Andy Burnham: 'Judge me by what I did for the NHS'
Ahead of the 65th anniversary of the health service, a former health secretary talks about his time at the helm, his regrets – and his plans for a new kind of NHS under Labour
John Rentoul is chief political commentator for The Independent on Sunday, and visiting professor at King's College, London, and at Queen Mary University of London. Previously he was chief leader writer for The Independent. He has written a biography of Tony Blair, whom he admired more at the end of his time in office than he did at the beginning.
Sunday 30 June 2013
Andy Burnham is still smarting from Prime Minister’s Questions when I see him in his office in Westminster. Two hours earlier, the Conservative MP Charlotte Leslie had asked a question about “the sinister culture of cover-up in our NHS over the past decade”. David Cameron replied by reading out a quotation from Baroness Young, the former head of the Care Quality Commission (CQC), the independent NHS regulator. She had said she had been under “huge government pressure, because the Government hated the idea that a regulator would criticise it by dint of criticising one of the hospitals or one of the services that it was responsible for”, and that “we were under more pressure” when Burnham “became minister, from the politics”.
Burnham, the last Labour Health Secretary, 2009-10, sitting on the opposition front bench, shook his head and looked like a “Tasered choirboy”, according to one sketch writer.
To me, he says: “It’s frustrating, isn’t it, when people are throwing stuff and you can’t reply and you reject it entirely.” He is furious because he appointed Robert Francis, the lawyer who carried out a three-year inquiry into excess deaths at Stafford hospital. “It was one of the first things I did as Health Secretary, and my mindset was the opposite of what they are saying. I was in the mindset of, ‘Bring it all out, we need to know if other -hospitals have serious problems’.”
They did. And, “literally on the eve of the last general election”, he published a list of 27 hospitals that were “registered with conditions” – which meant that “they couldn’t be registered as safe; they couldn’t be given a clean bill of health [by the CQC]”.
Unfortunately, the list did not include Morecambe Bay hospitals, where several babies and mothers seem to have died as a result of NHS errors, which the CQC missed. “That clearly in the end was the wrong judgement. But that wasn’t my judgement. That was a judgement for the independent regulator.
“The point I really want to get over is: Judge me by what I did.”
But he – the Labour government – set up the regulator and it was at fault, I say. “We brought in independent regulation. [But] with the best will in the world, it isn’t going to spot the problem on a ward in the north of England immediately.”
He cannot resist pointing out – it’s a “minor” point – that the CQC report on Morecambe Bay, which was allegedly suppressed, “if it was deleted, was deleted under them”, the present government. But the larger point is this: “The NHS was never perfect and no party should claim that it was, under them.“ Burnham says the Tory attack on him ”is an attempt by someone on the other side to try to damn the whole system, to pick on examples of poor care that should never have happened and in the case of Mid Staffs appalling care, but it is not possible to say, and the whole thing is sinister, corrupt, - that isn’t possible. There have been periodically problems in the NHS, in Bristol, there was Alder Hey, there was Shipman. These things sadly have been there in the past. The NHS is such a complicated, vast thing that there will always be things that are wrong with it.”
But it is a “caricature” of Labour that “we were closed and secretive”, when “we began the process of the publication of clinical data so that outcomes could be published, we began rating hospitals”. But wasn’t that part of the problem, I ask, in that it put pressure on staff to suppress bad news?
He concedes that this is a problem at the “very local level” in the NHS. “When people bring complaints, the shutters do come down. But that tendency is very, very deep-rooted and I couldn’t say, hand on heart, we managed to crack that.”
Burnham’s admission of past failings takes an unexpected turn at this point. Instead of rejecting the “culture of secrecy”, he repudiates Tony Blair’s reforms based on patient choice. “I’ve reflected carefully on our time in government - and much of it I’m proud of. The NHS was transformed from a service that was offering a two-year wait for a heart-bypass operation when we came in – people were dying on NHS waiting lists – that situation was turned around completely. But I look at a lot of the things we said about choice and control: I think we offered people fairly meaningless choices. You know: ‘Where do you want to go for your hip operation; which provider of these five do you want?’ We had a very simplistic notion of choice, almost applying the supermarket test - care is a much more fundamental human endeavour than which place you want to go to.”
Declaring that this is “quite an important break, really, with where we were”, he says he wants to celebrate this week’s 65th anniversary of the NHS with a “renewed settlement” that would integrate physical, ¬mental and social well-being in one service, free at the point of need.
Isn’t “integrated health and social care” what George Osborne has just announced in his Spending Review? The Chancellor said he would be “bringing together a significant chunk of the health and social-care budgets” so that services for older people would be “commissioned jointly and seamlessly by the local NHS and local councils working together”.
Burnham is dismissive: “I don’t think what Osborne announced today comes anywhere near what I’m talking about. I’m talking about the full integration of health care.” He welcomes it to the extent that it reverses the trend of the past three years, in which “all the incentive is to disinvest in preventive care that keeps older people out of hospitals, because councils want to keep council tax low, and hospitals get paid by how many people go through the door. So the whole system at the moment pushes people towards the expensive end of the care world.”
But he claims his ideas are more ambitious: “In the same way when we created the NHS we didn’t let people get financially ruined by the cost of medical care, we’re not going to let people be financially ruined by the costs associated with ageing. I’ve got a strong sense that if Labour can be that bold, it’s the best antidote to the people on the doorstep who say:you’re all the same, there’s no point in voting.”
He thinks that the Chancellor, on the other hand, is using his ideas quite cynically to get round the ring fence that protects NHS spending, simply to raid the NHS budget to pay for social care.
But he wears the Government's focus on him as a badge of pride: “Attacked by the Prime Minister; plagiarised by the Chancellor: I must be doing something right.”
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