Editorial Friday 7 October 2011: Shadow cabinet: Burnham back to health; Liz Kendall to care
Labour's Andy Burnham takes over the shadow health secretary role (again), and Liz Kendall is promoted to the shadow cabinet as minister for care and older people.
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Click here for details of 'Will Lords QE2 end the political confusion over Health Bill? Party conferences leave us neither wiser nor better-informed', the new issue of subscription-based Health Policy Intelligence.
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Burnham's performance in office, particularly over 'preferred provider', will be as scrutinised as his leadership campaign. His campaign for a National Care Service is likely to be brought up as proof of Labour's spendthrift ways: good answers will be needed (and Andrew Dilnot may offer them).
Kendall has been an impressive performer in the Health Bill debates and committee, and her promotion is deserved.
Her colleague Emily Thornberry is also promoted to attend shadow Cabinet meetings, and has likewise deserved her place.
Below follows Andy Burnham's responses from the Socialist Health Association health hustings in the Labour leadership contest.
ANDY BURNHAM: "Well I do agree with the last speaker on the messages we sent out. I did change policy on the use of private sector in the NHS because I did feel when we came into government we alienated staff rather than saying NHS staff are its resource. We almost set ourselves up in opposition to NHS staff rather than getting them with us on that journey to improvement. It's something I changed when I changed the policy to make the NHS the preferred provider.
"Thoughts on the bad side? The GP contract was a mistake in 2004, and we should acknowledge that. I also look to a chequered history in the government of public participation. The abolition of Community Health Councils in the early days of the government was again a mistake. We never articulated a strong successor to Community Health Councils.
"But perhaps the biggest on the negative side I point to would be whether or not we gave enough priority, I believe we didn't, to mental health. People's lives have changed in the last 20 years a lot. Not just in this part of the country, all over, people have traded very secure employment and secure family life for a much more insecure existence with much more stress and everybody has felt the pace of life. I don't think the NHS yet has ever undergone real service change to reflect that great emphasis we need on mental well-being as opposed to physical well being. That probably for me is the biggest failure. We didn't sufficiently prioritise mental health services.
"On the plus side we said we will save the NHS. We did. We re-built it in primary care and also largely the secondary care estate. We invested in its people, in its workforce. We brought down waiting times. Barbara mentioned Ian McCartney. My Dad had a heart bypass at Broadgreen a year ago. He waited six weeks for the appointment, not because he was my Dad, because that was the waiting time from Warrington general. I checked as Health Secretary what the waiting time was at Broadgreen in the mid-90s: 2 years 1 month.
"That tells you everything about the transformation that Labour made in the NHS. How many of those poor sods on the waiting lists never made it off the waiting list? We made a major effort. Blood sweat and tears brought down those waiting lists. I find if the 18 week maximum waiting list has gone people are facing that old choice - wait longer or go private - and it breaks my heart.
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"I joined Labour 25 years ago in this region as a young person. I wanted a fairer spread of health wealth and life chances in this country and 25 years on it's why I am still Labour and standing for our party. I believe there is much, much, more for us to do to create a fairer spread of health wealth and life chances in this country.
"For all of the great things we have done down the decades as a party, it's still the case the postcode of the bed you are born in will pretty much determine where you end up in life, how much you earn, what opportunities you will have and how healthy you will be. It is very true of people who live close by to where we are now the postcode here will determine what I have just said
"If we are not in this Labour Party to change that and in many ways what was wrong with our time in government was that Official Doctrine Mandelson edict we were supposed to believe in be more relaxed about differential economic differential in society which leads to a gap in health and in life chances and I believe that is, where any Labour person, is the reason we join Labour is because we are worried about the gap in society. It brings us into the party in the first place - and going forward, to capture ourselves and our identity, we need to talk about that much more and move away from the idea if only people at the bottom are moving up it doesn't matter no we are about much more.
"Health inequalities was a banned term in health before we came in. We set up the Aitcheson report, ground-breaking, and towards end of our time in government had the Marmot Report. Though they were very good reports, there are much bigger things that determine inequality in our society and sometimes we shied away from those things.
"In this campaign, I have spoken of a fairer system of property taxation to bring that equality into the heart of our taxation system - and I also think we need a debate when are looking at ageing society. There is lots of talk how we are going to need to raise the retirement age for everybody to 68 or even higher. Let's think about that. That is unfair on the people who have done hard physical manual work all of their life and find they reach their 60s and find they are physically worn out. That then drives more inequality in society as people are working longer having been physically worn out throughout their life.
"We have to stand up and say 'No'. We are not having people putting forward policies like that without the Labour Party pointing (inaudible) we have got to find our voice on this issue. We can't be a Labour Party intensely relaxed about these things. We have to worry about these things. As your leader, I can give you my word that is precisely what I will do".
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"When I was setting my last operating framework at the Department of Health as Health Secretary I said explicitly history should not repeat itself or the NHS go first for health promotion when it comes to saving money. I think the evidence is already there, that's why precisely what is happening, as we are looking at the way the NHS is facing up to the financial challenge.
"It's a great shame from our point of view. We have lots to be proud of and took bold action on tobacco and on a whole range of public health measures we should feel proud of.
"If we have a criticism, it should be more on presentation than on policy. We allowed this fear of Nanny State to be built, perhaps because we didn't articulate precisely enough the limits of state action. We should have always said we should consider public health intervention where they meet two criteria. Firstly, where it affects children. We have an obligation to protect health of children; particularly when they are in care of the state, when they are at school, or elsewhere. And secondly, we should always act where one person's actions affects the health of another person.
"Again if we have clearer criteria, I think we can build more support for the Nanny State. The Guardian said recently people support it more than people think. There was a poll said support the banning of smoking in cars with children ran at 60 or 70%. It was a finding that surprised me. Maybe the public is running ahead of politicians at times. Let's set.
"The last couple of points we have to look back and say we took bold action on tobacco. Too much ambivalence in our response to the rising levels of alcohol abuse and rising levels of public concern on the effects of alcohol abuse. We have to reflect on that as a party the public were ahead of us on the issue and we were behind the debate and the last point I make is this.
"When people talk about public health, people think of finger-wagging approach don't do this that or the other and Change for Life tried to break that and come forward with a more positive approach to health promotion promoting physical activity and good diet and I think there was something very important in what Change For Life was trying to do and the policies we brought forward for it such as free swimming. It's a positive encouragement to say 'we will help you to lead the healthiest life you can', and I have had moving letters from young people. Given scrapping of free swimming, they can only go once a week instead of 4 or 5 times a week.
"If we are serious about tackling an obese society, we need to get policy putting investment into promoting good health. Too often politicians on all sides are guilty of paying lip service to it rather than funding the services that help people live a healthier life".
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Questioner: The question is a two-parter, first part is straight yes or no: are you in favour of PFI to re-build Royal Liverpool Hospital when PFI debt has dragged down local health economies in Manchester and around England? And the second part is, moving forward do you have a policy or potential remedy to secure future costs of PFIs are limited or possibly secure them in shareholdings we have in UK banks thus achieving practical and workable interest rates?
ANDY BURNHAM: "Given I approved the new hospital for the Royal, I'd better say yes in answer to your first question. Actually it brings home the argument for PFI, because we would not have a new hospital being built in Liverpool without the PFI route: quite frankly, there is not public capital available to build a new hospital for the Royal. So I took that decision before the election. I know in taking that decision we have the prospect of a new hospital for the city which it badly needs.
"To go to the second part I am not going to defend every PFI deal that was done. Some did represent questionable deals in the rush to get all of the deals done. Clearly those in the early days of the government. what I can say to you is that every time a PFI comes forward there is a very strict test of a 30-year lifespan of that deal.
"Department of Health were subjected to a public capital test which is value for money way offer approving that hospital, and the PFI often does represent better value for money. It's a different way of building hospitals. Without it, we would not have built many of the 120 hospitals we built under our time in government and renewed the fabric of the NHS and to give further backing to what I am saying the National Audit Office recently looked at PFI in health and it concluded that on balance that most contracts are well managed and deliver value for money.
"There is room for improvement and other ways it can be looked at bringing down the interest rates in PFI deals by perhaps using NHS as a guarantor of the contracts. I am open to those ideas. It may not be popular to say it to this audience.
"I could not have given new hospitals to many towns, communities, cities without PFI. The real strength of it, it allowed more areas to have a new hospital simultaneously. I can look you in the eye and say it wasn't at the cost of value for money in the National Health Service and I am not going to apologise for it".
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Question: Would you like your doctor to think about you or his budget when arranging your treatment?
ANDY BURNHAM: "Well, you have put your finger on what is deeply damaging about this White Paper. I point to two problems in terms of the GP-patient relationship.
"First, there is the GPs traditional role as champion of the patient. That is compromised somewhat when the GP is also the budget holder and they are not popular. PCTs perform an important function in taking that pressure out of the consulting room, and a secondary problem at the heart of the NHS. A conflict of interest where GP is both provider and commissioner, and the GPs need neither have the desire nor expertise to commission population wide health services and they will have to bring in others to help them do that and I believe we are looking really at a fundamental change to the character of our National Health Service and it's privatisation of the commissioning function in NHS leads to great fragmentation of services a postcode lottery writ large and when you put all that alongside the effect on patients.
"They are removing the 18 week national waiting standard statement of lifting private patients cap on NHS trusts: the effect of those two changes mean that hospitals can devote more theatre time to private patients; they no longer have a private waiting time for NHS patients. They will let NHS patients pay the price.
"It brings back the old choice in the NHS of wait longer or pay to go private. The whole package of reforms threatens to unpick the fabric of our National Health Service, and it is an attack in the end to. NHS services will be so fragmented from one GP commissioning group to another; it will no longer have a character of an NHS and the greatest irony of all, I have great respect for GPs and general practitioners there may be many in the audience today, the very people who decided not to come into NHS at the outset are now being handed the entire budget for the National Health Service and that is what is being promoted here. (
"I think these reforms are ill-conceived on practically every level. I don't believe it is right now to subject the NHS to the biggest ever re-organisation in its history. It's currently facing the biggest ever financial challenge in its history to combine those two things together is a recipe to turn the order we have in the NHS today into chaos in a few weeks time.
"The Coalition Agreement said no further top down re-organisation of the NHS. How can they possibly defend a white paper a few weeks later that gives NHS the biggest and most dangerous re-organisation in its history? I don't see any democratic legitimacy or mandate for these proposals or any of the 7 million people who voted Lib Dem voted for the break-up of the NHS. I ask all Lib Dem MPs to show some courage and stand up to the government and say we were not elected on the back of this promise therefore we will vote against this Bill when it comes to House of Commons.
"If we pull together and launch a ground war against these plans, we can stop them. They threaten our NHS like nothing else before. I believe if we expose risk to patients we can bring this home to the public and stop this Bill. At the moment it will forever change the character of our NHS and will unlock a reform in the NHS that is very hard to put back. Even though we are fighting a leadership campaign we are all united in saying Labour will defend with everything it's got it's proudest achievement from this attack".
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Questioner: Having heard your criticisms of the white paper I was wondering if there is anything in the White Paper you agreed with much as there are many bad things I look at it and consider there may be positive outcomes to it. I wondered what you thought of that.
ANDY BURNHAM: "Not much (laughter) really not much. I have re-read it and re-read it to ensure the reaction is proportionate to what is being proposed.
"If I was looking for something - perhaps the abolition of GP boundaries, as something I proposed myself as Health Secretary because I think that more choice in primary care was a good thing, so people can choose to stay with a GP who was their family doctor when growing up or move to one nearer to work. I thought that was a good thing but ultimately you have to look at the combination of proposals here and look at them all together and say do these proposals together add up to a reform that will change the character of our NHS and is that reform desirable?
"I don't think you can pick one off or another. It's when you set them all alongside each other. There is a proposal in the white paper of no bail-outs for any NHS organisation. That essentially takes hospitals, as Diane said before, that takes hospitals off the public sector balance sheet. They will not be guaranteed by the Department of Health or Treasury anymore and when you think about the lifting cap on private patients and all of what comes with that this will change the behaviour and mindset of people working there. They are no longer protected by the government.
"Then they will have to compete in the market place and adopt a very competitive approach to health care. It's no coincidence that the duty of Monitor the foundation trust regulator is changed so promoting competition is the primary objective of that regulator. So what I would say to you. It's looking at the whole package together. I don't think you can just take out one thing or another.
"There is lots of warm words in the White Paper about the patient being in charge and the expert patient. I agree with that. We want to move more towards the notion of expert patient see lots of clinical leadership that was the great theme of Lord Darzi's next stage review. Those things I could say yes we agree with those in principle.
"It's when you come to put them into practise. GP fundholding in the early 90s at least there was a framework of public accountability behind it with the health authority. Ed mentioned accountability. That is one of the gravest dangers of the white paper it hands over the budget to the people who didn't want to come into the NHS and wipes away the whole infrastructure that represents public accountability for that.
"It's saying to NHS managers, PCTs you are expendable. I know those PCTs are staffed by decent, hard-working, committed people who helped put NHS back on its feet and it's a terrible message for the government to send to those people.
"What happens there is no expertise in population-wide health commissioning in general practitioners. Who is going to be the voice for the voiceless and people who never come over the threshold of GP surgery? Complex mental health needs or HIV / AIDS, homeless or travelling community, who is going to commission for that whole population going forward in the future?
"That's why it's an 18 billion pound gamble. Primary Care Trust it's not perfect. It commissions services for everybody and ensures there is a safety net for everybody. To simply take it away and take a huge step into the unknown when there is no evidence is appalling.
"Let me finish on this point. They are ruthless, aren't they, the Tories? it's unbelievable to see you forget until you see them back in government. Announcements are being made that come from nowhere just drop that affect the public fabric of our country. Friday afternoon for a bank holiday weekend; Health Secretary visits a hospital and casually let's it slip he is minded to abolish NHS Direct. 3,000 or more people work for them. The public values NHS direct for the support it gives to families with children and it saves 100 million pounds for the NHS every year in preventing trips to the accident and emergency department. To say it's being scrapped on the day of a Bank Holiday with no proven alternative in its place is no way to treat NHS staff who have served NHS loyally for years. It's no way to run National Health Service and if you do one thing today sign John Prescott's petition saying Save NHS Direct. It sends a direct message to the Health Secretary that he cannot go on acting in this high-handed arrogant manner in dealing with our Health Service".
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Questioner: What should we do about the division between health and social care? Should we move to the principle that social care should be free at the point of need and paid for out of general taxation?
ANDY BURNHAM: "Well, I think the biggest public policy challenge facing this country in this century is the ageing society, and unless we find as a society a better way of funding care and support for older people and people with disabilities then we face a very bleak prospect. Indeed where we look to a century where people will live longer but what kind of lives?
"More anxious lives as they face cost of care and don't have peace of mind, don't have the independence to live a long happy and fulfilled life. I believe unless we find a solution then really we are going to fail a generation of older people.
"Figures show in every local area numbers of people who are over 85 in any Local Authority these numbers are doubling very quickly and the challenge gets bigger every year. It's an indictment of us all. When you look at the social care system in England, 80% of the people work in it work at or close to the national minimum wage. What message are we as a society sending to people who work within our care system on how importantly we value them and what they do on our behalfs in caring for our loved ones?
"We have to do better. The system in England is malnourished and underfunded. If we leave it as it is it's struggling to fund an ever ... I was accused before the election of wanting to introduce a death tax. My answer is we have something far worse right here right now in this country and that is a dementia tax where the people who faced the hardest circumstances in life, people who have got Alzheimer's or Parkinson's or severe dementia, they are not just wiped out physically by those terrible conditions around them the family is wiped out emotionally. More than that they are utterly cleaned out financially. How can any member of the Labour Party look at that and feel we don't need urgent reform?
"We criticised American health care system in such superior way from our vantage point and the same injustices are present in our system of social care. We let people fend for themselves and the most unfortunate pay most and lose everything they have worked for their homes and savings.
"In this leadership campaign I have put on the table what I believe is the biggest idea any candidate has put forward. A National Care Service free at the point of use available for each funded by a 10% levy on all estates. I believe it is the only solution to the challenges that we face in this century and I also believe it could give empowerment to all older people as they face a longer life and give them piece of mind and the ability to protect everything they have worked for.
"For those reasons, this change could be for Labour in this century what the National Health Service was for us in the last century. It's ideas on this scale that will re-connect Labour to the people out there. They will say I know what this Labour Party is all about now again. They are trying to build a fairer society for everybody.
"For me, it's a reform it's time has come. I wouldn't pay for it from general taxation. I don't think that's fair to the working age population today; to give them another thing to pay for. If we create it right now, after the war it should have been included, it never was included in the post war settlement. I do think it's fair to ask today's pensioners to pay 10% levy on their estate to pay for a free at the point of use National Care Service and I think it gives people peace of mind and ability to protect everything they have worked for".
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Summing up: ANDY BURNHAM "As a minister and as a backbencher in Parliament I was 100% loyal to Tony Blair and Gordon Brown. Why? I wanted to sustain a Labour government for as long as I possibly could and I gave them that loyalty they needed. Not everybody in our party can say that. I can.
"Coming forward to stand for leadership it takes loyal members of the Labour Party to tell home truths, and that is this. Labour became dangerously disconnected from ordinary people during our time in government. New Labour was formed out of a distrust of its own party members, its grass roots and wider Trade Union movement and developed a controlling top-down elitist Londoncentric approach to party management.
"It alienated people up and down the country. It told us 'we have to be relaxed about the gaps in society'. I wasn't. I bet you weren't. It took us away from who we were, what we were all about. It took the heart and soul out of the people’s party. That's what we have to put back in as part of the leadership election.
"That's what I can offer. A candidate who can give Labour back its heart and soul and re-connect Labour with people we need to win back. I talk about a National Care Service and free at the point of use. That is how Labour re-connects brings forward big inspiring ideas. It can shape this century in the way the best of our values shaped the last century. That's how Labour puts itself back in touch with the people we need to put us back.
"I don't have support of the media establishment in this election or the union establishment or Labour establishment. I am not seeking their support. I am seeking your support.
"Things need to change in our party. People want things to stay as they are, have more of the same. We can't have that. If we do Labour will be on a path to irrelevance and in slow decline and we need to re-build this people's party of ours from the bottom up.
"There are those out there now trying to re-run battles of the past and make the leadership contest a battle of new and old Labour. That's to entrench the factions. Party members have to say 'we want to move beyond that era and want a united Labour Party to unite around true Labour. Values that speak to us'.
"I say I am not old Labour or new Labour I am true Labour. I speak and always have done for the mainstream majority opinion in the Labour party. Right now, that's the opinion people need to hear and the way old Labour didn't represent ... nor did new Labour and the voice we need to hear in this election now is the voice of mainstream majority members that were and Labour Party focused on the concerns of ordinary people. That's what I can offer you in these final stages of the leadership campaign.
"Think of the kind of party we need. How we will re-build the party from the bottom up true to Labour principles? Let's together make sure Labour values shape this century in the way our values shape the best of the last".