Andy Burnham in Willow Park Housing Trust

I am not even a hard-core ‘activist’ of Labour, whatever that is. I do nonetheless find it highly amusing how a pretty bog standard hate campaign against Labour and Andy Burnham MP, former Secretary of State for Health and current Shadow Secretary of State for Health, went so badly wrong. Isabel Hardman from the Spectator recently remarked that Andy Burnham MP is driving the Conservatives potty. Nothing would give the Conservatives greater satisfaction than to achieve the Burnham scalp, but the fundamental problem is that the facts keep on getting in the way of this hate campaign. Burnham, unfortunately for them, has considerably more experience than his counterpart, who is currently Jeremy Hunt. Burnham does not fit the mould either of someone who looks as if he wishes to work for a private equity fund when he’s more ‘grown up’. Burnham firmly believes in the founding principles of the NHS, and ideologically he is desperate to unwind the marketisation of the NHS. He wishes to make a break from the past, and “good for him”, many will say. He is in fact one of Labour’s biggest assets in the party as a whole, and has even put his neck on the block to say constructively why Labour might need to up their game to be guaranteed of a good working majority. Labour can win a massive majority on the back of their policy in the NHS, as indeed the 1997 Blair victory, helps to demonstrate. As in all of medicine, it has to make an accurate diagnosis of the problem before putting in a coherent management plan. The argument against the markets, which can drive up shareholder dividend at the expense of patient care and which introduces a level of inefficiency and waste such that an estimated 31% of the budget will now be going on admin. and wastage (as beautifully articulated by the Himmelstein and Woolhandler papers), has been won. The need to encourage collaboration and the dignity of clinical staff cannot be underestimated. The Conservative Party have failed miserably on the NHS, and it is for this fundamental reason why they will ultimately become unstuck on May 8th 2015.

The problem with the Conservative HQ copy, regurgitated in the medical and health policy press uncritically, is that it simply does not make sense. Even worse, it is not borne out by the facts. Take the meme that “money does not grow on trees“. Even the most ardent patient safety campaigners need to acknowledge the need for safe staffing levels, which might include a basic level of nursing staffing numbers. If money does not grow on trees, how is it possible that £860 billion was found miraculously by a Labour government to fix market failure of the first global financial crash. If money does not grow on trees, how come is it that estimates of HS2 are pitched around £40-60 billion realistically? Even the £2.4 billion McKinsey ‘efficiency savings’ were returned to the Treasury, and not ploughed back into frontline care. It all fundamentally hinges on a steady stream of lies about the NHS from the Conservative Party.

Money tree

Andrew Dilnot, chair of the UK Statistics Authority, recently  concluded in December 2012 that changes in NHS spending over the two years had been small and health spending was actually lower in 2011-12 than in 2009-10. He nonethlesss said the watchdog’s calculations were based on what he considered “the most authoritative source” of national statistics on the subject from the Treasury. In a letter to Health Secretary Jeremy Hunt, Mr Dilnot said: “On the basis of these figures, we would conclude that expenditure on the NHS in real-terms was lower in 2011-12 than it was in 2009-10.”

Another trick is the misuse of the term ‘sustainability’ is used by people who really have no idea what this means – sustainability clearly not be a lame excuse of stripping frontline staff of the resources they need to do their job. This all pricks the nation’s conscience which is increasingly skeptical of the ‘austerity’ blank cheque excuse to decimate public services in the name of ‘public sector reform’. It simply is a pack of lies, as Labour knows the public fundamentally has no problem with a well-funded by taxpayers state-run service, free-at-the-point of use, offering a comprehensive universal healthcare? The current Coalition vastly underestimate the public’s fundamental mistrust of money being paid on excessive CEO salaries in the NHS, especially on senior members of NHS England who repeatedly offend on the point of lack of accountability of their decisions. They do not accept the business plan that it is necessary to spend thousands or millions on redundancy payments, or compromise settlements to avoid unfair dismissal claims.

Even the question of the nation’s “priorities” generally runs into the buffers immediately. The public resent the idea of carers in a ‘caring profession’ by definition being put on ‘zero hour contracts’, even if the party-line from profit generating multinational corporates is that these allows staff ‘flexibility’. The arguments criticising the NHS have swung from one hyperbole to another, with the NHS having been called a 65 year mistake. And yet, this argument is unable to touch the scandal at Winterbourne in the private sector. On the issue of the nation’s priorities, can one reasonably suggest that one of the very worst things for this current Government to do was to embark on a £3bn reorganisation of the NHS with the sole primary purpose of outsourcing and privatising the NHS? As the lawyers say, “res ipsa loquitur” or the facts peak for themselves. In a 493 page Act, there is not a single clause on patient safety, which seems rather odd given everyone’s correct focus following the disasters at Mid Staffs and Morecambe Bay which Labour has every intention of remedying. The Act clearly thrusts private competitive tendering as the prime method of commissioning, which is being played out as a disaster in the legal/justice system. The Act has clearly massively increased the amount of income that a NHS Trust can make from private sources. It is an Act which fundamentally the public did not vote for, and it is little wonder that Andy Burnham MP and his team have repeatedly promised to repeal the Act. Like High Speed 2, which many do not similarly remember ‘voting for’, the costs are threatening to spiral out of control, which makes it all the more ludicrous that it is the Labour Party should be blamed for misuse of the handling of the public finances. Like High Speed 2, this policy is an outcome of intensive behind-closed-doors lobbying, and the genesis of the Act sits uncomfortably with the widely reported general issue of the Conservative Party and hedge funds.

Burnham has not sat on the fence over issues of health policy either. Despite the ‘smoke and mirrors’ of untrue fatuous claims of David Cameron, Burnham resolutely has promoted plain packaging of cigarettes, consistent with current global evidence and much to the chagrin of Philip Morris International. Burnham has also supported the evidence-led view of the Faculty of Public Health of the UK Royal Colleges of Physicians over ‘minimum pricing’ of alcohol. Burnham has said ad infinitum and absurdum that, despite the purported advantages, the ‘private finance initiatives’ need to be drafted such that the public do not lose out. Three things to say here, that the policy has been extended by the current Government under George Osborne. Secondly, it is a policy which was born under John Major’s government in the mid 1990s Thirdly, the first ‘sighting’ of this policy, which represents fundamentally a synthesis of a Conservative ‘Butskellite‘ policy, was in a 1993 policy document published by the Social Market Foundation with David Willetts MP, current Conservative minister for Universities, entitled “The Opportunities for Private Funding in the NHS”. Burnham, furthermore, has not his hid under a bushell regarding NHS 111. He has in fact accused the Government of destroying NHS Direct, “a trusted, national service” in an “act of vandalism”. According to him, “It has been broken up into 46 cut-price contracts. Computers have replaced nurses and too often the computer says ‘go to A&E’.”

Writing about the situation in Lewisham, Burnham unsurprisingly has been spitting bullets, remarking that:

“The High Court yesterday delivered a damning verdict on an NHS now being run by accountants rather than in the interests of local communities. This ruling is a humiliating blow to Jeremy Hunt. It is outrageous that he thought he could rob a community of its A&E and maternity services to solve financial problems at a neighbouring trust.Labour warned him that he was acting above the law but he refused to listen, and that arrogance has cost taxpayers dear in legal fees but has also caused people of Lewisham unnecessary worry.”

The general public resent this general sense of arrogance with which Jeremy Hunt and colleagues behave in their management of the NHS. The ‘democratic deficit’, where the public are simply not included in decisions about the NHS, makes a mockery of the ‘no decision about me without me’ mantra so beloved of NHS commissioners currently. Arguably, this is not seen any more clearly than in the sharing of confidential data without the valid consent ethically or legally of NHS patients. This was even reported in right-wing newspapers who have on occasion been strongly in favour of patient rights as follows:

“Mr Burnham said it is “absolutely essential” that patient data is safeguarded, after The Sunday Telegraph revealed David Cameron will use a keynote speech to outline far closer “collaboration” between the health service and life science companies. The Prime Minister will say that the controversial industry has the potential to be a powerhouse of Britain’s 21st century economy, but that it is stifled by excessive regulation at present. Speaking to Sky News, Mr Burnham said that while he did not object in principle to close ties between the NHS and private sector life science companies, he was concerned that “one of the patients’ groups that was on the working group looking at this issue has walked away”.”

I first spoke with Andy Burnham after one of the leadership hustings in 2010 at the Methodist Central Hall. I liked him as a person, and I was really struck by the sheer passion he genuinely had for an integration of health and social care pathways, even long before the political shennanigans of the Dilnot Review which were delayed because of the Health and Social Care Act. This was further embellished in a seminal speech to the King’s Fund in January 2013:

“For 65 years, England has tried to meet one person’s needs not through two but three services: physical, through the mainstream NHS; mental, through a detached system on the fringes of the NHS; and social, through a means-tested and charged-for council service, that varies greatly from one area to the next. One person. Three care services.  For most of the 20th century, we just about managed to make it work for most people. When people had chronic or terminal illness at a younger age, they could still cope with daily living even towards the end of life. Families lived closer to each other and, with a bit of council support, could cope.  Now, in the century of the ageing society, the gaps between our three services are getting dangerous.  The 21st century is asking questions of our 20th century health and care system that, in its current position, will never be able to answer to the public’s satisfaction. As we live longer, people’s needs become a complex blur of the physical, mental and social. It is just not possible to disaggregate them and meet them through our three separate services. But that’s what we’re still trying to do. So, wherever people are in this disjointed system, some or all of one person’s needs will be left unmet.”

I feel that nobody could have worked harder than Andy Burnham for the NHS on a range of issues, such as nursing staffing levels, the lie about the NHS budget being protected, the sharing of confidential patient data, the Lewisham decision under appeal, minimum pricing of alcohol, standard packaging of cigarettes, the repeal of the Health and Social Care Act (2012), and PFI. He has also worked extremely hard in exploiting his ‘first mover advantage’ over health-and-social integrated care and ‘whole person’ care. Labour is consistently trusted by the voters on the NHS ahead of the other parties, and this is not particularly any surprise when you consider that many employees of the NHS receive more balanced information about the actual situation of the NHS from their Unions of which they are a part. There is no doubt that the toxic memes of “competition” and “choice” are here to stay, totally bastardised by health policy wonks who have never set foot on a busy NHS ward in their life. Andy Burnham MP can do no worse than to maintain the reputation of and trust in the medical and nursing professions and the NHS. After years of the Coalition rubbishing the NHS, it is definitely time for a change, and we can’t go on like this.