Editorial Thursday 24 January 2013: Ten thoughts about Andy Burnham's Labour health policy review speech

In the wholly spurious interests of binary 'balance', here are five snarky observations about shadow health secretary and Mascara Kid Andy Burnham's health policy review launch speech and subsequent Q&A this morning, followed by five non-snarky ones:

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The snarky five
1. TMK said "our fragile NHS has no capacity for further top-down reorganisation, having been ground down by the current round. I know that any changes must be delivered through the organisations and structures we inherit in 2015".

Mmmmm.

Giving the money and thus the power to local authorities while turning CCGs into talking shops and marking the end of the line for the NHS Commissioning Board as a system manager (oh, and repealing the Health and Social Care Act 2012) is not a top-down redisorganisation of the NHS.

Of course it isn't. Don't be so silly!

It's 'refocusing"!

2. PbR will be tweaked, but not abolished and NHS Preferred Provider is back in the mix.

Sounds familiar?

Time to party like it's 2009 - and remember The Mascara Kid's last set-piece speech at the Kings Fund.

Health Policy Insight analysis of that one is here.

3. The funding of social care is the key issue to making this viable - and it's the one New Labour ducked it in 2000, when they slipped out their 'sod off, grannies and disabled people' response to the Royal Commission on Long-Term Care alongside The NHS Plan.

One to remember, just in case any piety were to slip in to the conversation.

4. New One Nation Labour invented Torbay to pilot care trusts (which were evaluated by Rand & Ernst & Young as not reducing emergency admissions) and integration.

Seriously. Torbay didn't actually exist before the mid-1990s. It's amazing what you can do with some back-projection and Polish migrant labourers.

5. After the Tories' 'death tax' bollocks aimed at the financially illiterate in the last general election campaign, I can understand why TMK would retaliate by calling the current system a "dementia tax", as he did.

But he shouldn't. Firstly, this seems like a grown-up effort, and grown-ups don't join cretins in gutters of debate (well, not unless they've got a killer line that they can deliver well).

Secondly, what we have now is the system that New Labour left in place for 13 years. Spot of humility, innit?

Thirdly, is there the evidence that dementia is definitely the major cause of cost for social care?

The non-snarky points
1. That was genuinely an attempt to open a new front in the policy discussion. Well done to The Mascara Kid for a genuinely credible and creditable speech.

Expecting a lot of detail would of course be ridiculous at this stage: this is a consultation.

Enough broad principles are emerging to make for fruitful conversations.

2. Ambiguity about the costs of funding social care will be unhelpful to the national debate.

Broadly speaking, putting a penny on the basic rate of income tax raises about £2 billion. We need a costed vision of what kind of social care would be affordable if we fund this from direct income tax; what from co-payments to a cap (whether posthumously or insured); and what about a market for insurable risk.

There you go, The Kings Fund: nice little project for you.

3. It's obvious from some remarks he made in the subsequent press conference (of which I'll write tomorrow) that TMK is going to kill the NHS Commissioning Board's current system management role, and so insource that function to a ministerial department to re-create political accountability.

TMK had reached the same conclusion I had in the last PMQs: the ritual is empty in the absence of the SOS having a meaningfully democratically accountable role. (I tweeted "At some point after 1 April, it'll occur to Parliament that Health questions's an anachronism. No Comrade Sir David & Chairman Mal; no point".)

4. At one point, TMK told the Kings Fund audience that "it will need a change of culture".

To which the only response is "oh dear, we're in the shit, then".

As the legendary Nigel Edwards points out, all naive plans for health policy improvement have a section in the flow chart which effectively says 'and then there's a shift in the culture'.

And as Nigel also pointed out, this is a synonym for 'and now a miracle happens'.

Relying on cultural change is a very bad idea unless you've got some very clever, cunning, shrewd and slightly ruthless anthropologists on your team: just now, I don't think we have those people.

5. This is a clever reaction to the sense of surprise that the NHS felt with the top-down reorganisation of Andrew Lansley (saviour, liberator). It's a good start. But it's just a start.