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NHS “credibility gap”

The Conservatives have overtaken Labour for the first time since March 2012 in the latest YouGov/The Sun poll.


David Cameron has an inherent advantage in the public perception’s of his leadership qualities, in that he is doing the job every day and being seen to do so on the news. Credibility is an important currency. And Labour has already stated ‘the market went too far’ in the NHS. It is not a secret that many parts of the media try to present Ed Miliband in a negative light. Labour is trusted on the NHS, and the Tories are trusted on the economy; so a rationale strategy for the Tories is to make the link between the country’s economy and the NHS. However, real-terms NHS funding has effectively flatlined for a number of years now, not keeping up with the inflation in the system, and debt under this Government has got out of control.

For example, you’re more likely to get a discussion of the ‘bacon butty’ incident than a discussion of how NHS contracts have been aggressively been promoted to the private sector, or how the Health and Social Care Act (2012) locks in the market.

bacon butty

The Prime Minister often blames this lack of coverage on the era of the rolling news, but conversations in the social media have been very productive in exposing events which the BBC would rather not cover. David Cameron’s segment on the NHS was certainly passionate. Cameron must have been distraught at the closure of the Cheyne Centre which he had once fought to keep alive.

But actions speak louder than words.  When Cameron claims he will protect the NHS he doesn’t say from whom or what he needs to protect it.   He no longer talks about the importance of competition in the NHS and many of the initiatives associated with Andrew Lansley seem to have been quietly forgotten.

If David Cameron had wanted to win the trust of the medical profession, he would not have ambushed them out of nowhere with a ‘top down reorganisation’ which he promised would never happen. The £2.4 bn reorganisation is widely considered to be a tragic waste, when money could have, and should have, been invested in frontline services. The chunk of the speech on the NHS was little consolation to hardworking nurses who’ve witnessed yet another pay freeze, despite the economy’s performance recovering. Nurses, part of the lifeblood of the service, are not immune from the ‘cost of living crisis’, particularly if they are living in London and working in one of the powerhouse teaching hospitals.

A&E targets have been consistently missed during the duration of this period of office by the Conservative Party (and the Liberal Democrat Party).

The current Government need to address what to do about the ‘private finance initiative’. New contracts have been awarded during the lifetime of this Government, and, whilst they were undoubtedly popular under New Labour, their origin is clearly found in the John Major Conservative administration of 1992-1997.

David Cameron, in his conference speech, simply behaved so passionately about the NHS as if the Lewisham debacle had never happened. The current Government even spent money trying to win the case in the Court of Appeal.

GP waiting times have been an unmitigated disaster under this GovernmentThere has been a marked rise in the number of NHS trusts in deficit. Jeremy Hunt is stuck in a time warp. He mentions Mid Staffs at every opportunity. Hunt, completely disingenuously, does not let the failures in culture, quality or management, identified at the CQC, soil his lips. The “Keogh Trusts” were dealt with due to failings which had occurred in the lifetime of and due to this government.

Like the referendum on Europe, promising ‘to protect’ the NHS could be ‘jam tomorrow‘, if the Conservative Party fail to get re-elected. It is either a sign of confidence, or sheer arrogance, that David Cameron and colleagues can hang these uncoated promises in thin air.

The position in an editorial of the Financial Times is clear – and damning:

“But in the bid both to draw a clear dividing line with Labour and reassure the wavering right, they have staked out a fiscal position that is neither sober nor realistic.”

And, hard though it might be to swallow, the Coalition appears to have an ‘edge’ on some key policy areas.

policy edge

Labour would never have been able to get away with such dodgy promises, with their plans for government being watched like a hawk. With the help of the BBC and other supine media outlets, rather, there will be an inadequate scrutiny of these Conservative plans, which hopefully will be better articulated before the time of the election. As such, it does not matter what Labour promises its voters on the abolition of the purchaser-provider split, whole person care, the private finance initiative, reconfiguration of hospitals, GP waiting times, patient safety, and so on, if voters wish to vote for ‘jam tomorrow’.

The hope is that a Secretary of State for a Labour government would be able to untangle the UK government out of TTIP and CETA trade agreements further giving propulsion to neoliberal forces attacking the NHS. There is a hope that health and care finances will be properly funded in the next Government. All parties have arguably failed to have this conversation with the general public thus far.

Some policies of the current Conservative-led administration are incredibly unpopular with Labour voters: e.g. welfare benefits, NHS privatisation, repeal of the Human Rights Act. The feeling of many, currently, is that, while they do not particularly like this Government, they do not wish to vote for Labour which appears to be offering a diluted form of what the Conservative Party is offering. This is not in any way a indictment of the sterling efforts of the Labour Party Shadow Health Team.

But, before Labour attempts to plug the ‘funding gap’, it will need to resolve any ‘credibility gap’ first.



Andy Burnham’s speech to the Labour conference on 24 September 2014



Andy Burnham MP, Labour’s Shadow Secretary of State for Health, in a speech to Labour’s Annual Conference 2014 in Manchester, said:



Conference I’ve got a question for you.

Hands up how many of you would walk 300 miles to save the NHS?

Stand up if you actually have?

Leading from the front, speaking for millions – Conference, please show your appreciation for the Darlo mums and the People’s March for the NHS. We have arrived at a big moment.

The party that created the NHS in the last century today sets out a plan to secure it in this. A rescue plan for a shattered service.

But more than that. A vision for a 21st century NHS there when you need it, personal to you and your family, with time to care. A national health and care service based on people before profits.

Today we place that proud Labour plan at the centre of our election campaign.

And, thanks to Ed’s great speech, we have the money to back it up.

A plan worth voting for, proof that all parties are not the same, giving you a real choice over the future of your NHS.

Because it certainly didn’t happen last time.

Remember that solemn promise of “no top-down reorganisation”?

It was a bare-faced lie.

Days into office, the Tories set about dismantling your NHS.

And the plan that dared not speak its name before the last election is now plain for all to see: run it down, break it up, sell it off.

So today we serve notice on Cameron and Clegg: Thursday 7th May 2015 – your day of reckoning on the NHS.

A reckoning for trashing the public’s most prized asset without their permission.

And a reckoning for a ruinous reorganisation that has dragged it down and left it on the brink.

A winter crisis in A&E now a spring, summer and autumn crisis too.

Over three million people on NHS waiting lists.

Families waiting longer for cancer treatment to start – and the national cancer target missed for the very first time.

The NHS can’t take five more years of Cameron.

I could go on about the damage he’s done.

But let’s be honest – would that help people worried about where the NHS is heading and wanting real answers?

I know there will be families and carers out there watching us today wondering whether anyone really understands what their life is like.

Soldiering on from one day to the next, feeling invisible and taken for granted, ringing the surgery early in the morning but unable to get through, telling the same story to everyone who comes through the door.

You feel no one listens – and no wonder.

So that’s why I’m going to do something different today.

I want to speak directly to you.

And to the parents of children with disabilities, for whom life feels like one long battle and who fret endlessly about what would happen to your son and daughter if you weren’t around to fight.

To the millions of you who face the daily worry and stress of arranging mum or dad’s care whilst trying to hold down a job.

And, most of all, to those of you who might be watching this alone at home fearing what the future might hold.

My message is simple: Labour is with you; your worries are ours; we know things can be better than they are; we want an NHS that takes your worries away; and we can achieve it if we do something bold.

The time has come for this party to complete Nye Bevan’s vision and bring social care in to the NHS.

That allows us to rebuild our NHS around you and your family.

No longer ringing the council for this, the NHS for that.

But one service, one team, one person to call.

An NHS for the whole person, an NHS for carers, an NHS personal to you. At last, a National Health Service keeping you well, not a national sickness service picking up the pieces.

And an end, once and for all, to the scandal that is care of older and vulnerable people in England in 2014.

I ask you this: how much longer will we say that people who are so frail that they need help with getting up, washing and eating, and who suffer from loneliness and isolation, are only worth a slap-dash 15 minute visit?

How much longer will society send out the message to young people looking after someone else’s mum, dad, brother or sister that it is the lowest form of work, lower than the minimum wage because it doesn’t pay the travel time between the 15 minute visits?

How much longer will we see these shameful scenes from care homes on our TV screens of people being shouted at or abused and not say enough is enough?

And for how much longer, in this the century of the ageing society, will we allow a care system in England to be run as a race to the bottom, making profits off the backs of our most vulnerable?

If this party is about anything, then surely it is about ending that.

I want you to understand why I feel like this.

About ten years ago, I saw my own mum ground down and worn out by the battle to get decent care for my gran.

She was in a nursing home where corners were often cut and where it was hard to get GPs to visit. The decent people who worked there were let down by the anonymous owners who filled it with untrained, temporary staff.

My gran’s things often went missing and we had got used to that.

But I will never forget the day when we walked in to see her and her knuckle was red raw where her engagement ring had been ripped off.

Right there, right then – I made it my mission to end this scandal.

And the greatest sadness of all was that this so-called care cost my grandmother everything she and my granddad had worked for.

I know millions of families have been through the same or are going through it now.

People look to Labour to change these things and that is what we will do. You know the Tories will never do it. They put profits before people – always – it’s in their DNA.

Their answer is to let the market that has ripped through social care carry on ripping through the NHS.

Conference, we will do the precise opposite.

I am clearer about this than anything in my life – the market is not the answer to 21st century health and care.

People out there know a minimum wage, zero hours approach will never secure the care they want for their mum and dad.

So our ten year plan for the NHS is founded on people before profits.

We will free the NHS from Cameron’s market and, yes, repeal his toxic Health and Social Care Act.

We will ask hospitals to collaborate once again and reinstate the NHS as our preferred provider.

The public NHS, protected with Labour. Not for sale. Not now, not ever.

Cemented at the core of every community so that it can then begin the job of bringing social care in and lifting it up. Building a culture of respect for all people who care and ending the indignity of flying 15 minute visits.

Caring no longer a dead-end job but part of one workforce working to NHS standards.

But there is a reason why we give the public NHS such stability.

It is so that we can ask it to embrace radical change in the way it provides services to you and your family.

We will ask hospital trusts and other NHS bodies to evolve into NHS integrated care organisations, working from home to hospital coordinating all care – physical, mental and social.

Why? Because it makes no sense to cut simple support in people’s homes only to spend thousands keeping them in hospital.

We can’t afford it. It will break the NHS.

But, more, it’s not right for you.

The ever-increasing hospitalisation of older people is no answer to the ageing society.

Bringing social care in doesn’t add to the financial burden.

It is the key to unlocking the money. But it will mean change and you need to know what that means for you.

Just as Nye Bevan wrote to every household to introduce his new NHS, so I will write again in 2015 to explain what people can expect from our national health and care service.

And this is what I will say for any family caring for someone with long-term needs, one team around you.

No longer should frail or vulnerable people be shunted around the system, from ambulance to A&E to noisy ward. Instead, this team will come to you. Its goal will be to keep you in your own home, safe and well.

You and your carers will have one person to call to get help so no longer telling the same story over and over again.

You will have a care plan personal to you and your family.

If you and your carers get what you really need from the start, then it’s more likely to work. Building the NHS around you will need a new generation of NHS staff, as Ed said yesterday.

So we will recruit new teams of home care workers, physios, OTs, nurses, midwives with GPs at the centre.

And will we have mental health nurses and therapists at the heart of this team, no longer the poor relation on the fringes of the system but making parity a reality.

And to make sure this investment is not creamed off by others, we will look at how we can ensure private health providers contribute their fair share towards the cost of training.

But, with the best will in the world, the NHS won’t be able to do it all.

That is why I can announce today a big change in the way the NHS supports carers so they can keep going.

No longer invisible but at the very centre of this new service.

So today we announce new support for carers: protected funding for carer’s breaks; the right to ask for an annual health check; help with hospital car parking for carers; and we will go further.

We will give all families the right to care in their home, if they want it.

A national health and care service truly there from cradle to grave – from a new right to have a home-birth and a right to be in your own home at the end of your life, surrounded by the people you love, with your care provided on the NHS and no worry about its cost – starting with those who are terminally ill with the greatest care needs.

These are the things that matter and this is about an NHS there for you at the most important moments in life.

This is what people want and this is what becomes possible with our plan.

True whole person care – simply not possible in Cameron’s fragmented, privatised, demoralised service.

Make no mistake – this coming election is a battle for the soul of the NHS. The fight of our lives.

Now we must walk 300 miles for the NHS to every doorstep in the land. With hope. With pride. With passion. With a plan you can believe in. But, in the end, this is about more than us. This is about you.

Your children, your grandchildren, your great grandchildren.

It’s about whether an NHS will still be there for them in their hour of need as it has been for you.

Don’t regret it when it’s gone. Join the fight for it now.

So I make this appeal to you.

Help the party that founded the NHS give it a new beginning.

Help us make it the service we all want it to be.

An NHS that puts people before profit.

An NHS that cares for the carers.

An NHS there for your mum and dad.

An NHS with time to care.

An NHS for all of you.AB

How do you solve a problem like Andy?


When I first met Andy Burnham MP at the Methodist Central Hall, Westminster, in 2010, where I was later to have a University graduation, he wasn’t as I expected him to be.

He was there for the leadership debate for Labour’s leader. And I remember thinking what a good idea a National Care Service would be.

I have now met Andy on several occasions, and he always waves and says hello. But it’s hard to describe the quality he has to somebody who’s never met him.

He has exactly the same quality as HM The Queen, whom I remember meeting in 1987. I had just been awarded a scholarship to Westminster School, and her husband asked me, “So tell me Shibley, what do you spend my wife’s money on? I bet you it’s booze, fags and wild women.”

The quality I mean is that the Queen has a real ability, despite her status, to make you feel completely at ease. Andy Burnham has this quality too. The thing you end up being struck by is his considerable gravitas.

Having met him, I’ve tuned into this in how he deals with TV interviews or shows such as Question Time. He speaks as somebody who knows the brief backwards, and who doesn’t need to say a lot to impress people.

You get this feeling when you hear a report that Sir Bruce Keogh has apologised to him for the alleged smear attacks. You get this feeling with Sir Andrew Dilnot writes to Andy over the latest statistics screw up.

But I concede it must be driving the Conservative Party potty. The Conservatives trump card is there is a groundswell of opinion that Labour ‘crashed the economy’. While not true, it’s been an opinion which has been hard to shift.

I don’t doubt the NHS will be at least number 2 on the list of factors affecting most people’s voting intentions, but opinions tend to divide amongst people who’ve experienced the NHS and those who haven’t.

There are people who’ve had a terrible time which they will never forget. At another end of the spectrum, there are some people who’ve had a positive experience, but think perhaps ‘they’ve been one of the lucky ones’.

So how do you solve a problem like Andy if you’re a Conservative? Extremely tricky, as Andy Burnham by a long margin is one of the most popular members of the Shadow Cabinet.

Whilst his speech in Manchester was a litany of the current Government’s failings, and the usual critics of Labour piped up to say “what about PFI?” and all that, Andy does not have to say much to impress further people who believe in him.

There’s a group of people who feel that they can never vote for Labour ever again, due to where Labour has taken them in the past. But it’s not at all clear how they will vote, given that the most likely outcome is that Labour will be the largest party at least.

There are people in other NHS campaign groups who really are not convinced that Labour ‘mean it’, and not nearly going enough to address their complaints about the NHS. But they will need at some stage to collaborate with Andy Burnham, not compete with him, if they wish to go anywhere.

Andy Burnham said today, “By starting to bring social care into the NHS, we will build a health service for the whole person.” One suspects that Burnham will have to bring in a person-centred approach, encouraging professional communication between different disciplines looking after a person with, say, dementia, but not go anywhere near personal budgets which have turned out to be a poisoned chalice.

And one of his examples was particularly telling.

“So what happened? The trust launched a private treatment service for varicose veins – using NHS facilities – as they were permitted to do under the new freedom to earn up to half of their income from treating private patients.”

Nye Bevan is possibly the most outstanding Secretary of State for Health which the Labour Party has ever had.

In 1951, Bevan was moved to become minister of labour. Shortly afterwards he resigned from the government in protest at the introduction of prescription charges for dental care and spectacles.

I complete understand the staunch skepticism that Labour is any different to how they used to be under Blair, with Hewitt and Milburn as the Secretary of States for Health.

Lynton Crosby has advised the Conservatives that they should play ‘on their side of the pitch’.

Fine – and it could be that many voters are still concerned about the economy.

But as Carville himself said, “It’s the economy stupid, but don’t forget about healthcare.”

Put your money where your mouth is. Campaign for the NHS not incessantly whinge.

We might disagree on various things to do with the NHS, but there’s no doubting the robust commitment of ‘Keep Our NHS Public’ (@KeepNHSPublic) and the ‘National Health Action Party’ (@NHAParty) Despite their obvious clear antagonism to the Labour Party, I think the last thing they want is another Conservative government, this time propped up by UKIP. Twitter’s where it’s at, and both Dr Jacky Davis (@DrJackyDavis) and Dr Clive Peedell (@cpeedell) are extremely ‘media savvy’. Marcus Chown (@MarcusChown) is indeed known to be one of the high-impact ‘influencers’ of Twitter.

But bloody Nora. You can even order on the internet a box of 500 wristbands in a colour of your choice, with lettering in a font of your choice.


It’s tempting to buy a box of 500 with the words, “Make PFI history”, or “Make the internal market history”.

Or “Make the purchaser-provider split history”.

But you’d have to make the lettering increasingly smaller to make it all the criticisms about previous Labour health policy fit onto a small wristband.

But there is every chance that the general election will make “Make Miliband history”.

So far, there’s not even been a smidgeon of what Ed Miliband intends to do about the private finance initiative in the context of NHS infrastructure, or what he intends to do to prevent accident and emergency departments being selectively killed off during the lifetime of the next Government.

All of this is very awkward. If the bacon-butty haters are onto something, Ed Miliband (@Ed_Miliband) won’t be in the next Prime Minister after all that. And we could see the privatisation of the National Health Service receive atomic rocket boosters.

You won’t get whole person care either. The decline in social care inevitably will reach apocalyptic proportions.

And yet on the coalface we’ve got Jos Bell (@jos21), Chair of the Socialist Health Association London division, actively campaigning. Here is her excellent interview on LBC.

This was shortly followed by Andy Slaughter (@hammersmithandy), elected as the MP for Hammersmith in 2010.

With the lack of reporting on the NHS on the BBC at all-time new lows. there will inevitably be a lot of benefit in campaigning from those who are savvy with the social media. But I don’t think the battle for the soul of the NHS will be won on the pages of the Guardian newspaper, either.

If certain “campaigners” spent less time writing voluminous emails and documents which go nowhere, and learnt how to use Twitter instead, this would help the cause immensely. Éoin Clarke (@DrEoinCl) in a relatively short space of time has gained a massive following, and his observations are highly influential – much more so than the official press office of Labour, some might say.

Gabriel Scally (@GabrielScally) has been tireless in myth busting on Twitter. Kailash Chand (@KailashChandOBE) is personally a very supportive bloke, in addition to producing a prolific output of articles, in for example Pulse or GP magazine. Both are not ‘terrified of Twitter’.

And the superb Shadow Secretary of State for Health – Andy Burnham (@andyburnhammp) and the outstanding Labour Health Team (@LabourHealth) are leading by example.

The Shadow Minister for Care and Older People is Liz Kendall (@leicesterliz) and is highly influential too.

Jamie Reed (@jreedmp), Debbie Abrahams (Debbie_Abrahams), Andrew Gwynne (@gwynnemp), and Luciana Berger (@lucianaberger), are all in the front guard too.

Dr David Wrigley is an outstanding campaigner (@DavidGWrigley); and for another inside view from the profession, a great blog and twitter timeline are from Dr Jonathon Tomlinson (@mellojonny).

They all tweet even when the going gets tough.

@LabourPress is a great way to catch up with key speeches by leading members of @UKLabour nationally.

You will find few truer advocates of the #saveourNHS campaign than Grahame Morris (@grahamemorris), Chair of @LabourLeft, and MP for Easington. Grahame is always polite, fair and precise in his questioning for the House of Commons Health Select Committee. Possibly a future Chairman of this committee?

Tweeters can only ignore @Jeremy_Twunt at their peril. No cruelty in his compassion. Never knowingly behind a tree.

There’s a battle still to be won, if you’re up for it.



Fighting each other on the left is a waste of resources

arm wrestle

We keep on being told that there is a finite amount of resources to share. So why on the left are we not channeling our energy into things we care about?

Among the various things I have been witness to in the last year have been endless discussions on procedure and constitution. Such discussions while possibly well intended by some have virtually ended up being circular and being presented in summary in an incredibly unimpressive manner.

There are serious matters afoot. There was a draft Bill proposed by the Law Commission, which didn’t make it into the Queen’s Speech, on the regulation of clinical professionals. This promises to be a landmark piece of legislation, and has now been bounced into the next parliament’s lifetime. Clearly this Bill will prioritise patient safety, on which there was not a single clause in the Health and Social Care Act (2012) apart from abolition of the National Patient Safety Agency.

Many of us have allowed the narrative to be articulated in terms of ‘sustainability’, in other words we can’t afford the National Health Service – but curiously can afford war, and afford a lengthy inquiry into the legality of it. We have allowed a ‘there is no alternative’ closure of ‘failing’ hospitals, but have not addressed the principal issue of how clinicians and patients can be in charge of their own services without a firestorm by the Trust Special Administrator.

We have lost time on how we can make the health service function nationally, not in a piecemeal fragmented way like the privatised railway industry. We have lost time on implementing serious methods of keeping vulnerable frail patients out of hospital, or people living with dementia, in cases where they’d be better off with some proactive intervention out of hospital.

It is simply impossible to have this sort of discussion of what the left wishes to do in terms of solidarity, justice, equity and equality, while certain people are at each other throats. Whilst I am not a big fan of Tony Blair by any stretch of the imagination, it cannot be said that the previous Labour administrations can be the root of all of the ills of the National Health Service.

Basic things being done well matter a lot to people, like seeing their local GP or being attend an A&E unit in a timely matter. Andy Burnham MP has a golden opportunity to make sure medical records are shared freely between one part of the health and care service with the other, to prevent reduplication and poor medical decision-making based on information asymmetry. There is a key chance to break down barriers between health and social care, so urgently need, for example, in my academic field of living well with dementia.

There are many people who are now publicly concerned about the effect of competition in English health policy. Margaret Heffernan, of ‘wilful blindness’ fame, is just about to have a bestseller on her hands on this subject.

So can we cut the incessant concerns about how the Labour Party is still a cover for corporate Britain? That Labour hasn’t learned anything from the past, which includes John Major activating the private finance initiative initially before badly negotiated contracts under the early years of the Blair administrations?

It is impossible to divorce the needs of physical and mental health of a person from social care needs. So we can we put a sock in the movement that integrated care of any variety can only be a Trojan Horse for privatisation? There is a possibility that a future Labour government might be able to provide a fully funded national care service, if there were a momentum of public support.

Labour’s position on personal health budgets (“PHBs”) for the last few years has been clear. Whilst there are noteworthy successes, there have been a plethora of concerns, including safeguarding issues for people with dementia. It was never intended that they should be compulsory, despite the subject of PHBs at all being promoted previously by some very senior in the Labour Party.

There’s a battle to be fought indeed, but the outcome of that battle should not a Conservative-UKIP coalition. You’ll find that they will not be the answer to all your concerns about the NHS.

Care at the crossroads. Burnham has something big, and you may be quite pleased to see him

Social care funding is on its knees.

Andy Burnham MP, Shadow Secretary of State for Health, addressed a sympathetic audience at the #NHSConfed2014 yesterday, talking about unlocking resources for general medicine.

We live in crazy times. Newark saw the christening of the Conservative Party as the protest party you should vote if you wanted to STOP UKIP. But let me take you back to an era when the Labour Party had principles (!)  In August 1945, Aneurin Bevan was made Minster for Health following the 1945 General Election. The National Health Service (NHS) was one of the major achievements of Clement Attlee’s Labour government. By July 1948, Minister for Health, Aneurin Bevan had helped guide the National Health Service Act through Parliament.

A full day has been allocated to the Opposition health on Monday in parliament in part of their discussions on her Majesty’s Gracious Speech. Simon Stevens – NHS England’s new chief – has asked for solutions for well rehearsed issues, and Andy Burnham is clear that this is no time for another apprentice like Jeremy Hunt. Whilst being upbeat about the future of the health and social care system, he wants to move away from a “malnourished system”, with carers employed on zero hours contracts and less than the minimum wage. Indeed, this is a serious issue which has caused me some considerably anxiety too. A “product of [my] time in Government”, clearly this framework has also benefited from a parliamentary term in opposition.

Burnham crucially identifies not an inefficiency in which money is spent (although the ongoing Nicholson savings rumble on). But he does identify an inefficiency in outcomes (such as the near-inevitable fractured neck of the femur in the leg for a seemingly-trivial cost-saving in not purchasing a grab handrail). Labour, inevitably, though has an uphill battle now. The system appears to encourage the medical model of care, according to Burnham, encourages hospitalisation of people, so it is not simply a question of throwing money at the service. People are more than aware that an ‘unsustainable NHS’ is in a nutshell code for a NHS starved of adequate fundings.

Burnham feels that you can’t half-believe in ‘integration’, and is mollified about the consensus about a need for integration across all main political parties.

“I am really worried that the ‘Better Care Fund‘ might give integration a bad name”, comments Burnham.

People who have watching Burnham’s comments will note how Burnham has openly commented how he feels he has been misled by certain think-tanks in the past. A period of opposition has enabled Burnham conversely to obtain a crisis of insight. And yet he talks about his “precious moment” in order “to build a consensus of shared endeavour, which I intend to use to the full and very carefully.” Intriguingly, he does not wish to ‘foist a grand plan’ on voters after the next general election. This is of course is political speak for his ‘shared agenda’, driving a cultural change by stakeholders within the system. This is precisely what Burnham feels he has achieved through the commission on whole person care by Sir John Oldham.

“Not a medical or a treatment model, but a truly preventative service, that can at last aspire to give people a state of physical, mental and social wellbeing.”

Burnham wants to put a stop to the ‘random set of disconnected meetings with individuals within the service.’

An exercise was carried out at the start of the NHS.

This is the famous leaflet.

Pages from the first leaflet introducing NHS to British Public in 1948.

Burnham desires a new leaflet from an incoming Labour government to introduce how social care can become under the umbrella of the National Health Service.

“Going forward, you should expect to receive much more support in your home. The NHS will work to assemble one team to look after you covering all the needs you have. We want to build a personal solution that works for you, for your family, and for your carers, because if we get right at the very outset and the very beginning it’s more likely to work for you and give you what you want, and cost us all much less. We want you to have one point of contact for the co-ordination of your care. We know you are fed up with telling the same story to everyone who comes through the door. It’s frustrating for you, and wasteful for us. To get the care that you’re entitled to, when and where you want it, you will have powerful new rights set out in the NHS Constitution such as the right to a single point of contact for the coordination of all of your care and a personalised care plan that you have signed off. But – and there is a big but – to make of all this happen, you will changes in your local NHS, and, in particular, you will changes in your local hospital. We can do a better job of supporting you where you want to be, we won’t need to carry out as much treatment in hospitals, or have as many hospital beds. It is only by allowing the NHS to make this kind of change to move from hospital to home that we will all secure it for the rest of this century.”

Burnham feels that the NHS must be the ‘preferred provider’ and the DGH should be allowed to reinvent itself - building the notion of one team around the person. I personally have formed the opinion: “close smaller hospitals at haste, and repent at leisure“. Critics of marketisation will inevitably point out the blindingly obvious: that even with a NHS preferred provider, there’s still a market, and nothing short of abolition of the purchaser-provider split will remedy the faultlines. There could be a one person tariff or one person budget for a person for a year. It would give an acute trust a much more stable platform, according to Burnham, in contradistinction to the activity based tariff. This does require some rejigging of how we have the proper financial performance management system in place: there should be a drive, I feel, for rewarding behaviours in the system that promote good health rather than rewarding disproportionately the work necessary to deal with failures of good control, such as dialysis, amputations or laser treatment.

Burnham is clearly inspired by the ‘Future Hospitals’ soundings from the Royal Colleges of Physicians, focused on a new generation of generalist doctors working across boundaries of primary and secondary care:

“Since its inception, the NHS has had to adapt to reconcile the changing needs of patients with advances in medical science. Change and the evolution of services is the backbone of the NHS. Hospitals need to meet the requirements of their local population, while providing specialised services to a much larger geographical catchment area.”

Burnham even talks about possibly reviewing the “independent contractor” status of GPs.

Centralised care is mooted for people in life threatening situations. But Burnham has found that barriers to service reconfiguration exist through the current competition régime and market, with integration encouraging in contrast to collaboration, people before profit, and merge “without the nonsense of competition lawyers looking over their shoulders”. Therefore, Burnham repeats his pledge to remove the Health and Social Care Act (2012), which has driven “fragmentation, complexity and greater cost”. Under this construct, section 75 and its associated Regulations is disabling rather than enabling for health policy. There is clearly much work to be done here to make the legislation fit for purpose, as indeed I have discussed previously. Wider dangers are at play, as Burnham well knows, however. Here he is speaking about his opposition to TTIP (the EU-US Free Trade Treaty) which the BBC News did not seed fit to cover despite their Charter requirements for public broadcasting. And here is George Eaton writing about his opposition to TTIP in the New Statesman.

Burnham is clearly, to me, positioning himself to the left, distancing himself from previous Labour administrations. There are clearly budgets in the system somewhere, and while Burnham talks about unified budgets he does not put the emphasis on personal budgets. There is no doubt to me that personal budgets can never be ‘compulsory’, and each person group (e.g. people living with dementia) presents with unique challenges. It’s clear to me that deep down Andy Burnham is still in principle keen on something like the ‘National Care Service’, in preference to any gimmicks from the Cabinet Office. Burnham in the Q/A session with Anita Anand indeed describes how this had been thrown into the long grass at the time of Labour losing the general election in 2010, but how paying for social care in 2014 is as fundamentally unfair as paying for medicine had been pre-NHS according to Burnham. This would take some time to put in place, such as a mechanism for a mandatory insurance system, and a proper care coordinator infrastructure. And these are not without their own controversies. But, with Miliband playing safe one unintended consequence for neoliberal fanatics has been that it has not been possible to impose a strong neoliberal thrust to whole person care; and whatever Miliband’s personal preferences, the pendulum to me is definitely swinging to the left. Burnham talks specifically about a well planned social care system as part of the NHS.

And so Burnham looks genuinely burnt by previous administrations, and, whilst certain key players will want personal budgets and competition to be playing a greater part in policy, it appears to me that the current mood music is for Labour not appearing to promote privatisation of the NHS in any form.  The ultimate success of the next Labour administration will be determined by the clout of the Chancellor of Exchequer, whoever that is. It could yet be Ed Balls. For matters such as ‘purse strings’ on the social impact value bond or the private finance initiative, Burnham may have to slog out painful issues with Balls in the way that Aneurin Bevan once did with Ernie Bevin in a previous Labour existence. Burnham’s problem is ensuring continuity with the current system where services have been proactively pimped out to the private sector, but ultimately it is the general public who call the shots. Burnham knows he’s onto something big, and, for once, some people may be quite pleased to see him.



The NHS needs an innovative ‘blockbuster’ now. That is to be brought back under the State.


The term “innovation” must be one of the most misused terms in the media. It simply means a different way of doing things, such as a product or a service, whose popularity and effectiveness ultimately govern its success.

And yet the term has been strikingly bastardised to be used in conjunction with a whole plethora of memes such as “ageing”, “technology” and “unsustainable”. The right wing has been consistently ‘on message’ in this script.

Ed Miliband in Manchester gave last night what was a perfectly plausible speech on the NHS last night. Excerpts of it have indeed been posted on our blog. And there was the usual ‘red meat’, to be accompanied at some later date by how realistic the costings are.

But the legitimate concern of voters, whether hardworking or not, is he who pays the piper calls the tune. It may not be the frontline staff with whom Ed Miliband had photo opportunities earlier this week.

Fifty shades of government, apart from green, have been obsessed with inflicting ‘transformative’ changes, perhaps ‘charismatic’ visions, without ever consulting the wider population. Examples include the private finance initiative, or ratcheting up the NHS into a competitive market.

But Nigel Farage, whether or not he is ‘establishment’, has struck a chord with some voters. I don’t mean with his allegedly racist twangs, but I mean his ‘trust the voter’ skit. He bangs on about the referendum which he knows will never see the light of day.

Labour’s argument for why the NHS needs private companies working for it remains unconvincing with many voters. That’s why the National Health Action Party or the Green Party are watched so keenly by many.

The argument is possibly not as complicated as that justifying our membership of the European Union, but it is one which is best left to the voters to justify.

Labour in pursuing its ‘35% strategy’, where it can squeeze into office on the back of disaffected Liberal Democrat voters, is by definition risk averse. But with taking low risks the return can be very low. Labour’s lack of “blockbuster” is potentially alarming.

And many of the arguments can be discussed under the assumption that GPs work for the NHS. The BMA’s “#YourGPcares” campaign is calling for long-term, sustainable investment in general practice now to attract, retain and expand the number of GP, expand the number of practice staff, and improve premises that GP services are provided from.

The pitch for state ownership is pretty basic. Ed Miliband MP, Leader of the Labour Party, yesterday Labour’s new GP guarantee as part of the next government’s plan to improve services for patients, ease the pressure on hospitals, and restore the right values to the heart of the NHS.

Speaking in Manchester, he underlined his determination to put the health service at the centre of Labour’s campaign over the next year, beginning with these local and European elections.

But it feels as if Ed Miliband is making a meal lacking the key ingredients.

Andy Burnham MP’s ‘NHS preferred provider’ is conspicuous by its absence in the speech.

Only once Ed Miliband has slain this dragon, he can be given to talk about how primary care is best delivered. Labour is aware of its history of “polyclinics” first proposed by Professor the Lord Darzi of Denham in his review of healthcare in London for NHS London “Healthcare for London: A Framework for Action”.

The Labour Government at the time argued that this was a way of providing more services in the community closer to home and at more convenient times (including antenatal and postnatal care, healthy living information, community mental health services, community care, and social care and specialist advice).

Ed Miliband seems to care about ‘privatisation of the NHS’, in that he cared to mention ‘ending’ it.

But this is again at odds with what Simon Stevens has been thinking about.

A “Free School” is a type of Academy, a State-funded school, which is free to attend, but which is not controlled by a Local Authority.
Like other types of academy, Free Schools are governed by non-profit charitable trusts that sign funding agreements with the Secretary of State.

Supporters of Free Schools, such as the Conservative Party, including that they will “create more local competition and drive-up standards” They also feel they will allow parents to have more choice in the type of education their child receives, much like parents who send their children to independent schools do.

But Ed Miliband also talking about ‘ending competition’ which is somewhat against the mood music Simon Stevens was singing in his appearance against the Commons Select Committee.

It’s innovative bringing something back into state control, but could make good ‘business sense’, akin to insourcing a service which had been previously outsourced.

The main arguments for state control and ownership of the NHS are that such a drive would encourage co-operation, collaboration, equity; services could be properly planned not fragmented; and services would not be run for shareholder dividends.

It’s undoubtedly true that there could be operational changes to be made, such that patients could plan their GP appointments without having to ring up as an emergency at 8.30am the same day.

NHS GPs overall say that they are working flat out, and, short of having greater resources, no political gimmick will help them. Instead of lame slogans such as “Hardworking Britain Better Off”, and making do with “35%”, Labour could do something really innovative – and return to a socialist approach.

‘Saving the NHS for the public good’, on the other hand, is not a vacuous gimmick. It’s what many people in Labour also believe, possibly. More importantly, it’s the title of a current party election brodcast by the Green Party. It might be the case that Ed Miliband is left wing than the Labour Party membership. This has been mooted here. If so, “bring it on!”

Ed Miliband should not be so obsessed about the economy, but talk about the NHS


Time after time, voters in polls and in focus groups return the finding that they don’t especially trust any mainstream political party with their handling of the economy.

But in a forced choice, a small majority of voters think the Conservatives are ‘better at handling the economy’.

This of course depends on what your definition of the economy is. If it means the rich getting a lot richer, that is possibly true. And don’t forget Lord Mandelson was ‘intensely relaxed about that too’.

Gordon Brown and Ed Balls are adamant that they’ve won the argument on needling to pump money into the investment banking sector to avert a ‘Great Recession’.

However, David Cameron and Nick Clegg appear to have succeeded in spinning repetitively their yarn that it was Labour that ‘brought the economy to its knees’.

And it seems Ed Miliband is equally obsessed about ‘winning the argument’. Miliband is continuing with the line that the cost of living outstrips real wages, even though it is widely reported that this trend will reverse sometime this year.

But Miliband possibly is on surer ground with ‘zero hour contracts’, and the financial insecurity of some who have them. He would be on massively firmer ground if he were to attack the lack of access of justice through the closure of law centres through legislation introduced by this Government.

He would be on much firmer ground if here were to attack the changes in employment rights such as unfair dismissal.

There’s no doubt that the ‘cost of living crisis’ is important to many – with the well known #shockedface when many of us open our energy bills.

But he almost appears to mention the NHS as an after thought. Now is the time when Labour should produce a series of announcements on what it wants to do, aside from leaks on public health which look pretty deliberate in the Daily Mail.

Labour could campaign strongly to ensure that the English Law Commission’s proposals on the regulation of clinical professions see the light of day, with Jeremy Hunt having made this such a totemic issue.

Labour could hone in on the incredible waste in PFI loan repayments, and their subsequent effect on budgets regarding safe staffing. These have been identified by Margaret Hodge’s team in the Public Accounts Committee.

It could decide to wish to implement legislation which makes it a certainty there’ll be no hospital closures appearing from nowhere and any discussion of changes to health services will require a meaningful discussion with the local community first.

It is up to Labour to choose the narrative too. People desperately want Labour, and Ed Miliband, to take a lead on the NHS. As Carville said, “It’s the economy stupid….. but don’t forget about healthcare.”

If the NHS is a sacred cow, it is possibly about to sacrificed at the altar of a UKIP-Tory coalition.

Nuttall Farage

In between elections, some of the electorate leave it up to Polly Toynbee to construct a forensic dissection of the section 75 Regulations on competition and choice in the NHS, or park a discussion of inequality at the foot of a major tome on the subject by Thomas Piketty.

The Guardian readers of North London therefore pride themselves on their immaculate understanding of their world. They occupy the tents of St. Paul’s Cathedral, or protest about tax on Oxford Street.

Who’d then have thunk of a novel way of influencing democracy through the good old-fashioned ballot box?

It sometimes seems that every cappuccino sipping intelligentsia fluent in every investor protection clause of TTIP can lay the blame of every evil at Andy Burnham’s door, without offering anything constructive to help Labour run the National Health Service from May 8th 2015.

If there’s a protest vote to be had, it should go to the nice anti-establishment man who went to a minor public school.

You can’t simply get enough of him on Question Time, LBC, or the Andrew Marr Show.

Just a pity you have absolutely no idea what UKIP stands for, in terms of the National Health Service.

The arithmetic might easily work out that UKIP come first with the Conservatives third, with the Labour Party coming second. Then it won’t matter that Andy Burnham MP has just returned from Strasbourg to try to negotiate some exclusions for us for the EU-US trade treaty.

It won’t even matter that Jeremy Hunt MP has failed to bring the long-awaited reform of clinicians, at Draft Bill Stage from the English Commission to combat scenarios such as Mid Staffs, before parliament.

Can it really be that the NHS is a spectator sport for the general public, where anyone who talks about the NHS is some crackpot, fringe ‘special interest’ group?

Isabel Hardman writing in the Spectator on 20 September 2013:

“Paul Nuttall MEP is about as different a Ukipper as you can get from Nigel Farage. He’s a bald Liverpuddlian, for starters. This means he can appeal to a different section of the electorate, and one that as Fraser said earlier, Farage needs to attract. He told the conference that Labour voters are ‘easy pickings’, adding:

‘It’s clear now ladies and gentlemen that Ukip is now the official opposition to Labour in the North of England.’”

The usual defence for atypical UKIP opinions is that every party is choc-a-bloc with wackos and nuts, so any extreme, offensive opinions are to be tolerated – an argument used at full throttle from Nigel Farage, UKIP leader, this morning on “The Andrew Marr Show”.

But clearly Nuttall believes in what he is saying. Besides, Paul Nuttall is the UKIP MEP for North West England, UKIP Deputy Leader.

Paul Nuttall MEP indeed talks about the NHS, or rather the privatisation of it, with great fondness:

“I would like to congratulate the coalition government for bringing a whiff of privatisation into the beleaguered National Health Service. The fact that successive governments have undertaken what they call ‘substantial’ changes to the NHS should tell us all we need to know: there is something fundamentally wrong with how we treat the ill in our country.”

“Beleaguered” in what sense?  Possibly he means the NHS is at ‘death’s door’ having had its reputation totally destroyed by the UK media.

Or maybe he means that spending for the NHS actually fell in real terms last year, as has been pointed out in a letter to Jeremy Hunt by Andrew Dilnot CBE much to the disgust of the current Government.

“The NHS is the second biggest employer in the world, beaten only by Walmart, but as with all state monopolies, it is costly, inefficient and stuffed with bureaucrats. In New Labour’s NHS, for every nurse there is a manager and vital workers, such as midwives, are falling in numbers.”

Except the NHS, prior to privatisation, has been considered to be one of the most efficient healthcare systems in the world.

“The problem, however, goes far deeper. I would argue that the very existence of the NHS stifles competition, and as competition drives quality and choice, innovation and improvements are restricted.”

Ah – that wonderful policy plank called ‘competition’, the poster boy of neoliberalism, which has been one of the biggest disasters in English health policy ever, and which has even been called “killing the NHS“.

This is no time for hyperbole, of course.

“Therefore, I believe, as long as the NHS is the ‘sacred cow’ of British politics, the longer the British people will suffer with a second rate health service.”

If the NHS is a sacred cow, it is possibly about to sacrificed at the altar of a UKIP-Tory coalition.

Burnham goes from strength to strength as ‘striker’, but who’s the David Moyes?

There’s no doubt Andy Burnham MP drives the Conservatives potty.

Despite the Conservatives’ best attempts to annihilate Burnham MP, Burnham keeps on scoring goals.

Meanwhile Jeremy Hunt continues to score blanks, apart from where profits from ‘Hot Courses’ are concerned.

But Burnham is more concerned about the day job, and that is running the NHS to a level of some degree of competence.

Hunt meanwhile continues to run his NHS into the ground, paying for costly advice on the managerial implementation of compassion, when he could be paying nurses to do the professional job they’re trained to do.

So Burnham can certainly hold his head up high as chief striker or scorer for Labour United.

As the Conservatives spit out the oranges from their half-time pep talk, as the oranges were in fact horsemeat due to the abolished Food Safety Agency, it’s time to recapitulate.

Burnham United

Clive Peedell kindly tweeted the other day points on which he would like Labour to play ball.

Before the 2010 election, Liberal Democrat leader Nick Clegg indeed condemned PFI as “a bit of dodgy accounting – a way in which the government can pretend they’re not borrowing when they are, and we’ll all be picking up the tab in 30 years”. It’s well known that PFI is a relic of the John Major government from 1995 (predating New Labour in fact). In opposition, Osborne pledged that the Conservatives would stop using PFI and denounced Labour for relying so much on a source of finance that he said was “totally discredited”. “We need to find new ways to leverage private-sector investment. Labour’s PFI model is flawed and must be replaced,” Osborne muttered in November 2009. Indeed Margaret Hodge, chair of the powerful Commons public accounts committee, said the coalition had failed to come up with the promised alternative since coming to power.  The facts speak for themselves.


And Burnham is handicapped by not being the actual Secretary of State for Health at this crucial time for the NHS.

He nonetheless did go to Strasbourg last month to try to explain the case:

(This is a video recording I took of Andy’s talk at the Southwark Labour meeting recently.)

Labour will need to abolish PFI contracts or renegotiate them or both. But Ed Balls will need to be on the wing to help Burnham shoot. And it’s hoped the football manager is not asleep on the job. Labour has indeed proposed a five point plan to tackle ‘tax avoidance’. Labour supports a form of country-by-country reporting. It would extend the Disclosure of Tax Avoidance Schemes regime, which Labour introduced, to global transactions. It would open, further, open up tax havens, with requirements to pass on information about money which is hidden behind front companies or trusts. Crucially, Labour also wants to see fundamental reform of the corporate tax system. But Peedell’s work is not done.

The abolition of the purchaser-provider split remains one of the totemic political decisions to be made, as is not a ‘deal maker’ for many grassroots voters.

In fact, the whole issue of whether the general public is interested by public health or competition remains uncertain.

Nonetheless, a pioneering integrated healthcare scheme in New Zealand has improved the care of patients while reducing demand on hospital services.

On the contracting side, the report said that the abolition of the purchaser-provider split in the health system was important as it gave boards the autonomy to decide how to fund their hospitals.

The project was launched in 2007 in response to rising hospital admissions and waiting times and to a population that was ageing more rapidly than in other parts of New Zealand and other developed countries.

Similar to the drive towards whole person care in this jurisdiction, is aim was to create a “one system, one budget” approach to health and social care, together with various aspects as centrepieces: sustained investment in training, support for staff to innovate, and new forms of contracting, including abolition of the split between healthcare service purchasers and providers.

The outgoing NHS England chief executive Sir David Nicholson last year told HSJ his organisation was looking at “whether the straightforward commissioner-provider split is the right thing for all communities”.

Hospitals wish to focus on delivering better services to patients and often get frustrated by the amount of time they have to spend negotiating contracts with commissioners with the legal shutgun pointing in the direction of their necks.

And there’s no doubt there’s a steady stream of whistleblower tragedies, with Raj Mattu the latest in the long line of casualties.

People still struggle to think of a NHS whistleblower who has had a good outcome.

The Nursing Times ‘Speak Out Safely’ has only so far succeeded in signing up 30% of NHS Trusts.

Most people accept that the whole system is rotten, not least in how clinical regulators appear to pass the buck or even worse target whistleblowers.

Many do not think the Public Interest Disclosure Act, enacted by New Labour is 1998, is fit for purpose either.

So Clive Peedell is right, but Andy Burnham may have trouble in shooting goals on target with nobody on wing or a manager more concerned about ‘One Nation’.

Moyes, sacked by United on Tuesday after the 2-0 defeat at former club Everton on Sunday confirmed their failure to secure Champions League qualification, oversaw just 51 games in charge of the team after succeeding Sir Alex Ferguson last summer.

Moyes, like Ed Miliband, though had his army of people who thought he was doing a good job.

But Burnham like many, although focused on sorting out the undeniable problems of the NHS, is avoiding relegation for his team too.

I certainly don’t want to ask who the Ryan Giggs is. That certainly would be tempting fate.

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