.

@ John Edwards

I think the proposal is to transfer much of the responsibility for commissioning care and managing budgets from CCGs to Health and Well Being Boards that are both more democratically accountable and better able to take the widest view of local needs.

Re 1 Ian.
Who is this mysterious, stupid ‘minister’ you’re talking about? Obviously not Andy Burnham as he’s not in government. Remind me exactly who’s being stupid here?

‘A single point of contact for their care’

That’ll be the GP then ie the person doing it now. Doesn’t sound like big change to me. But given that we have a model of primary care that is the envy of the world, quite rightly, it would be good to start here when thinking of more integrated models.

Before rushing headlong into giving health and social care to local government, or to a partnership board with dubious governance arrangements, no clear remit or processes for making decisions I would follow closely two things specifically that are taking shape now;
1. The experience of moving public health put of the NHS to local government. This is a seismic change which no one in government understands and the rest of us can only guess at the consequences but you can be sure some of them will be unintended.
2. How work of Health & Wellbeing Boards unfolds. Some will probably be well run, transparent, strategic and focus on the wider determinants of health in its widest sense and the added value of partnership. Others will be parochial, small minded and narrow, confining their discussions to the latest headline, local minutiae and on sectional interests so they will pass the buck, argue over money and duck their responsibilities and fall apart or become cosy and closed. What citizens end up with will be pot luck. In the face of the latter I might prefer NHS ‘grip’ and command and control.


Which is worse ignoring Any Burnham’s speech or ignoring the Mid-Staffs inquiry?

Come on – direct your attention towards where some real good can be done.

20. the a&e charge nurse

[19] I agree there is an important debate to be had in the wake of the Francis report (Mid-Staffs) but the article you link to is a pretty feeble analysis

21. the a&e charge nurse

And wasn’t Burnham singled for criticism by the families of those affected by the Mid-Staffs scandal?

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