Has Andy Burnham really reinvented himself to prepare for a future leadership bid? In this week’s Spectator, I interviewed the Shadow Health Secretary about his rather forthright views on the NHS: views that some suspect have conveniently changed in order to appeal to Labour’s base. You can read the interview here, but for Coffee House readers, here are some extended quotes from our discussion.
Burnham was insistent that his views on the health service today are the ones he put into practice when he was Health Secretary under the last Labour government. When I asked whether he’d changed politically, he said:
‘Well, there are a couple of ways to answer that. Not politically because as I say, if these were easy words in opposition about the public NHS then people might be able to make that point but I changed it in government. People keep forgetting this but I took a difficult decision at the time to say that I wanted a different approach because I suppose I am mainstream Labour.’
‘Mainstream Labour’ means, according to Burnham, making a definite decision that ‘what works is the NHS’. I asked him what his response was to the Blairite mantra of ‘what matters is what works’ (something Liz Kendall said very firmly in her interview with the House magazine), and the Shadow Health Secretary replied:
‘My response to that is that it’s the NHS that works, it has worked pretty well for 67 years and I’m talking about the public NHS. That would be my… if you look around the world at healthcare systems, on what basis does this system not work? It is much more cost effective than the market based systems and it provides decent care to everybody so on what basis has it failed? I would argue that it hasn’t, it’s shown itself to be the best way of providing healthcare to a whole generation.’
He elaborated on why he thinks that ‘what works is the NHS’:
‘If you were to say, let’s take end of life care or another example, dialysis and if you were to say we now want dialysis to be offered in the home rather than as a hospital-based service. So there are two ways of doing that, you could say to the staff at the hospital that are currently providing that dialysis service, we are going to ask you to work differently to provide that service, working in a range of settings or you could do an open tender for it and make the change in a different way. My view is that it is better and quicker and cheaper to ask staff, give staff the security to embrace change to a different way of working.
‘So there is partly a technical argument for it but I am unapologetic about saying that I believe in the public NHS. I believe in a system that puts people before profits and doesn’t confuse the two things and I also believe that the reason why the public have such a high degree of trust in the NHS is for that simple reason. When they use the NHS, when they go into the door of a hospital or come into contact with paramedic staff or whoever it might be, they don’t have this sense that something else is driving their decision making, the shareholders views, the cost of it.
‘It’s the sense that this system is focused on people gives it I think that high degree of public trust and that to me is what Danny Boyle was trying to capture at the opening ceremony of the Olympic Games. Politicians here I think have been too cavalier with that for too long, allowing this experimentation of market. It’s gambling with something that is really quite precious to people.’
Burnham’s language on the NHS is always rather emotive, and that’s one of his techniques for getting such rapt applause at Labour conferences. But when you ask him about the technical differences between some of his reforms and those of his opponents, he talks about a ‘reorganisation test’ that his party now always passes and that his opponents always seem to fail. He said that ‘Osborne, he fails my reorganisation test’ on the devolution of health spending to Greater Manchester. But when I asked how Burnham’s own plans for devolution in health policy would be different, I got this reply:
‘Because I’m going to work through … my vision was about empowering individual councils to lead integration and I honestly believe that integration is led from a local level not from a Greater Manchester or county level but that’s what Osborne’s plans seem to be about.
‘He is going to create a new body at Greater Manchester level, he wants to appoint a new Chief Executive I’m told which again I’m really not convinced of the wisdom of that. This is about a lot of functions moving around and people being moved from NHS England.
‘What I’ve said is, I need to be convinced. The principles I support, the actual precise vehicle he’s come up with I’m not yet persuaded by. Also the Swiss cheese point is important because is he saying that he’s going to get a funding deal for Manchester and that’s it, you’re on your own? Is that what he’s actually saying? Because if he is, then that’s a big change to the way the NHS has operated.’
I do wonder whether, having complained so vigorously about the Conservatives reorganising the NHS, Burnham is now getting rather hooked up on his own ‘reorganisation test’ to the extent that he has to claim, Magritte-style, that what he wants to do doesn’t fall into the definition of a reorganisation, even if it does change the way the NHS works in a way that Burnham thinks is better.
But what’s impressive is that this shadow minister, who did not fare well in the party’s 2010 leadership contest, now speaks the language of ‘mainstream Labour’ to the extent that he is considered a frontrunner in the next contest, whenever it comes.