Chris Skidmore MP is the MP for Kingswood and a member of the Health Select Committee.
Several commentators have already picked up that Ed Milliband’s decision to reshuffle Andy Burnham from education points towards an admission that Labour had dropped the baton on school reform, moving away from an agenda of raising school standards through the creation of more good school places pioneered under Blair. In his unwavering support of local authorities and opposition to the expansion Academies and Free Schools, Burnham painted Labour into a corner of being the party of anti-reform. His successor, Steven Twigg, has quickly moved to change Labour’s position, deciding to take a more evidence-based approach, rather than the outright ideological opposition mooted by Burnham.
So, now back in his old job in health, Burnham has moved quickly to his default position of opposition for opposition’s sake. The problem is that while it may be easy for Labour to say what they are against, but they cannot tell us what they are for, much less what they would do to solve the financial crisis that the NHS will face if reform does not take place. With an ageing population, where the number of people over 85 will reach 3.5 million by 2030, it has been estimated that without change, the NHS will need £130 billion by 2015, and possibly £230 billion by 2030.
Even Ed Miliband accepts that doing nothing is not an option. In a speech to the RSA earlier this year, he admitted that “to protect the NHS is to change it… to create an ever better health service, change will be essential.” But with Burnham at the helm, just as with education, it seems that ideology will blind Labour into becoming the anti-reform party in health. This is to be regretted, given that it was New Labour who managed to extend the use of new providers within the NHS, particularly Independent Treatment Centres, which undertook a total of 797,773 procedures between 2006 and 2010.
Indeed, leading Blarite advisers such as Julian Le Grand have asserted that The coalition’s Health Reforms “ are evolutionary, not revolutionary: a logical, sensible extension of those put in place by Tony Blair”.
While he was in post as Shadow Health Secretary, John Healey was also broadly supportive of the need for reform. “The general aims of reform are sound” he told the King’s Fund in January, “greater role for clinicians in commissioning care, more involvement of patients, less bureaucracy and greater priority on improving health outcomes – and are common ground between patients, health professions and political parties. They could be achieved by the evolution of Labour’s reforms ….”. According to other sections of the speech, Healey admitted that “No-one in the House of Commons knows more about the NHS than Andrew Lansley – except perhaps Stephen Dorrell. But Andrew Lansley spent six years in Opposition as shadow health secretary. No-one has visited more of the NHS. No-one has talked to more people who work in the NHS than Andrew Lansley.” These words were to hang millstone-like around his neck.
In a populist drive to simply oppose for opposition’s sake, level-headed thinkers such as Healey have been dumped in favour of crude scare tactics promising ‘72 hours to save the NHS’ and bandying around words such as privatisation and competition as if they were four letter words.
Compare this to eighteen months ago, when the Labour party stood on its manifesto commitment that “We will support an active role for the independent sector working alongside the NHS in the provision of care, particularly where they bring innovation,” adding, “Patients requiring elective care will have the right, in law, to choose from any provider who meets NHS standards of quality at NHS costs.”
Now, with Milliband’s lurch leftwards, all this has been committed to the fire as Labour have decided to rip up any commitment to diversity of provision within the NHS. Appointing Burnham back at health is a clear sign that Labour are reverting to out-dated dogma. During his time as Health Secretary, Burnham sought to undermine Blairite reforms with his ‘preferred provider’ model, turning against third-sector and voluntary providers. Under Burnham’s proposals, failing or underperforming NHS trusts would have been allowed to keep an NHS contract to allow them to improve, rather than allowing charities and private companies a chance to take over provision of that service. Burnham's decision surprised cabinet colleagues and charities alike, who stated that his position was ‘profoundly worrying’.
Nevertheless, Burnham delighted his union colleagues, with Unite congratulating him on the move, stating that "The not-for-profit sector cannot provide the stability needed for health provision."
Presumably, Burham’s heart still lies in favour of his preferred provider model within in the NHS. It will be interesting to see how discussions develop with his shadow minister, Liz Kendall, who admitted in December 2010 that “I’m a long-standing supporter of Independent Sector Treatment Centres and of the need for commissioners to be able to bring in private and voluntary sector providers, as well as alternative NHS provision, where existing services fail to improve.”
Perhaps Kendall will get her boss to see sense, and not abandon key principles of reforming the NHS that needs to take place if we are to have an effective service free at the point of delivery for the twenty-first century. At the moment, however, the most worrying position Burnham has taken is to oppose any real-terms increases in the NHS budget. “It is irresponsible to increase NHS spending in real terms within the overall financial envelope” he stated in June 2010, while still Shadow Health Secretary.
At a time when the government will be increasing NHS funding by £12.5 billion over the course of the parliament in order to cope with demographic change and rising demand of around 4% a year, to oppose an increase in the health budget is simply reckless.
Reform is not an option, but a necessity.The NHS must work better, delivering greater productivity within its services, but even these savings will not be able to solve the impending crisis that the health service faces if we do not create a patient-led service with clinicians responsible for budgets at the same time as a renewed focus on prevention. New providers will be crucial to this strategy, yet it seems that with Burnham’s appointment, Milliband and Labour are turning their back on the work they did in government to open up a rational and responsible debate on how to improve the NHS.